OBJECTIVE. Objectives To explore the prevalence of various categories of hypertension in diabetic patients, and assess any corresponding associations with end-organ complications.

DESIGN. Cross-sectional study.

SETTING. Tertiary centre of a regional hospital in Hong Kong.

PATIENTS. All ambulatory type 2 diabetic patients attending our clinics from January 2002 to November 2004 were invited to participate in the protocol.

RESULTS. A total of 133 diabetic patients were included; 82 had normal clinic blood pressures, 15 (18%) of whom had masked hypertension, the remaining 67 (82%) had 'normotension' The remaining 51 patients had high clinic blood pressures, of whom 28 (55%) had white-coat hypertension and 23 (45%) had sustained hypertension. Urinary albumin excretion rate was higher in patients with masked hypertension (10 mg/day; range, 7-580 mg/day) and sustained hypertension (7 mg/day; 7-3360 mg/day) in comparison to those with white-coat hypertension (7 mg/day; 7-109 mg/day) or 'normotension'(7 mg/day; 7-181 mg/day) [P<0.01]. Likewise, the prevalence of albuminuria was significantly higher in patients with masked hypertension (40%) and sustained hypertension (26%) than in those with 'normotension'(6%) and white-coat hypertension (11%) [P<0.01]. The prevalence of left ventricular hypertrophy was significantly higher in subjects with masked hypertension (38%) and sustained hypertension (26%) compared to patients with 'normotension'(8%) or white-coat hypertension (11%) [P<0.01]. Left ventricular diastolic dysfunction was more prevalent in patients with masked hypertension (46%), sustained hypertension (48%), and white-coat hypertension (43%) in comparison to subjects with 'normotension'(18%) [P=0.01].

CONCLUSION. Masked hypertension is associated with a higher prevalence of albuminuria, left ventricular diastolic dysfunction, and hypertrophy. White-coat hypertension carries a more benign prognosis than sustained hypertension and masked hypertension. Our cross-sectional study supports the recommendation to performing ambulatory blood pressure measurements in type 2 diabetic patients.

Key words: Albuminuria; Blood pressure monitoring, ambulatory; Diabetes mellitus, type 2; Hypertension

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OBJECTIVES. To investigate the prevalence and characteristics of patients with renal stone in Hong Kong, and awareness of corresponding prevention strategies.

DESIGN. Telephone public survey.

SETTING. Hong Kong community.

PARTICIPANTS. A public telephone survey concerning the occurrence of renal stone disease and the public awareness of the condition was performed. Respondents whose telephone numbers were randomly selected by computer and the family member of the household who had the closest birthday to that date was chosen for interview. Data collected were further adjusted for the gender and age distribution of the Hong Kong population in mid-2007.

RESULTS. A total of 1010 Hong Kong citizens aged 18 years or above were successfully interviewed in November 2007. Among them, 25 respondents themselves had a history of renal stones, yielding a point prevalence of 2.5%. In addition, 70 respondents had family members with a history of renal stones, yielding an estimated household point prevalence of 6.9%. Stone patients were mainly older, male, and imbibed less fluids than the average for all respondents. The public's concepts with regard to the diet necessary and the importance of taking more fluid to prevent stone formation was poor.

CONCLUSION. Hong Kong has a relatively low prevalence of renal stone disease, compared to neighbouring areas. However, the local public and affected patients had little knowledge and awareness about this important health problem.

Key words: Demography; Food habits; Kidney calculi; Prevalence; Primary prevention

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OBJECTIVES. To investigate the epidemiology of surgical site infection in cardiac surgery patients operated on in 2006.

DESIGN. Retrospective study of a case-control sample.

SETTING. Cardiac surgery unit of a university teaching hospital in Hong Kong.

PATIENTS. Cardiac surgery patients with surgical site infection were matched by procedure type, sex, and year of surgery with non-infected patients.

MAIN OUTCOME MEASURES. Identification of risk factors for surgical site infection.

RESULTS. The infected and non-infected cardiac surgery patients did not differ in age, sex, or smoking history; however, patients with surgical site infection were significantly heavier (mean body mass index, 26.6 vs 23.9 kg/m²), P<0.046). Almost 41% of the subjects had a history of diabetes mellitus, there being a significantly greater proportion among infected than non-infected patients (53.1% vs 28.1%, P<0.042). All 37 of the patients without a diagnosis of diabetes had normal (ie <8 mmol/L) preoperative glucose levels, but 99% of them yielded evidence of subsequent glycaemic dysfunction during or after surgery. Overall, 50% of the patients had a blood transfusion during the operation, with infected patients significantly more likely to have been transfused than the non-infected ones (65.6% vs 34.4%, P<0.008).

CONCLUSIONS. There appears to be a relationship between surgical site infection in cardiac surgery patients and pre-existing (diagnosed and covert) diabetes mellitus and blood transfusion. Future studies should consider these factors in relation to surgical site infections, both in the wider surgical population and from a risk-minimisation perspective.

Key words: Blood transfusion; Cardiac surgical procedures; Diabetes mellitus; Risk factors; Surgical wound infection

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OBJECTIVE. To evaluate the early and mid-term results of the first 100 elective endovascular repairs for abdominal aortic aneurysms.

DESIGN. Retrospective analysis of prospectively collected data.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. The first 100 patients with infrarenal abdominal aortic aneurysms who underwent elective endovascular repair.

MAIN OUTCOME MEASURES. Peri-operative data, mortality and morbidities as well as the follow-up details were recorded. Cumulative data on endoleaks, clinical failures, secondary procedures, and survival were evaluated with Kaplan-Meier analyses.

RESULTS. There were 85 men and 15 women, with a mean age of 75 (range, 50-90) years. Failed implantations due to access difficulty occurred in two patients during the same period, giving a technical success rate of 98%. The mean aneurysm diameter was 6.2 cm. Access site injury requiring repair occurred in four (4%) of the patients, while wound problems were the most common complications (11%). The median hospital stay was 6 days, and there were two hospital deaths, giving a hospital mortality rate of 2%. During a mean follow-up of 36 (standard deviation, 24) months, there were three aneurysmal ruptures and four elective open conversions, with only one aneurysm-related death after hospital discharge. At 3 years, the cumulative rates of freedom from any endoleak, freedom from primary failure, freedom from secondary failure, freedom from secondary procedures, and survival were 60%, 84%, 89%, 88%, and 78%, respectively.

CONCLUSIONS. The early and mid-term results of elective endovascular repair for abdominal aortic aneurysms appear promising. The procedure is effective in preventing aneurysm-related death in the mid-term. Nevertheless, the importance of constant surveillance cannot be over-emphasised, as clinical failures and ruptures are still a concern.

Key words: Aortic aneurysm, abdominal; Aortic rupture; Treatment outcome; Vascular surgical procedures

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OBJECTIVE. To study the childhood renal disease pattern based on the renal biopsy histology in a local paediatric tertiary renal centre.

DESIGN. Retrospective study.

SETTING. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong.

PATIENTS. All patients who underwent real-time ultrasound-guided closed renal biopsy from 1 April 1997 to 31 March 2007 were included.

RESULTS. A total of 209 renal biopsies were performed, 162 on native kidneys and 47 on grafts. In the native group, major indications were renal manifestations secondary to systemic diseases (34%), followed by idiopathic nephrotic syndrome (28%) and haematuria (27%). In 94% the histopathology revealed glomerular diseases. Among the primary glomerular diseases, thin glomerular basement membrane disease, immunoglobulin A nephropathy, minimal change disease, and focal segmental glomerulosclerosis accounted for most. In all, 37% of patients with steroid-resistant nephrotic syndrome had focal segmental glomerulosclerosis and its relative incidence was increased when compared to previous studies. Minimal change disease and minimal change disease with mesangial immunoglobulin M deposits accounted for the majority of steroid dependent and frequent relapsers. Among patients with isolated microscopic haematuria, 73% had thin glomerular basement membrane disease, while patients with concomitant haematuria and proteinuria had a wide variety of pathology. In the kidney graft group, acute graft dysfunction was due to acute rejection in 38% of the patients, followed by calcineurin inhibitor toxicity in 14%. Chronic allograft nephropathy caused chronic allograft dysfunction in the majority of cases. Post-transplant proteinuria was caused by recurrence of the primary renal disease in all of our patients.

CONCLUSION. This study provides updated epidemiological information for childhood renal disease and a change in the pattern of disease was observed.

Key words: Biopsy; Glomerulonephritis, IGA; Glomerulosclerosis, focal segmental; Kidney transplantation; Nephrotic syndrome

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