Treatment of patients with chronic obstructive pulmonary disease as practised in a defined Hong Kong community: a cross-sectional pilot survey

ABSTRACT
Hong Kong Med J 2011;17:306–14 | Number 4, August 2011
ORIGINAL ARTICLE
Treatment of patients with chronic obstructive pulmonary disease as practised in a defined Hong Kong community: a cross-sectional pilot survey
WC Yu, Emily LB Tai, SN Fu, KC Kwong, YC Yeung, Y Chang, YK Yiu, CM Tam
Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
 
 
OBJECTIVES. To examine the characteristics of chronic obstructive pulmonary disease patients of the Kwai-Tsing area, Hong Kong, and the chronic treatments they received.
 
DESIGN. Cross-sectional survey.
 
SETTING. Four clinic settings in Hong Kong: Respiratory Specialist Clinic, Princess Margaret Hospital (group 1); Medical Specialist Clinics, Princess Margaret Hospital (group 2); General Outpatient Clinics, Princess Margaret Hospital (group 3); South Kwai Chung Chest Clinic, Department of Health (group 4).
 
PATIENTS. Thirty physician-diagnosed chronic obstructive pulmonary disease patients in each of the above groups with post-bronchodilator 1-second forced expiratory volume/forced vital capacity ratios of less than 70% predicted values, who had been followed up at any of the participating clinics for at least 6 months.
 
RESULTS. There were 111 male and nine female patients. The median age was 72.5 years and 79% had at least one medical co-morbidity. The mean duration of their chronic obstructive pulmonary disease was 9.8 years, and their mean post-bronchodilator 1-second forced expiratory volumes were 45% (for males) and 58% (for females) of predicted values. There were significantly fewer stage I and more stage IV patients in group 1. Influenza vaccination coverage within the previous 1 year was 54% and did not differ significantly between groups. Chronic obstructive pulmonary disease education was given significantly more often to group 1 patients. Short-acting beta agonists were used to treat all patients but long-acting bronchodilators and pulmonary rehabilitation were used almost exclusively in group 1. Overall, long-acting bronchodilators and pulmonary rehabilitation were offered to 16% and 5%, respectively, of those for whom these were indicated (according to international guidelines).
 
CONCLUSION. In general there was insufficient education and under-treatment for chronic obstructive pulmonary disease patients. Management of such patients warrants improvements by way of increased accessibility to structured education programmes, pulmonary rehabilitation programmes, long-acting bronchodilator drugs, and respiratory specialist care.
 
Key words: Airway obstruction; Forced expiratory volume; Lung diseases, obstructive; Pulmonary disease, chronic obstructive; Vital capacity
 
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Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical and functional outcomes

ABSTRACT
Hong Kong Med J 2011;17:301–5 | Number 4, August 2011
ORIGINAL ARTICLE
Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical and functional outcomes
Cindy MY Chan, Helen HX Liang, WW Go, William WK To, KM Mok
Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Hong Kong
 
 
OBJECTIVE. To evaluate the anatomical and functional outcomes following laparoscopic sacrocolpopexy in a local unit.
 
DESIGN. Retrospective case series.
 
SETTING. A regional hospital in Hong Kong.
 
PATIENTS. All women who underwent laparoscopic sacrocolpopexy for symptomatic uterine or post-hysterectomy prolapse from January 2003 to December 2008.
 
MAIN OUTCOME MEASURES. Anatomical outcomes, functional outcomes including complications.
 
RESULTS. A total of 31 patients were recruited. The success rate in treating apical vaginal wall prolapse was 100%. There were no recurrences of vault prolapse (defined as stage II or higher). Approximately 19% of women had anterior vaginal wall prolapse and 23% had urinary stress incontinence postoperatively; 6% had a second operation because of anterior vaginal wall prolapse. The rates of dyspareunia and constipation were low. The mean hospital stay was 4 (range, 2-11) days. Two patients sustained bladder injuries and one rectal injury resulting in a rectovaginal fistula. For three patients the procedure was converted to a laparotomy.
 
CONCLUSIONS. Laparoscopic sacrocolpopexy is feasible in our population and has a high success rate for treating apical vaginal wall prolapse. The incidence of complications was acceptable.
 
Key words: Laparoscopy; Pelvic organ prolapse/ surgery; Sacrococcygeal region; Surgical mesh; Treatment outcome
 
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Validation study of the Chinese Identification Pain Questionnaire for neuropathic pain

ABSTRACT
Hong Kong Med J 2011;17:297–300 | Number 4, August 2011
ORIGINAL ARTICLE
Validation study of the Chinese Identification Pain Questionnaire for neuropathic pain
Anne Chan, Steven Wong, PP Chen, TH Tsoi, Joseph Lam, WY Ip, CP Wong, Lawrence Wong, Vincent Mok
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
 
 
OBJECTIVES. For diagnosing neuropathic pain, a simple 6-item patient-completed identification pain questionnaire has been validated among Caucasians. We aimed to study the validity and reliability of this questionnaire among Hong Kong Chinese patients.
 
DESIGN. Questionnaire survey.
 
SETTING. Two pain clinics and two neurology clinics in Hong Kong.
 
PATIENTS. Patients with either neuropathic pain or nociceptive pain were recruited randomly from the four clinics. The patients completed the questionnaire themselves and the diagnosis of neuropathic pain and nociceptive pain was made by the pain specialists. We determined the optimal cutoff, positive and negative predictive values, sensitivity, specificity, the area under the receiver operating characteristic curve, and test-retest reliability of the translated version.
 
RESULTS. Among the 92 participants, 60 (65%) had neuropathic pain and 32 (35%) had nociceptive pain. At an optimal cutoff score of 3 or higher, the positive predictive value was 87% while the negative predictive value was 55%, and it correctly classified 71% of cases. The specificity and sensitivity were 81% and 65%, respectively. The area under the curve was 0.78 (P<0.001). Test-retest reliability in the 10 randomly selected patients showed a good intraclass correlation of 0.72.
 
CONCLUSION. The Chinese Identification Pain Questionnaire is a valid and reliable scale that may be used as an initial diagnostic tool for neuropathic pain among Hong Kong Chinese patients.
 
Key words: Neuralgia; Pain measurement; ROC curve; Reproducibility of results; Sensitivity and specificity
 
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Mercury exposure: the experience of the Hong Kong Poison Information Centre

ABSTRACT
Hong Kong Med J 2011;17:292–6 | Number 4, August 2011
ORIGINAL ARTICLE
Mercury exposure: the experience of the Hong Kong Poison Information Centre
KL Fan, CK Chan, FL Lau
Accident and Emergency Department, Queen Mary Hospital, Hong Kong
 
 
OBJECTIVES. To review the characteristics of the consultation about the management of mercury exposure and identify the controversial issues on the clinical management of individuals with a history of mercury exposure.
 
DESIGN. Descriptive case series.
 
SETTING. Hong Kong Poison Information Centre, Hong Kong.
 
PARTICIPANTS. Persons consulting the Hong Kong Poison Information Centre about individuals with possible or definitive mercury exposure.
 
MAIN OUTCOME MEASURES. Characteristics of the consultations, including: the demographics of affected individuals, source and reason for the consultation, tissue mercury levels, the source of mercury exposure, specific intervention if any, and clinical outcomes.
 
RESULTS. Forty-one consultations were analysed. Most consultations were from the public sector. Reasons of the consultation were very variable. Individuals with abnormal tissue mercury levels were uncommon. There was only one case of acute mercury poisoning. The majority of identified individuals were not subjected to specific interventions. Chelation therapy was given to three patients, but in one of them it was considered to be contra-indicated.
 
CONCLUSION. The management of mercury exposure is highly variable. Recommendations were made on the approach to an individual with potential mercury exposure or poisoning.
 
Key words: Mercury poisoning; Metals, heavy
 
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Small bowel enema use in an Asian population: our eleven years of local experience

ABSTRACT
Hong Kong Med J 2011;17:286–91 | Number 4, August 2011
ORIGINAL ARTICLE
Small bowel enema use in an Asian population: our eleven years of local experience
WH Luk, Peter SM Yu, Andrea WS Au-Yeung, Adrian XN Lo, Lily KM Wong
Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Hong Kong
 
 
OBJECTIVE. To retrospectively analyse the outcome of patients who underwent investigation by small bowel enema in a local centre.
 
DESIGN. Case series.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. All patients referred for small bowel enema in a local hospital from 1 January 1999 to 31 December 2009 were identified; respective findings from imaging and clinical records were reviewed.
 
RESULTS. A total of 341 patients were referred for small bowel enema, of whom 289 successfully completed the examination. There were 211 patients whose small bowel enema findings were considered normal and 78 were regarded as abnormal. The sensitivity of this investigation was 73% and its specificity was 91%. The respective positive and negative predictive values were 66% and 93%.
 
CONCLUSIONS. The selection of patients by clinicians with specific indications for small bowel enema is essential for making effective use of small bowel enema as an investigative tool.
 
Key words: Enema; Intestinal obstruction; Intestine, small; Sensitivity and specificity
 
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Immunoglobulin G4-related sclerosing disease: experience with this novel entity in a local hospital

ABSTRACT
Hong Kong Med J 2011;17:280–5 | Number 4, August 2011
ORIGINAL ARTICLE
Immunoglobulin G4-related sclerosing disease: experience with this novel entity in a local hospital
TL Ng, IS Leong, WL Tang, KF Chan, YW Luk, WC Lao, CM Leung, SY Liu, CS Kho, KL Lee, KK Chan, Michael KW Li
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVE. To review the site of involvement, clinical presentation, and treatment outcome of patients having immunoglobulin G4-related sclerosing disease in a local regional hospital.
 
DESIGN. Retrospective case series.
 
SETTING. Pamela Youde Nethersole Eastern Hospital, Hong Kong.
 
PATIENTS. All patients with a diagnosis of immunoglobulin G4-related sclerosing disease in the hospital diagnosed in the period from April 2008 to March 2010.
 
RESULTS. A total of 12 patients with involvement of various organs were identified. There was a male predominance (male-to-female ratio=5:1). The mean age at diagnosis was 65 years. The salivary glands, biliary tract, pancreas, and cervical lymph nodes were the commonest involved sites. The immunoglobulin G4 level was elevated in 83% of the patients. Patients usually appeared to respond well to steroid treatment.
 
CONCLUSION. Immunoglobulin G4-related sclerosing disease is a systemic disease and can involve various systems.
 
Key words: Autoimmune diseases; Immunoglobulin G; Lymph nodes; Pancreatitis, chronic; Sclerosis
 
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Using bevacizumab in the fight against malignant glioma: first results in Asian patients

ABSTRACT
Hong Kong Med J 2011;17:274–9 | Number 4, August 2011
ORIGINAL ARTICLE
Using bevacizumab in the fight against malignant glioma: first results in Asian patients
Jenny KS Pu, Raymond TT Chan, Gloria KB Ng, Gilberto KK Leung, KN Hung, CF Fung
Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
OBJECTIVES. To investigate the efficacy and safety profile of bevacizumab in combination with irinotecan in Hong Kong Chinese patients with recurrent malignant glioma and to determine whether their response differed from that reported in other populations.
 
DESIGN. Retrospective study.
 
SETTING. Two private clinics and a public hospital in Hong Kong.
 
PATIENTS. Fourteen individuals who presented with recurrent glioma presenting to the hospital between November 2005 and November 2009.
 
INTERVENTION. Salvage therapy with bevacizumab (10 mg/kg) and irinotecan (125 mg/m(2) [340 mg/m(2) for those taking enzyme-inducing antiepileptic drugs]) on a 14-day schedule.
 
RESULTS. A radiological response was observed in 12 (86%) of the patients, four (33%) of whom had a complete response. The median progression-free survival was 6 (range, 1-15) months; 71% remained progression-free at 6 months. The median overall survival was 18 (range, 9-61) months. The most common adverse events during the bevacizumab and irinotecan treatment period were haematological; five patients had grade 2/3 adverse events. Pulmonary embolism occurred in two patients, one of whom died. Intracranial haemorrhage was not detected in any of the 14 treated patients.
 
CONCLUSIONS. Bevacizumab plus irinotecan was at least as effective at treating Chinese patients with recurrent glioma as previously reported in clinical trials in different patient populations.
 
Key words: Antineoplastic combined chemotherapy protocols; Brain neoplasms; Glioblastoma; Neoplasm recurrence, local; Treatment outcome
 
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Urinary symptoms and impaired quality of life in female ketamine users: persistence after cessation of use

ABSTRACT
Hong Kong Med J 2011;17:267–63 | Number 4, August 2011
ORIGINAL ARTICLE
Urinary symptoms and impaired quality of life in female ketamine users: persistence after cessation of use
Rachel YK Cheung, Symphorosa SC Chan, Jacqueline HS Lee, Albe WL Pang, KW Choy, Tony KH Chung
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVE. To compare the urinary symptoms and quality of life in ex-ketamine abusers and controls.
 
DESIGN. Prospective observational study.
 
SETTING. A hospital in Hong Kong.
 
PATIENTS. Female ex-ketamine abusers admitted to a local drug rehabilitation centre and age-matched controls attending a general gynaecology clinic between December 2009 and April 2010.
 
MAIN OUTCOME MEASURES. Evaluation of urinary symptoms based on a 3-day bladder diary, and responses to the Urogenital Distress Inventory Short Form (UDI-6) and the Incontinence Impact Questionnaire Short Form (IIQ-7). The study group had repeat measurements 3 months later.
 
RESULTS. Overall, 90% of ex-ketamine abusers had active urinary symptoms. On average, they had increased 24-hour urinary frequency (10.0 vs 5.8; P=0.001) and lower maximum voided volume (253.3 mL vs 401.9 mL; P<0.001) compared to controls. Correspondingly, the median functional bladder capacity was smaller (195.3 mL vs 261.2 mL; P=0.011) and the mean UDI-6 and IIQ-7 scores were higher (P<0.001). Among those who abused ketamine for 2 years or more, the mean UDI-6 and IIQ-7 scores were higher (P=0.03, P=0.02 respectively). When they stopped abusing ketamine for 3 months or more, their mean 24-hour urinary frequency had decreased (P=0.03), the maximum voided volume had increased (P=0.03) and the mean UDI-6 and IIQ-7 scores had decreased (P=0.04, P=0.02 respectively), although they were still higher than in controls. After 3 more months, in the ex-ketamine abusers there had been a further decrease in 24-hour urinary frequency (P=0.01) and a further improvement in quality of life based on mean UDI-6 scores (P=0.04) but nevertheless poorer than the control group (P<0.01).
 
CONCLUSION. Female ex-ketamine abusers had significant urinary symptoms affecting their quality of life when studied at a mean of 8 (range, 0.5-48) months after cessation of use. The symptom severity was inversely correlated with the duration of cessation; though they improved with time, some still persisted.
 
Key words: Female urogenital diseases; Ketamine; Quality of life; Substance-related disorders; Urinary incontinence
 
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A synopsis of current care of thalassaemia major patients in Hong Kong

ABSTRACT
Hong Kong Med J 2011;17:261–6 | Number 4, August 2011
ORIGINAL ARTICLE
A synopsis of current care of thalassaemia major patients in Hong Kong
WY Au, Vincent Lee, CW Lau, Jeffrey Yau, Desmond Chan, Eric YT Chan, Winnie WW Cheung, SY Ha, Bonnie Kho, CY Lee, Rever CH Li, CK Li, SY Lin, Alvin SC Ling, Vivien Mak, Lina Sun, Kris HF Wong, Raymond Wong, HL Yuen
Department of Medicine, Queen Mary Hospital, Hong Kong
 
 
OBJECTIVE. To provide a synopsis of current thalassaemia major patient care in Hong Kong.
 
DESIGN. Retrospective study.
 
SETTING. All haematology units of the Hospital Authority in Hong Kong.
 
PATIENTS. All patients with thalassaemia major with regular transfusion.
 
RESULTS. To date, there were 363 thalassaemia major patients under the care of the Hospital Authority. Prenatal diagnosis has helped to reduce the number of indigenous new cases, but in recent years immigrant cases are appearing. The patients have a mean age of 23 (range, 1-52) years, and 78% of them are adults. In 2009, they received 18 782 units of blood. This accounted for 9.5% of all blood consumption from the Hong Kong Red Cross. In the past, cardiac iron overload was the major cause of death (65%) and few patients survived beyond the age of 45 years. The availability of cardiac iron assessment by magnetic resonance imaging (T2* MRI) to direct the use of oral deferiprone chelation has reduced the prevalence of heart failure and cardiac haemosiderosis, which should reduce mortality and improve life expectancy.
 
CONCLUSION. The future for thalassaemia care in Hong Kong is bright. With better transfusion and chelation, it should be possible to avoid growth and endocrine deficiencies in younger patients.
 
Key words: beta-Thalassemia; Blood transfusion; Chelation therapy; Hemosiderosis; Iron chelating agents
 
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The development of a Health Call Centre in Hong Kong: a study on the perceived needs of patients

ABSTRACT
Hong Kong Med J 2011;17:208–16 | Number 3, June 2011
ORIGINAL ARTICLE
The development of a Health Call Centre in Hong Kong: a study on the perceived needs of patients
Frank WK Chan, Fiona YY Wong, H Fung, EK Yeoh
Division of Health System, Policy and Management, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
OBJECTIVES. To assess the preference for the development of a Health Call Centre and the perceived needs of patients in Hong Kong.
 
DESIGN. Cross-sectional, questionnaire-based survey.
 
SETTING. Two general out-patient clinics from health facilities in a geographical region in Hong Kong.
 
PARTICIPANTS. Patients aged 18 years or above were recruited for the study, which was conducted between January and March 2009.
 
MAIN OUTCOME MEASURES. Patients’ perspectives of a Health Call Centre, perceived needs for services, perceived health status, and socio-demographic status.
 
RESULTS. A total of 403 participants completed the questionnaire with a response rate of 78%. A total of 342 (85%) supported the development of a Health Call Centre. Providing basic health and chronic disease information, current health conditions and treatment information, and caregiver support advice were cited as the top perceived needs on the development of a Health Call Centre. Adjusting for age, education, and individual monthly income, participants aged 31 to 64 years (odds ratio=4.37; 95% confidence interval, 1.92-9.99; P<0.001) and caregivers (odds ratio=3.41; 95% confidence interval, 1.21-9.59; P=0.020) were more likely to use the Health Call Centre. Presence of chronic illness had no significant correlation with the use of a Health Call Centre (odds ratio=1.43; 95% confidence interval, 0.69-3.00; P=0.340).
 
CONCLUSIONS. This is the first study to assess the preferences for the development of a Health Call Centre and the perceived needs of patients in Hong Kong. The majority supported the development of a Health Call Centre. Services provided could meet the general need.
 
Key words: Health services accessibility; Practice management
 
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