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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OBJECTIVE. To determine the results of scan-directed unilateral neck exploration for primary hyperparathyroidism.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients who underwent parathyroid surgery for primary hyperparathyroidism between January 2000 and December 2007 were included.

MAIN OUTCOME MEASURES. The demographic, imaging, biochemical, and pathological data, as well as surgical outcomes were analysed according to the treatment received.

RESULTS. A total of 78 patients were included in this study; 65 underwent unilateral neck exploration with image guidance by ultrasonography or technetium Tc99m sestamibi scan. The scan sensitivity for localising the side of the lesion was 66% for ultrasound scans, 71% for technetium Tc99m sestamibi scans, and 85% for both scans used in combination. Pathological analysis showed that 95% (74/78) of the patients had a single parathyroid adenoma, two had hyperplasia of four glands, one had a double adenoma, and one a parathyroid carcinoma. Among the patients undergoing scan-directed unilateral neck exploration, one defaulted follow-up, while the remaining 64 patients achieved normal calcium levels at a median follow-up of 6 months.

CONCLUSION. Scan-directed unilateral neck exploration is a safe alternative form of treatment for patients with primary hyperparathyroidism, with a cure rate similar to conventional therapy.

Key words: Hyperparathyroidism; Parathyroidectomy; Sensitivity and specificity; Technetium Tc99m sestamibi

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OBJECTIVE. To review our results of laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass for the treatment of morbid obesity.

DESIGN. Prospective cohort study.

SETTING. Bariatric Surgery Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.

PATIENTS. All patients consisted of those referred to our Combined Obesity Clinic (to provide multidisciplinary weight management for severely obese patients) during the period July 2002 to December 2007. For patients who received bariatric surgeries as treatment of morbid obesity, peri-operative data, postoperative weight change, and co-morbidity improvements were collected and prospectively reviewed.

RESULTS. During the study period, 531 patients attended our Clinic for treatment of obesity. Their mean (standard deviation) body weight was 96 (22) kg, mean body mass index was 36 (6) kg/m(2), mean age was 40 (10) years, and 64% were female. Of these patients, 94 (18%) underwent bariatric surgery, which included: laparoscopic adjustable gastric banding (n=57), laparoscopic sleeve gastrectomy (n=30), and laparoscopic gastric bypass (n=7). Adverse events occurred in 11 (12%) of these 94 patients, but there was no operative mortality. At 2 years, the mean percentage weight loss for patients having laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass were 34%, 51% and 61%, respectively. After operative treatment, obesity-related co-morbidities including metabolic syndrome, type 2 diabetes, hypertension, and sleep apnoea had also improved significantly.

CONCLUSION. Through a multidisciplinary weight management programme and various bariatric procedures, favourable results can be achieved in Chinese patients with severe obesity.

Key words: Bariatric surgery; Gastrectomy; Gastric bypass; Laparoscopy; Obesity, morbid

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OBJECTIVES. To evaluate the clinical significance of Trichomonas vaginalis detected in Papanicolaou (Pap) smears in our local population.

DESIGN. Retrospective study.

SETTING. A sexually transmitted disease clinic in Hong Kong.

PATIENTS. All patients having Pap smear, wet mount microscopy, and high vaginal swab culture performed in Tuen Mun Social Hygiene Clinic from April 2005 to December 2006 were recruited.

MAIN OUTCOME MEASURES. Sensitivity, specificity, positive and negative predictive values of the Pap smear for the diagnosis of Trichomonas vaginalis.

RESULTS. A total of 209 patients had the diagnosis of Trichomonas vaginalis in the study period. From among these, the results of 149 patients who had Pap smears, wet mount microscopy, and high vaginal swab culture performed were used in the analysis. Sixty cases were excluded because treatments were initiated before the consultation or because the Pap smear had not been done. Among the Trichomonas vaginalis cases with positive Pap smears, 58% (85/146) were symptomatic and 41% (60/146) had concomitant sexually transmitted disease. The respective sensitivity and specificity of the Pap smear in our study were: 98% (128/131; 95% confidence interval, 94-100%) and 96% (440/458; 94-98%). In total, 128 patients were defined as true positives by wet mount microscopy or culture, while 18 were defined as false positives. In our study population, the positive predictive value was 88% (128/146; 95% confidence interval, 82-93%). On comparing the clinical features of patients with true-positive and false-positive Pap smears, the odds ratio for the presence of symptoms and concomitant sexually transmitted disease was 1.9 (95% confidence interval, 0.7-5.1) and 2.0 (0.7-5.8), respectively. There were no statistically significant differences in the univariate analysis by Chi squared testing.

CONCLUSION. Treatment for vaginal trichomoniasis is recommended if Trichomonas vaginalis is detected in a Pap smear.

Key words: Sensitivity and specificity; Sexually transmitted diseases; Trichomonas vaginalis; Trichomonas vaginitis; Vaginal smears

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