Treatment of severe acute respiratory syndrome with convalescent plasma

ABSTRACT

Hong Kong Med J 2003;9:199-201 | Number 3, June 2003
EXPEDITED CASE REPORT
Treatment of severe acute respiratory syndrome with convalescent plasma
VWS Wong, D Dai, AKL Wu, JJY Sung
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
In March 2003, an outbreak of severe acute respiratory syndrome started in Hong Kong. A 57-year-old woman had a typical presentation, including fever, non-productive cough, malaise, lymphopenia, and raised liver aminotransferases. The clinical course and successful treatment with convalescent plasma, ribavirin, and corticosteroids are discussed.
 
Key words: Fever; Pneumonia; Ribavirin; Severe acute respiratory syndrome
 
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Unusual neurological presentation of neuroblastoma

ABSTRACT

Hong Kong Med J 2003;9:142-4 | Number 2, April 2003
CASE REPORT
Unusual neurological presentation of neuroblastoma
WL Yeung, CK Li, EAS Nelson, KW Chik, GM Joynt, E Yuen, CK Yeung
Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Acute cerebellar ataxia and opsomyoclonus are presenting signs of occult neuroblastoma for a substantial proportion of paediatric patients. Cerebellar ataxia may be due to antibodies against the neuroblastoma crossreacting with cerebellar tissue. This report is of a 26-month-old boy who presented with encephalitis-like features of ataxia, seizures, decreased consciousness, and involuntary movements. Magnetic resonance imaging of the brain and spine were normal 2 weeks after presentation. The child didnot have the classical signs of opsoclonus or myoclonus at any stage of the disease but was found to have occult neuroblastoma. The late demyelinating changes seen on magnetic resonance imaging of the brain support an immunological basis for the paraneoplastic manifestations of occult neuroblastoma in this child. Occult neuroblastoma should be considered as one of the differential diagnoses for children presenting with persisting encephalitis-like features in the presence of normal neuroimaging findings.
 
 
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Isolated ventricular non-compaction presenting with ventricular tachycardia

ABSTRACT

Hong Kong Med J 2003;9:137-40 | Number 2, April 2003
CASE REPORT
Isolated ventricular non-compaction presenting with ventricular tachycardia
KL Tsui, KK Chan, TC Leung, KH Lam, SK Li
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
Isolated ventricular non-compaction is a rare congenital cardiomyopathy, manifested morphologically as prominent myocardial trabeculations and deep inter-trabecular recesses that communicate with the ventricular cavity. Heart failure is the most common presenting condition. Other manifestations include arrhythmia and cardioembolic events. This report is illustrative of isolated ventricular non-compaction in a 78-year-old woman. The diagnosis was made when she presented with ventricular tachycardia many years after a stroke. She subsequently underwent implantation of a cardioverter-defibrillator. This report documents an uncommon presentation of this disease entity in the oldest patient at presentation as yet reported in the literature.
 
Key words: Cardiomyopathy; Echocardiography; Heart defects, congenital; Tachyarrhythmias
 
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Non-Hodgkin’s lymphoma with left suprascapular neuropathy on magnetic resonance imaging

ABSTRACT

Hong Kong Med J 2003;9:134-6 | Number 2, April 2003
CASE REPORT
Non-Hodgkin’s lymphoma with left suprascapular neuropathy on magnetic resonance imaging
Y Faridah, BJJ Abdullah
Department of Radiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
 
 
Magnetic resonance imaging is gaining importance in the diagnosis of nerve and muscular disorders. The ability of magnetic resonance imaging to delineate the different muscles and the nerve in any plane has made the differentiation between the changes of neuropathy, denervation, and nerve entrapment possible. Although findings on magnetic resonance imaging are non-specific, their use, coupled with clinical symptoms and electromyographic findings, allow an accurate diagnosis to be made without resorting to invasive biopsies.
 
Key words: Denervation; Lymphoma; Magnetic resonance imaging; Non-Hodgkin
 
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Diagnosis of dihydropyrimidine dehydrogenase deficiency in a neonate with thymine-uraciluria

ABSTRACT

Hong Kong Med J 2003;9:130-2 | Number 2, April 2003
CASE REPORT
Diagnosis of dihydropyrimidine dehydrogenase deficiency in a neonate with thymine-uraciluria
KM Au, CK Lai, YP Yuen, CC Shek, CW Lam, AYW Chan
Department of Pathology, Princess Margaret Hospital, Princess Margaret Hospital Road, Laichikok, Hong Kong
 
 
Dihydropyrimidine dehydrogenase deficiency is an inborn error of pyrimidine metabolism characterised by thymine-uraciluria, convulsive disorders and developmental delay in paediatric patients, and an increased risk of toxicity from 5-fluorouracil treatment. This report is of the first patient with dihydropyrimidine dehydrogenase deficiency diagnosed in Hong Kong. The patient was a 2-day-old male neonate of Pakistani origin who presented with convulsions. Diagnosis was made by gas chromatographic-mass spectrometric detection of thymine-uraciluria and by molecular detection of a G to A point mutation in a 5’-splicing site leading to skipping of exon 14 in the DPYD gene of chromosome location 1q22. The results showed that the patient and his mother were homozygous and the father heterozygous for the splice site mutation. The mother also had thymine-uraciluria but was clinically asymptomatic.
 
Key words: Fluorouracil; Infant; Purine-pyrimidine metabolism, inborn errors; Thymine-uraciluria
 
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The first patient with locally acquired dengue fever in Hong Kong

ABSTRACT

Hong Kong Med J 2003;9:127-9 | Number 2, April 2003
CASE REPORT
The first patient with locally acquired dengue fever in Hong Kong
TW Auyeung, TL Que, KS Lam, HL Ng, ML Szeto
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong
 
 
This report is of the first locally acquired case of dengue fever. The diagnosis was made even in the absence of a history of travel outside Hong Kong. The patient was a 21-year-old man, who presented with high fever, leukopenia, thrombocytopenia, and elevated liver enzymes. His haematocrit revealed mild haemoconcentration but the albumin was normal throughout the course of the illness. His blood pressure remained low with no tachycardia or overt shock syndrome. The pyrexia subsided 4 days after admission to hospital and all haematological and biochemical abnormalities eventually normalised. The pathogenesis, diagnostic criteria of dengue haemorrhagic fever and dengue shock syndrome, and control of dengue infection are discussed.
 
Key words: Dengue; Hong Kong; Infection control
 
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Moyamoya syndrome in a child with Down syndrome

ABSTRACT

Hong Kong Med J 2003;9:63-6 | Number 1, February 2003
CASE REPORT
Moyamoya syndrome in a child with Down syndrome
CW Fung, KL Kwong, EYK Tsui, SN Wong
Department of Paediatrics, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong
 
 
Moyamoya syndrome has been reported in association with Down syndrome. In paediatric patients, the usual presentation is that of ischaemic stroke. We report a 9-year-old boy with Down syndrome and moyamoya syndrome who presented with acute-onset left hemiparesis. This is the first such reported case in Hong Kong. There is growing evidence that the chromosomal abnormalities in patients with Down syndrome may contribute to a vulnerability for the development of moyamoya syndrome. A high index of suspicion is necessary to make the correct diagnosis. Medical and surgical management strategies for this disease are discussed. Surgical intervention should proceed without delay, if indicated, to prevent further neurological deterioration. A multidisciplinary approach is recommended for the rehabilitation of these patients.
 
Key words: Cerebrovascular disorders; Child; Down syndrome; Moyamoya disease
 
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Tuberculous meningitis with spinal tuberculous arachnoiditis

ABSTRACT

Hong Kong Med J 2003;9:59-61 | Number 1, February 2003
CASE REPORT
Tuberculous meningitis with spinal tuberculous arachnoiditis
TL Poon, WS Ho, KY Pang, CK Wong
Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital
 
 
This report is of a 36-year-old woman who initially presented with confusion and fever. Subsequent investigations showed tuberculous meningitis with acute hydrocephalus. Ventriculoperitoneal shunt was performed and anti-tuberculosis therapy was given. The patient was later noticed to have weakness of both lower limbs and urinary retention. Magnetic resonance imaging of the thoracic spine showed radiological features of tuberculous arachnoiditis with cord compression. Decompressive laminectomy was performed and high-dose systemic corticosteroid was given. A high level of awareness is required when diagnosing tuberculous arachnoiditis and the importance of high-dose corticosteroid in the treatment regimen is emphasised.
 
Key words: Arachnoiditis; Decompression; Laminectomy; Steroids; Tuberculosis, spinal
 
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Spontaneous spinal epidural haematoma—an unusual cause of spinal cord compression

ABSTRACT

Hong Kong Med J 2003;9:55-7 | Number 1, February 2003
CASE REPORT
Spontaneous spinal epidural haematoma—an unusual cause of spinal cord compression
JKF Kong, KH Mak
Department of Orthopaedic Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
Spinal epidural haematoma is uncommon. Spontaneous spinal epidural haematoma of unknown aetiology is a rarity. This report is of two patients with spontaneous spinal epidural haematoma with different outcomes and discussion of the clinical picture and possible aetiology of this rare condition.
 
Key words: Decompression; Hematoma, epidural; Laminectomy; Spinal cord compression
 
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Carotid stenting for irradiation-associated carotid stenosis 3 years after previous carotid endarterectomy

ABSTRACT

Hong Kong Med J 2003;9:51-3 | Number 1, February 2003
CASE REPORT
Carotid stenting for irradiation-associated carotid stenosis 3 years after previous carotid endarterectomy
ACW Ting, SWK Cheng, PW Cheng
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
Extracranial carotid stenosis is a known complication of external irradiation to the head and neck region. We report on a patient with previous carotid endarterectomy for irradiation-associated carotid stenosis. This patient developed symptomatic carotid stenosis over the ipsilateral common carotid artery proximal to the previous endarterectomy site 3 years later, and was successfully treated with carotid angioplasty and stenting. This case illustrates the importance of Duplex scan surveillance after carotid endarterectomy for patients with irradiation-associated carotid stenosis. The complimentary role of carotid endarterectomy and carotid angioplasty for managing such a patient is highlighted.
 
Key words: Carotid stenosis; Radiotherapy, adverse effects; Stents; Ultrasonography, Doppler, Duplex
 
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