OBJECTIVE. To determine the effectiveness and toxicity of docetaxel for Chinese patients with castrate-resistant prostate cancer in a local Hong Kong hospital.

DESIGN. Case series.

SETTING. A tertiary cancer centre in Hong Kong.

PATIENTS. In all, 39 castrate-resistant prostate cancer patients were treated with 3-weekly docetaxel at 75 mg/m² and prednisolone 10 mg daily between January 2006 and December 2011 in Queen Elizabeth Hospital.

MAIN OUTCOME MEASURES. Prostate-specific antigen control rate, pain control rate, progression-free survival, overall survival, and complication rates.

RESULTS. The prostate-specific antigen response rate was 36%, and 27 (69%) of the patients had improved pain control after chemotherapy. The median progression-free survival, cancer-specific survival, and overall survival was 7.8 (95% confidence interval, 4.9-10.8) months, 13.0 (95% confidence interval, 9.6-16.3) months, and 12.2 (95% confidence interval, 9.3-15.1) months, respectively. The grade 3 anaemia and thrombocytopenia rates were 5%, and the neutropenic fever rate was 8%.

CONCLUSIONS. hemotherapy with docetaxel at a dose of 75 mg/m² given once every 3 weeks together with daily prednisolone is well tolerated in Chinese and can offer good symptom palliation in suitable patients with castrate-resistant prostate cancer.

Key words: Androgen antagonists; Drug therapy; Prostate neoplasms; Survival

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OBJECTIVE. To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease.

DESIGN. Case series.

SETTING. A regional hospital in Hong Kong.

PATIENTS. Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal anti-inflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012.

RESULTS. There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt. No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation.

CONCLUSION. Given the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.

Key words: Anti-inflammatory agents, non-steroidal; Aspirin; Coronary artery disease; Desensitization, immunologic

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OBJECTIVE. To validate the Hong Kong Accident and Emergency Triage guidelines.

DESIGN. Retrospective chart review.

SETTING. The Accident and Emergency Department of a tertiary hospital in Hong Kong.

PARTICIPANTS. Patients who attended the Accident and Emergency Department on one day in February 2012.

MAIN OUTCOME MEASURES. The inter-rater reliability in two pairs of nurses grouped according to experience and validity as compared with an expert panel.

RESULTS. Of the 100 patients recruited and triaged into levels 1 to 5, the weighted kappa coefficient (inter-rater reliability) for the two pairs of nurses was 0.699 and 0.717, respectively. The weighted kappa coefficient for validity was 0.766. When only patients in triage levels 3 and 4 were included, the weighted kappa coefficient for reliability dropped to 0.632 and 0.585, respectively. The weighted kappa coefficient for validity also decreased to 0.558.

CONCLUSIONS. The overall inter-rater reliability and validity of the Guidelines appeared acceptable. Further revision of the Guidelines on triaging patients to levels 3 or 4 is probably necessary.

Key words: Emergency service, hospital; Triage; Validation studies

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OBJECTIVES. (1) To evaluate the safety and efficacy of supine percutaneous nephrostomy, nephrolithotomy, and combined percutaneous nephrolithotomy and ureteroscopic lithotripsy. (2) To describe the skill-acquiring process in supine procedures and share our initial experience.

DESIGN. Three-staged case series with prospective data collection. SETTING. Two public hospitals in Hong Kong.

PATIENTS AND INTERVENTION. Stage 1: Forty patients indicated for percutaneous renal access were recruited for supine percutaneous nephrostomy with prospective data collection. Stage 2: A prospective comparative study of percutaneous nephrolithotomy involving 60 patients allocated non-randomly to a supine (n=25) or prone (n=35) approach was conducted. Stage 3: Data of 11 patients who underwent simultaneous supine percutaneous nephrolithotomy and ureteroscopic lithotripsy were prospectively captured.

RESULTS. Stage 1: The procedural success rate was 100%. The mean operating time in unilateral procedures was 44 minutes; one patient had perinephric haematoma as a complication. Stage 2: Overall stone-free rates for prone and supine procedures were 46% and 68%, respectively (P=0.087), and mean operating times were 122 and 123 minutes, respectively (P=0.905). Stage 3: Of the 11 patients, six were rendered stone-free after the first combined procedure, and one experienced transient postoperative fever. There was no major complication.

CONCLUSION. Percutaneous nephrolithotomy was feasible via both prone and supine approaches. With the exception of staghorn stones, the supine percutaneous approach was an equally safe and effective option for patients with specific conditions favouring such an approach. The ability to incorporate simultaneous ureteroscopic lithotripsy was an additional benefit of adopting the supine approach.

Key words: Kidney calculi; Nephrostomy, percutaneous; Patient positioning; Supine position

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OBJECTIVE. To evaluate potential risk factors, presenting symptoms, management, and outcomes of intracranial haemorrhage in Chinese children with immune thrombocytopenia managed in a regional hospital.

DESIGN. Retrospective case series.

SETTING. A regional hospital in Hong Kong.

PATIENTS. All paediatric patients with immune thrombocytopenia complicated by intracranial haemorrhage in the period January 1996 to December 2009.

RESULTS. Nine episodes of intracranial haemorrhage were reported in eight patients (aged 0.9 to 19 years) with immune thrombocytopenia; three of the patients had acute immune thrombocytopenia and the other five had chronic immune thrombocytopenia. Intracranial haemorrhage occurred as early as the initial presentation with immune thrombocytopenia (n=2) and as late as up to 5 years after the diagnosis. The median platelet count at the time of intracranial haemorrhage was 12 x 10⁹ /L (<10 x 10⁹ /L [n=4]; 10-20 x 10⁹ /L [n=2]; >20 x 10⁹ /L [n=3]). The bleeding was considered spontaneous in six episodes, while head trauma (n=2) and vascular malformation (n=1) were identified in three patients with mild-to-moderate thrombocytopenia (42-82 x 10⁹ /L) at the time of the bleed. Headache and mucosal bleeding were the commonest presenting symptoms (n=5). All patients received multimodal treatment after diagnosis of intracranial haemorrhage, and included platelet transfusion (n=8), intravenous immunoglobulin (n=6), methylprednisolone (n=4), and splenectomy (n=4); three individuals underwent neurosurgical interventions. One (11%) patient died of posterior fossa bleeding and one (11%) had neurological sequelae. All survivors achieved remission of their immune thrombocytopenia with a median follow-up of 5.3 years.

CONCLUSION. Intracranial haemorrhage can occur anytime during the course of immune thrombocytopenia. A high index of suspicion for intracranial haemorrhage should be maintained during follow-up, as favourable outcomes can be achieved after early and vigorous interventions.

Key words: Child; Chinese; Intracranial hemorrhages; Purpura, thrombocytopenic, idiopathic

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