Fracture of a Broviac catheter in a low-birth-weight infant

ABSTRACT

Hong Kong Med J 2008;14:411-3 | Number 5, October 2008
CASE REPORT
Fracture of a Broviac catheter in a low-birth-weight infant
Surasak Puvabanditsin, Eugene Garrow, Rungtiwa Weerasethsiri, Nisha Patel, Suzanne E Davis, Moe-Akahira Azuma
Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, US
 
 
Central venous catheters are widely used in children, particularly in very-low-birth-weight infants in whom long-term access to the venous system is required. This may be achieved by using peripherally inserted central catheters or tunnelled central venous lines (eg Broviac or Hickman lines). Previous case reports of fractured central catheters in premature neonates have involved peripherally inserted silastic catheters. Fractures and embolisation of Broviac central venous fragments have not been previously reported in preterm neonates. We describe a premature neonate with this rare complication along with the retrieval technique used.
 
Key words: Catheterization, central venous; Equipment failure; Infant, low birth weight
 
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Magnetic resonance imaging for ureteral fibroepithelial polyp

ABSTRACT

Hong Kong Med J 2008;14:408-10 | Number 5, October 2008
CASE REPORT
Magnetic resonance imaging for ureteral fibroepithelial polyp
Thomas KK Lai, Cathy HS Chung, Angus CW Chin, Petrus S Szeto, WC Wong, Ronee YY Chan, Henry YH Huang, WF Ng
Department of Radiology, Tseung Kwan O Hospital, 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong
 
 
Ureteric tumours are rare and most of them are malignant. Of benign tumours, ureteral fibroepithelial polyps are the most common but are still considered clinical rarities. In the past, most benign ureteric tumours were only diagnosed after surgical removal. With technological advance, magnetic resonance imaging has become an effective means of assessing ureteric lesions. Non-contrast enhanced magnetic resonance urography can produce an image comparable to an intravenous urogram without use of intravenous water-soluble contrast. A polyp can be diagnosed on imaging if there is an elongated filling defect inside the ureter. Nevertheless, a definitive diagnosis relies on ureteroscopic examination with biopsy. When a non-obstructive polyp is being managed conservatively, imaging is helpful for monitoring. Equally, the information obtained from imaging can be used to plan operative treatment.
 
Key words: Magnetic resonance imaging; Neoplasms, fibroepithelial; Polyps; Ureter
 
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Grayanotoxin poisoning from Rhododendron simsii in an infant

ABSTRACT

Hong Kong Med J 2008;14:405-7 | Number 5, October 2008
CASE REPORT
Grayanotoxin poisoning from Rhododendron simsii in an infant
WT Poon, CH Ho, KL Yip, CK Lai, KL Cheung, Rita YT Sung, Albert YW Chan, Tony WL Mak
Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
We report a case of severe poisoning in a 57-day-old infant who presented with vomiting, convulsions, and shock after ingesting a bottle of milk containing a decoction of Rhododendron simsii (紅杜鵑). The grandmother collected this toxic plant from a cultivated area, believing it was good for the airways. Grayanotoxin was detected in both the urine and plant specimens. The infant made a good recovery after requiring ventilatory support for 2 days. Rhododendron is a common gardening shrub in Hong Kong. Some Rhododendron species are poisonous and contain grayanotoxin. Intentional or accidental ingestion of toxic plants can be severe or even life-threatening. It is therefore essential that clinicians be familiar with local toxic plant species.
 
Key words: Flowers; Plant poisoning; Rhododendron; Toxins, biological
 
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Clinical and radiological features of generalised lymphangiomatosis

ABSTRACT

Hong Kong Med J 2008;14:402-4 | Number 5, October 2008
CASE REPORT
Clinical and radiological features of generalised lymphangiomatosis
CS Wong, Tiffany YC Chu
Department of Diagnostic Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
We report a paediatric patient who presented with fever, shortness of breath, and vague abdominal discomfort. Lesions removed surgically proved to be generalised lymphangiomatosis and were treated conservatively. The spectrum of abnormalities and radiological features are discussed.
 
Key words: Lymphangioma, cystic; Magnetic resonance imaging; Tomography, X-ray computed
 
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Cystinuria: a rare diagnosis that should not be missed

ABSTRACT

Hong Kong Med J 2008;14:399-401 | Number 5, October 2008
CASE REPORT
Cystinuria: a rare diagnosis that should not be missed
Peter KF Chiu, Eddie SY Chan, Simon SM Hou, CF Ng
Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
Cystinuria is a rare autosomal recessive defect causing recurrent urinary tract stone formation. Morbidity from stone formation and repeated urological interventions can be reduced by early diagnosis and adequate medical treatment. In this review, we illustrate these points by discussing three patients with cystinuria and give a brief review of its management.
 
Key words: Cystine; Cystinuria; Treatment outcome; Urinary calculi
 
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The first nocturnal home haemodialysis patient in Hong Kong

ABSTRACT

Hong Kong Med J 2008;14:395-8 | Number 5, October 2008
CASE REPORT
The first nocturnal home haemodialysis patient in Hong Kong
HL Tang, Candic MK Tang, KH Chu, W Lee, A Cheuk, KF Yim, KS Fung, Hilda WH Chan, KL Tong
Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
We report our experience of the first use of nocturnal home haemodialysis in Hong Kong. The patient, a 40-year-old man with end-stage renal failure, was recruited into the Nocturnal Home Haemodialysis Programme at Princess Margaret Hospital in 2006. He received haemodialysis at home on alternate nights (3.5 sessions per week) for 5.5 to 6 hours per session. After 1 year of nocturnal home haemodialysis, his recombinant human erythropoietin requirement had been reduced by more than 50%. His serum phosphate level decreased by 35% and calcium phosphate product by 34%. After nocturnal home haemodialysis, his blood pressure control has been excellent and he was able to cease taking anti-hypertensive medications soon after commencing nocturnal home haemodialysis. Regression of his left ventricular hypertrophy has also been noted, with a 39% decrease in his left ventricular mass index. The haemodialysis adequacy index, weekly single-pool Kt/V, increased by 59% after switching to nocturnal home haemodialysis and his quality-of-life indices also showed significant improvement. Nocturnal home haemodialysis holds promise as an alternative dialytic therapy for patients on chronic haemodialysis in Hong Kong.
 
Key words: Blood pressure; Hemodialysis, home; Kidney failure, chronic; Phosphates; Quality of life
 
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Does chronic radiation enteritis pose a diagnostic challenge? A report of three cases

ABSTRACT

Hong Kong Med J 2008;14:327-30 | Number 4, August 2008
CASE REPORT
Does chronic radiation enteritis pose a diagnostic challenge? A report of three cases
Abdulzahra Hussain, Hind Mahmood, Adrian Thomas, Claire Frazer, Shamsi El-Hasani
Department of General Surgery, Princess Royal University Hospital, Farnborough Common, BR6 8ND, Kent, United Kingdom
 
 
We present three cases of late radiation enteritis, all admitted through the accident and emergency unit and managed in the surgical department. All presented with acute symptoms. Two had abdominal pain, nausea, and vomiting and in these two cases, plain radiology and computed tomography scans demonstrated small bowel obstruction. Exploratory laparotomies confirmed chronic radiation damage to the small bowel. The affected areas were resected and anastomoses were performed. The postoperative course was uneventful. The other patient presented with bleeding per rectum and a colonoscopy with biopsy of the rectum confirmed proctitis and radiation enteritis. This patient was treated conservatively and responded well. The key factor needed for successful diagnosis and management of chronic radiation enteritis is a high index of suspicion leading to appropriate use of imaging.
 
Key words: Enteritis; Intestine, small; Radiation injuries
 
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Bilateral cervical spondylolysis in a young Chinese woman presenting with a neck injury

ABSTRACT

Hong Kong Med J 2008;14:324-6 | Number 4, August 2008
CASE REPORT
Bilateral cervical spondylolysis in a young Chinese woman presenting with a neck injury
Annie CW Tam, John LY Leung, KY Lau, PK Yee
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai, Hong Kong
 
 
Cervical spondylolysis is an uncommon entity. It is important to recognise its characteristic radiological features and differentiate it from acute cervical fractures or dislocations in patients with neck injuries. We report the relevant clinical and radiological findings seen in a young Chinese woman managed in our hospital after a neck injury who was ultimately diagnosed with bilateral cervical spondylolysis with spondylolisthesis at C6.
 
Key words: Spondylolisthesis; Spondylolysis; Tomography, X-ray computed
 
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Severe right heart failure in two patients with thyrotoxicosis

ABSTRACT

Hong Kong Med J 2008;14:321-3 | Number 4, August 2008
CASE REPORT
Severe right heart failure in two patients with thyrotoxicosis
Vicki HK Tam, LM Fung
Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong
 
 
Congestive heart failure is a recognised complication of uncontrolled thyrotoxicosis but isolated right heart failure is rarely seen in association with thyrotoxicosis. Two cases of right heart failure associated with thyrotoxicosis are presented. In a 45-year-old man with right heart failure, investigations for all common secondary causes of right heart failure were negative. The only concurrent disease identified was thyrotoxicosis. The right heart failure subsided after treatment of the thyrotoxicosis. In a 36-year-old woman, the right heart failure had two underlying causes, thyrotoxicosis and an atrial septal defect. Treatment of thyrotoxicosis alone resulted in improvement of pulmonary hypertension and right heart failure. Thyrotoxicosis should be considered as a possible cause of pulmonary hypertension or isolated right heart failure.
 
Key words: Heart failure; Heart septal defects, atrial; Hypertension, pulmonary; Thyrotoxicosis
 
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Prenatal sonographic diagnosis of familial Holt-Oram syndrome associated with type B interrupted aortic arch

ABSTRACT

Hong Kong Med J 2008;14:317-20 | Number 4, August 2008
CASE REPORT
Prenatal sonographic diagnosis of familial Holt-Oram syndrome associated with type B interrupted aortic arch
KM Law, KT Tse
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
We present a rare case of familial Holt-Oram syndrome diagnosed sonographically at 18 weeks of gestation. The foetus had serious bilateral upper limb malformations, a ventricular septal defect and a type B interrupted aortic arch, while the mother had bilateral upper limb malformations only. The pregnancy was terminated. A pathological and radiological examination of the foetus confirmed the prenatal sonographic findings. Although genetic investigation of TBX5 mutations was not available in our locality at the time of diagnosis, the geneticists made a clinical diagnosis of familial Holt-Oram syndrome. The clinical features of our case completely fulfilled the strict diagnostic criteria for the syndrome. The cardiac malformations most commonly associated with Holt-Oram syndrome are atrial or ventricular septal defects. To the best of our knowledge, a prenatal diagnosis of Holt-Oram syndrome in association with a type B interrupted aortic arch has not been reported in the English literature before.
 
Key words: Heart defects, congenital; Upper extremity deformities, congenital; Syndrome; Ultrasonography, prenatal
 
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