OBJECTIVE. To review the pattern of ruptured intracranial aneurysms in terms of size, location, and the prevalence of multiple aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage.

DESIGN. Retrospective study.

SETTING. Three public hospitals in Hong Kong.

PATIENTS. A total of 267 Chinese patients with subarachnoid haemorrhage from ruptured intracranial aneurysms between July 1998 and June 2002 were reviewed retrospectively.

RESULTS. The patients had a mean age of 59 (range, 13-96) years, with a female-to-male ratio of 2:1. Concerning the age at presentation, males presented with ruptured intracranial aneurysms at a younger age (P=0.001) than females. Ruptured aneurysms were more commonly located in the anterior than posterior circulation (84% vs 16%). The posterior communicating artery (26%) and anterior communicating artery (22%) were the most common sites of rupture. As a whole, 64% of the aneurysms had a size of 5 mm or less. The anterior communicating artery had a higher proportion with a size of 5 mm or less compared to other locations (P<0.05). In this cohort, the prevalence of multiple aneurysms was 17%. There was no significant difference in the prevalence of multiple aneurysms between men and women (P=0.30). In patients with multiple aneurysms, the sizes of ruptured aneurysms were greater than those of the largest unruptured aneurysms (P<0.001). When compared with the group with single aneurysms, patients with multiple aneurysms had a smaller proportion of small aneurysms, sized 5 mm or less (P<0.05).

CONCLUSIONS. The pattern of ruptured intracranial aneurysms in the Hong Kong Chinese population was different from western and Japanese populations. Although the distribution of locations for ruptured aneurysms was similar, Hong Kong Chinese had a larger proportion of small aneurysms sized 5 mm or less. The prevalence of multiple aneurysms in Hong Kong is comparable to that in the Japanese population, but lower than that in the western populations.

Key words: Aneurysm, ruptured; Intracranial aneurysm; Subarachnoid hemorrhage

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OBJECTIVES. To define the role of bypass surgery and percutaneous transluminal angioplasty to manage critical limb ischaemia due to infrainguinal arterial occlusive disease.

DESIGN. Retrospective review.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Consecutive patients treated for critical limb ischaemia, for whom data were prospectively collected in those who underwent: (i) infrainguinal percutaneous transluminal angioplasty first, or (ii) infrainguinal bypass surgery.

RESULTS. Among patients with critical lower limb ischaemia, 364 consecutive individuals having infrainguinal bypass operations and 100 having percutaneous transluminal angioplasty first were compared. The latter patients were older (77 vs 74 years, P=0.014) and had more co-morbidities but higher ankle pressure than those having bypass surgery. In the angioplasty-first group, 74% had favourable lesions (classified as TransAtlantic Inter-Society Consensus A/B). In the bypass group, operative mortality was higher (4% vs 1%, P=0.03) than that in the angioplasty-first group. Hospital mortality was comparable (8% vs 3%, P=0.15). In the bypass group, median hospital stay was longer than that in the angioplasty-first group (24 vs 4 days, P<0.001), and postoperatively they also had a higher median ankle-brachial index (0.92 vs 0.70, P<0.001) and superior long-term patency. In the bypass group, American Society of Anesthesiologists class 4 patients suffered very high operative and hospital mortality (15% and 31%, respectively). Long-term patency of percutaneous transluminal angioplasty depended on the TransAtlantic Inter-Society Consensus class of the treated lesion. Limb salvage rates at 3 years were 89% and 78% for percutaneous transluminal angioplasty first and surgical bypass, respectively (P=0.046). Long-term survival was poorer in the percutaneous transluminal angioplasty-first group (21% vs 51% at 5 years, P=0.04).

CONCLUSION. Infrainguinal bypass and percutaneous transluminal angioplasty are complementary. For TransAtlantic Inter-Society Consensus A and B lesions, percutaneous transluminal angioplasty should be offered first. For American Society of Anesthesiologists class 4 patients, percutaneous transluminal angioplasty should be considered first, regardless of the TransAtlantic Inter-Society Consensus class.

Key words: Angioplasty, balloon; Arterial occlusive diseases; Ischemia; Leg

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OBJECTIVES. To describe a cluster of Hong Kong subjects with hypoglycaemia, after they had taken various non-prescription sildenafil products containing glibenclamide.

DESIGN. Retrospective study.

SETTING. A tertiary referral centre for clinical toxicology analysis in Hong Kong.

PATIENTS. All men referred to the laboratory for investigation of suspected drug-induced hypoglycaemia from December 2007 to September 2008.

MAIN OUTCOME MEASURES. The characteristics of these patients, including their clinical presentations, outcomes, drug history, urine toxicology analysis results, and in some instances, analysis results of unused products.

RESULTS. A total of 144 male patients were referred for suspected drug-induced hypoglycaemia. Sildenafil and glibenclamide, or their metabolites, were detected in the urine specimens of 68 (47%) patients, none of whom had been prescribed either drug by a registered medical practitioner. Among these subjects, 24 (35%) denied any use of sexual enhancement products despite repeated questioning. Eight patients had repeated exposure resulting in re-admission. The sources of these sexual enhancement products included pharmacies in Mainland China, friends, local pharmacies, peddlers, or were unknown. Three patients died, one remains in a vegetative state and one suffered cognitive impairment; the remaining 63 recovered fully. Twenty-five unused sexual enhancement products of seven different kinds were recovered for analysis. The median (range) of sildenafil and glibenclamide per unit dose was 64 (0.05-198) mg and 70 (0-158) mg, respectively.

CONCLUSION. These illegal products pose a severe and continued threat to society and therefore deserve widespread vigilance, so that such products can be eradicated at their source.

Key words: Drug contamination; Erectile dysfunction; Hypoglycemia; Nonprescription drugs

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OBJECTIVE. To determine the oral bacterial flora associated with two common local venomous snakes in Hong Kong, namely the Chinese cobra (Naja atra) and the bamboo pit viper (Trimeresurus albolabris).

DESIGN. Cross-sectional study.

SETTING. A non-government organisation and a regional hospital in Hong Kong.

SUBJECTS. Thirty-two Chinese cobras and seven bamboo pit vipers.

MAIN OUTCOME MEASURES. Species identification of bacteria in the oral cavity of both snakes and their antibiotic susceptibilities.

RESULTS. The oral cavity of Chinese cobra harbour a wide range of pathogenic bacteria, including: Gram-negative bacterial species like Morganella morganii, Aeromonas hydrophila and Proteus, and Gram-positive bacteria like Enterococcus faecalis, coagulase-negative Staphylococcus as well as anaerobic species (clostridia). The oral cavity of the Chinese cobra is more likely than that of the bamboo pit viper to harbour pathogenic bacteria associated with snakebite infection (P<0.001). The median number of pathogenic bacteria per snake was significantly higher in the Chinese cobra (P<0.001). All pathogenic Gram-negative bacteria isolated were susceptible to levofloxacin. Amoxicillin/clavulanate provided good coverage against pathogenic Gram-positive bacteria (Enterococcus faecalis) and anaerobes.

CONCLUSION. 'Prophylactic' antibiotic treatment for Chinese cobra bites may be beneficial, owing to the multiple pathogenic bacteria in its oral cavity and the higher risk of ensuing necrosis. The regimen of levofloxacin plus amoxicillin/clavulanate appears promising for this purpose, but further study is required to confirm its clinical utility in patients.

Key words: Abscess; Antibiotic prophylaxis; Snake bites; Wound infection

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OBJECTIVE. To determine the impact of diabetes on early and mid-term survival in the Hong Kong Chinese population undergoing coronary artery bypass graft surgery.

DESIGN. Prospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. A total of 904 consecutive patients following coronary artery bypass graft surgery from November 1999 to December 2003 were prospectively analysed. Among them, 377 (42%) diabetic and 527 (58%) non-diabetic patients were evaluated.

MAIN OUTCOME MEASURES. Hospital mortality, mid-term mortality, and percutaneous coronary intervention-free survival.

RESULTS. The diabetic group had a higher risk score than the non-diabetic group (mean+/-standard deviation: EuroSCORE 4.7+/-3.4 and 3.6+/-3.4, respectively; P<0.001). Hospital mortality was 3.4% in the diabetic group compared to 2.8% in the non-diabetic group (P=0.698). Multiple logistic regression analysis identified left ventricular ejection fraction of less than 30% and preoperative intubation as independent risk factors for early hospital death. There were 81 late deaths and the actuarial survival at 48 months for the diabetic and non-diabetic patients were 86% and 90%, respectively (P=0.298). The angina-free survival and percutaneous coronary intervention-free survival at 48 months for the diabetic and non-diabetic patients yielded no statistically significant difference.

CONCLUSIONS. Diabetes mellitus was not a predictor of early and mid-term mortality after coronary artery bypass graft surgery in our Chinese population. Furthermore, diabetes did not affect angina recurrence or intervention free-survival up to 4 years.

Key words: Coronary artery bypass; Coronary disease; Diabetes mellitus; Survival analysis

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