Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review

ABSTRACT

Hong Kong Med J 1999;5:240–4 | Number 3, September 1999
ORIGINAL ARTICLE
Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review
KW Chan, TM Chan, IKP Cheng
Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
OBJECTIVE. To examine the prevalence of glomerular disease in Hong Kong.
 
DESIGN. Prospective review.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. All patients who presented with suspected glomerular disease from 1993 through 1997.
 
MAIN OUTCOME MEASURES. Histopathological diagnosis from biopsy examination and clinical features of presentation.
 
RESULTS. A total of 1629 consecutive percutaneous renal biopsies of native kidneys showed glomerular disease in 1413 cases. The most common clinical indication for renal biopsy was persistent proteinuria (n=735; 52.0%), while the most frequently found glomerular lesion was immunoglobulin A nephropathy (n=338; 23.9%). Minimal-change nephrotic syndrome (n=125; 8.8%) and immunoglobulin M nephropathy (n=11; 0.8%), were the most common glomerular diseases that presented with nephrotic syndrome. The male to female ratio for lupus nephritis was 1:14 (n=290), whereas for minimal-change nephrotic syndrome, the ratio was 1.8:1 (n=125). Immunoglobulin A nephropathy and membranous glomerulonephritis (n=117) affected approximately equal numbers of male and female patients. Familial fibrillary glomerulonephritis, a disease hitherto unknown in Hong Kong, was diagnosed in two siblings.
 
CONCLUSION. Immunoglobulin A nephropathy was the most common glomerular disease in this survey and represents an important cause of end-stage renal failure in the Hong Kong population.
 
Key words: Biopsy; Glomerulonephritis; Kidney diseases/pathology
 
View this abstract indexed in MEDLINE:
 

Evaluation of the ThinPrep Papanicolaou test in clinical practice: 6-month study of 16 541 cases with histological correlation in 220 cases

ABSTRACT

Hong Kong Med J 1999;5:233–9 | Number 3, September 1999
ORIGINAL ARTICLE
Evaluation of the ThinPrep Papanicolaou test in clinical practice: 6-month study of 16 541 cases with histological correlation in 220 cases
GPS Yeoh, KW Chan, I Lauder, MB Lam
Diagnostix Pathology Laboratories, Canossa Hospital, 1 Old Peak Road, Hong Kong
 
 
OBJECTIVE. To evaluate the liquid-based ThinPrep Papanicolaou test.
 
DESIGN. Prospective comparison of the ThinPrep test with the conventional Papanicolaou test.
 
SETTING. Cervical smear specimens sent to a private practice, Hong Kong.
 
PATIENTS. A total of 16 541 ThinPrep test specimens and 7258 conventional Papanicolaou smears from Hong Kong women who had been screened for cervical cancer between mid-July 1998 and mid-January 1999.
 
MAIN OUTCOME MEASURES. Specimen adequacy, endocervical cell content, epithelial cell abnormalities, and micro-organisms present in both types of cervical smears; histological diagnosis of cervical biopsy specimens of women who had the ThinPrep test.
 
RESULTS. Compared with the conventional Papanicolaou smear test, the ThinPrep test showed a reduction in the frequency of ‘unsatisfactory’ (0.56% versus 1.36%; P<0.01), ‘satisfactory but limited’ (1.67% versus 15.87%; P<0.01), and ‘atypical squamous cells of undetermined significance’ reports (1.72% versus 3.64%; P<0.01). The ThinPrep test was also more effective at detecting squamous intraepithelial lesions, showing a 58% increase for low-grade lesions (2.66% versus 1.68%; P<0.01) and 28% increase for high-grade lesions (1.71% versus 1.34%; P<0.01). The sensitivity and positive predictive value of the ThinPrep system were 97.5% and 94.2%, respectively. The liquid-based method yielded a higher percentage of samples that contained endocervical cells compared with conventional smear specimens (70.57% versus 51.23%; P<0.001).
 
CONCLUSIONS. The ThinPrep test has high a sensitivity and positive predictive value. The ThinPrep test gives higher-quality specimens and has a higher detection rate of squamous intraepithelial lesions than does the conventional Papanicolaou smear test. The drawbacks of the liquid-based system, however, pertain to cost and the additional procedures and training needed.
 
Key words: Cervical intraepithelial neoplasia; Cervix neoplasms; Cytological techniques; Laboratory techniques and procedures; Vaginal smears/methods
 
View this abstract indexed in MEDLINE:
 

Cervical smear screening: questionnaire study of histories and attitudes of patients with squamous cervical carcinoma

ABSTRACT

Hong Kong Med J 1999;5:229–32 | Number 3, September 1999
ORIGINAL ARTICLE
Cervical smear screening: questionnaire study of histories and attitudes of patients with squamous cervical carcinoma
SSN Lee, LC Wong
Department of Obstetrics and Gynaecology, Tsan Yuk Hospital, 30 Hospital Road, Hong Kong
 
 
OBJECTIVE. To determine why invasive cervical carcinoma still occurs despite the availability of cervical smear screening.
 
DESIGN. Questionnaire survey and retrospective study of patient records of women who attended a gynaecological oncology out-patients clinic from 13 February 1997 to 30 June 1997.
 
SETTING. Public hospital, Hong Kong.
 
PATIENTS. Ninety-nine women (median age 53 years; range, 30-79 years) who gave a history of squamous cervical carcinoma.
 
MAIN OUTCOME MEASURES. The date of the last cervical smear test prior to the development of cervical carcinoma; reasons for non-attendance; attitudes to screening; and the stage and histological diagnosis of disease.
 
RESULTS. Only 19 (19.2%) of the 99 patients had received routine cervical smear testing during the previous 3 years prior to their disease; 76 (76.8%) had not been tested within the past 10 years. The major reasons for not having been tested included being unaware that cervical carcinoma is preventable by screening or can be asymptomatic, being too busy to go for screening, and not knowing where to go for screening. After receiving treatment, 17 (17.2%) of the 99 patients still thought screening was unnecessary and 20 (20.2%) had no idea how frequently smears should be taken.
 
CONCLUSION. The greatest barrier to effective cervical screening is patient ignorance. Public education about cervical smear screening in Hong Kong is needed.
 
Key words: Carcinoma, squamous cell; Cervix neoplasms; Knowledge, attitudes, practice; Mass screening; Patient acceptance of health care; Questionnaires
 
View this abstract indexed in MEDLINE:
 

The diagnostic value of fine-needle aspiration cytology in the assessment of thyroid nodules: a retrospective 5-year analysis

ABSTRACT

Hong Kong Med J 1999;5:140–4 | Number 2, June 1999
ORIGINAL ARTICLE
The diagnostic value of fine-needle aspiration cytology in the assessment of thyroid nodules: a retrospective 5-year analysis
GPS Yeoh, CK Wai
Histopathology, Canossa Hospital, 1 Old Peak Road, Hong Kong
 
 
OBJECTIVE. To audit the diagnostic accuracy and value of fine-needle aspiration cytology in the assessment of thyroid nodules over a 5-year period.
 
DESIGN. Retrospective study.
 
SETTING. Private practice, Hong Kong.
 
PATIENTS. The computerised records from cytological and histological examinations of all thyroid specimens submitted from 1993 through 1997 were studied; the 1236 aspirates came from 1033 women and 175 men (gender was not specified in 28 cases).
 
MAIN OUTCOME MEASURES. Cytological reports were classified diagnostically, and histological and cytological correlations were determined.
 
RESULTS. Of the 1236 aspirates, 113 (9.1%) were unsatisfactory; 1013 (82.0%), including cysts, were benign; and 110 (9.0%) were neoplastic or malignant. Histological follow-up was available for 149 cases; 13 were unsatisfactory for cytological diagnosis. Statistical analysis of the remaining 136 cases yielded the following results: sensitivity of fine-needle aspiration cytology, 56%; specificity, 90%; positive predictive value, 74%; negative predictive value, 80%; accuracy, 79%. These results were within the range of previously published values. The sensitivity was improved by combining clinical information: if nodules larger than 3-cm diameter were excised (despite a non-neoplastic aspiration cytology report), the sensitivity increased to 71% and the accuracy to 84%.
 
CONCLUSION. Fine-needle aspiration cytology is an effective screening test to help evaluate whether surgery is required in the management of thyroid nodules. False-positive and false-negative rates can be minimised by taking clinical and imaging data into consideration.
 
Key words: Biopsy, needle; Cytodiagnosis; Predictive value of tests; Sensitivity and specificity; Thyroid neoplasms
 
View this abstract indexed in MEDLINE:
 

Chinese herbal formula XQ-9302: pilot study of its clinical and in vitro activity against human immunodeficiency virus

ABSTRACT

Hong Kong Med J 1999;5:135–9 | Number 2, June 1999
ORIGINAL ARTICLE
Chinese herbal formula XQ-9302: pilot study of its clinical and in vitro activity against human immunodeficiency virus
LY Kang, XZ Pan, WX Yang, QC Pan, XH Weng, WQ Yang
Shanghai Municipal Center for Disease Control, Hua Shan Hospital, Shanghai Xiong-Qi Biological Products Ltd, Shanghai, China
 
 
OBJECTIVES. To evaluate the effectiveness of QX-9302—a purified, precise mixture of 20 Chinese herbs—against infection with human immunodeficiency virus in vitro and in the clinic.
 
DESIGN. In vitro cell culture assay, heavy metal content analysis, and pilot non-randomised clinical trial.
 
SETTING. Drug rehabilitation centre and municipal surveillance centre, Shanghai, China.
 
PATIENTS. Forty-eight patients who had various clinical histories, such as drug abuse, cancer, and infection with human immunodeficiency virus, participated in the clinical study.
 
INTERVENTION. During the clinical trial, multiple 15-day courses of XQ-9302 10.8 g/d were given to participants.
 
MAIN OUTCOME MEASURES. CD4 count, P24 antigen level, level of antibody against human immunodeficiency virus, numbers of copies per millilitre of human immunodeficiency virus in the plasma (viral load), and side effects.
 
RESULTS. XQ-9302 protected cultured MT4 cells from infection with human immunodeficiency virus in vitro. Clinical tests showed that the herbal formula relieved the symptoms of acquired immunodeficiency syndrome and enhanced CD4 counts in patients infected by the human immunodeficiency virus. There were no observable side effects, even after taking the drug for several months. In three patients who had acquired immunodeficiency syndrome, treatment with XQ-9302 reduced the magnitude of the viral load by more than 1 log.
 
CONCLUSION. XQ-9302 not only improves the immune function of patients infected with the human immunodeficiency virus, but also interrupts viral replication and slows the progression of the disease without detectable side effects. In addition, the heavy metal content of XQ-9302 is well within safety levels set by the Government of China.
 
Key words: Acquired immunodeficiency syndrome, drug therapy; Drugs, Chinese herbal/therapeutic use; Evaluation studies; Follow-up studies; HIV antibodies/blood; Virus replication
 
View this abstract indexed in MEDLINE:
 

Epidemiology of paediatric cancer in Hong Kong, 1982 to 1991. Hong Kong Cancer Registry

ABSTRACT

Hong Kong Med J 1999;5:128–34 | Number 2, June 1999
ORIGINAL ARTICLE
Epidemiology of paediatric cancer in Hong Kong, 1982 to 1991. Hong Kong Cancer Registry
CK Li, OWK Mang, W Foo
Department of Paediatrics, Lady Pao Children's Cancer Centre, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVE. To review the data of paediatric cancer that had been collected by the Hong Kong Cancer Registry from 1982 through 1991.
 
DESIGN. Cross-sectional retrospective study.
 
SETTING. Hong Kong.
 
PATIENTS. Children aged 15 years or younger.
 
MAIN OUTCOME MEASURES. The types of cancer were classified into 12 diagnostic groups according to morphology (following the International Classification of Diseases for Oncology M-code). The incidences of the different types of cancer were obtained with reference to the Hong Kong population aged 15 years or younger. Data collected between 1989 and 1991 were checked by paediatric oncologists from the Hong Kong Paediatric Haematology and Oncology Study Group.
 
RESULTS. A total of 1756 cases of paediatric cancer were registered during the 10-year period. The incidence of cancer was 144.3 new cases per million children. Leukaemia was the most common form of childhood cancer (40.0%), followed by brain tumour (16.3%), and lymphoma (10.8%). The relative frequencies of neuroblastoma (2.4%) and Wilms’ tumour (3.5%) were lower than those reported from western countries.
 
CONCLUSION. The incidences and types of paediatric cancer in Hong Kong are similar to those in western countries. Collaboration with paediatric oncology groups should provide more accurate information on the incidence and survival rates of children with cancer in Hong Kong.
 
Key words: Age factors; Child; Neoplasms/epidemiology; Neoplasms/mortality; Survival rate
 
View this abstract indexed in MEDLINE:
 

Cardiopulmonary response to exercise of 8- and 13-year-old Chinese children in Hong Kong: results of a pilot study

ABSTRACT

Hong Kong Med J 1999;5:121–7 | Number 2, June 1999
ORIGINAL ARTICLE
Cardiopulmonary response to exercise of 8- and 13-year-old Chinese children in Hong Kong: results of a pilot study
RYT Sung, SSF Leung, TK Lee , JCY Cheng, PKW Lam, YY Xu
The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To assess the cardiopulmonary response of healthy Hong Kong Chinese children to the treadmill test, and to identify anthropometric factors that may be related to fitness.
 
DESIGN. Cross-sectional study.
 
SETTING. University teaching hospital, Hong Kong.
 
PARTICIPANTS. Forty-three 8-year-old and fifty-seven 13-year-old healthy Chinese children from middle– or lower–social class families in Shatin and nearby areas.
 
MAIN OUTCOME MEASURES. The forced vital capacity, 1-second forced expiratory volume, pulse rate, and blood pressure were measured before and after undertaking the treadmill test (Bruce protocol). The endurance time until volitional exhaustion, the number of metabolic equivalents of energy used, and the sum of the skinfold thicknesses were also obtained.
 
RESULTS. Multiple regression analysis showed that the sum of the skinfold thicknesses was positively associated with pulse rates and diastolic blood pressure at all stages of exercise and was negatively associated with the endurance time of and number of metabolic equivalents used by the 8-year-old children. The 13-year-old children had a longer cardiopulmonary endurance than the 8-year-old children. In both age-groups, pulmonary function was positively associated with height and weight.
 
CONCLUSION. The study provides useful reference data for Hong Kong Chinese 8- and 13-year-old children when subjected to the treadmill test. A larger study is needed to establish the normal standards for children of all different ages.
 
Key words: Adolescent; Blood pressure; Body mass index; Child; Exercise test/standards; Heart rate; Respiration; Skinfold thickness
 
View this abstract indexed in MEDLINE:
 

Geriatric screening in acute care wardsa novel method of providing care to elderly patients

ABSTRACT

Hong Kong Med J 1999;5:34–8 | Number 1, March 1999
ORIGINAL ARTICLE
Geriatric screening in acute care wards a novel method of providing care to elderly patients
JKH Luk, T Kwok, J Woo
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVE. To assess a nurse-implemented geriatric screening system.
 
DESIGN. Descriptive study.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. All (5080) elderly patients admitted between 1 January 1996 and 31 December 1996.
 
MAIN OUTCOME MEASURES. Patient characteristics such as disease, prior admission, living quarters, and regular medications; interventions taken; and morbidity and mortality.
 
RESULTS. The most common interventions were referral to a convalescent hospital, patient education, and carer contact. The overall death rate was 8.5% and the diseases with the highest mortality rates were renal failure, liver cirrhosis, and cancer. Approximately one quarter of patients had been admitted to hospital in the previous month. The death rate was higher among women than men (10.8% versus 6.7%, P<0.001; odds ratio=1.68; 95% confidence interval, 1.38-2.05), as was the percentage of those with a history of admission in the previous month (32.8% versus 20.0%, P<0.001; odds ratio=1.95; 95% confidence interval, 1.71-2.21). Patients with multiple pathologies and polypharmacy had a greater frequency of previous 1-month admission compared with those who did not have these features (37.5% versus 20.0%, P<0.001; odds ratio=2.37; 95% confidence interval 2.0-2.7). Patients living in old-age homes had a higher death rate and more previous 1-month admissions than home dwellers, and patients living in private old-age homes had a higher death rate but lower number of previous 1-month admissions than those living in subsidised old-age homes.
 
CONCLUSIONS. This study has collected important data from one form of integrated geriatric practice, which can be used for future service provision.
 
Key words: Aged; Geriatric assessment; Health services for the aged; Hospitalization; Patient care team
 
View this abstract indexed in MEDLINE:
 

Anaesthesia for liver transplantation: experience at a teaching hospital

ABSTRACT

Hong Kong Med J 1999;5:27–33 | Number 1, March 1999
ORIGINAL ARTICLE
Anaesthesia for liver transplantation: experience at a teaching hospital
SKY Fung, TWC Hui, AKY Wong, GMY Lei
Department of Anaesthesiology, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
OBJECTIVE. To assess the anaesthetic aspects of liver transplantation.
 
DESIGN. Retrospective study.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. The first 55 patients who received liver transplantations between 5 October 1991 and 14 June 1997.
 
MAIN OUTCOME MEASURES. The anaesthetic technique used; indications for liver transplantation and type of graft transplanted; survival rate; duration of anaesthesia and surgical starting time; intra-operative changes associated with major transfusion; frequency of hypothermia, coagulopathy, and reperfusion; frequency of use of cell saver devices, veno-venous bypass, and a rapid infusion system; and associated complications.
 
RESULTS. All patients received general anaesthesia with rapid sequence induction. Most adult recipients had cirrhosis from various causes, whereas biliary atresia was the most common condition in the paediatric population. Both cadaveric and living-related liver transplantations were performed, and the overall 1-year survival rate of patients who received a transplantation before June 1996 was 85%. Veno-venous bypass was used in 84% of adults, but in none of the paediatric patients; a cell saver device was used for all adult patients and 92% of paediatric patients. All transplant recipients had acidosis, hypothermia, and hypotension during the operation.
 
CONCLUSIONS. Liver transplantation is no longer experimental. It is the therapeutic option for patients with chronic liver failure. Good anaesthetic support is an essential element of a liver transplantation service.
 
Key words: Anesthesia; Intraoperative complications; Liver transplantation; Postoperative complications
 
View this abstract indexed in MEDLINE:
 

Parental anxiety associated with participation in anaesthetic induction in children: questionnaire survey

ABSTRACT

Hong Kong Med J 1999;5:21–6 | Number 1, March 1999
ORIGINAL ARTICLE
Parental anxiety associated with participation in anaesthetic induction in children: questionnaire survey
JCZ Lui, KK Wu
Department of Anaesthesia, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong
 
 
OBJECTIVE. To determine the reasons why Chinese parents for accompanying their child during anaesthetic induction; to explore the level of anxiety experienced by the parents; and to evaluate the factors that contribute to parental anxiety.
 
DESIGN. Questionnaire study of Chinese parents who had chosen to be present during the anaesthetic induction of their child between January 1997 and July 1997.
 
SETTING. Day Surgery Unit at a public hospital, Hong Kong.
 
PARTICIPANTS. One hundred and fifty-one Chinese parents of 151 children undergoing general anaesthetic for surgery.
 
MAIN OUTCOME MEASURES. Parental anxiety, as evaluated by a self-reporting rating system and the State-Trait Anxiety Scale.
 
RESULTS. More than half (56%) of the participants graded their experience as either "very anxious but tolerable" or "a little anxious", and only 2% graded the situation as "very anxious, intolerable". All participants were either "satisfied" or "very satisfied" with their experience. The type of surgery and any history of previous surgical intervention were found to be factors that determined the level of state anxiety (P<0.05).
 
CONCLUSIONS. Most Chinese parents decide to be present at their child’s anaesthetic induction because of a sense of duty and concern. Parental presence does not provoke further or intolerable parental anxiety. One limitation of this study is that the level of anxiety measured might be due to the combination of anaesthetic induction and surgery rather than to concerns about anaesthetic induction alone.
 
Key words: Anesthesia; Anxiety; Child; Parent-child relations; Preoperative care; Psychology; Questionnaires
 
View this abstract indexed in MEDLINE:
 

Pages