OBJECTIVE. To study the epidemiological, clinical, and microbiological features of Plesiomonas shigelloides infection in Hong Kong.

DESIGN. Retrospective study.

SETTING. Infectious Disease Unit of a district hospital, Hong Kong.

PATIENTS. Patients with laboratory-confirmed cases of Plesiomonas shigelloides infection between 1 January 1995 and 31 December 1998.

MAIN OUTCOME MEASURES. Epidemiological and clinical data, antibiotic sensitivity, and clinical outcome.

RESULTS. There was an increasing trend in the number of isolates of Plesiomonas shigelloides obtained and the prevalence of the bacterium. A total of 197 isolates were obtained from 188 patients, and most isolates (172; 87.3%) were obtained during the summer. Clinical and epidemiological data were available for 167 patients (85 males, 82 females). Patient age ranged from 1 month to 95 years; the mean and median ages of the patients older than 15 years were 51.0 and 40.5 years, respectively (n=132). Only 35 (21.0%) of the 167 patients had a history of travel outside Hong Kong, whereas 21 (12.6%) had a history of consuming seafood or uncooked food; 39 (23.4%) had underlying medical conditions. Most patients (165; 98.8%) had symptoms of Plesiomonas shigelloides infection. Nine (5.4%) patients had had chronic diarrhoea for more than 2 weeks; watery and bloody diarrhoea was discharged by 122 (73.1%) and 42 (25.1%) of the patients, respectively. All 197 Plesiomonas shigelloides isolates were sensitive to ofloxacin, or levofloxacin and ceftriaxone. Resistance or partial resistance was recorded for ampicillin (72%), tetracycline (67%), co-trimoxazole (12%), and chloramphenicol (5%). The majority of patients (142/167; 85.0%) had self-limiting cases of infection, but 25 patients were given antibiotics for more severe symptoms at the time of presentation; there were two deaths.

CONCLUSIONS. The occurrence of Plesiomonas shigelloides infection in Hong Kong is increasing, although most cases of are self-limiting.

Key words: Diarrhea/microbiology; Gastroenteritis; Gram-negative bacterial infections; Plesiomonas/drug effects

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OBJECTIVE. To study the effectiveness and safety of non-invasive positive-pressure ventilation in the management of acute respiratory failure.

DESIGN. Prospective study.

SETTING. Regional public hospital, Hong Kong.

PATIENTS. One hundred and eighty-nine haemodynamically stable adult Chinese patients with acute respiratory failure (119 men and 70 women; mean age, 71.2 years [range, 18-92 years]) who were treated with non-invasive positive-pressure ventilation as the primary mode of ventilatory assistance from 1 January 1996 to 31 December 1998.

MAIN OUTCOME MEASURES. Arterial blood gas measurements, respiratory rate, airway pressures used, use of endotracheal intubation, and standardised mortality ratio.

RESULTS. Fifty-two patients had hypoxaemic respiratory failure (group I); 97 had hypercapnic respiratory failure (group II); and 40 had either type with advanced co-morbidities and were not planned to receive endotracheal intubation (group III). For groups I and II, the overall mean duration of non-invasive positive-pressure ventilation was 56.2 hours. Improvements in gas exchange were seen in approximately 71% of these patients, endotracheal intubation was not needed for 82%, and the standardised mortality ratio was 0.86. The hospital survival rate was approximately 93% in non-intubated patients and 41% in intubated patients. Predictors of success were reduction in respiratory rate within 6 hours (P<0.005), and (for hypercapnic respiratory failure) increased pH and reduced arterial carbon dioxide tension within 24 hours (P<0.005). Patients with pneumonia had significantly higher failure rates (P<0.05). Group III patients were older, had higher Acute Physiology and Chronic Health Evaluation II scores, and required longer ventilatory support, but their gas exchange response rate was 68%. The only complication of treatment was minor facial skin abrasions.

CONCLUSION. Non-invasive positive-pressure ventilation is effective in treating haemodynamically stable patients with acute respiratory failure and causes few and minor complications.

Key words: Intubation, intratracheal; Lung disease, obstructive; Positive-pressure respiration; Respiratory distress syndrome, adult; Treatment outcome

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OBJECTIVE. To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women.

DESIGN. Prospective longitudinal study involving self-report questionnaires and face-to-face interviews.

SETTING. University teaching hospital, Hong Kong.

PARTICIPANTS. Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997.

MAIN OUTCOME MEASURES. Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales.

RESULTS. Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn.

CONCLUSION. Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.

Key words: Depression, postpartum; Female; Mass screening/methods; Pregnancy complications; Psychiatric status rating scales

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OBJECTIVE. To review local experience of neoadjuvant chemotherapy in breast cancer.

DESIGN. Retrospective study.

SETTING. Public hospital, Hong Kong.

PATIENTS. Seventeen patients who presented from August 1988 through April 1997 with locally advanced breast cancer, which was treated with neoadjuvant chemotherapy.

RESULTS. The clinical response rate was 71% and two of the 12 patients who responded to chemotherapy achieved complete remission. Three patients had their tumours downstaged sufficiently to allow them to undergo breast conservation surgery after neoadjuvant chemotherapy. None of these three patients has so far had a local recurrence of disease.

CONCLUSION. Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer and thus enables breast conservation surgery to be performed on patients who are initially not suitable for this procedure.

Key words: Antineoplastic agents, combined; Breast neoplasms/surgery; Neoadjuvant therapy; Neoplasm recurrence, local; Neoplasm staging

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OBJECTIVES. To compare the contributions of patients, emergency physicians, and surgeons in the delay of diagnosis and treatment of appendicitis, and the effects of delay on disease stage and complication rate.

DESIGN. Retrospective study.

SETTING. Accident and emergency department of a district public hospital, Hong Kong.

PATIENTS. All patients undergoing emergency appendectomy between August 1998 to September 1999.

MAIN OUTCOME MEASURES. Patient delay in presentation, emergency physician delay in hospital admission, and surgeon delay in performing the operation; operative findings; and postoperative complications.

RESULTS. Of 158 patients undergoing emergency operation, 14 had no pathological diagnosis and four had a diagnosis other than that of acute appendicitis. Of the 140 pathologically confirmed cases of appendicitis, the mean emergency patient delay was greater in advanced appendicitis than it was in simple appendicitis (42.0 hours versus 24.9 hours; P<0.005). The mean emergency physician delay in advanced appendicitis was also greater than it was in simple appendicitis (17.9 hours versus 5.8 hours; P<0.05). The difference in the mean surgeon delay in simple (10.9 hours) and advanced (16.3 hours) appendicitis, however, was not significant. The mean emergency physician delay showed a significant association with the postoperative complication rate (P=0.05). The delay was mainly because of a failure to diagnose the condition and admit the patient at the first visit to the accident and emergency department (22.1%). The diagnostic accuracy showed a significant association with the level of experience of the emergency physician involved (P<0.05).

CONCLUSION. There should be a higher index of suspicion, better surgical training, and better senior supervision at accident and emergency departments, to avoid preventable morbidity and mortality in acute appendicitis.

Key words: Acute disease; Appendectomy; Appendicitis/surgery; Appendicitis/diagnosis; Emergency medical services; Time factors

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