Analogues of erectile dysfunction drugs: an under-recognised threat

ABSTRACT
Hong Kong Med J 2007;13:359-63 | Number 5, October 2007
ORIGINAL ARTICLE
Analogues of erectile dysfunction drugs: an under-recognised threat
WT Poon, YH Lam, CK Lai, Albert YW Chan, Tony WL Mak
Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
OBJECTIVES. To investigate the problem of drug analogue adulteration in male erectile dysfunction health products.
 
DESIGN. Survey of over-the-counter male erectile dysfunction health products available in convenience stores and pharmacies in Hong Kong.
 
SETTING. Tertiary referral centre for clinical toxicology analysis in Hong Kong.
 
MAIN OUTCOME MEASURES. The pattern and extent of adulteration of male erectile dysfunction health products with sildenafil, tadalafil, and vardenafil as well as their structurally modified analogues.
 
RESULTS. Of 26 products studied, one (4%) was found to contain undeclared sildenafil, while 14 (54%) contained drug analogues of different kinds. The latter included acetildenafil, hydroxyacetildenafil, hydroxyhomosildenafil, and piperidenafil. The first three were analogues of sildenafil and the last was an analogue of vardenafil. One young patient presented with ataxia after taking an acetildenafil-containing product.
 
CONCLUSIONS. The positive rate of concealed drug analogues in male erectile dysfunction health products is alarmingly high. Such analogues are difficult to detect by ordinary laboratory methods, and might be used in an attempt to evade regulatory inspection. Without going through the stringent drug testing process, the adverse effects of these chemicals remain largely unknown and unpredictable. Effective surveillance system and control measures are needed urgently. The medical profession and the public should be alerted to this under-recognised threat.
 
Key words: Designer drugs; Impotence; Sildenafil; Vardenafil
 
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Is regular follow-up scan for giant liver haemangioma necessary?

ABSTRACT
Hong Kong Med J 2007;13:353-8 | Number 5, October 2007
ORIGINAL ARTICLE
Is regular follow-up scan for giant liver haemangioma necessary?
Wilson WC Ng, YS Cheung, KF Lee, John Wong, Simon CH Yu, Paul SF Lee, Paul BS Lai
Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To review the reliability of radiological diagnosis and need of regular scans for giant liver haemangioma, in terms of long-term outcome and management options.
 
DESIGN. Retrospective study.
 
SETTING. Division of Hepato-biliary and Pancreatic Surgery, Prince of Wales Hospital, Hong Kong.
 
PATIENTS. Patients with giant liver haemangioma noted on initial imaging from February 1996 to July 2006.
 
MAIN OUTCOME MEASURES. Patient demographics, clinical assessments, management, and outcomes.
 
RESULTS. There were 42 female and 22 male patients with a median age of 49 (range, 27-84) years with a suspected haemangioma. The median maximal diameter of the lesions was 5.5 cm (range, 4.0-20.3 cm). They were first detected by ultrasonography (n=45), contrast-enhanced computed tomographic scan (n=18), or magnetic resonance imaging (n=1). Besides regular follow-up scans, 22 patients were investigated further to confirm the diagnosis/ exclude malignancy. Finally, 63 patients had a haemangioma and one had a hepatocellular carcinoma. Regarding the patients with haemangiomas, two were operated on for relief of pain and the rest were managed conservatively. The median duration of follow-up was 34 months. Most (54%) of the patients were asymptomatic, but in 17% the haemangioma enlarged to exceed its original size by more than 20%. There were no haemangioma-associated complications.
 
CONCLUSIONS. Majority of patients having giant liver haemangioma are asymptomatic and do not suffer complications. If the diagnosis is uncertain, selective further investigations may be necessary. Lesions with a confirmed diagnosis tend to remain static in size; performing regular scans for asymptomatic giant liver haemangiomas may not be necessary.
 
Key words: Hemangioma; Liver neoplasms; Magnetic resonance imaging; Tomography, X-ray computed
 
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Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients

ABSTRACT
Hong Kong Med J 2007;13:348-52 | Number 5, October 2007
ORIGINAL ARTICLE
Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients
SH Wan, TC Wong, TH Yip, FK Ip
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVE. To report preliminary experience on the Camitz operation for elderly Chinese patients in a Hong Kong public hospital.
 
DESIGN. Retrospective study.
 
SETTING. Tertiary referral hospital with hand surgery service in Hong Kong.
 
PATIENTS. Between January 2000 and January 2004, patients with carpal tunnel syndrome having the Camitz operation were recruited. They were assessed using the measurements of pinch and grip power, sensation, the Kapandji score, and functional grading as well as complications encountered during the subsequent follow-up.
 
INTERVENTION. The Camitz operation.
 
RESULTS. A total of 21 patients (8 male and 13 female; mean age, 70 years) were recruited. The mean duration of follow-up was 15 months. There was significant improvement in pinch power, grip power, and hand functions, as well as a positive correlation between the functional score and the Kapandji score. No major complication was recorded. One patient with pre-existing osteoarthritis of the ring finger developed contracture of the proximal interphalangeal joint.
 
CONCLUSION. The Camitz operation is a simple, effective, and safe means of improving hand function in elderly Chinese patients with long-standing carpal tunnel syndrome and thenar muscle atrophy. Newly acquired strength in antepulsion of thumb resulted in improved pinch, grip, and hand function in this patient group.
 
Key words: Aged; Carpal tunnel syndrome; Hand/surgery; Thumb
 
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Evaluation of a Hong Kong Chinese version of a self-administered questionnaire for assessing symptom severity and functional status of carpal tunnel syndrome: cross-cultural adaptation and reliability

ABSTRACT
Hong Kong Med J 2007;13:342-7 | Number 5, October 2007
ORIGINAL ARTICLE
Evaluation of a Hong Kong Chinese version of a self-administered questionnaire for assessing symptom severity and functional status of carpal tunnel syndrome: cross-cultural adaptation and reliability
Margaret WM Fok, HB Leung, WM Lee
Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam Road, Hong Kong
 
 
OBJECTIVES. To evaluate the application of a translated version of an established self-administered questionnaire for carpal tunnel syndrome on Chinese patients in Hong Kong.
 
DESIGN. Evaluation of an instrument tool.
 
SETTING. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong; Holistic Medical Centre, Aberdeen, Hong Kong.
 
PARTICIPANTS. Patients with carpal tunnel syndrome, translators.
 
MAIN OUTCOME MEASURES. The adaptation was based on forward-backward translation from English to Chinese (Hong Kong) and vice versa. Meetings with translators, investigators, and patients were organised to generate an acceptable version of the questionnaire. A pilot study was carried out on 20 patients and subsequently minor adjustments were added. Fifty patients were recruited to validate the reliability and internal consistency of the questionnaire.
 
RESULTS. The ordinality of response agreed with the original instrument. Test-retest reproducibility showed no significant difference between tests. The Pearson correlation coefficient ranged from 0.83 to 0.93. Internal consistency was good, at 0.85.
 
CONCLUSION. Through the validation of the Hong Kong Chinese version of the questionnaire, we are able to produce an assessment tool for the local patients. Furthermore, we are able to create a platform for: (i) a cross-national and cross-cultural epidemiological comparison as well as a means of (ii) evaluating different types of treatments.
 
Key words: Carpal tunnel syndrome; Questionnaires; Reproducibility of results
 
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Attitudes towards day-case surgery in Hong Kong Chinese patients

ABSTRACT
Hong Kong Med J 2007;13:298-303 | Number 4, August 2007
ORIGINAL ARTICLE
Attitudes towards day-case surgery in Hong Kong Chinese patients
YC Lee, PP Chen, Jacqueline Yap, Patricia Yeo, Christopher Chu
Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, Hong Kong
 
 
OBJECTIVE. To evaluate attitudes of Chinese patients towards day-case surgery.
 
DESIGN. Prospective cross-sectional questionnaire survey. SETTING. District public hospital, Hong Kong.
 
PATIENTS. Two hundred patients attending a preanaesthetic assessment clinic between 1 January and 30 June 2004 were invited to participate.
 
MAIN OUTCOME MEASURES. Demographic profiles, understanding and attitudes towards day-case surgery, preference for day-case surgery before and after the experience, postoperative adverse effects, and patient satisfaction.
 
RESULTS. The mean age of the patients was 28 (standard deviation, 19) years. In all 200 respondents completing the survey, 180 preferred day-case surgery. Important reasons for this view were: shorter duration of hospitalisation, dislike of hospital environments, belief that hospitals are highly infectious, need to look after their families, desire to return to work early, and doctors??advice. Small home environments and belief that day-case surgery was unsafe were not important. Respondents who did not prefer day-case surgery stressed the importance of better care available for hospital in-patients, concerns about surgical complications, postoperative nausea and vomiting, and doctors??advice. Only 11% patients complained of postoperative adverse effects. Demographic characteristics and previous day-case surgery experience did not have any effect on patient preferences. However, experiencing a postoperative adverse effect significantly affected the preference (P=0.005) and satisfaction (P=0.001) of respondents for day-case surgery.
 
CONCLUSION. Local Chinese patients attending our institution have a high preference for day-case surgery. Postoperative adverse effects might influence the respondents??satisfaction and preference after their surgical experience.
 
Key words: Ambulatory surgical procedures; Patient satisfaction
 
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Mortality prediction in adult cardiac surgery patients: comparison of two risk stratification models

ABSTRACT
Hong Kong Med J 2007;13:293-7 | Number 4, August 2007
ORIGINAL ARTICLE
Mortality prediction in adult cardiac surgery patients: comparison of two risk stratification models
WK Au, MP Sun, KT Lam, LC Cheng, SW Chiu, SR Das
Division of Cardiothoracic Surgery, The Grantham Hospital, Aberdeen, Hong Kong
 
 
OBJECTIVE. To assess and compare the two commonly applied models 'EuroSCORE and Parsonnet' in our local adult cardiac surgery patients, according to risk factor quantification related to mortality using a risk stratification protocol to assess the quality of cardiac surgical care.
 
DESIGN. Prospective study.
 
SETTING. Cardiac surgery centre in a regional hospital in Hong Kong.
 
PATIENTS. All adult patients undergoing coronary artery bypass graft and heart valve surgery at the Grantham Hospital were evaluated prospectively from November 1999 to July 2005.
 
MAIN OUTCOME MEASURES. In-hospital mortality was the defined end-point. Statistical analyses consisted of observed against expected mortality, Hosmer-Lemeshow goodness-of-fit test for calibration accuracy, and receiver operating characteristic curve for discrimination performance.
 
RESULTS. During the study period, 1247 patients underwent coronary artery bypass graft surgery and 1406 underwent heart valve surgery. Observed mortality rates in these two patient groups were 2.9% and 4.8% respectively. The expected mortality rates as predicted by the EuroSCORE were (mean±standard deviation) 4.0±3.3% and 5.2±3.0% respectively, and by the Parsonnet model were 5.9±4.2% and 7.3±4.4% respectively. EuroSCORE performed better than the Parsonnet model at predicting in-hospital mortality assessed by the Hosmer-Lemeshow goodness-of-fit test. The areas under the receiver operating characteristic curves in coronary artery bypass graft surgery were 0.76 for EuroSCORE and 0.74 for Parsonnet. The receiver operating characteristic curve areas in valve surgery were 0.77 for EuroSCORE and 0.79 for Parsonnet.
 
CONCLUSION. Despite significant geographic and demographic differences between European and Asian patients, in our local adult cardiac surgery patients, the EuroSCORE performed well with good calibration and discrimination in predicting mortality. There was a tendency for both models to over predict. However, the EuroSCORE can serve as a baseline for the development of a local risk model.
 
Key words: Heart diseases; Hospital mortality; Prospective studies; Risk assessment; Risk factors
 
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Drug non-adherence and associated risk factors among Chinese geriatric patients in Hong Kong

ABSTRACT
Hong Kong Med J 2007;13:284-92 | Number 4, August 2007
ORIGINAL ARTICLE
Drug non-adherence and associated risk factors among Chinese geriatric patients in Hong Kong
PW Lam, CM Lum, MF Leung
Specialty Outpatient Department, United Christian Hospital, Kwun Tong, Hong Kong
 
 
OBJECTIVES. To study the prevalence of drug non-adherence among Chinese elderly people and its associated risk factors.
 
DESIGN. Cross-sectional survey.
 
SETTING. Medical and Geriatrics specialist out-patient clinic in a regional hospital.
 
PATIENTS. Elderly patients (≥5 years) with chronic diseases requiring regular medications were selected by systematic sampling.
 
MAIN OUTCOME MEASURES. Drug non-adherence; potential risk factors studied include patients' factors, availability of assistance, and prescription factors.
 
RESULTS. Two hundred and nine elders participated with 84% response rate. Estimated mean prevalence rate of drug non-adherence was 37% (standard deviation, 7%). The risk factors for drug non-adherence were: (1) self-perceived adverse drug effects (odds ratio=2.5; 95% confidence interval, 1.2-5.2; P=0.017); (2) use of respiratory drugs (2.7; 1.0-7.5; P=0.048); (3) complicated drug regimens (7.4; 3.2-16.9; P<0.001); and (4) necessity to cut tablets (4.8; 2.1-10.7; P<0.001). Presence of caregiver/community nursing services assistance to pack medication (odds ratio=0.2; 95% confidence interval, 0.1-0.5; P=0.001), and the use of medication boxes (0.5; 0.3-1.0; P=0.050) were found to be the protective factors against drug non-adherence.
 
CONCLUSIONS. Drug non-adherence is an important concern in patient management. Medication regimen should be simplified as far as possible, in particular to avoid cutting pills or use of different dosage at different timing. Patients receiving drugs for respiratory diseases should be the first target group for intervention. Patients should be encouraged to voice out their perceived adverse drug effects.
 
Key words: Aged; Chinese; Patient compliance; Prescriptions, drug; Risk factors
 
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Intussusception trends in Hong Kong children

ABSTRACT
Hong Kong Med J 2007;13:279-83 | Number 4, August 2007
ORIGINAL ARTICLE
Intussusception trends in Hong Kong children
Hong Kong Intussusception Study Group
 
 
OBJECTIVES. To assess trends in intussusception and to validate the coding in Hong Kong's computerised discharge information system.
 
DESIGN. Case notes were reviewed for all children under the age of 5 years who had a discharge diagnosis indicating intussusception or a procedure indicating reduction of intussusception during the 6-year period 1 July 1997 through 30 June 2003.
 
RESULTS. Intussusception rates for infants under 1 year of age (108/100 000) and under 5 years of age (38/100 000) were slightly higher than previous estimates (78-100/100 000 and 27-32/100 000, respectively) that used passive discharge data alone.
 
CONCLUSIONS. Hong Kong's passive computer data systems could be used to monitor rates of intussusception after the introduction of new rotavirus vaccines, provided readmissions, inter-hospital transfers, and hospital follow-ups for the same episode are taken into account.
 
Key words: Child, preschool; Infant; Intussusception; Population surveillance; Rotavirus
 
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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

ABSTRACT
Hong Kong Med J 2007;13:271-8 | Number 4, August 2007
ORIGINAL ARTICLE
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
Simon CH Yu, George KC Wong, Jeffrey KT Wong, WS Poon
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
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.
 
Key words: Aneurysm, ruptured; Cerebral arteries; Embolization, therapeutic; Intracranial aneurysm; Treatment outcome
 
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Intercostal nerve blockade for cancer pain: effectiveness and selection of patients

ABSTRACT
Hong Kong Med J 2007;13:266-70 | Number 4, August 2007
ORIGINAL ARTICLE
Intercostal nerve blockade for cancer pain: effectiveness and selection of patients
Frank CS Wong, TW Lee, KK Yuen, SH Lo, WK Sze, Stewart Y Tung
Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
 
 
OBJECTIVES. To review treatment results of intercostal nerve blockade at our centre and those reported in the literature, and to determine which patients benefit most from this procedure.
 
DESIGN. Retrospective study.
 
SETTING. Regional palliative care centre in a regional hospital in Hong Kong.
 
PATIENTS. Oncology patients who had intercostal nerve blockade at Tuen Mun Hospital from 1995 to 2005 were divided into three groups: (1) those who appeared not to tolerate opioids; (2) those deemed to have inadequate pain control, despite high doses of analgesics; and (3) those referred to avoid early use of high-dose opioids and tolerance.
 
MAIN OUTCOME MEASURES. The effectiveness and complications of intercostal nerve blockade, and the extent of benefit derived from intercostal nerve blockade in different patient groups.
 
RESULTS. This study found that 80% of the 25 patients noted optimal local pain control and 56% experienced reduction in analgesic use after intercostal nerve blockade. About 32% did not notice recurrence of the targeted pain till the end of their lives. None of the patients developed pneumothorax. Most benefit from intercostal nerve blocks were derived by group 2 patients, 90% of whom obtained optimal local pain control (P=0.23) and enjoyed a significant reduction in analgesics use (P=0.019), and in 40% their target pain was controlled till the end of life. Only about one third of group 3 patients had subsequent reduction in use of analgesics, mainly because they had co-existing pain other than at the target selected for treatment. Half (50%) of group 1 patients achieved optimal pain control.
 
CONCLUSION. Our treatment results from intercostal nerve blockade are comparable to those reported in the literature. The procedure is safe if closely monitored. Good selection of cases is important for optimising the therapeutic gain. The largest benefit is obtained in patients who have inadequate pain control after high-dose morphine.
 
Key words: Anesthesia, local; Intercostal nerves; Nerve block; Pain clinics; Palliative care
 
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