OBJECTIVES. To describe the clinical presentation, management, and outcomes of patients with Penicillium marneffei infections in a regional hospital in Hong Kong.

DESIGN. Retrospective study.

SETTING. A regional and tertiary human immunodeficiency virus–referral hospital in Hong Kong.

PATIENTS. Those who had penicilliosis during the inclusive period January 1994 to February 2004.

RESULTS. Forty-seven immunocompromised patients (44 being human immunodeficiency virus–positive) with penicilliosis were retrospectively studied. Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). Five (11%) died, death being attributable to penicilliosis; four (9%) of them had received no specific antifungal treatment due to late presentation and late diagnosis. The CD4 count of human immunodeficiency virus–infected patients upon diagnosis of penicilliosis was low (median, 20.0 cells/mm³). Most (70%) patients received amphotericin B as an induction treatment, followed by oral itraconazole, although a smaller proportion (21%) received oral itraconazole only. All surviving human immunodeficiency virus–infected patients took highly active antiretroviral treatment and oral itraconazole as secondary prophylaxis after treatment of penicilliosis. The prognosis appeared satisfactory with early diagnosis and administration of appropriate antifungal therapy. Relapse ensued in two (4%) of the patients only.

CONCLUSION. Penicillium marneffei infection in immunocompromised patients is a serious disease with significant mortality if not diagnosed early and treated with appropriate antifungal drugs. Simple investigations like blood culture enable the diagnosis in the majority of cases. Immunocompromised patients who have been successfully treated should receive oral itraconazole as a maintenance therapy to prevent relapse.

Key words: AIDS-related opportunistic infections; HIV infections; Immunocompromised host; Itraconazole; Penicillium

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OBJECTIVES. To evaluate the feasibility of whole body imaging using a 3 Tesla magnetic resonance scanner without a contrast agent, and to study the prevalence of abnormal findings among a cohort of asymptomatic doctors.

DESIGN. Prospective study.

SETTING. Private hospital, Hong Kong.

PARTICIPANTS. A total of 132 asymptomatic medical doctors (111 men, 21 women), with a mean age of 56 (range, 38-82) years, volunteered for the study. They underwent corresponding whole body imaging at our hospital between October 2005 and February 2006. Imaging involved a 3 Tesla magnetic resonance scanner with 32 channels, parallel imaging, Total Imaging Matrix technology, a maximum gradient amplitude of 40 mT/m and a slew rate of 200 mT/m/ms (Magnetom Tim Trio, Siemens Medical Solution, Erlangen, Germany). The use of matrix coils enabled coverage of the whole body. No contrast agent was used.

MAIN OUTCOME MEASURES. Detection of abnormalities in asymptomatic, apparently healthy adults.

RESULTS. All examinations were completed successfully. The mean scan time per subject was 33 (standard deviation, 4) minutes. All subjects tolerated the examination well and overall imaging quality was satisfactory. A total of 124 (94%) subjects had positive findings, of whom 24 (18%) had further workup. Five (4%) subjects were found to have tumours, of which two (1.5%) were proven malignant. Our cancer detection rate was comparable to that of other reported whole body screening studies using contrast magnetic resonance imaging and positron emission tomography.

CONCLUSION. We demonstrated the feasibility of performing whole body imaging in 30 minutes, using 32-channel magnetic resonance imaging at 3 Tesla without a contrast agent or any ionising radiation.

Key words: Image interpretation, computed-assisted; Magnetic resonance imaging; Whole body imaging

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OBJECTIVES. To determine the infection rate and identify the risk factors of primary total knee replacement in a general hospital and discuss possible preventive measure.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All cases of primary total knee replacement performed between the period July 1997 and June 2006 were reviewed.

MAIN OUTCOME MEASURES. Infection rate of primary total knee replacement and its relationship to risk factors.

RESULTS. In the defined period, 479 total knee replacements were performed in 353 patients (291 female and 62 male); 105 women and 21 men had bilateral replacements. The mean patient age was 69 (range, 40-88) years. In all, 447 knees had osteoarthritis, and 32 had rheumatoid arthritis. The mean follow-up period was 46 (range, 1-107) months; 345 knees were followed up longer than 24 months, but seven had no postoperative follow-up. Wound infection was defined by clinical, bacteriological, and/or histological examination. Primary total knee replacement was invariably performed in a theatre with vertical laminar flow, under prophylactic antibiotic cover, and body exhaust suits, water impermeable gowns, and double gloves were always used. The overall infection rate was 3.0% (14/472); the acute deep infection rate (within 4 weeks) was 0.2% (1/472), the delayed deep infection rate (4 weeks-2 years) was 0.6% (2/345). The superficial infection rate was 1.9% (9/472) and the late deep infection rate (after 2 years) was 0.6% (2/345). Diabetic patients had a threefold higher risk of infection than non-diabetic patients, though this difference did not attain statistical significance (P=0.077).

CONCLUSIONS. Our infection rates for primary total knee replacement were comparable to those encountered internationally.

Key words: Arthroplasty, replacement, knee; Infection

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OBJECTIVE. To further study the clinical value of a herbal supplement in the treatment of chronic foot ulcers in diabetic patients.

DESIGN. Double-blind randomised, placebo-control trial.

SETTING. Two general hospitals in Hong Kong.

PATIENTS. Eighty patients were recruited according to strict selection criteria.

INTERVENTIONS. Clinical measures included standard antidiabetic treatment, daily wound care including antiseptic bath, debridement, toe removal for gangrene when necessary, and the daily consumption of a herbal drink or placebo.

MAIN OUTCOME MEASURES. The primary outcome was limb salvage. Secondary outcomes included: granulation maturation, local temperature and circulatory changes, tumour necrosis factor–alpha levels, and adverse events.

RESULTS. Limb salvage was achieved in 85% of the patients. Among the early failures, three each came from the treatment and placebo groups. After shifting to herbal treatment (without unblinding of the original treatment), all were rescued in those initially assigned to herbal concoction (6 out of 6) while only 50% (6 out of 12) were rescued from among those initially assigned to placebo. The speed of granulation maturation, and decline in tumour necrosis factor–alpha levels indicating control of inflammation, were also more favourable with the herbal group. No serious adverse events were observed.

CONCLUSION. The herbal adjuvant therapy was effective in helping the healing of chronic diabetic ulcers.

Key words: Diabetes mellitus; Drugs, Chinese herbal; Wound healing

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OBJECTIVE. To examine the efficacy and safety of bronchial artery embolisation in patients with acute major haemoptysis and those with chronic recurrent haemoptysis.

DESIGN. Retrospective review of clinical records.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Clinical records of 70 consecutive patients who had undergone bronchial artery embolisation in Queen Elizabeth Hospital from 1998 to 2003 were reviewed. Altogether 74 bronchial artery embolisation procedures were attempted, 46 (62%) for acute major haemoptysis, and 28 (38%) for chronic recurrent bleeding. Follow-up data were available for 32 patients.

MAIN OUTCOME MEASURES. After bronchial artery embolisation, the Kaplan-Meier method and log-rank tests were used to compare the probability of recurrence in the two patient categories.

RESULTS. Overall immediate control was attained following 99% of the procedures, with a complication rate of 13%; all complications were mild and self-limiting. For the 32 patients (19 having acute major haemoptysis and 13 having chronic recurrent bleeding) with follow-up data available, the overall recurrence rate was 36% (26% in the acute and 47% in chronic group). No statistically significant difference in recurrence probability between the two groups was observed (P=0.24). Presence of active pulmonary tuberculosis was associated with increased risk of recurrence (P=0.005).

CONCLUSION. Bronchial artery embolisation was noted to be effective and safe in both acute major and chronic recurrent haemoptysis.

Key words: Bronchial arteries; Bronchiectasis; Embolization, therapeutic; Hemoptysis; Recurrence

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