2010 Jan - Respiratory Articles by Local Authors Update

From the HK Respiratory Medicine Website. Dr David CL Lam, Department of Medicine, Queen Mary Hospital. Jan 2010
From September to November 2009, 17 articles with contribution by local colleagues in respiratory medicine were published in indexed medical journals or PubMed Central and were chosen for sharing in this column.
In the last issue of the Newsletter, we have also reported recent publications on influenza from local colleagues; and we have also incorporated such information in this issue.

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2010 Feb - Five-year experience with Chinese cobra (Naja atra)-related injuries in two acute hospitals in Hong Kong

OF Wong, Tommy SK Lam, HT Fung, CH Choy. Hong Kong Med J 2010;16:36-43. Department of Accident and Emergency Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong

OBJECTIVE. To review the clinical features and management of patients with injuries related to the Chinese cobra (Naja atra).

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2010 Feb - HKMJ Letters to the Editor: A cautionary note on the use of intravenous metoclopramide

Anselm CW Lee, Children's Haematology and Cancer Centre, ParkwayHealth, Singapore. Hong Kong Med J 2010;16:75
"A slow intravenous infusion over at least 2 minutes may be associated with fewer side-effects."

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2009 Dec - Management of patients admitted with pneumothorax: a multi-centre study of the practice and outcomes in Hong Kong

Johnny WM Chan, Fanny WS Ko, CK Ng, Alwin WT Yeung, Wilson KS Yee, Loletta KY So, B Lam, Maureen ML Wong, KL Choo, Alice SS Ho, PY Tse, SL Fung, CK Lo, WC Yu; Hong Kong Med J 2009;15:427-33

OBJECTIVE. To examine the management practice of pneumothorax in hospitalised patients in Hong Kong, especially the choice of drainage options and their success rates, as well as the factors associated with procedural failures.

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2009 Dec 8 - Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: a 10-year retrospective review

Natalie YW Leung, Arthur CW Lau, Kenny KC Chan, WW Yan. Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. Hong Kong Med J 2009;15:Epub 2009 Dec 8

Report of this article at Apple Daily here, Yahoo/SingTao News here

OBJECTIVE. To review the characteristics and health-related quality-of-life outcomes of obstetric patients admitted to the Intensive Care Unit.
DESIGN. Retrospective cohort study.
SETTING. A regional hospital in Hong Kong.
PATIENTS. Consecutive obstetric patients admitted to the Intensive Care Unit of Pamela Youde Nethersole Eastern Hospital from January 1998 to December 2007.

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2009 Nov - Epidemiological characteristics of 1st wave of HSI in Hong Kong

Commun Dis Watch. 2009 Oct 25 - Nov 7;6(23):89-90

As of 7 Nov 2009, there were 31,865 laboratory confirmed cases of HSI. The highest attack rate were in children aged 5 years to 9 years (2,389 cases/100,000 population), followed by children aged 0-4 years and 10-14 years.

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2009 Oct - The first novel influenza A (H1N1) fatality despite antiviral treatment and extracorporeal membrane oxygenation in Hong Kong

T Liong, KL Lee, YS Poon, SY Lam, CP Chan, CS Yue, CM Chu, KY Yuen, KI Law. Intensive Care Unit, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong. Hong Kong Med J 2009;15:381-4
We report the first fatality caused by novel influenza A (H1N1) infection despite having the diagnosis confirmed and being given antiviral treatment after hospitalisation. This patient was also the first with influenza A (H1N1) to be supported with extracorporeal membrane oxygenation in Hong Kong. Although extracorporeal membrane oxygenation is an effective means of supporting patients with refractory hypoxaemia on high mechanical ventilatory support, it is labour-intensive and technically demanding. We also discuss the challenges faced when managing this case.

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2009 Sep - Respiratory Articles by Local Authors Update

Dr. David CL LAM; Department of Medicine, Queen Mary Hospital, Hong Kong on 28 Sep 2009
From June to August 2009, 15 articles with contributions by local colleagues have been published in indexed local and international medical journals and have been chosen for sharing in this column. Indeed, we have missed one review article and an original article that were published by Ko FW et al in March and by Chan KH et al in May 2009 respectively but it is still worth putting them up here in retrospect.

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2009 Myocardial rupture associated with bolus injection of contrast medium during computed tomographic study in a patient with acute myocardial infarction: a rare but lethal complication

Vincent Lai, KC Hau, HY Lau, WC Chan. Hong Kong Med J 2009;15:Epub 2009 Jun 5; Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong

Well-documented potential cardiovascular complications associated with the use of contrast media include bradycardia, hypotension, arrhythmia, and conduction disturbances. Rupture of the myocardium after acute myocardial infarction is a known cause of death, but has yet to be recognised as a potential complication of the use of a bolus injection of contrast medium. On the contrary, contrast-enhanced computed tomographic studies have been performed widely for the diagnosis and evaluation of myocardial infarction. We report a case of complicated myocardial rupture after a single bolus injection of contrast medium during a computed tomographic study in an elderly woman with acute myocardial infarction, which led to cardiac tamponade and rapid death. Although rare, this should alert us to the need for cautious use of contrast medium in patients with acute myocardial infarction.

Click Read More to download the article at the HKMJ website.

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2009 Epidemiology and outcome of Candida bloodstream infection in an intensive care unit in Hong Kong

HY Yap, KM Kwok, Charles D Gomersall, SC Fung, TC Lam, PN Leung, Mamie Hui, Gavin M Joynt
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong
Hong Kong Medical Journal (coming in the August issue)


OBJECTIVE. To study the epidemiology of Candida bloodstream infection in the Intensive Care Unit.
DESIGN. Retrospective study.
SETTING. A 22-bed, mixed medical and surgical Intensive Care Unit of a 1400-bed university teaching hospital in Hong Kong.
PATIENTS. All adult patients (>18 years old) who had at least one blood culture positive for Candida.

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2009 Fluid resuscitation in burns: an update [Review]

By JK CHAN , SJ GHOSH

Hong Kong j.emerg.med. 2009;16:51-62 (free access)

Fluid resuscitation has been a mainstay in the treatment of major burns for over 50 years. Fluids must be commenced as soon as possible prior to transfer to a specialist unit in order to minimise burn wound conversion and reduce the incidences of burn shock, post-burn renal failure, life-threatening electrolyte disturbances and mortality. Due to the lack of robust evidence, uncertainty exists regarding the type of fluid, the rate of fluid administration and method of monitoring fluid resuscitation in these patients. The advances in our understanding of burn pathology and technology may have rendered fluid resuscitation formulae, such as the Parkland, obsolete. This review aims to provide an up-to-date summary on the controversies and advances in burns fluid resuscitation to aid the emergency practitioner to make informed decisions.

2009 Should N-acetylcysteine be administered orally or intravenously for the treatment of paracetamol overdose?

Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, Hong Kong, on 30 May 2009
GN CATTERMOLE.
Hong Kong j.emerg.med. 2009;16:106-116  (Free access)

Paracetamol is the most commonly used drug in deliberate poisoning. N-acetylcysteine is the standard antidote for significant acute paracetamol overdose, but the route of administration varies between countries. This review aimed to find and appraise those comparative studies which would help answer the following question: in patients who have taken an overdose of paracetamol requiring antidote, is there any difference between intravenous and oral N-acetylcysteine in mortality, hepatotoxicity, adverse drug reactions or cost?

Methods:A literature search was conducted using Medline and other databases. Relevant papers were identified and appraised.

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2009 Star fruit intoxication successfully treated by charcoal haemoperfusion and intensive haemofiltration

Ching-Kit Chan, Richard Li, HP Shum, Stanley HK Lo, Kenny KC Chan, KS Wong, TH Tsoi, WW Yan
Department of Medicine & Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital (PYNEH), Chai Wan, Hong Kong

Hong Kong Med J 2009;15:149-52

Dr Ching-Kit CHAN is a Specialist in Nephrology. He was trained in the Department of Medicine of PYNEH and had also rotated to work in the Department of Intensive Care of PYNEH. He is now serving in United Christian Hospital, Hong Kong. 
 
star fruit

We report on a case of an elderly woman with chronic renal impairment, secondary to diabetic nephropathy, who developed a deep coma and seizure shortly after consumption of star fruit. She was managed in the intensive care unit,

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2009 Renal replacement therapy in critically ill patients

Anne KH Leung, WW Yan
Department of Anaesthesia and Operation Theatre Service, Queen Elizabeth Hospital, Hong Kong (AKHL)
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong (WWY)
Hong Kong Med J 2009; 15:122- 9

crrt chinese abstract
OBJECTIVE. To provide updated information (including on treatment) in relation to renal replacement therapy in critically ill patients.

DATA SOURCES AND STUDY SELECTION. Literature search of Medline and PubMed till June 2008.

DATA EXTRACTION. Original studies, literature review, and book chapters.

DATA SYNTHESIS. The prevalence of acute renal failure in critically ill patients remains high and mortality is up to 60%. Both the practice of renal replacement therapy (continuous against intermittent, haemofiltration against haemodialysis) and patient outcomes vary widely between studies. To better understand this heterogeneous group of patients, a unified classification of acute renal failure proposed by the Acute Dialysis Quality Initiative allows better understanding of the epidemiology and outcome of this disease. Similar to patients with chronic renal failure, there exists a direct relationship between the dose of dialysis and survival; 35 mL/kg/h is the accepted norm. However, this traditional practice is being challenged by recent trials. Although the use of citrate as anticoagulant in renal replacement therapy can prolong circuit patency and decrease bleeding risk, its use is limited by the complex set up and metabolic problems.

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2009 The Incidence of Deep Venous Thrombosis in Chinese Medical Intensive Care Unit Patients

Gavin M Joynt, Thomas ST Li, James F Griffith, Charles D Gomersall, Florence HY Yap, Anthony MH Ho, Patricia Leung
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

dvt chinese

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2007 Endovascular coiling versus neurosurgical clipping for ruptured intracranial aneurysms: significant benefits in clinical outcome and reduced consumption of hospital resources in Hong Kong Chinese patients

Hong Kong Med J. 2007 Aug;13(4):271-8. Epub 2007 Jun 4.

Yu SC, Wong GK, Wong JK, Poon WS.

Department of Diagnostic Radiology and Organ Imaging, The Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. This email address is being protected from spambots. You need JavaScript enabled to view it.

OBJECTIVES. Using specific selection criteria to determine whether endovascular
coiling as compared to neurosurgical clipping is associated with significant
benefits, in terms of 1-year clinical outcomes and consumption of hospital
resources, for the treatment of ruptured intracranial aneurysms in Hong Kong
Chinese patients. DESIGN. Retrospective study. SETTING. University teaching
hospital, Hong Kong. PATIENTS. Records of outcomes of 169 consecutive Chinese
patients, who were treated with endovascular coiling (n=80) or surgical clipping
(n=89), were reviewed. All patients were followed up clinically for a mean of 55
(standard deviation, 201) months and radiologically with sequential digital
subtraction angiography at 6 and 18 months after treatment. RESULTS. The mean
ages of patients were 56 (standard deviation, 13) years for the coiling group,
and 57 (standard deviation, 13) years for the clipping group (P=0.575). The
median aneurysm size was 4 mm in both groups (P=0.898). The severity of
subarachnoid haemorrhage in the two groups did not differ (P=0.619). The rate of
death or permanent disability leading to dependency (Glasgow Outcome Scale, 1-3)
at 1 year was significantly lower in the coiling group (12/80, 15%) as compared
to the clipping group (30/89, 34%) [P=0.005], resulting in a risk reduction of
19% (95% confidence interval, 6-32%). There were significantly more frequent
admissions into the intensive care unit in the clipping group (P<0.001); the
median duration of intensive care unit stay was 2 days (vs 0 days in the coiling
group). The incidence of subsequent treatment procedures for residual or
recurrent aneurysm was more common in the coiling group (13/80 vs 3/89; P=0.004).
CONCLUSION. Endovascular coiling as compared to neurosurgical clipping for
treatment of patients with ruptured intracranial aneurysms is associated with
significant benefits in terms of a reduced need for intensive care unit
admissions and better general clinical outcomes in Hong Kong Chinese patients.