Seizure-related injury in an adult tertiary epilepsy clinic

ABSTRACT
Hong Kong Med J 2006;12:260-3 | Number 4, August 2006
ORIGINAL ARTICLE
Seizure-related injury in an adult tertiary epilepsy clinic
S Tiamkao, SD Shorvon
Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
 
 
OBJECTIVE. To assess the frequency, characteristics, and risk of injury during seizure attacks.
 
DESIGN. Questionnaire survey.
 
SETTING. Epilepsy out-patient clinic of the National Hospital for Neurology and Neurosurgery, Institute of Neurology, London.
 
PATIENTS. One hundred consecutive epileptic patients and their caretakers or relatives, who attended the hospital between 1 May and 30 June 2000.
 
MAIN OUTCOME MEASURES. Details of epilepsy including the age of onset, causes, types, and number of seizures during the previous 12 months; injuries incurred as a result of seizures; and treatment required.
 
RESULTS. The mean age of the 100 patients (38 male, 62 female) was 39 years (range, 16-78 years). Generalised tonic-clonic seizures occurred in 51% of patients and complex partial seizures in 40%. Hippocampal sclerosis was found in 12% of patients. Twenty-seven patients reported 222 seizure-related injuries. The total number of seizures per year was 4459 (mean, 45), of which 1094 (mean, 11) were with a fall (24.5%). Soft-tissue injury was the most common (61%), followed by burns (17%), head injury (14%), orthopaedic injury (5%), and injuries in water (3%). The most common site of soft-tissue injury and burns were to the face: 49% and 38% respectively. Burns occurred during cooking in 78% of cases. Two patients had skull fractures. Orthopaedic injuries usually occurred at home (73%). In cases of seizures in water, five of six occurred while swimming. Injury occurred once in every 20 seizures, every 11 generalised tonic-clonic seizures, and every five seizures with a fall. The significant risk factors for injury were generalised tonic-clonic seizures, high frequency of seizures, and seizures with a fall.
 
CONCLUSION. Soft-tissue injury was the most common seizure-related injury. Injury occurred once in every 20 seizures. The risk factors were generalised tonic-clonic seizures, high frequency of seizures, and seizures with a fall.
 
Key words: Risk factors; Seizures; Soft tissue injuries
 
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Use of lithium in the treatment of thyrotoxicosis

ABSTRACT
Hong Kong Med J 2006;12:254-9 | Number 4, August 2006
ORIGINAL ARTICLE
Use of lithium in the treatment of thyrotoxicosis
YW Ng, SC Tiu, KL Choi, FKW Chan, CH Choi, PS Kong, CM Ng, CC Shek
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong
 
 
OBJECTIVES. To evaluate the efficacy and safety of lithium in the treatment of thyrotoxicosis, and to study the dose and serum levels at which therapeutic response occurs.
 
DESIGN. Retrospective study.
 
SETTING. Thyroid clinic of a regional hospital in Hong Kong.
 
PATIENTS. Thirteen patients with thyrotoxicosis pending therapy with radioiodine or surgery, in whom thionamides were contra-indicated due to adverse reactions or failure of treatment.
 
MAIN OUTCOME MEASURES. Free thyroxine levels, time to euthyroidism, and side-effects of lithium.
 
RESULTS. A satisfactory response, defined as a fall by 40% or more in free thyroxine levels and clinical improvement, was achieved in eight patients within 1 to 2 weeks of lithium therapy. In four others, response occurred in 3 to 5 weeks. Response was slow and inadequate in one patient due to 'escape'. The median dosage of lithium was 750 mg daily, with a range of 500 to 1500 mg daily. The median serum lithium level was 0.63 mmol/L. Lithium toxicity was observed in one patient.
 
CONCLUSIONS. A relatively low dose of lithium offers a safe and effective alternative means of controlling thyrotoxicosis in patients who cannot tolerate or do not respond to thionamides.
 
Key words: Graves' disease; Lithium; Thyrotoxicosis; Thyroxine
 
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A prospective case-control study of ankle fracture in postmenopausal women

ABSTRACT
Hong Kong Med J 2006;12:208-11 | Number 3, June 2006
ORIGINAL ARTICLE
A prospective case-control study of ankle fracture in postmenopausal women
PY Ho, N Tang, SW Law, HF Tsui, TP Lam, KS Leung
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To compare bone mineral density of women with postmenopausal ankle fractures with controls and review patient characteristics, injury mechanisms, and outcomes.
 
DESIGN. Prospective case-control study.
 
SETTING. University teaching hospital, Hong Kong.
 
PARTICIPANTS. Women older than 60 years, admitted with ankle fractures between 2002 and 2003 and controls (age-matched women with femoral neck fractures).
 
MAIN OUTCOME MEASURES. Demographic data, bone mineral density, mechanism of injury, fracture pattern, treatment, and the functional outcome.
 
RESULTS. The mean age of the study group (18 ankle fracture patients) was 74 years. The fractures usually resulted from a low-energy trauma; isolated lateral malleolar fracture was the most common (8/18), whilst six had bimalleolar fractures. Their mean T-score bone mineral density values at the spine and hip were -1.67 and -1.70, respectively; corresponding Z-scores were +0.73 and +0.99. The bone mineral density of the study group was significantly higher than in patients with fractured neck of femur (controls) and the general population (P<0.05). Nine of the study group had diabetes and one had impaired glucose tolerance. Treatment comprised casting in 10 patients and operative fixation in seven. Good functional recovery was achieved; most patients were able to resume their premorbid level of independent daily activities with a good motor functional independence score (85.18/91) 1 year post-injury.
 
CONCLUSION. In this case-control study, postmenopausal ankle fractures were not associated with osteoporosis. Diabetic neuropathy may have been a risk factor for such injury. The functional outcome of such patients was generally satisfactory, provided appropriate treatment was given.
 
Key words: Ankle injuries; Bone density; Fractures, bone; Osteoporosis, postmenopausal
 
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Prevalence of subclinical infection and transmission of severe acute respiratory syndrome (SARS) in a residential care home for the elderly

ABSTRACT
Hong Kong Med J 2006;12:201-7 | Number 3, June 2006
ORIGINAL ARTICLE
Prevalence of subclinical infection and transmission of severe acute respiratory syndrome (SARS) in a residential care home for the elderly
LCL Heung, T Li, SK Mak, WM Chan
Elderly Health Services, Department of Health, 35/F Hopewell Centre, 183 Queen's Road East, Wanchai, Hong Kong
 
 
OBJECTIVE. To ascertain the prevalence of subclinical severe acute respiratory syndrome–coronavirus (SARS-CoV) infection and study the transmission of SARS-CoV in a local outbreak at a residential care home for the elderly.
 
DESIGN. Cross-sectional study.
 
SETTING. A residential care home for the elderly in Hong Kong with a local outbreak of SARS.
 
PARTICIPANTS. Residents and staff in the residential care home who had contact with three patients with SARS (residents A and B, and staff C).
 
MAIN OUTCOME MEASURES. Blood samples were tested for total antibodies to SARS-CoV by immunofluorescence antibody test. The transmission of SARS was elucidated based on information from standardised questionnaires, and records of investigation and surveillance by the Department of Health.
 
RESULTS. Among the 90 eligible residents, three died, one moved out, and 19 refused to participate. Of the 32 eligible staff, six refused to participate. None of the remaining 93 participants tested positive for antibody to SARS-CoV. Based on the chronological order, resident A might have transmitted infection to resident B and staff C. Sitting close to the bathroom doorway while resident A took a shower was the only contact of resident B with resident A. The only opportunity for staff C to have contact with body fluids/excreta of resident A was in the handling of rubbish from the resident’s room.
 
CONCLUSION. Subclinical SARS-CoV infection was rare in a residential care home for the elderly with an outbreak of SARS. Nonetheless the close working and living conditions for staff and residents in such a home may facilitate transmission of SARS despite vigilant precautionary measures.
 
Key words: Aged; Disease transmission; Homes for the aged; Seroepidemiologic studies; Severe acute respiratory syndrome
 
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'Fracture' of the penis: a case series

ABSTRACT
Hong Kong Med J 2006;12:197-200 | Number 3, June 2006
ORIGINAL ARTICLE
'Fracture' of the penis: a case series
CH Chung, YK Szeto, KK Lai
Accident and Emergency Department, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong
 
 
OBJECTIVES. To examine the epidemiology of penile ‘fracture’ and its presenting characteristics in the local population.
 
DESIGN. Retrospective study.
 
SETTING. District hospital, Hong Kong.
 
PATIENTS. Patients with a discharge diagnosis of ‘fractured’ penis during a 7-year period from August 1998 to August 2005.
 
MAIN OUTCOME MEASURES. Age, time of attendance, cause, symptoms, signs, emergency department diagnosis, site of rupture, operative findings, and final outcome.
 
RESULTS. A total of 11 patients were identified. The mean age was 44 years (range, 30-63 years). The interval between time of injury and presentation ranged from 17 minutes to 7 days. Seven (64%) cases were attributed to sexual intercourse, three (27%) to penile manipulation, and one (9%) to rolling over the erect penis during sleep. Ten patients underwent surgery; all had primary suturing of the tunica tear, while two also required primary urethral repair. At follow-up, three (27%) patients had erectile dysfunction, one had mild penile deformity and one had a mild urethral stricture.
 
CONCLUSION. Emergency physicians and surgeons, as well as family physicians, should be familiar with the presentation of ‘fractured’ penis, as prompt diagnosis and early surgical repair are instrumental in ensuring a successful outcome with minimal complications. The public should also be educated to seek medical attention immediately, as delay or failure to report may result in permanent physical and psychological disabilities that could otherwise have been avoided.
 
Key words: Male; Middle aged; Penis/injuries; Rupture
 
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Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre

ABSTRACT
Hong Kong Med J 2006;12:191-6 | Number 3, June 2006
ORIGINAL ARTICLE
Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre
CN Tang, KK Tsui, JPY Ha, WT Siu, MKW Li
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
OBJECTIVES. To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones.
 
DESIGN. Retrospective study.
 
SETTING. Regional minimal access surgery training centre in Hong Kong.
 
PATIENTS. Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005.
 
MAIN OUTCOME MEASURES. Demographic information, reasons for failed endoscopic retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality.
 
RESULTS. A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months.
 
CONCLUSIONS. Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.
 
Key words: Cholangiopancreatography, endoscopic retrograde; Cholecystectomy, laparoscopic; Common bile duct/surgery; Gallstones/surgery; Sphincterotomy, endoscopic
 
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MicroAlbuminuria Prevalence Study (MAPS) in hypertensive type 2 diabetic patients in Hong Kong

ABSTRACT
Hong Kong Med J 2006;12:185-90 | Number 3, June 2006
ORIGINAL ARTICLE
MicroAlbuminuria Prevalence Study (MAPS) in hypertensive type 2 diabetic patients in Hong Kong
VTF Yeung, KF Lee, SH Chan, LF Ho, SK Leung, HY Wong
Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, 118 Shatin Pass Road, Wong Tai Sin, Hong Kong
 
 
OBJECTIVES. To assess the prevalence of macroalbuminuria and microalbuminuria, and the level of blood pressure control in patients with type 2 diabetes and hypertension in Hong Kong.
 
DESIGN. Cross-sectional clinic-based epidemiological study.
 
SETTING. Six medical centres (including two public hospital diabetes centres) in Hong Kong.
 
PATIENTS. Recruited from the medical centres from April to November 2002, after excluding those with bacteriuria and haematuria.
 
MAIN OUTCOME MEASURES. Body mass index; blood pressure; levels of blood glucose, macroalbuminuria, and microalbuminuria; treatments for hypertension and diabetes.
 
RESULTS. The as per-protocol recruited population of 437 hypertensive type 2 diabetic patients had a mean age of 61.7 (standard error, 0.5) years. Overall, the prevalence of diabetic nephropathy in this population was high; 18.3% had macroalbuminuria (95% confidence interval, 16.5-20.2%) and 24.9% had microalbuminuria (95% confidence interval, 22.9- 27.0%). Predictive factors were advanced age, male sex, poor blood pressure control, and existing cardiovascular complications. Whilst almost all patients (96.1%) were receiving treatment for hypertension, only 25.6% had systolic/diastolic blood pressures below the 130/85 mm Hg target.
 
CONCLUSIONS. In Hong Kong, the prevalence of microalbuminuria and macroalbuminuria is high in type 2 diabetic patients with hypertension, particularly in males and those with poorly controlled systolic blood pressure. Tight glycaemic control, antihypertensive therapy, and use of renin-angiotensin system inhibitors/blockers are necessary to retard the progression of nephropathy to advanced renal disease.
 
Key words: Albuminuria; Diabetes mellitus, type 2; Diabetic nephropathies; Hypertension; Renin-angiotensin system
 
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Prevalence study of cerebral palsy in Hong Kong children

ABSTRACT
Hong Kong Med J 2006;12:180-4 | Number 3, June 2006
ORIGINAL ARTICLE
Prevalence study of cerebral palsy in Hong Kong children
WKL Yam, HSS Chan, KW Tsui, BPHL Yiu, SSL Fong, CYK Cheng, CW Chan
Working Group on Cerebral Palsy, Hong Kong Society of Child Neurology and Developmental Paediatrics Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Chuen On Road, Tai Po, Hong Kong
 
 
OBJECTIVES. To investigate the prevalence of cerebral palsy in local children aged 6 to 12 years and to evaluate service utilisation by those children who attend mainstream schools.
 
DESIGN. Cross-sectional survey.
 
SETTING. Mainstream primary schools and special needs schools in Hong Kong.
 
PARTICIPANTS. Headmasters or headmistresses of special needs schools, and various organisations that provide services to children with cerebral palsy in the school year September 2003 to June 2004.
 
MAIN OUTCOME MEASURES. Prevalence of cerebral palsy and support services used by children with cerebral palsy who attend a mainstream school.
 
RESULTS. Of 435 572 children, 578 with cerebral palsy were identified. The overall point prevalence was 1.3 per 1000 children. The age-specific prevalence rate varied from 1.04 to 1.50 per 1000 children. Approximately 38% of children with cerebral palsy attended a mainstream school. Among those studying in special needs schools, 96% attended a school for the physically handicapped or a school for the severely mentally handicapped. Among 219 children with cerebral palsy in mainstream schools, 57 (26%) received educational support, and 134 (61%) received out-patient therapy support. Only 12% received both supporting services. No educational or therapeutic support was received by 26% of children.
 
CONCLUSIONS. Compared with overseas data, the low prevalence of cerebral palsy detected in local children in this investigation may be due to the differences in study design or a genuinely low prevalence. Setting up a cerebral palsy registry could help monitor the local prevalence of this childhood disability more accurately, thereby providing more reliable information for planning support services for this subgroup of children.
 
Key words: Cerebral palsy; Children; Prevalence; Survey
 
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Epidemiology of leprosy and response to treatment in Hong Kong

ABSTRACT
Hong Kong Med J 2006;12:174-9 | Number 3, June 2006
ORIGINAL ARTICLE
Epidemiology of leprosy and response to treatment in Hong Kong
CK Ho, KK Lo
Cheung Sha Wan Dermatology Clinic, 3/F West Kowloon Health Centre, 303 Cheung Sha Wan Road, Kowloon, Hong Kong
 
 
OBJECTIVES. To review the reported trend of leprosy in Hong Kong.
 
DESIGN. Retrospective study.
 
SETTING. Three major leprosy clinics in Hong Kong.
 
PATIENTS. Leprosy patients registered between 1970 and 2004.
 
MAIN OUTCOME MEASURES. Incidence, rate of deformities, distribution of leprosy subtypes, age distribution, and relapses after therapy.
 
RESULTS. The incidence of leprosy has decreased from 3.2 per 100 000 population in 1970 to 0.088 per 100 000 population in 2004. The proportion of the three subtypes of leprosy has remained roughly equal. There have been 87 relapses within this period with 54 (62%) cases of lepromatous leprosy, 22 (25%) borderline leprosy, and 11 (13%) tuberculoid leprosy. The overall relapse rate was 6.7% (0.2 per 100 person-years); this can be subdivided as a relapse rate for multidrug therapy of 3.2% (0.33 per 100 person-years) and for dapsone monotherapy of 8.3% (0.2 per 100 person-years). The mean interval to relapse for multidrug therapy and dapsone monotherapy was 1.83 and 5.8 years, respectively. The mean duration till relapse for patients on dapsone monotherapy was 15.6 years.
 
CONCLUSION. Treatment with recommended WHO-multidrug therapy is effective and well tolerated. Dapsone monotherapy is no longer effective. Leprosy is well controlled in Hong Kong but continued surveillance is required to detect relapses and to ensure good patient compliance with treatment.
 
Key words: Dapsone; Drug therapy; Leprosy; Recurrence
 
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Clinical experience of trainee anaesthesiologists: logbook analysis

ABSTRACT
Hong Kong Med J 2006;12:125-32 | Number 2, April 2006
ORIGINAL ARTICLE
Clinical experience of trainee anaesthesiologists: logbook analysis
CY Kwok, CT Hung
Department of Anaesthesiology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong
 
 
OBJECTIVE. To study the clinical experience acquired by trainee anaesthesiologists after 6 years of training in Hong Kong.
 
DESIGN. Retrospective observational study.
 
SETTING. Recognised anaesthesiology training posts in the Hong Kong Hospital Authority.
 
PARTICIPANTS. All anaesthesiology trainees who sat the Exit Assessment between January 2001 and June 2002 after completing more than 48 months of anaesthetic training.
 
MAIN OUTCOME MEASURES. Anaesthetic experience of trainees.
 
RESULTS. All data provided by 25 trainees were computed for analysis. Each trainee administered a mean of 2668 anaesthetics over a 6-year period, including 57 anaesthetics for thoracic surgery, 15 for cardiac surgery, 213 for caesarian section (34% under general anaesthesia), and 100 for neurosurgical operations. The paediatric anaesthesia exposure involved a mean of 12 neonates and 180 children who were younger than 4 years. Apart from cardiac and thoracic anaesthesia, there was no statistical difference in subspecialty anaesthetic experience among trainees from different parent hospitals.
 
CONCLUSION. The current training system provides sufficient anaesthetic experience in terms of case variety and subspecialty case numbers. There was uneven exposure to cardiac, thoracic, and paediatric anaesthesia. An accurate logbook that is reviewed regularly by a supervisor will help ensure adequate subspecialty exposure. An electronic logbook will facilitate a more comprehensive reviewing process.
 
Key words: Anesthesiology/education; Medical audit; Records
 
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