OBJECTIVES. To evaluate the outcome of intraventricular thrombolytic therapy for intraventricular haemorrhage and to formulate a safe and effective regimen.

DESIGN. Retrospective study.

SETTING. Regional neurosurgical centre, Hong Kong.

PATIENTS. Twenty-nine consecutive adult patients who presented from November 1995 to November 1998 with non-traumatic intraventricular haemorrhage (Graeb score, >=7) with no active rebleeding risks from vascular abnormalities.

INTERVENTIONS. Fourteen consecutive patients received intraventricular streptokinase via the external ventricular drainage, and 15 consecutive patients received intraventricular urokinase treatment.

MAIN OUTCOME MEASURES. Patient demographics, Glasgow coma scale score, Graeb score, mortality rate, shunt rate, fever response, infection rate, catheter blockage rate, and local and systemic bleeding tendency. RESULT. The mean age of the 16 men and 13 women was 59 years (range, 14-76 years). The median Graeb score for cases of intraventricular haemorrhage was 10 (range, 7-12). There was no significant difference in terms of the Graeb score distribution, total dosage, and duration of treatment between the streptokinase and urokinase groups. More cases of fever were observed in the streptokinase group, which could be due to its antigenicity. The infection rate of the central nervous system was 3%, and the shunt rate was 24%. The overall 1-month postoperative mortality was 10%, which was related to a low preoperative Glasgow coma scale score (<=4). No local rebleeding, systemic coagulopathy, or catheter blockage occurred.

CONCLUSIONS. Intraventricular thrombolytic therapy is a safe and effective method of managing intraventricular haemorrhage. We suggest instilling 20 000 units urokinase intra-operatively, followed by 20 000 units daily for about 3 days, except in cases of vascular abnormality, bleeding tendency, and trauma.

Key words: Cerebral ventricles; Drainage; Intracranial hemorrhages; Thrombolytic therapy; Tomography, X-ray computed

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OBJECTIVES. To evaluate the knowledge of basic life-support and training experience in cardiopulmonary resuscitation among the public in Hong Kong and to identify areas for improvement in public education.

DESIGN. Telephone interview using a structured multiple-choice questionnaire.

SETTING. Random cross-section of the Hong Kong public, from mid-March to May 2002.

PARTICIPANTS. Men and women aged 16 years and older selected using random telephone dialling.

MAIN OUTCOME MEASURE. Overall score in the cardiopulmonary resuscitation knowledge questionnaire.

RESULTS. Of the 357 participants, approximately 12% had received cardiopulmonary resuscitation training. Cardiopulmonary resuscitation knowledge in Hong Kong was poor, even among the previously trained and especially with regard to circulatory maintenance. The most common reason for not taking cardiopulmonary resuscitation training was lack of time.

CONCLUSION. The degree of citizen preparedness in initiating cardiopulmonary resuscitation is very poor in Hong Kong. Intensified educational efforts and exploration of new approaches to improve this first stage in the chain of survival are warranted.

Key words: Cardiopulmonary resuscitation; Heat arrest; Hong Kong; Knowledge; Questionnaires

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OBJECTIVE. To determine the prevalence and risk factors of default from tuberculosis treatment in Hong Kong.

DESIGN. Retrospective study.

SETTING. Data were obtained from programme forms completed by physicians in the Hong Kong Government Tuberculosis and Chest Service and from medical records from Hong Kong chest clinics.

PATIENTS. In all, 5917 patients registered for antituberculous drug therapy in 1996; medical records of 5757 patients were reviewed.

MAIN OUTCOME MEASURES. Patients who defaulted treatment were defined as those who had failed to collect medication for more than 2 consecutive months after the date of the last attendance during the course of treatment. Demographic and clinical characteristics, including history, treatment, and outcome, were compared between defaulters and non-defaulters, both among the whole group and among those with pulmonary disease.

RESULTS. There were 442 (8%) patients who defaulted from treatment. Forty-five percent of those who defaulted did so in the first 2 months of treatment. Key risk factors associated with non-compliance were a history of default, male sex, and a history of concomitant liver disease or lung cancer. Among patients with pulmonary tuberculosis (381 defaulters and 1537 non-defaulters), multiple drug resistance was also associated with default from treatment. Among defaulters with pulmonary disease, 39% were still bacteriologically positive at the time of default.

CONCLUSION. Default from treatment may be partially responsible for the persistent high rates of tuberculosis in Hong Kong in the past decade. Health professionals should ensure that all barriers to treatment be removed and that incentives be used to encourage treatment compliance.

Key words: Hong Kong; Treatment refusal; Tuberculosis

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OBJECTIVES. To examine epidemiological data on epilepsy for the Hong Kong west region.

DESIGN. Descriptive study.

SETTING. Epilepsy clinic, university teaching hospital, Hong Kong.

PATIENTS AND METHODS. The epilepsy clinic of Queen Mary Hospital manages the majority of adult patients (aged 15 years or older) with chronic seizure disorders resident in the Hong Kong west area with an adult population of 475 900. All patients underwent electroencephalography examination and each subject was independently assessed by two epileptologists for diagnosis and classified according to the International League Against Epilepsy recommendations.

RESULTS. Seven hundred and thirty-six patients (female, 42.9%; male, 57.1%; mean age, 40.8 years; standard deviation, 13.6 years) with epilepsy were enrolled in the study. The prevalence rate of active epilepsy in the population 15 years or older was estimated at 1.54 per 1000 on 1 January 2002. Two hundred and eighty-five (38.7%) patients had idiopathic epilepsy syndromes, 100 (13.6%) had cryptogenic epilepsy, and 285 (38.7%) had a remote symptomatic aetiology. Seizure type was partial in 408 (55.4%) patients and generalised in 285 (38.7%). Thirty-one (4.2%) patients had a positive family history. Idiopathic generalised epilepsy syndromes described as common in the literature, such as juvenile myoclonic epilepsy and childhood absence epilepsy, were infrequently seen at 0.68% and 0.95% of cases, respectively.

CONCLUSIONS. This study provides baseline data for epilepsy service development and research in Hong Kong. The prevalence rate of active epilepsy in this Chinese, adult population was low compared with that reported in other developed countries. Further population-based epidemiological research is indicated to confirm the prevalence of seizure disorders in this locality.

Key words: Epilepsy; Hong Kong; Prevalence; Seizures

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OBJECTIVE. To assess whether valvular lesions are associated with the use of dexfenfluramine in Chinese patients with type 2 diabetes.

DESIGN. Case-control study.

PATIENTS AND METHODS. Thirty-six obese Chinese patients with type 2 diabetes and a history of dexfenfluramine use during the period January 1992 and September 1997 were recruited into the study, while another 43 age- and sex-matched Chinese patients with type 2 diabetes were recruited as controls. The mean age for the cases was 44.1 years (standard deviation, 11.2 years; median, 42.5 years; range, 20-64 years). The 43 control subjects were age- and sex-matched, and had a mean age of 48.5 years (standard deviation, 10.9 years; median, 51.0 years; range, 16-63 years; P>0.05). The male-to-female ratio was confirmed as similar between the two groups (10:26 versus 12:31; P>0.05). All patients were clinically free from cardiovascular disease. Patients with a history of underlying valvular disease from any cause were excluded from the study. All patients underwent echocardiographic assessment, and the presence of any valvular lesions was documented.

RESULTS. The mean duration of dexfenfluramine use by the cases was 21.8 weeks (standard deviation, 29.0 weeks; median, 18.0 weeks; range, 1-160 weeks). Subjects with a history of dexfenfluramine use had higher rates of ignificant aortic regurgitation, tricuspid regurgitation of any severity, and of any valvular regurgitation, compared to controls (11.1% versus 0%, P<0.05; 30.6% versus 4.7%, P<0.01; and 61.1% versus 34.9%, P<0.05, respectively). Logistic stepwise regression analysis to predict the risk of valvular lesion was conducted, with age, sex, history of dexfenfluramine use, body mass index, waist-hip ratio, blood pressure, fasting plasma glucose, lipid profile, and duration of diabetes as independent variables. A history of dexfenfluramine use was the only significant parameter entered into the model (significant aortic regurgitation: beta=9.19, standard error=46.6, P<0.05; any tricuspid regurgitation: beta=2.76, standard error=10.8, P<0.05).

CONCLUSION. In Chinese patients with type 2 diabetes, a history of dexfenfluramine use is associated with heart-valve regurgitation, particularly aortic regurgitation.

Key words: Chinese; Dexfenfluramine; Diabetes mellitus; Heart valves

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