Is benign paroxysmal positional vertigo underdiagnosed in hospitalised patients?

ABSTRACT
Hong Kong Med J 2008;14:198-202 | Number 3, June 2008
ORIGINAL ARTICLE
Is benign paroxysmal positional vertigo underdiagnosed in hospitalised patients?
TP Chan
TWGHs Wong Tai Sin Hospital, 124 Shatin Pass Road, Kowloon, Hong Kong
 
 
OBJECTIVES. To investigate the proportion of sufferers of benign paroxysmal positional vertigo among hospitalised patients in Hong Kong who complained of dizziness, and to determine the predictive values and likelihood ratios of classical presenting symptoms.
 
DESIGN. Cross-sectional study.
 
SETTING. Convalescence/rehabilitation hospital, Hong Kong.
 
PATIENTS. A cohort of 88 newly admitted patients, who complained of dizziness or complained of having had dizziness in the 2 weeks prior to admission from September 2005 to February 2006.
 
MAIN OUTCOME MEASURES. Presence of the pathognomonic nystagmus of benign paroxysmal positional vertigo.
 
RESULTS. Five patients had benign paroxysmal positional vertigo, all with the posterior type. The frequency of its occurrence among patients complaining of dizziness was 6% (95% confidence interval, 1-11%), which was more than double the figure of 3% in our local convalescence/rehabilitation hospitals, though this difference was not statistically significant. Regarding the five identified patients, in two it involved the left ear, in two others the right ear, and in one it was bilateral. All four classical presenting symptoms had low positive predictive values, high negative predictive values, and small likelihood ratios.
 
CONCLUSION. Benign paroxysmal positional vertigo in the setting of a convalescence/rehabilitation hospital in Hong Kong seems to be underdiagnosed. Small and insignificant likelihood ratios for the classical presenting symptoms preclude their use in making the diagnosis. However, absence of these symptoms in a clinical setting of low occurrence rate can be regarded as against the diagnosis.
 
Key words: Prevalence; Sensitivity and specificity; Vertigo
 
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Laparoscopic radical prostatectomy: single centre experience after 5 years

ABSTRACT
Hong Kong Med J 2008;14:192-7 | Number 3, June 2008
ORIGINAL ARTICLE
Laparoscopic radical prostatectomy: single centre experience after 5 years
Steven WH Chan, KM Lam, SC Kwok, C Yu, WH Au, YP Yung, Ida SF Mah, Peggy SK Chu, CW Man
Division of Urology, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong
 
 
OBJECTIVE. To summarise our experience of laparoscopic radical prostatectomy in a single centre in Hong Kong over 5 years.
 
DESIGN. Retrospective study.
 
SETTING. Urology Division, Department of Surgery, Tuen Mun Hospital, Hong Kong.
 
PATIENTS. A total of 87 patients who underwent laparoscopic radical prostatectomy from March 2002 to May 2007.
 
MAIN OUTCOME MEASURES. Peri-operative data and follow-up information.
 
RESULTS. The operative procedure used entailed Montsouris technique and its modifications, including the latest method involving the extraperitoneal descending technique. In all, 87 patients underwent the operation; in two, the procedure was converted to open surgery. Peri-operative parameters which showed improvement included: operating time, blood loss, resort to blood transfusions, and the complication rate. There was no operation-related mortality. In organ-confined disease, a clear surgical margin was achieved in 93% of the patients, but in those whose disease was not organ-confined, the positive margin rate was 87%. Among patients with organ-confined disease, 13% had evidence of biochemical recurrence. Hormonal therapy was started in five patients, none of whom died during the follow-up period (mean, 24 months). Continence recovered in 69% of the patients by 6 months and in 92% by 12 months post-surgery. Assessment of erectile function before and after the surgery was problematic and estimated to be 20% among patients having the nerve-sparing procedure performed.
 
CONCLUSION. Although Hong Kong has a relatively low incidence for prostate cancer, it was possible to develop laparoscopic radical prostatectomy with acceptable early results. Further follow-up is warranted before formulating definitive conclusions about this procedure.
 
Key words: Laparoscopy; Postoperative complications; Prostatectomy; Prostatic neoplasms; Treatment outcome
 
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A cluster of chilblains in Hong Kong

ABSTRACT
Hong Kong Med J 2008;14:185-91 | Number 3, June 2008
ORIGINAL ARTICLE
A cluster of chilblains in Hong Kong
Y Chan, William YM Tang, WY Lam, Steven KF Loo, Samantha PS Li, Angelina WM Au, WY Leung, CK Kwan, KK Lo
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
 
 
OBJECTIVE. To report a recent clustering of chilblain cases in Hong Kong.
 
DESIGN. Case series.
 
SETTING. A regional hospital and a social hygiene clinic in the New Territories West, Hong Kong.
 
PATIENTS. Patients with a clinical diagnosis of chilblains in February 2008.
 
RESULTS. Eleven patients with chilblains were identified; seven (64%) gave an antecedent history of prolonged exposure to cold. They all presented with erythematous or dusky erythematous skin lesions affecting the distal extremities, especially fingers and toes. Laboratory tests revealed elevated antinuclear antibodies titres in two, positive rheumatoid factor in two, presence of cold agglutinins in one, and a raised anti-DNA titre (>300 IU/mL) in one. Skin biopsies were performed in six patients, four of them showed typical histopathological features of chilblains. In the patient with systemic lupus erythematosus, features of vasculitis were suspected, and in the one with pre-existing juvenile rheumatoid arthritis, there were features of livedo vasculitis. In 10 (91%) of the patients, the skin lesions had resolved when they were last assessed (at the end of March 2008), but had persisted in the patient who had pre-existing systemic lupus erythematosus.
 
CONCLUSION. The recent clustering of chilblains was possibly related temporally to the prolonged cold weather at the end of January to mid-February. In our series, most of the patients developed chilblains as an isolated condition and resolved spontaneously within a few weeks. Laboratory tests and skin biopsies for chilblains are not necessary, unless the condition persists, the diagnosis in doubt or an underlying systemic disease is suspected.
 
Key words: Chilblains; Cold/adverse effects; Fingers; Hypothermia; Toes
 
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Pleuroscopy: our initial experience in Hong Kong

ABSTRACT
Hong Kong Med J 2008;14:178-84 | Number 3, June 2008
ORIGINAL ARTICLE
Pleuroscopy: our initial experience in Hong Kong
WL Law, Johnny WM Chan, Samuel Lee, CK Ng, CK Lo, WK Ng, KK Ho, Thomas YW Mok
Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
 
 
OBJECTIVE. To report our preliminary experience using pleuroscopy for patients with pleural diseases.
 
DESIGN. Prospective cohort study.
 
SETTING. Tertiary referral hospital with service input from respiratory physicians and cardiothoracic surgeons in Hong Kong.
 
PATIENTS. Between April and November 2007, patients with undiagnosed exudative pleural effusions and proven malignant pleural effusions were recruited for diagnostic evaluations and therapeutic interventions, respectively.
 
INTERVENTION. Pleuroscopy with a semi-rigid thoracoscope performed under local anaesthesia and conscious sedation.
 
RESULTS. A total of 20 patients (16 males and 4 females; mean age, 63 years) underwent the procedure and were followed up for a mean of 19 weeks. For the 14 patients having diagnostic pleuroscopy, the yield was 79% (11 patients). The 3-month success rate for the six patients undergoing pleurodesis was 83% (five patients). Complications were mild and included self-limiting fever (20%, four patients) and localised subcutaneous emphysema (20%, four patients). No major complications or mortality were noted.
 
CONCLUSION. Pleuroscopy using a semi-rigid instrument is a safe and efficacious procedure for the management of pleural diseases in suitable patients.
 
Key words: Pleural diseases; Pleural effusion; Safety; Thoracoscopy
 
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Review of dengue fever cases in Hong Kong during 1998 to 2005

ABSTRACT
Hong Kong Med J 2008;14:170-7 | Number 3, June 2008
ORIGINAL ARTICLE
Review of dengue fever cases in Hong Kong during 1998 to 2005
Vivien WM Chuang, TY Wong, YH Leung, Edmond SK Ma, YL Law, Owen TY Tsang, KM Chan, Iris HL Tsang, TL Que, Raymond WH Yung, SH Liu
Infection Control Branch, Centre for Health Protection/Infectious Disease Control Training Centre, Hospital Authority, Hong Kong
 
 
OBJECTIVE. To describe the epidemiology, clinical and laboratory findings, and outcomes of patients presenting locally with dengue.
 
DESIGN. Retrospective review of case records.
 
SETTING. Public hospitals, Hong Kong.
 
PATIENTS. Medical records of all laboratory-confirmed dengue patients admitted to public hospitals during 1998 to 2005 were reviewed retrospectively.
 
RESULTS. A total of 126 cases were identified, 123 (98%) being dengue fever and three (2%) dengue haemorrhagic fever. One patient who had blood transfusion-acquired dengue fever was highlighted. A total of 116 (92%) cases were 'imported', while 10 (8%) were local. Among the 56 dengue cases confirmed by reverse transcription-polymerase chain reaction, dengue virus type 1 was the most common accounting for 48% of them, followed by type 2, type 3, and type 4 responsible for 23%, 16%, and 13%, respectively. Only type 1 and type 2 were present in locally acquired infections. The median age of the patients was 38 years and the mean duration of hospitalisation was 6 days. There was no mortality, and nearly all patients (98%) presented with fever. Other symptoms at presentation included: myalgia (83%), headache (65%), fatigue (59%), and skin rash (60%). More than one third of patients had gastro-intestinal and upper respiratory complaints. Maculopapular skin rash was the most common physical finding. Thrombocytopenia, neutropenia, and lymphopenia were present in 86%, 78%, and 69% of the patients, respectively. In only 29% of the patients was dengue fever included in the initial differential diagnosis. The demographic, clinical, and laboratory findings as well as outcomes did not differ significantly among the four dengue serotypes, but the lowest lymphocyte counts of type 3 was lower than the other serotypes (P=0.004).
 
CONCLUSION. When physicians encounter patients with a relevant travel history, presenting with fever and skin rash, and having compatible haematological findings, dengue fever should be included in the differential diagnosis.
 
Key words: Dengue; Dengue hemorrhagic fever; Serotyping
 
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Gadolinium-enhanced magnetic resonance angiography in renal artery stenosis: comparison with digital subtraction angiography

ABSTRACT
Hong Kong Med J 2008;14:136-41 | Number 2, April 2008
ORIGINAL ARTICLE
Gadolinium-enhanced magnetic resonance angiography in renal artery stenosis: comparison with digital subtraction angiography
YM Law, KH Tay, YU Gan, FK Cheah, BS Tan
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608
 
 
OBJECTIVES. To evaluate the accuracy of gadolinium-enhanced magnetic resonance angiography in assessing renal artery stenosis compared to catheter digital subtraction angiography.
 
DESIGN. Retrospective study.
 
SETTING. Singapore General Hospital.
 
PATIENTS. Records of patients who underwent magnetic resonance angiography as well as digital subtraction angiography for assessment of renal artery stenosis from January 2003 to December 2005 were reviewed.
 
RESULTS. There were 27 patients (14 male, 13 female) with a mean age of 62 (range, 44-77) years. There were 10 patients with renal transplants; their native renal arteries were not evaluated. Each of the two experienced interventional and body magnetic resonance radiologists, who were blinded to the results, reviewed the digital subtraction angiography and magnetic resonance angiography images respectively. Digital subtraction angiography was used as the standard of reference. A total of 39 renal arteries from these 27 patients were evaluated. One of the arteries was previously stented and could not be assessed with magnetic resonance angiography due to severe artefacts. Of the remaining 38 renal arteries, two were graded as normal, seven as having mild stenosis (<50%), eight as having moderate stenosis (>=50% but <75%), and 21 as having severe stenosis (>=75%). Magnetic resonance angiography and digital subtraction angiography were concordant in 89% of the arteries; magnetic resonance angiography overestimated the degree of stenosis in 8% and underestimated it in 3% of them. In the evaluation of clinically significant renal artery stenosis (>=50%) with magnetic resonance angiography, the overall sensitivity, specificity, positive predictive value, and negative predictive value were 97%, 67%, 90%, and 86% respectively. The sensitivity and specificity of magnetic resonance angiography in transplant renal artery stenosis was 100%.
 
CONCLUSION. Our experience suggested that gadolinium-enhanced magnetic resonance angiography is a sensitive non-invasive modality useful in the assessment of clinically significant renal artery stenosis.
 
Key words: Angiography, digital subtraction; Gadolinium; Magnetic resonance angiography; Renal artery obstruction; Sensitivity and specificity
 
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HER2 overexpression of breast cancers in Hong Kong: prevalence and concordance between immunohistochemistry and in-situ hybridisation assays

ABSTRACT
Hong Kong Med J 2008;14:130-5 | Number 2, April 2008
ORIGINAL ARTICLE
HER2 overexpression of breast cancers in Hong Kong: prevalence and concordance between immunohistochemistry and in-situ hybridisation assays
TK Yau, H Sze, IS Soong, F Hioe, US Khoo, AWM Lee
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVES. To evaluate the prevalence of human epidermal growth factor receptor 2 (HER2) gene overexpression in breast cancer patients encountered in Hong Kong and the concordance of HER2 findings from primary immunohistochemistry assays and confirmatory in-situ hybridisation assays.
 
DESIGN. Retrospective study.
 
SETTING. Department of Clinical Oncology in a public hospital in Hong Kong.
 
PATIENTS. All patient referrals between July 2006 and June 2007 with newly diagnosed invasive breast cancer (for prevalence evaluation), and all patients treated at our unit with confirmatory in-situ hybridisation tests performed within the study period (for concordance evaluation).
 
MAIN OUTCOME MEASURES. Prevalence of Mycoplasma genitalium and Ureaplasma urealyticum among symptomatic male patients with non-gonococcal urethritis and asymptomatic patients without non-gonococcal urethritis.
 
RESULTS. There were 272 consecutive breast cancer patients eligible for prevalence evaluation. The distribution for immunohistochemistry staining in 249 cases for scores 0, 1+, 2+, and 3+ were 99 (40%), 40 (16%), 58 (23%), and 52 (21%) respectively. In the remaining 23 patients, four and 19 breast cancers were unscored and reported by immunohistochemistry to be HER2-positive and -negative, respectively. The overall HER2 overexpression rate (3+ or reported as positive) was 21%. HER2 overexpression was associated with grade 3 histology (P<0.001) and negative hormonal receptor status (P<0.001). However, it was not associated with age (P=0.525), T-classification (P=0.740), N-classification (P=0.691), nor group stages (P=0.433). Of the 37 patients with confirmatory in-situ hybridisation tests performed, 10 (71%) of 14 with immunohistochemistry staining of 3+ and 1 (4%) of 23 with immunohistochemistry staining of 2+ were found to have HER2 gene amplification.
 
CONCLUSIONS. More than 25% of HER2 overexpression identified by immunohistochemistry assays in this Hong Kong cohort could not be verified by confirmatory in-situ hybridisation assays. Compliance with the latest guidelines for HER2 testing should improve the future accuracy and concordance.
 
Key words: Breast neoplasms; Gene amplification; Immunohistochemistry; In situ hybridization, fluorescence; Receptor, epidermal growth factor
 
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Role of Mycoplasma genitalium and Ureaplasma urealyticum in non-gonococcal urethritis in Hong Kong

ABSTRACT
Hong Kong Med J 2008;14:125-9 | Number 2, April 2008
ORIGINAL ARTICLE
Role of Mycoplasma genitalium and Ureaplasma urealyticum in non-gonococcal urethritis in Hong Kong
John THT Yu, William YM Tang, KH Lau, LY Chong, KK Lo, Carlos KH Wong, MY Wong
Yau Ma Tei Dermatology Centre, Social Hygiene Service, Hong Kong
 
 
OBJECTIVE. To determine the association of Mycoplasma genitalium and Ureaplasma urealyticum in symptomatic male patients presenting with non-gonococcal urethritis in a sexually transmitted infection clinic in Hong Kong.
 
DESIGN. Cross-sectional study.
 
SETTING. A sexually transmitted infection clinic, Department of Health, Centre for Health Protection, Hong Kong.
 
PATIENTS. A cohort of consecutive new male patients attending the government sexually transmitted infection clinic.
 
MAIN OUTCOME MEASURES. Prevalence of Mycoplasma genitalium and Ureaplasma urealyticum among symptomatic male patients with non-gonococcal urethritis and asymptomatic patients without non-gonococcal urethritis.
 
RESULTS. Specimens of 22 and 10 patients tested positive by polymerase chain reaction for Ureaplasma urealyticum and Mycoplasma genitalium respectively, among the symptomatic non-gonococcal urethritis group (n=98). In the asymptomatic control group (n=236), corresponding patient numbers whose specimens tested positive were 47 and 5. There was no statistically significant difference between the two groups, in terms of the proportion of patients infected with Mycoplasma genitalium (P=0.799) or Ureaplasma urealyticum (P=0.535).
 
CONCLUSIONS. In our study, demonstration of Mycoplasma genitalium and Ureaplasma urealyticum by polymerase chain reaction was not associated with symptomatic non-gonococcal urethritis in male patients attending a Hong Kong government clinic for sexually transmitted infections.
 
Key words: Mycoplasma infections; Polymerase chain reaction; Sexually transmitted diseases; Ureaplasma infections; Urethritis
 
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Treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children

ABSTRACT
Hong Kong Med J 2008;14:116-23 | Number 2, April 2008
ORIGINAL ARTICLE
Treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children
XJ Yuan, Godfrey CF Chan, SK Chan, Tony WH Shek, Dora LW Kwong, William I Wei, SY Ha, Alan KS Chiang
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
OBJECTIVES. To review the treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children.
 
DESIGN. Retrospective review.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. Consecutive cases of rhabdomyosarcoma diagnosed and treated by the Department of Paediatrics and Adolescent Medicine of Queen Mary Hospital between 1989 and 2005. Each patient was staged and treated according to the Intergroup Rhabdomyosarcoma Study guidelines.
 
MAIN OUTCOME MEASURES. Overall and event-free survival rates, and toxicity data.
 
RESULTS. Of 19 patients (8 males and 11 females), 14 (74%) were younger than 10 years old. The median age at diagnosis was 6 (range, 0.5-17) years. Primary sites of rhabdomyosarcoma included: the head and neck (n=8; 6 classified as cranial parameningeal), genitourinary (3), extremity (3), pelvis (3), and trunk (2). Thirteen (68%) had embryonal and six (32%) had alveolar histology. Two, 2, 9, and 6 were classified as belonging to Intergroup Rhabdomyosarcoma Study groups 1, 2, 3, and 4, respectively. Respective 5-year overall and event-free survival rates of the entire cohort were 49% (95% confidence interval, 26-73%) and 32% (10-55%), with a median follow-up of 3.4 (range, 0.2-16.7) years. In non-metastatic cases (Intergroup Rhabdomyosarcoma Study groups 1-3), the 5-year overall survival rate was 66% (95% confidence interval, 39-93%) and in metastatic cases (group 4) it was 17% (0-46%). The 5-year overall survival rate for patients aged less than 10 years was 60% (95% confidence interval, 33-87%) compared to 20% (0-55%) in those aged 10 years and over. Significant treatment-related toxicities including myelosuppression, infections, peripheral neuropathy, and second cancers were encountered.
 
CONCLUSIONS. Treatment outcome of rhabdomyosarcoma in this cohort of Chinese children was less favourable than that reported in international studies. Whilst the main reason could have been related to the high proportion of metastatic cases, also non-metastatic cases faired worse. Improved outcomes may be achieved by advances in multidisciplinary (paediatric oncology, pathology, radiotherapy, and surgery) management and supportive care.
 
Key words: Adolescent; Child; Rhabdomyosarcoma; Treatment outcome
 
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Personal use and professional recommendations of complementary and alternative medicine by Hong Kong registered nurses

ABSTRACT
Hong Kong Med J 2008;14:110-5 | Number 2, April 2008
ORIGINAL ARTICLE
Personal use and professional recommendations of complementary and alternative medicine by Hong Kong registered nurses
Charlie CL Xue, Anthony L Zhang, Eleanor Holroyd, Lorna KP Suen
Division of Chinese Medicine, School of Health Sciences, The WHO Collaborating Centre for Traditional Medicine, RMIT University, Melbourne, Australia
 
 
OBJECTIVE. To provide an understanding of Hong Kong registered nurses' personal and professional use of complementary and alternative medicine.
 
DESIGN. Cross-sectional questionnaire study.
 
PARTICIPANTS. Registered nurses who were members of the Hong Kong College of Nursing were invited to participate.
 
MAIN OUTCOME MEASURES. Demographic data of the respondents, prevalence of personal and professional use of complementary and alternative medicines, including their use for detailed clinical conditions.
 
RESULTS. A total of 187 nurses participated in this study. Nearly four fifths (80%; 95% confidence interval, 74-86%) of the participants had used at least one form of complementary/alternative medicine. In addition to the personal use of such treatment, over two fifths (41%; 95% confidence interval, 34-48%) had recommended at least one form of complementary/alternative medicine to their patients. These included bone-setting (20%), Chinese remedial massage (tuina, 19%), and meditation (19%). Specifically, registered nurses recommended acupuncture or acupressure to patients with musculoskeletal disorders, chronic pain, or headaches/migraines.
 
CONCLUSIONS. Personal use and professional recommendations for complementary and alternative medicine by registered nurses in Hong Kong is substantial. Registered nurses played an active role in advising such treatment for their patients based on their personal knowledge of perceived benefit in specific conditions. Further investigations with a larger sample size should focus on registered nurses??educational needs in respect of complementary and alternative medicine and the advice they recommended.
 
Key words: Complementary therapies; Health personnel; Medicine, Chinese traditional; Nurses; Utilization review
 
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