OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease.

DESIGN. Prognostic study on a historical cohort.

SETTING. A regional hospital in Hong Kong.

PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital.

MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities.

RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors.

CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication.

Key words: Duodenal ulcer; Emergencies; Gastrectomy; Mortality; Stomach ulcer

View this abstract indexed in MEDLINE:

OBJECTIVES. To review the 10-year trend of reperfusion strategies in patients with ST-segment elevation myocardial infarction, and the adoption rate of percutaneous coronary interventions as opposed to thrombolytic therapy. Also to explore why some patients did not receive reperfusion therapy, and document changes in reperfusion strategies after the introduction of primary percutaneous coronary intervention programmes.

DESIGN. Case series.

SETTING. A regional hospital, Hong Kong.

PATIENTS. All patients with ST-segment elevation myocardial infarction from January 2000 to December 2009.

RESULTS. There were 1835 patients with ST-segment elevation myocardial infarction in that period, of which 1179 (64.3%) received reperfusion therapy (thrombolytic therapy, 46.0%; primary percutaneous coronary intervention, 17.5%; emergency coronary artery bypass graft, 0.7%). After introduction of the primary percutaneous coronary intervention programme, significantly more ST-segment elevation myocardial infarction cases underwent that particular intervention (1.6% in 2000 increasing to 30.6% in 2009), while the proportion receiving thrombolytic therapy declined (57.4% in 2000 decreasing to 35.0% in 2009). Seven reasons for no reperfusion therapy were identified. The commonest ones were delayed presentation (45.1%), succumbed before reperfusion (16.0%), multiple medical co-morbidities (15.2%), and contra-indication to thrombolytic therapy (14.8%). The proportion without reperfusion therapy due to a contra-indication to thrombolytic therapy declined (22.7% in 2000 decreasing to 4.9% to 2009), whilst an increasing proportion received primary percutaneous coronary interventions.

CONCLUSIONS. Primary percutaneous coronary intervention is increasingly used as the reperfusion therapy in ST-segment elevation myocardial infarction and is replacing thrombolytic therapy, though the latter still remains a mainstay of therapy. A significant proportion of ST-segment elevation myocardial infarction cases received no reperfusion due to various reasons.

Key words: Angioplasty, balloon, coronary; Myocardial infarction; Myocardial reperfusion; Thrombolytic therapy

View this abstract indexed in MEDLINE:

OBJECTIVES. To investigate the frequency of pseudoprogression of glioblastoma in Chinese patients receiving concomitant chemoradiotherapy and investigate its association with pseudoprogression and tumour molecular marker O6-methylguanine-DNA methyltransferase promoter methylation status.

DESIGN. Case series with internal comparisons.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Patients with glioblastoma treated with concomitant chemoradiotherapy during April 2005 to June 2010 were reviewed. Magnetic resonance imaging brain scans, pre- and post-concomitant chemoradiotherapy and 3-monthly thereafter were reviewed by an independent neuroradiologist according to Macdonald's criteria. Relevant patient information (clinical condition, performance score, development of new neurological deficits, use of steroids, and survival) was retrieved. For each patient, O⁶-methylguanine-DNA methyltransferase methylation status was investigated with genomic DNA from formalin-fixed or paraffin-embedded sections of tumour tissues by methylation-specific polymerase chain reaction.

RESULTS. During the study period, 28 primary glioblastoma patients underwent concomitant chemoradiotherapy. The mean age of the patients was 48 (range, 16-71) years. Thirteen patients (13/28, 46%) developed early radiological progression of the tumour after completion of concomitant chemoradiotherapy, of whom five (39%) were subsequently found to have had pseudoprogression. Patients with pseudoprogression showed a trend towards longer survival (22 months in pseudoprogression vs 17 months in all others vs 11 months in those with genuine progression). Among the 27 patients tested for O⁶-methylguanine-DNA methyltransferase promoter status, 12 (44%) were methylated. Two (2/12, 17%) in the methylated group had pseudoprogression, while three (3/15, 20%) in the unmethylated group had pseudoprogression.

CONCLUSIONS. Nearly half of all patients (46%) developed early radiological progression (within 3 months of completing concomitant chemoradiotherapy). Moreover, about one in three of such patients had pseudoprogression. Pseudoprogression is an important clinical condition to be aware of to prevent premature termination of an effective treatment.

Key words: Antineoplastic agents, alkylating; Biological markers; Brain neoplasms; Glioblastoma; O(6)-Methylguanine-DNA methyltransferase

View this abstract indexed in MEDLINE:

OBJECTIVE. To compare the outcome of cryothermal and radiofrequency energy transcatheter ablation of atrioventricular junctional re-entrant tachycardia in children and adolescents.

DESIGN. Case series with internal comparison.

SETTING. Two hospitals in Hong Kong.

PATIENTS. Consecutive transcatheter ablation procedures for atrioventricular junctional re-entrant tachycardia in children and adolescents in our unit from August 2000 to September 2008 were retrospectively reviewed. Radiofrequency ablation was performed from August 2000 to June 2005, and cryoablation from July 2005 to September 2008.

MAIN OUTCOME MEASURES. Demographic data, outcome and procedural details.

RESULTS. Thirty-eight procedures were reviewed. The radiofrequency ablation group (n=20) and cryoablation group (n=18) had similar demographic characteristics, except that there were more patients with congenital heart disease in the latter group (P=0.03). Acute procedural success rate was 100% in both groups. One patient from the radiofrequency ablation group had recurrence of atrioventricular junctional re-entrant tachycardia. The frequency of post-ablation persistent heart block was higher in the radiofrequency ablation than cryoablation group (10% vs 0%, P=0.17), but this difference was not statistically significant. A shorter fluoroscopy time was noted in the cryoablation group (31 ± 13 vs 38 ± 18 minutes; P=0.03).

CONCLUSIONS. Transcatheter cryoablation for atrioventricular junctional re-entrant tachycardia in children and adolescents is as effective as radiofrequency ablation over the medium term. It has an excellent safety profile in terms of avoiding heart block.

Key words: Catheter ablation, radiofrequency; Cryosurgery; Tachycardia, atrioventricular nodal reentry

View this abstract indexed in MEDLINE:

OBJECTIVES. To estimate the point prevalence of primary hyperaldosteronism in a government out-patient setting and to compare associated patient characteristics with those having essential hypertension.

DESIGN. Case series with external comparison.

SETTING. A single public hospital (Caritas Medical Centre) and all five associated general out-patient clinics in Sham Shui Po district in Hong Kong.

PATIENTS. All patients with confirmed primary hyperaldosteronism and randomly selected patients with essential hypertension from a medical specialist clinic and general out-patient clinics, retrieved from a computer database for the period January 2007 to December 2008.

MAIN OUTCOME MEASURES. Estimated point prevalence of primary hyperaldosteronism among hypertensive patients treated in the public sector of Sham Shui Po district. Patient age when hypertension was diagnosed, number of antihypertensive drugs used for treatment, and the presence of target organ damage in the patients with primary hyperaldosteronism and those with essential hypertension were compared.

RESULTS. Among the 46 012 patients receiving antihypertensive treatment, 49 were confirmed to have primary hyperaldosteronism. The estimated point prevalence of primary hyperaldosteronism among these hypertensive patients was 0.106% only, which was far smaller than figures from other countries. When compared with the 147 patients with essential hypertension by multivariate analysis, those with primary hyperaldosteronism were: (1) associated with longer durations of hypertension (odds ratio=1.14; 95% confidence interval, 1.06-1.24) despite being younger at the time of study, (2) likely to be taking three or more antihypertensive drugs (odds ratio=2.51; 95% confidence interval, 1.59-3.95), and (3) more likely to have left ventricular hypertrophy (odds ratio=5.01; 95% confidence interval, 1.83-13.69). All primary hyperaldosteronism patients studied presented with hypokalaemia. The need for antihypertensive drugs was markedly reduced after adrenalectomy for adrenal adenoma.

CONCLUSIONS. Primary hyperaldosteronism, which is potentially a surgically curable cause of hypertension, appeared to be underdiagnosed in our locality. Screening by aldosterone-renin ratio of high-risk individuals may help improve patient outcomes.

Key words: Adrenal cortex neoplasms; Aldosterone; Hyperaldosteronism; Hypertension; Prevalence

View this abstract indexed in MEDLINE: