Mah-jong–induced seizures: case reports and review of twenty-three patients

ABSTRACT

Hong Kong Med J 2007;13:314-8 | Number 4, August 2007
MEDICAL PRACTICE
Mah-jong–induced seizures: case reports and review of twenty-three patients
Richard SK Chang, Raymond TF Cheung, SL Ho, Windsor Mak
Department of Medicine, Queen Mary Hospital, Hong Kong
 
 
'Mah-jong epilepsy' is a rare reflex epilepsy syndrome, manifesting as recurrent epileptic seizures triggered by either playing or just watching mah-jong. We present three patients with this condition and review all the reported cases. Mah-jong – induced seizures can be considered a subtype of cognition-induced epilepsy. Nonetheless, these patients have distinctive clinical and electrophysiological features: late age of onset, different seizure patterns, single seizure-trigger, lack of spontaneous seizures, and electroencephalographic findings not supportive of idiopathic generalised epilepsy. The pathophysiological mechanism underlying mah-jong-induced seizures may be different from the other cognition-associated reflex epileptic phenomena.
 
Key words: Cerebral cortex; Electroencephalography; Epilepsy, generalized; Epilepsy, reflex; Gambling
 
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Diagnostic value and safety of long-term video-EEG monitoring

ABSTRACT

Hong Kong Med J 2007;13:228-30 | Number 3, June 2007
MEDICAL PRACTICE
Diagnostic value and safety of long-term video-EEG monitoring
Andrew CF Hui, Patrick Kwan, TW Leung, Y Soo, Vincent CT Mok, Lawrence KS Wong
Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
This paper aimed to assess the usefulness and safety of video-EEG (video-electroencephalography) monitoring in patients with refractory epilepsy. We analysed the video-EEG recordings of consecutive patients over a 3-year period from 2002 to 2005. The pre-admission diagnosis, demographic information, number of ictal episodes, adverse events, and final diagnosis were recorded in all patients. The diagnostic labels before and after monitoring were compared in order to assess whether it had led to a change in diagnosis and management. Of the 100 patients who underwent video-EEG, 227 clinical events were recorded in 62 cases. The most common events were complex partial seizures followed by non-epileptic attacks. Video-EEG allowed a diagnosis to be made in 81 patients and the diagnosis at discharge was altered in 19 cases. Major injuries and status epilepticus did not occur during monitoring. In our experience video-EEG is safe and provides important clinical information in over 80% of patients.
 
Key words: Electroencephalography; Monitoring, physiologic; Video recording
 
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A report of four cases of caesarean scar pregnancy in a period of 12 months

ABSTRACT

Hong Kong Med J 2007;13:141-3 | Number 2, April 2007
MEDICAL PRACTICE
A report of four cases of caesarean scar pregnancy in a period of 12 months
CM Yan
Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
 
 
We report on four cases of caesarean scar pregnancy with different modes of treatment—expectant, surgical, systemic medical, and local medical. We attempt to explore the indications, and pros and cons of the various management modalities for caesarean scar pregnancy.
 
Key words: Cesarean section; Embolization, therapeutic; Laparoscopy; Methotrexate; Pregnancy; Uterus
 
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Gastro-intestinal stromal tumours: a review of current management options

ABSTRACT

Hong Kong Med J 2007;13:61-5 | Number 1, February 2007
MEDICAL PRACTICE
Gastro-intestinal stromal tumours: a review of current management options
HHF Loong
Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Gastro-intestinal stromal tumours are uncommon malignancies of the gastro-intestinal tract, accounting for only 0.2% of all gastro-intestinal malignancies, but are the most common of abdominal sarcomas. Classically, they have been considered amenable only to early stage surgical intervention. Recent advances in targeted cancer therapies have led to the development of effective non-surgical treatment options. This article discusses the epidemiology and physiopathology of, as well as treatment options available for, this uncommon disease.
 
Key words: Epidemiology; Gastrointestinal stromal tumors; Gastrointestinal tract; Physiopathology
 
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Aconite poisoning in camouflage

ABSTRACT

Hong Kong Med J 2006;12:456-9 | Number 6, December 2006
MEDICAL PRACTICE
Aconite poisoning in camouflage
WT Poon, CK Lai, CK Ching, KY Tse, YC So, YC Chan, LM Hau, TWL Mak, AYW Chan
Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
 
 
The Toxicology Reference Laboratory has confirmed 10 cases of aconite poisoning from March 2004 to May 2006. In four of these 10 cases, the aconite herb was not listed in the written prescription. We report these four cases to highlight the problem of 'hidden' aconite poisoning.
 
Key words: Aconitum; Drugs, Chinese herbal; Poisoning
 
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Recurrent pneumothorax in pregnancy: what should we do after placing an intercostal drain

ABSTRACT

Hong Kong Med J 2006;12:375-80 | Number 5, October 2006
MEDICAL PRACTICE
Recurrent pneumothorax in pregnancy: what should we do after placing an intercostal drain
MK Wong, WC Leung, JK Wang, TT Lao, MS Ip, WK Lam, JC Ho
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
 
 
Recurrent pneumothorax is rare during pregnancy. We describe a Chinese woman, with a history of spontaneous pneumothorax managed with an intercostal drain, who developed a recurrent pneumothorax during her 32nd week of pregnancy. There is no consensus on management in this situation. We review the literature and discuss different management approaches. Thirty-six cases of antepartum pneumothorax have been reported in 31 case reports. An intercostal drain only (n=11) or surgeries (thoracotomy, n=9; or video-assisted thoracoscopy, n=2) were common treatment options with no surgical complications reported. Twenty-two (61%) patients progressed to a normal vaginal delivery, while the rest required forceps delivery (22%) or Caesarean section (14%). No single treatment option outweighed the others. There were no maternal or foetal complications reported in those who underwent antepartum surgical intervention. Surgical management of recurrent pneumothorax during pregnancy is well tolerated.
 
Key words: Pneumothorax/surgery; Pregnancy, Thoracic surgery, video-assisted
 
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Computed tomography-guided percutaneous radiofrequency ablation of osteoid osteoma: local experience

ABSTRACT

Hong Kong Med J 2006;12:305-9 | Number 4, August 2006
MEDICAL PRACTICE
Computed tomography-guided percutaneous radiofrequency ablation of osteoid osteoma: local experience
PSC Yip, YL Lam, MK Chan, JSJ Shu, KC Lai, YC So
Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong
 
 
Osteoid osteoma is a slow-growing tumour with limited growth potential. In the past, treatment comprised open surgery with en-bloc resection or curettage of the tumour. In recent years, various minimally invasive percutaneous treatments have gained popularity. We report on six patients who underwent computed tomography-guided percutaneous radiofrequency ablations of osteoid osteomas between January 2000 and December 2003 in a regional hospital in Hong Kong. Technical success was achieved in all procedures, with a mean follow-up of 40 months (range, 18-65 months). Five of the six patients achieved complete pain relief after the procedure and remained pain-free on subsequent follow-up. One patient with persistent symptoms after the first ablation was successfully treated with a second ablation. The mean in-hospital stay was 2.4 days. Progress in radiological healing was observed in all patients. There was one complication of skin burn over the needle entry site. Our experience shows that percutaneous computed tomography-guided radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteoma.
 
Key words: Bone neoplasms; Catheter ablation; Osteoma, osteoid
 
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Foreign body--induced aorto-oesophageal fistula: a review of five cases and their management

ABSTRACT

Hong Kong Med J 2006;12:219-21 | Number 3, June 2006
MEDICAL PRACTICE
Foreign body--induced aorto-oesophageal fistula: a review of five cases and their management
LC Cheng, CSW Chiu
Division of Cardiothoracic Surgery, Department of Surgery, University of Hong Kong, Grantham Hospital, Aberdeen, Hong Kong
 
 
Foreign body–induced aorto-oesophageal fistula is a rare cause of massive upper gastro-intestinal bleeding and, in the absence of a timely diagnosis and surgical intervention, can be fatal. During a period of 25 years, five patients with foreign body–induced aorto-oesophageal fistula underwent surgery in our department. Three patients survived. All survivors required more than one surgical intervention. The clinical course of these five patients and the management of this potentially fatal condition are reviewed.
 
Key words: Aortic diseases; Esophageal fistula; Foreign bodies; Hematemesis
 
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Optimising antimicrobial prescription in hospitals by introducing an antimicrobial stewardship programme in Hong Kong: consensus statement

ABSTRACT

Hong Kong Med J 2006;12:141-8 | Number 2, April 2006
MEDICAL PRACTICE
Optimising antimicrobial prescription in hospitals by introducing an antimicrobial stewardship programme in Hong Kong: consensus statement
PL Ho, JCF Cheng, PTY Ching, JKC Kwan, WWL Lim, WCY Tong, TC Wu, CWS Tse, R Lam, R Yung, WH Seto; Consensus Meeting Group on Antimicrobial Stewardship Programme
Centre for Health Protection, Department of Health, Hong Kong
 
 
OBJECTIVE. To discuss the implementation of an ‘antimicrobial stewardship programme’ as a means to improve the quality of antimicrobial use in a hospital setting in Hong Kong.
 
PARTICIPANTS. Consensus working group on ‘antimicrobial stewardship programme’, The Scientific Committee on Infection Control, Centre for Health Protection, Department of Health, comprised 11 experts. The remit of the working group was to discuss the rationale and requirement for optimising antimicrobial prescriptions in hospitals by the introduction of an ‘antimicrobial stewardship programme’.
 
EVIDENCE. PubMed articles, national and international guidelines, and abstracts of international meetings published between January 2000 and December 2004 on programmes for improving the use of antimicrobials in hospitals. Only English medical literature was reviewed.
 
CONSENSUS PROCESS. Data search was performed independently by three members of the working group. They met on three occasions before the meeting to discuss all collected articles. A final draft was circulated to the working group before a meeting on 3 January 2005. Five commonly asked questions about an 'antimicrobial stewardship programme’ were selected for discussion by the participants. Published information on the rationale, components, outcome measures, advantages, and disadvantages of the programme was reviewed. Recent unpublished data from local studies of an ‘antimicrobial stewardship programme’ were also discussed. The timing, potential problems, and practical issues involved in the implementation of an ‘antimicrobial stewardship programme’ in Hong Kong were then considered. The consensus statement was circulated to and approved by all participants.
 
CONCLUSION. The continuous indiscriminate and excessive use of antimicrobial agents promotes the emergence of antibiotic-resistant organisms. Antimicrobial resistance substantially raises already-rising health care costs and increases patient morbidity and mortality. Pattern of prescriptions in hospitals can be improved through the implementation of an ‘antimicrobial stewardship programme’. A ‘universal’ and ‘continuous’ ‘antimicrobial stewardship programme’ should now be established in Hong Kong hospitals.
 
Key words: Anti-bacterial agents; Cross infection; Drug resistance, microbial; Hong Kong; Prescriptions, drug
 
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Cardiac sarcoidosis: a potentially fatal but treatable form of infiltrative heart disease

ABSTRACT

Hong Kong Med J 2006;12:65-7 | Number 1, February 2006
MEDICAL PRACTICE
Cardiac sarcoidosis: a potentially fatal but treatable form of infiltrative heart disease
EMC Chau, KYY Fan, WH Chow
Department of Cardiology, Grantham Hospital, Wong Chuk Hang, Hong Kong
 
 
Cardiac sarcoidosis is a rare but important differential diagnosis in patients who present with progressive heart failure and arrhythmia. It may be diagnosed on endomyocardial biopsy. An excellent response can be achieved with steroid therapy in the early acute inflammatory stage. Progression of the disease may lead to end-stage heart failure that requires implantation of a permanent pacemaker, implantable cardioverter-defibrillator, or mechanical circulatory support as a bridge to heart transplantation. We present three Hong Kong Chinese patients with cardiac sarcoidosis.
 
Key words: Arrhythmia; Cardiomyopathies; Heart transplantation; Sarcoidosis
 
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