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Mak CM, Law EC, Lee HH, Siu WK, Chow KM, Au Yeung SK, Ngan HY, Tse NK, Kwong NS, Chan GC, Lee KW, Chan WP, Wong SF, Tang MH, Kan AS, Hui AP, So PL, Shek CC, Lee RS, Wong KY, Yau EK, Poon KH, Siu S, Poon GW, Kwok AM, Ng JW, Yim VC, Ma GG, Chu CH, Tong TY, Chong YK, Chen SP, Ching CK, Chan AO, Tam S, Lau RL, Ng WF, Lee KC, Chan AY, Lam CW. The first pilot study of expanded newborn screening for inborn errors of metabolism and survey of related knowledge and opinions of health care professionals in Hong Kong. Hong Kong Med J 2018; 24:226-237. [PMID: 29888706 DOI: 10.12809/hkmj176939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Newborn screening is important for early diagnosis and effective treatment of inborn errors of metabolism (IEM). In response to a 2008 coroners' report of a 14-year-old boy who died of an undiagnosed IEM, the OPathPaed service model was proposed. In the present study, we investigated the feasibility of the OPathPaed model for delivering expanded newborn screening in Hong Kong. In addition, health care professionals were surveyed on their knowledge and opinions of newborn screening for IEM. METHODS The present prospective study involving three regional hospitals was conducted in phases, from 1 October 2012 to 31 August 2014. The 10 steps of the OPathPaed model were evaluated: parental education, consent, sampling, sample dispatch, dried blood spot preparation and testing, reporting, recall and counselling, confirmation test, treatment and monitoring, and cost-benefit analysis. A fully automated online extraction system for dried blood spot analysis was also evaluated. A questionnaire was distributed to 430 health care professionals by convenience sampling. RESULTS In total, 2440 neonates were recruited for newborn screening; no true-positive cases were found. Completed questionnaires were received from 210 respondents. Health care professionals supported implementation of an expanded newborn screening for IEM. In addition, there is a substantial need of more education for health care professionals. The majority of respondents supported implementing the expanded newborn screening for IEM immediately or within 3 years. CONCLUSION The feasibility of OPathPaed model has been confirmed. It is significant and timely that when this pilot study was completed, a government-led initiative to study the feasibility of newborn screening for IEM in the public health care system on a larger scale was announced in the Hong Kong Special Administrative Region Chief Executive Policy Address of 2015.
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Affiliation(s)
- C M Mak
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - E Cy Law
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.,Division of Clinical Biochemistry, Queen Mary Hospital, Pokfulam, Hong Kong
| | - H Hc Lee
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - W K Siu
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - K M Chow
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - S Kc Au Yeung
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - H Ys Ngan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - N Kc Tse
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - N S Kwong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - G Cf Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - K W Lee
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - W P Chan
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - S F Wong
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - M Hy Tang
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - A Sy Kan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - A Pw Hui
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - P L So
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - C C Shek
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - R Sy Lee
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - K Y Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E Kc Yau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - K H Poon
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - S Siu
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - G Wk Poon
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - A Mk Kwok
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - J Wy Ng
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - V Cs Yim
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - G Gy Ma
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C H Chu
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | - T Y Tong
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Y K Chong
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - S Pl Chen
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - C K Ching
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - A Ok Chan
- Division of Clinical Biochemistry, Queen Mary Hospital, Pokfulam, Hong Kong
| | - S Tam
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - R Lk Lau
- Department of Pathology, Yan Chai Hospital, Tsuen Wan, Hong Kong
| | - W F Ng
- Department of Pathology, Yan Chai Hospital, Tsuen Wan, Hong Kong
| | - K C Lee
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - A Yw Chan
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - C W Lam
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Ng CM, Lam TK, Au Yeung YC, Choi CH, Iu YP, Shek CC, Tiu SC. Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing's syndrome. Hong Kong Med J 2017; 23:570-8. [PMID: 29026058 DOI: 10.12809/hkmj176240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There is a pressing need to identify diagnostic testing for Cushing's syndrome that can be achieved with ease and at low cost. This study aimed to explore the usefulness of late-night and post-overnight 1-mg dexamethasone suppression salivary cortisone, as measured by liquid chromatography-tandem mass spectrometry, for investigation of hypercortisolism. METHODS Salivary cortisone data of subjects were investigated according to a pre-specified protocol. Subjects were classified as having 'hypercortisolism' or 'eucortisolism' on the basis of histological or biochemical criteria. Receiver operating characteristic curves were drawn to identify the cut-off values and study their performance characteristics. We measured 24-hour urinary free cortisol; late-night salivary cortisol and cortisone; and post-overnight 1-mg dexamethasone suppression serum cortisol, and salivary cortisol and cortisone. Saliva and urine samples were assayed by liquid chromatography-tandem mass spectrometry. RESULTS In this study, 21 subjects were classified as having hypercortisolism and 78 as having eucortisolism. A late-night salivary cortisone cut-off of 13.50 nmol/L had a sensitivity of 94.7% and a specificity of 87.2%. After taking 1-mg dexamethasone the night before, a salivary cortisol cut-off of 0.85 nmol/L had a sensitivity of 76.2% and a specificity of 96.2%; a salivary cortisone cut-off of 7.45 nmol/L had a sensitivity of 85.7% and a specificity of 94.9%, while a salivary cortisone cut-off of 3.25 nmol/L had a sensitivity of 95.2% and a specificity of 79.5%. Many salivary cortisol samples were below the detection limit of liquid chromatography-tandem mass spectrometry. In comparison with salivary cortisol, salivary cortisone had a better correlation with total serum cortisol and better diagnostic performance following dexamethasone suppression. CONCLUSIONS Both late-night and post-overnight dexamethasone suppression salivary cortisone levels are of diagnostic value in the investigation of hypercortisolism.
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Affiliation(s)
- C M Ng
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - T K Lam
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - Y C Au Yeung
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - C H Choi
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - Y P Iu
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - C C Shek
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - S C Tiu
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
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Chan AOK, But WM, Lee CY, Lam YY, Ng KL, Loung PY, Lam A, Cheng CW, Shek CC, Wong WS, Wong KF, Wong MY, Tse WY. Aetiological bases of 46,XY disorders of sex development in the Hong Kong Chinese population. Hong Kong Med J 2015; 21:499-510. [PMID: 26492835 DOI: 10.12809/hkmj144402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Disorders of sex development are due to congenital defects in chromosomal, gonadal, or anatomical sex development. The objective of this study was to determine the aetiology of this group of disorders in the Hong Kong Chinese population. SETTING Five public hospitals in Hong Kong. PATIENTS Patients with 46,XY disorders of sex development under the care of paediatric endocrinologists between July 2009 and June 2011. MAIN OUTCOME MEASURES Measurement of serum gonadotropins, adrenal and testicular hormones, and urinary steroid profiling. Mutational analysis of genes involved in sexual differentiation by direct DNA sequencing and multiplex ligation-dependent probe amplification. RESULTS Overall, 64 patients were recruited for the study. Their age at presentation ranged from birth to 17 years. The majority presented with ambiguous external genitalia including micropenis and severe hypospadias. A few presented with delayed puberty and primary amenorrhea. Baseline and post-human chorionic gonadotropin-stimulated testosterone and dihydrotestosterone levels were not discriminatory in patients with or without AR gene mutations. Of the patients, 22 had a confirmed genetic disease, with 11 having 5α-reductase 2 deficiency, seven with androgen insensitivity syndrome, one each with cholesterol side-chain cleavage enzyme deficiency, Frasier syndrome, NR5A1-related sex reversal, and persistent Müllerian duct syndrome. CONCLUSIONS Our findings suggest that 5α-reductase 2 deficiency and androgen insensitivity syndrome are possibly the two most common causes of 46,XY disorders of sex development in the Hong Kong Chinese population. Since hormonal findings can be unreliable, mutational analysis of the SRD5A2 and AR genes should be considered the first-line tests for these patients.
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Affiliation(s)
- Angel O K Chan
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - W M But
- Department of Paediatrics, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - C Y Lee
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Shamshuipo, Hong Kong
| | - Y Y Lam
- Department of Paediatrics and Adolescent Medicine, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - K L Ng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong
| | - P Y Loung
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong
| | - Aimen Lam
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong
| | - C W Cheng
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - C C Shek
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - W S Wong
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K F Wong
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - M Y Wong
- Department of Paediatrics, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - W Y Tse
- Department of Paediatrics, Queen Elizabeth Hospital, Jordan, Hong Kong
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Lee KF, Chan AOK, Fok JMC, Mak MWH, Yu KC, Lee KM, Shek CC. Late presentation of simple virilising 21-hydroxylase deficiency in a Chinese woman with Turner's syndrome. Hong Kong Med J 2013; 19:268-71. [PMID: 23732434 DOI: 10.12809/hkmj133717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency is a well-known disorder of sexual development (previously known as ambiguous genitalia) in genotypic female neonates. We report on a 66-year-old Chinese, brought up as male, with a simple virilising form of congenital adrenal hyperplasia associated with Turner's syndrome (karyotype 45,X/47,XXX/46,XX). His late presentation was recognised due to his exceptionally short stature and persistent sexual ambiguity. His condition was only brought to medical attention as he developed a huge abdominal mass, which later turned out to be a benign ovarian mucinous cyst. It is therefore important to look out for co-existing congenital adrenal hyperplasia in patients with Turner's syndrome and virilisation, after the presence of Y chromosome material has been excluded.
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Affiliation(s)
- K F Lee
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Kowloon, Hong Kong.
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But WM, Chan A, Lee CY, Lam A, Lam YY, Loung PY, Ng KL, Wong MY, Chan KT, Tse WY, Shek CC. Etiologies of 46,XY disorders of sex development (DSD): a collaborative study in Hong Kong. Int J Pediatr Endocrinol 2013. [PMCID: PMC3850129 DOI: 10.1186/1687-9856-2013-s1-p185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan AOK, But WM, Lee CY, Lam YY, Ng KL, Tung J, Cheung PT, Chan D, Tse WY, Shek CC. Diagnosis of 5α–reductase 2 deficiency: is measurement of dihydrotestosterone essential? Int J Pediatr Endocrinol 2013. [PMCID: PMC3892203 DOI: 10.1186/1687-9856-2013-s1-p186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chan HY, Ng CM, Tiu SC, Chan AOK, Shek CC. Hypertriglyceridaemia-induced pancreatitis: a contributory role of capecitabine? Hong Kong Med J 2012; 18:526-529. [PMID: 23223655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Capecitabine is an orally administered pro-drug of 5-fluorouracil that confers superior disease-free survival and presumably has a more favourable side-effect profile. Here we report on a patient who developed acute necrotising pancreatitis and very high triglyceride levels as well as hand-foot syndrome after receiving capecitabine for colonic cancer. Increased awareness of this potential side-effect and close monitoring of lipid levels may be warranted, especially in patients who have other conditions predisposing them to severe secondary hyperlipidaemia when using this drug.
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Affiliation(s)
- H Y Chan
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong.
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Ng YW, Chan AOK, Au Yeung YT, Lau GTC, Cheng CW, Shek CC, Tiu SC. Hyperammonaemic encephalopathy in an adult patient with citrin deficiency associated with a novel mutation. Hong Kong Med J 2011; 17:410-413. [PMID: 21979481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We report on an adult patient with citrin deficiency in Hong Kong, in whom a novel mutation was identified. The patient presented with recurrent hyperammonaemic encephalopathy due to impairment of the liver urea cycle enzyme argininosuccinate synthetase. This autosomal recessive condition is also characterised by interesting food preferences, notably aversion to carbohydrates and craving for protein-rich and/or lipid-rich foods, as well as neuropsychiatric symptoms. Plasma amino acid analysis is very useful in revealing urea cycle disorders, and mutational analysis of the SLC25A13 gene can confirm the diagnosis.
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Affiliation(s)
- Y W Ng
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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Chan AOK, But WM, Ng KL, Wong LM, Lam YY, Tiu SC, Lee KF, Lee CY, Loung PY, Berry IR, Brown R, Charlton R, Cheng CW, Ho YC, Tse WY, Shek CC. Molecular analysis of congenital adrenal hyperplasia due to 21-hydroxylase deficiency in Hong Kong Chinese patients. Steroids 2011; 76:1057-62. [PMID: 21570420 DOI: 10.1016/j.steroids.2011.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency (21OHD) is an autosomal recessive disorder due to mutation in the CYP21A2 gene. OBJECTIVE To elucidate the genetic basis of 21-hydroxylase-deficient CAH in Hong Kong Chinese patients. PATIENTS AND METHODS Mutational analysis of the CYP21A2 gene was performed on 35 Hong Kong Chinese patients with 21OHD using direct DNA sequencing and multiplex ligation-dependent probe amplification (MLPA). RESULTS The genetic findings of 21 male and 14 female patients are the following: c.293-13A/C>G (intron 2 splice site; 20 alleles), p.I172N (13), p.R356W (7), p.Q318X (4). A total of 20 mutant alleles contained gross deletion/conversion of all or part of the CYP21A2 gene. A novel mutation, c.1367delA (p.D456fs), was detected in one patient. One patient had only a heterozygous mutation detected. Out of 35 patients, 16 would have been incorrectly genotyped if either DNA sequencing or MLPA alone was used for molecular analysis. CONCLUSIONS The frequency of various mutations in the studied patients differs from those reported in other Asian populations. Gross deletion/conversion accounts for nearly one-third of the genetic defects. Therefore, laboratories must include methods for detecting point mutations as well as gross deletions/conversions to avoid misinterpretation of genotype. Genotyping has increasingly been proven to be a useful tool for supplementing, if not replacing, hormonal profiling for the diagnosis of 21OHD.
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Affiliation(s)
- Angel O K Chan
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
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But WM, Wong MY, Chow JCK, Chan WKY, Ko WT, Wu SP, Wong ML, Miu TY, Tse WY, Hung WWY, Fan TW, Shek CC. Enzyme replacement therapy for mucopolysaccharidosis VI (Maroteaux-Lamy syndrome): experience in Hong Kong. Hong Kong Med J 2011; 17:317-324. [PMID: 21813902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Mucopolysaccharidosis VI (Maroteaux-Lamy syndrome) is a very rare inherited lysosomal storage disease. We evaluated the efficacy and safety of weekly infusions of recombinant human arylsulfatase B as enzyme replacement therapy for two patients in whom this condition was advanced. The primary outcome variables were the distance walked in a 6-minute walk test, forced vital capacity, and ejection fraction. The secondary outcome variables were the number of stairs climbed in a 3-minute stair climbing test, joint mobility, urinary glycosaminoglycan excretion, auto-continuous positive airway pressure study and liver size. After 24 weeks of treatment, patient A walked 40 m (36%) and patient B walked 66 m (58%) more in the walk test than at baseline. After 48 weeks, in patient A the corresponding improvements were 142 m (129%) in the walk test and 33 stairs (60%) in the 3-minute stair climbing test, and in patient B the respective improvements were 198 m (174%) and 77 stairs (140%). There was a significant decline in urinary glycosaminoglycan excretion and improvement in range of motion of joints in both patients. The auto-continuous positive airway pressure study revealed improvements in patient A, while other efficacy variables remained static. There were no drug-related adverse events or allergic reactions reported during and after the infusions of recombinant human arylsulfatase B. Recombinant human arylsulfatase B significantly improves endurance and reduces urinary glycosaminoglycan excretion. The drug is generally safe and well tolerated.
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Affiliation(s)
- W M But
- Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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But WM, Lo IFM, Shek CC, Tse WY, Lam STS. Ambiguous genitalia, impaired steroidogenesis, and Antley-Bixler syndrome in a patient with P450 oxidoreductase deficiency. Hong Kong Med J 2010; 16:59-62. [PMID: 20124576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Cytochrome P450 oxidoreductase deficiency is a recently established autosomal recessive disease characterised by ambiguous genitalia, impaired steroidogenesis, and skeletal malformations, referred to as Antley-Bixler syndrome. Clinical manifestations in affected patients are highly variable. We report on a girl with P450 oxidoreductase deficiency who presented with virilisation at birth. There was transient maternal virilisation during pregnancy as well. She was initially diagnosed with congenital adrenal hyperplasia caused by 21-hydroxylase deficiency and/or aromatase deficiency. At 1 year of age, skeletal abnormalities suggestive of Antley-Bixler syndrome were detected. Molecular analysis of the fibroblast growth factor receptor 2 (FGFR2) gene was normal but POR gene analysis showed that she was homozygous for an R457H missense mutation. The diagnosis, P450 oxidoreductase deficiency, was confirmed. Results of her endocrine studies and urinary steroid profiling are also presented.
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Affiliation(s)
- W M But
- Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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Tiu SC, Chan AOK, Taylor NF, Lee CY, Loung PY, Choi CH, Shek CC. Use of urinary steroid profiling for diagnosing and monitoring adrenocortical tumours. Hong Kong Med J 2009; 15:463-470. [PMID: 19966352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
It has been suggested that urinary steroid profiling may be used to provide information aiding the diagnosis and monitoring of adrenocortical carcinoma. Nonetheless, the abnormal patterns suggestive of adrenal malignancy are not well defined. We retrospectively studied the urinary steroid profiles of five patients with adrenocortical carcinoma at presentation and at follow-up, and compared these results with those from 76 patients with benign adrenocortical adenoma and 172 healthy controls. Three abnormal patterns of urinary steroid excretion were identified in patients with adrenocortical carcinoma at presentation and/or follow-up of residual disease: (1) hypersecretion in multiple steroid axes; (2) excretion of unusual metabolites, notably 5-pregnene-3alpha,16alpha,20alpha-triol, 5-pregnene-3beta,16alpha,20alpha-triol, and neonatal steroid metabolites in the post-neonatal period; (3) increase of tetrahydro-11-deoxycortisol relative to total cortisol metabolites. These preliminary findings offer ways in which urinary steroid profiling performed using gas chromatography-mass spectrometry can be helpful in the diagnosis and monitoring of adrenocortical carcinoma.
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Affiliation(s)
- S C Tiu
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Chan AOK, But BWM, Lau GTC, Lam ALN, Ng KL, Lam YY, Lee CY, Shek CC. Diagnosis of 5alpha-reductase 2 deficiency: a local experience. Hong Kong Med J 2009; 15:130-135. [PMID: 19342739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
5Alpha-reductase 2 deficiency is an autosomal recessive disorder characterised by lack of masculinisation in XY individuals due to failure to convert testosterone to dihydrotestosterone, the bioactive androgen. Traditionally, the testosterone-to-dihydrotestosterone ratio is used to diagnose this condition but interpreting these results is not always straightforward, thus they may be inconclusive. On the contrary, urinary steroid profiling unambiguously demonstrates a significantly reduced excretion of 5alpha-reduced steroid metabolites compared to their 5beta counterparts. This analytical technique can also simultaneously confirm or rule out other causes of ambiguous genitalia due to steroidogenic defects. Making a DNA-based diagnosis by studying the SRD5A2 gene has become increasingly popular. Here, we report six Chinese patients from different families who were all diagnosed with 5alpha-reductase 2 deficiency based on urinary steroid profile findings and mutational analysis of the SRD5A2 gene. R227Q was the most commonly identified mutation in these patients. Management of sexual development disorders is also discussed.
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Affiliation(s)
- Angel O K Chan
- Department of Pathology, Queen Elizabeth Hospital, Gascoigne Road, Hong Kong.
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Cheung CY, Chan AOK, Chan YH, Lee KC, Chan GPT, Lau GTC, Shek CC, Chau KF, Li CS. A rare cause of nephrotic syndrome: lipoprotein glomerulopathy. Hong Kong Med J 2009; 15:57-60. [PMID: 19197098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Lipoprotein glomerulopathy is a rare kidney disease in which lipoprotein thrombi are seen in the glomerular capillaries. Most of these patients are found in Japan and East Asian countries. The presenting symptoms include proteinuria, an abnormal plasma lipoprotein profile that resembles type III hyperlipoproteinaemia, and a marked increase in serum apolipoprotein E concentration. Previous studies have suggested that lipoprotein glomerulopathy might be related to APOE gene mutation. No effective therapeutic regimen has been established for lipoprotein glomerulopathy. We report the first case of biopsy-proven lipoprotein glomerulopathy in Hong Kong in a patient who presented with nephrotic syndrome and dyslipidaemia. DNA analysis revealed apolipoprotein E Kyoto together with a novel apolipoprotein E mutation, apolipoprotein E (Asp230Tyr) Hong Kong. There was significant improvement in the clinical parameters and resolution of symptoms after the introduction of statins. Further studies will be needed to clarify the role of apolipoprotein E Hong Kong and its interaction with apolipoprotein E Kyoto in the pathogenesis of lipoprotein glomerulopathy.
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Affiliation(s)
- C Y Cheung
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Chan AOK, Taylor NF, Tiu SC, Shek CC. Reference intervals of urinary steroid metabolites using gas chromatography-mass spectrometry in Chinese adults. Steroids 2008; 73:828-37. [PMID: 18452960 DOI: 10.1016/j.steroids.2008.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/10/2008] [Accepted: 03/11/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary steroid profiling by GC or GC-MS are established clinical tools to complement other biochemical tests in the diagnosis and investigation of a wide range of adrenocortical disorders, but normative data on adults using the more specific GC-MS are lacking. Our objective was to set up the reference intervals of commonly detected urinary steroid metabolites as well as marker metabolites seen in disease states. METHOD Apparently healthy adult Chinese males and females were recruited by completing health questionnaires. A 24-h urine specimen was collected from all the participants for urinary steroid profiling by GC-MS in cyclic scan mode. The analyzer was calibrated by using authentic steroid standards. Statistical methods recommended by the National Committee for Clinical Laboratory Standards were followed for setting up the reference intervals of various steroid metabolites. After outliers were excluded, the data were tested for the necessity to partition into sex-, menopausal status- and age-specific reference intervals. RESULTS 83 males and 89 females were recruited for the study. Necessity to partition into sex-specific reference intervals was demonstrated for almost all steroid metabolites. Menopausal status and age also had a significant impact on steroid metabolite excretion, making separate reference intervals necessary. CONCLUSIONS We have set up the normative data on the levels of urinary steroid metabolite excretion in Chinese adults for future reference in patient management and research in steroid metabolism.
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Affiliation(s)
- Angel O K Chan
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
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Chan AOK, Lau JSM, Chan CH, Shek CC. Cryoglobulinaemia: clinical and laboratory perspectives. Hong Kong Med J 2008; 14:55-59. [PMID: 18239245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Cryoglobulins are immunoglobulins that precipitate in the serum upon cooling to below core body temperature and re-dissolve at higher temperatures. Cryoglobulinaemia may be life-threatening. The three types of cryoglobulinaemia are associated with a wide spectrum of haematological, autoimmune, and chronic infectious diseases, especially hepatitis C infection. Our laboratory has received 378 requests for cryoglobulin testing over the past 5 years, with a detection rate of 4.8% in the 271 patients involved. Twelve per cent of the specimens were not processed due to being at an inappropriate temperature on arrival at the laboratory. Clinicians should be aware of temperature requirements when requesting cryoglobulin testing in suspected cases, and for all relevant protein tests in patients with cryoglobulinaemia. Handling specimens at inappropriate temperatures in the pre-analytical and analytical phases of the investigation might lead to cryoprecipitation and therefore false-negative results. The potential pitfalls encountered with specimen handling, analysis, and result interpretation are discussed in detail.
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Affiliation(s)
- Angel O K Chan
- Department of Pathology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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Chan AOK, Lam CW, Tong SF, Cheng MT, Yung K, Chan YW, Au KM, Yuen YP, Hung CT, Ng KP, Shek CC. Gene symbol: BCHE. Hum Genet 2007; 121:288. [PMID: 17598201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- A O K Chan
- Chemical Pathology Laboratory, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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20
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Chan AOK, Lam CW, Tong SF, Tung CM, Yung K, Chan YW, Au KM, Yuen YP, Hung CT, Ng KP, Shek CC. Gene symbol: BCHE. Hum Genet 2007; 121:289. [PMID: 17598228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- A O K Chan
- Chemical Pathology Laboratory, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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21
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Chan AOK, But WM, Lau GTC, Tse WY, Shek CC. Gene symbol: LPL. Hum Genet 2007; 121:289. [PMID: 17598202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- A O K Chan
- Chemical Pathology Laboratory, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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Lee RSY, Lam CW, Lai CK, Yuen YP, Chan KY, Shek CC, Chan AYW, Chow CB. Carnitine-acylcarnitine translocase deficiency in three neonates presenting with rapid deterioration and cardiac arrest. Hong Kong Med J 2007; 13:66-8. [PMID: 17277394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
We report on three Chinese neonates with carnitine-acylcarnitine translocase deficiency. They presented within the first 48 hours of life. Two neonates were found in cardiac arrest; one of them survived after resuscitation. The third neonate suddenly developed cardiorespiratory insufficiency and succumbed eventually. The clustering of three cases in 5 years suggests that carnitine-acylcarnitine translocase deficiency is not rare in our Chinese population. We advocate that investigation for metabolic diseases including carnitine-acylcarnitine translocase deficiency should be performed in cases of sudden infant death and unexplained abrupt clinical deterioration in the early neonatal period. Non-ketotic hypoglycaemia is an early clue. The mainstay of initial treatment is glucose infusion at a rate greater than 7 mg/kg/minute, which inhibits beta-oxidation of fatty acids (the defective enzymatic steps in carnitine-acylcarnitine translocase deficiency) and thus prevents the accumulation of toxic long-chain acylcarnitines.
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Affiliation(s)
- Robert S Y Lee
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong.
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Ching CK, Lai CK, Poon WT, Lui MC, Lam YH, Shek CC, Mak TWL, Chan AYW. Drug-induced hypoglycaemia--new insight into an old problem. Hong Kong Med J 2006; 12:334-8. [PMID: 17028351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To review the causes of drug-induced hypoglycaemia in patients not taking hypoglycaemic medications. DESIGN Retrospective study. SETTING Regional hospitals in Hong Kong. PATIENTS Patients with suspected drug-induced hypoglycaemia without a known history of exposure to hypoglycaemic agents, referred to the Hospital Authority Toxicology Reference Laboratory from June 2005 to March 2006 inclusive. MAIN OUTCOME MEASURES Rate of positive cases, laboratory findings, possible causes, age distribution, and final outcomes. RESULTS A total of 51 such patients were referred, in whom the presence of oral hypoglycaemic agents was detected (or inferred) in 23 (45%). In 12 of the 23 patients, oral hypoglycaemic agents could only be detected by target analysis, not through broad-spectrum screening. Gliclazide and glibenclamide were detected in 14 and eight patients respectively, whereas glimepiride, nateglinide and rosiglitazone were detected in the remaining patient. Possible sources of oral hypoglycaemic agents included drug administration errors in residential care homes for the elderly (n=9), mistakenly taking medication of a family member or employer (n=6), taking stock medication by mistake (n=2), taking Chinese proprietary medicine adulterated with oral hypoglycaemic agents (n=1), taking unknown pills bought from a retail pharmacy (n=1), and unknown (n=4). Regarding these 23 patients, 17 (74%) were aged 70 years or above and 21 (91%) recovered uneventfully. CONCLUSION Hypoglycaemia due to inadvertent use of oral hypoglycaemic agents is a recognised problem, particularly in cases where family members living in the same household are taking similar medications. Possible drug administration errors in residential care homes for the elderly should be investigated, and procedures rectified if confirmed. Health care providers should be vigilant to such potential errors, especially in cases of unexplained hypoglycaemia.
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Affiliation(s)
- C K Ching
- Princess Margaret Hospital, Laichikok, Hong Kong.
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Lee SYR, Ng DK, Fung GP, Chow CB, Shek CC, Tang PM, Shiu YK, Yu VYH. Chorioamnionitis with or without funisitis increases the risk of hypotension in very low birthweight infants on the first postnatal day but not later. Arch Dis Child Fetal Neonatal Ed 2006; 91:F346-8. [PMID: 16624881 PMCID: PMC2672823 DOI: 10.1136/adc.2005.071993] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the relation between chorioamnionitis and hypotension in very low birthweight infants. METHODS Retrospective cohort study in infants with a birth weight of <1500 g born between January 2002 and September 2004. The placentas were examined for evidence of chorioamnionitis and funisitis. Hypotension was defined by the use of vasopressors. RESULTS Of 105 infants, 37 (35%) were chorioamnionitis positive. The onset of hypotension had a skewed distribution: day 1 for 30 episodes and scattered from day 2 to day 19 for the remaining 22. Of the 30 infants who developed hypotension on day 1, 17 (57%) were chorioamnionitis positive. The mean maturity of the chorioamnionitis positive group was 27.91 weeks, marginally less than the mean maturity of 29.05 weeks of the chorioamnionitis negative group (p = 0.05). After adjustment of the effects for confounding variables (birth weight, gestation, surfactant therapy, mechanical ventilation on day 1, high frequency oscillatory ventilation, patent ductus arteriosus), chorioamnionitis was the significant factor in line with hypotension developing on day 1 (adjusted odds ratio 5.14, 95% confidence interval 1.51 to 17.50). There was no evidence that hypotension developing after day 1 was associated with chorioamnionitis. CONCLUSIONS There is a strong association between chorioamnionitis and hypotension developing on day 1 in very low birthweight infants.
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Affiliation(s)
- S Y R Lee
- Princess Margaret Hospital, Kwai Chung, New Territories, Hong Kong SAR.
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Ng YW, Tiu SC, Choi KL, Chan FK, Choi CH, Kong PS, Ng CM, Shek CC. Use of lithium in the treatment of thyrotoxicosis. Hong Kong Med J 2006; 12:254-9. [PMID: 16912350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of lithium in the treatment of thyrotoxicosis, and to study the dose and serum levels at which therapeutic response occurs. DESIGN Retrospective study. SETTING Thyroid clinic of a regional hospital in Hong Kong. PATIENTS Thirteen patients with thyrotoxicosis pending therapy with radioiodine or surgery, in whom thionamides were contra-indicated due to adverse reactions or failure of treatment. MAIN OUTCOME MEASURES Free thyroxine levels, time to euthyroidism, and side-effects of lithium. RESULTS A satisfactory response, defined as a fall by 40% or more in free thyroxine levels and clinical improvement, was achieved in eight patients within 1 to 2 weeks of lithium therapy. In four others, response occurred in 3 to 5 weeks. Response was slow and inadequate in one patient due to 'escape'. The median dosage of lithium was 750 mg daily, with a range of 500 to 1500 mg daily. The median serum lithium level was 0.63 mmol/L. Lithium toxicity was observed in one patient. CONCLUSIONS A relatively low dose of lithium offers a safe and effective alternative means of controlling thyrotoxicosis in patients who cannot tolerate or do not respond to thionamides.
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Affiliation(s)
- Y W Ng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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26
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Lam YY, Lo IFM, Shek CC, Tong TMF, Ng DKK, Tong TF, Choi MS, Lam STS, Ho CS. Triple-A syndrome--the first Chinese patient with novel mutations in the AAAS gene. J Pediatr Endocrinol Metab 2006; 19:765-70. [PMID: 16789645 DOI: 10.1515/jpem.2006.19.5.765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We report on the first Chinese patient with triple-A syndrome, who presented at 22 months with status epilepticus secondary to hyponatraemia and hypoglycaemia. Subsequent endocrine investigations confirmed primary adrenal insufficiency and aldosterone deficiency. In the presence of achalasia and alacrima, this patient satisfies the diagnostic criteria of triple-A syndrome. Further molecular testing detected compound heterozygous mutations in the AAAS gene: a c.580C --> T transition in exon 7 and a c.771delG single nucleotide deletion in exon 8. Testing of parents and brother confirmed their heterozygous carrier status.
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Affiliation(s)
- Y Y Lam
- Department of Paediatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
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Yuen LK, Lam CW, Fong NC, Tang PM, Shek CC, Chan YW, Chow CB. Jervell-Lange Nielsen syndrome in a Pakistani family. Hong Kong Med J 2004; 10:351-4. [PMID: 15479966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Congenital long QT syndrome is a rare hereditary disease that is related to the dysfunction of ion channels in cardiac cells. We report on a very rare case of its autosomal recessive form--the Jervell-Lange Nielsen syndrome--in a Pakistani family, which was diagnosed after the incidental finding of bradycardia in a newborn baby girl. We discuss the range of presentations in neonates; the importance of strong suspicion of the syndrome and family screening; the use of the diagnostic criteria and genetic tests; and the different management strategies.
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Affiliation(s)
- L K Yuen
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
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28
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Chan AOK, Chan JPS, Choi KL, Shek CC. A patient with an increased troponin level without evidence of ischaemic cardiac injury. Hong Kong Med J 2004; 10:277-9. [PMID: 15299174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
A 74-year-old man was admitted for chest infection with acute exacerbation of chronic obstructive pulmonary disease. He was incidentally found to have an increased serum level of cardiac troponin I, despite the absence of symptoms and electrocardiographic evidence of ischaemic heart disease. Troponin I became undetectable after the serum was treated with polyethylene glycol, which removed any interfering antibodies. Serum cardiac troponin T was also undetectable after this treatment. Interference of the cardiac troponin I assay by heterophilic antibodies was thus confirmed. Because of the possibility of false-positive results due to immunoassay interference, clinicians should be alerted whenever laboratory findings are incompatible with the clinical picture, and should be ready to perform additional laboratory tests.
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Affiliation(s)
- A O K Chan
- Department of Pathology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Wong SF, Chow KM, Shek CC, Leung YP, Chiu A, Lam PWY, Ho LC. Measures to prevent healtcare workers from contracting severe acute respiratory syndrome during high-risk surgical procedures. Eur J Clin Microbiol Infect Dis 2004; 23:131-3. [PMID: 14712366 PMCID: PMC7087897 DOI: 10.1007/s10096-003-1068-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S F Wong
- Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Unit, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong.
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30
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Tiu SC, Choi KL, Shek CC, Lau TC. A Chinese family with familial dysalbuminaemic hyperthyroxinaemia. Hong Kong Med J 2003; 9:464-7. [PMID: 14660816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
We report the results of biochemical and genetic studies in a Chinese family with familial dysalbuminaemic hyperthyroxinaemia. Total thyroxine levels were 1.2 to 1.7 times the upper limit of the reference range and free thyroxine levels were 1.2 to 1.6 times the upper reference limit. Concentrations of thyroid-stimulating hormone (thyrotropin) and free tri-iodothyronine were normal in all family members tested. Overall, thyroid function tests showed high total thyroxine levels in five males and two females over two generations in the family. The diagnosis of familial dysalbuminaemic hyperthyroxinaemia was confirmed by the detection of a guanine to adenine missense mutation in the second nucleotide of codon 218 of the gene encoding human serum albumin, showing that the mutation in this family is the same as that previously found in Caucasian populations.
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Affiliation(s)
- S C Tiu
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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31
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Au KM, Lai CK, Yuen YP, Shek CC, Lam CW, Chan AYW. Diagnosis of dihydropyrimidine dehydrogenase deficiency in a neonate with thymine-uraciluria. Hong Kong Med J 2003; 9:130-2. [PMID: 12668826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Dihydropyrimidine dehydrogenase deficiency is an inborn error of pyrimidine metabolism characterised by thymine-uraciluria, convulsive disorders and developmental delay in paediatric patients, and an increased risk of toxicity from 5-fluorouracil treatment. This report is of the first patient with dihydropyrimidine dehydrogenase deficiency diagnosed in Hong Kong. The patient was a 2-day-old male neonate of Pakistani origin who presented with convulsions. Diagnosis was made by gas chromatographic-mass spectrometric detection of thymine-uraciluria and by molecular detection of a G to A point mutation in a 5'-splicing site leading to skipping of exon 14 in the DPYD gene of chromosome location 1q22. The results showed that the patient and his mother were homozygous and the father heterozygous for the splice site mutation. The mother also had thymine-uraciluria but was clinically asymptomatic.
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Affiliation(s)
- K M Au
- Department of Pathology, Princess Margaret Hospital, Princess Margaret Hospital Road, Laichikok, Hong Kong
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Choi CH, Tiu SC, Shek CC, Choi KL, Chan FKW, Kong PS. Use of the low-dose corticotropin stimulation test for the diagnosis of secondary adrenocortical insufficiency. Hong Kong Med J 2002; 8:427-34. [PMID: 12459599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVE To assess the clinical utility and safety of the low-dose corticotropin stimulation test in the diagnosis of secondary adrenocortical insufficiency. DESIGN Prospective study. SETTING Regional hospital, Hong Kong. PARTICIPANTS Seventy-two Chinese patients with suspected secondary adrenocortical insufficiency. MAIN OUTCOME MEASURE Serum cortisol response during the low-dose corticotropin stimulation test, using the insulin tolerance test as the gold standard. RESULTS The 30-minute cortisol level during the low-dose corticotropin stimulation test was most closely correlated (r=0.79) with the peak cortisol level achieved during the insulin tolerance test. The optimum sensitivity and specificity of the low-dose corticotropin stimulation test were obtained at a cut-off value of 550 nmol/L or more for the 30-minute cortisol level. Using the insulin tolerance test as the gold standard for comparison, the low-dose corticotropin stimulation test had a sensitivity of 97%, a specificity of 78%, a positive predictive value of 81%, and a negative predictive value of 97% at this cut-off value. The positive likelihood ratio was 4.4 and the negative likelihood ratio 0.04. CONCLUSION The low-dose corticotropin stimulation test, using the cortisol response at 30 minutes after synacthen 1 microg is a safe, convenient, and sensitive method for screening abnormalities of the hypothalamic-pituitary-adrenocortical axis in Chinese patients suspected of having secondary adrenocortical insufficiency.
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Affiliation(s)
- C H Choi
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Lam CW, Poon PM, Tong SF, Lo AW, Lai CK, Choi KL, Tiu SC, Chan YW, Shek CC. Novel mutation and polymorphisms of the HMBS gene detected by denaturing HPLC. Clin Chem 2001; 47:343-6. [PMID: 11159788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- C W Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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Cheng YL, Shek CC, Tsang DN, Li CS, Lentino JR, Daugirdas JT, Kjellstrand CM, Ing TS. Stability of urea and creatinine in spent hemodialysate. Int J Artif Organs 2000; 23:670-4. [PMID: 11075896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Urea and creatinine levels in spent hemodialysates showed only small declines in spite of incubation at 37 degrees C for 36 hours. In the determination of dialysate-side solute removal, it would seem prudent to keep spent dialysate cold during collection to retard bacterial breakdown of these waste products.
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Affiliation(s)
- Y L Cheng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
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35
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Chan FK, Choi KL, Tiu SC, Shek CC, Au Yong TK. A case of giant malignant phaeochromocytoma. Hong Kong Med J 2000; 6:325-8. [PMID: 11025856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Malignant phaeochromocytoma is defined as the presence of tumour deposits at sites that are normally devoid of chromaffin cells. We report on a 63-year-old man who had a giant malignant phaeochromocytoma of the right adrenal gland that encased the inferior vena cava. The urinary excretion rates of catecholamines and their metabolites were normal, except for normetanephrine, which was excreted at a higher rate than normal. The tumour was surgically unresectable by laparotomy. Postoperatively, the patient was given a 4-month trial of subcutaneous octreotide and intravenous meta-iodobenzylguanidine I 131. Occult lung secondary tumours were first detected by meta-iodobenzylguanidine scintigraphy after 2 years, and the patient died of bone and lung metastases 1 year later. Because phaeochromocytoma is rare, local experience in managing this disease is limited. This report alerts physicians of the methods of diagnosing and managing surgically unresectable malignant phaeochromocytoma.
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Affiliation(s)
- F K Chan
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Abstract
The area under the concentration time curve (AUC) for oral tacrolimus (FK) may provide a more precise model for FK monitoring after renal transplantation. The purpose of this study is to identify a simple, cost-effective method for predicting FK AUC. FK concentrations were measured at 0, 1, 2, 4, 6, 8, and 12 hours after the morning dose. The predicted AUCs (AUC(p)s) derived from regression equations were used to estimate the actual 12-hour AUCs (AUC(12)s). The relationship between AUC(p) and AUC(12) was validated by determining the coefficient of multiple determination (R(2)), percentage of prediction error (PE%), and percentage of absolute prediction error (APE%). Eighteen stable Oriental renal transplant recipients (9 men, 9 women) with a mean age of 42.6 +/- 6 years and mean body weight of 62.7 +/- 10 kg were recruited for the study. The FK AUC(12), trough, 2-hour, and 4-hour concentrations were 125 +/- 24 h. ng/mL (range, 87.7 to 181.9 h. ng/mL), 6 +/- 1.3 ng/mL, 18.1 +/- 4.7 ng/mL, and 11 +/- 2.4 ng/mL, respectively. Trough FK concentration did not have a significant correlation with AUC(12) (r = 0.34; P = 0.17). AUC(p) obtained by a two-time point regression equation using 2-hour (C2) and 4-hour (C4) FK concentrations: (AUC(P) = 16.2 + 2.4*C2 + 5.9*C4) obtained an R(2), PE%, and APE% of 0.93, -0.2% +/- 5.2% (range, -13% to 9.3%), and 3. 6% +/- 3.7% (range, 0.02% to 13%), respectively. We conclude that a two-point sampling method using C2 and C4 may be a more cost-effective FK monitoring strategy than morning FK trough levels in transplant recipients.
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Affiliation(s)
- K M Wong
- Renal Unit, Department of Medicine, and the Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
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Abstract
Many studies showed an increased occurrence of primary hyperparathyroidism during lithium therapy. We studied 53 patients receiving lithium therapy prospectively for 2 yr. Serum PTH levels were unequivocally elevated. The baseline PTH level was 2.8 +/- 1.2 pmol/L and increased progressively to 3.9 +/- 1.5 pmol/L after 2 yr (P < 0.0005). There was no change in serum calcium, alkaline phosphatase, inorganic phosphate concentrations or tubular reabsorption of phosphate in relation to glomerular filtration rate. Fasting urinary reabsorption of calcium increased significantly (P < 0.0005), which was concordant with the PTH change. Fasting and 24-h urinary excretion of calcium decreased significantly (P < 0.0005), suggesting reduced, rather than enhanced, bone resorption as in primary hyperparathyroidism. This may be the main mechanism in maintaining normocalcemia, despite PTH elevation, during lithium therapy.
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Affiliation(s)
- T W Mak
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
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Cheng YL, Shek CC, Wong FK, Choi KS, Chau KF, Ing TS, Li CS. Determination of the solute removal index for urea by using a partial spent dialysate collection method. Am J Kidney Dis 1998; 31:986-90. [PMID: 9631843 DOI: 10.1053/ajkd.1998.v31.pm9631843] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In 22 hemodialysis patients, during a dialysis session, the solute removal index (SRI) for urea obtained from the use of a partial spent dialysate collection method was compared with that derived from the use of a total spent dialysate collection technique. The partial spent dialysate collection method was used to harvest a small representative sample of the total spent dialysate. The volumes of spent dialysate collected by the partial and the total spent dialysate collection methods were 1.7 +/- 0.4 L and 129.6 +/- 15.3 L, respectively. The total amount of urea nitrogen removed by dialysis as estimated by the partial spent dialysate collection method was similar to that determined by the total spent dialysate collection approach. As a result, the SRI value for urea obtained by the partial spent dialysate collection method (namely, 63% +/- 8%) correlated very well (r = 0.95, P < 0.001) with that derived by the total spent dialysate collection technique (namely, 62% +/- 8%). Our data suggest that it is feasible to use a simple partial spent dialysate collection method to obtain SRI results in patients treated with hemodialysis.
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Affiliation(s)
- Y L Cheng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
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39
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Lam CW, But WM, Shek CC, Tong SF, Chan YS, Choy KW, Tse WY, Pang CP, Hjelm NM. Glucose-6-phosphatase gene (727G-->T) splicing mutation is prevalent in Hong Kong Chinese patients with glycogen storage disease type 1a. Clin Genet 1998; 53:184-90. [PMID: 9630072 DOI: 10.1111/j.1399-0004.1998.tb02674.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glycogen storage disease type la (GSD1a) is an autosomal recessive metabolic disorder caused by a deficiency in glucose-6-phosphatase (G6Pase). We analyzed the G6Pase genes of two unrelated Chinese families with GSD1a. DNA sequencing of all five exons and the exon-intron boundaries revealed a G T transversion at nucleotide 727 (727G-->T) in exon 5, which has previously been reported to cause abnormal splicing. In one family, the subject and her affected sister were confirmed to be homozygous for this mutation and their parents to be heterozygotes. In the other family, the proband was identified to be heterozygous for this mutation, and a novel mutation, the 341delG in exon 2, was identified. This mutation alters the reading frame and creates a stop codon TAA 15 codons downstream from the mutation, resulting in a truncated protein. Family studies revealed that the father was heterozygous for the 727G-->T mutation and that the mother was heterozygous for the 341delG mutation. This is the first time that the 727G T mutation has been found in Chinese patients or outside Japan. Since we only tested two GSD1a families and found 727G-->T in both, we believe that this mutation may also be prevalent in our local Chinese population. To investigate allele frequencies, we screened 385 Chinese healthy volunteers and found two asymptomatic carriers. Our findings suggest that the 727G-->T mutation is indeed prevalent in Hong Kong.
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Affiliation(s)
- C W Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin.
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Pang CP, Law LK, Mak YT, Shek CC, Cheung KL, Mak TW, Lam CW, Chan AY, Fok TF. Biochemical investigation of young hospitalized Chinese children: results over a 7-year period. Am J Med Genet 1997; 72:417-21. [PMID: 9375724 DOI: 10.1002/(sici)1096-8628(19971112)72:4<417::aid-ajmg9>3.0.co;2-n] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During the seven years from January 1989 to December 1995, we investigated 2,269 Chinese infants and young children for metabolic disorders in Hong Kong. These young patients, all aged under 4 years and originated from southern China, were ill with no apparent cause and had clinical manifestations suggestive of inherited metabolic diseases. A spot urine and a plasma sample were obtained from each patient for biochemical analysis, including urinary organic acid identification and plasma amino acid analysis. Six cases of mucopolysaccharidosis, four multiple carboxylase deficiency, three 2-methylacetoacetyl CoA thiolase deficiency, two methymalonic aciduria, one glutaric aciduria type I, one glutaric aciduria type II, one a-oxoglutaric aciduria, and one case of orotic aciduria were detected. There were also single suspected cases of medium-chain acyl-CoA dehydrogenase deficiency and isovaleric aciduria. No primary amino acid disorder, such as phenylketouria and maple syrup urine disease, has been detected. Our results suggest that a different pattern of inherited metabolic diseases exists in the southern Chinese when compared with the Chinese in other regions of China.
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Affiliation(s)
- C P Pang
- Department of Chemical Pathology, Chinese University of Hong Kong, Shatin, N.T
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41
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Abstract
The pharmacokinetics of lithium was studied in 16 manic-depressive Chinese adults who were on lithium therapy in Hong Kong. A two-compartment open model was used to describe the plasma data obtained. The steady-state volume of distribution and total plasma clearance were estimated to be 63.4 +/- 38.3 L and 1.47 +/- 0.49 L/hr, respectively, which were similar to those reported in studies of Caucasian subjects. The lithium clearance was found to be significantly related to lean body mass (r = 0.646, p < 0.01) but not to either total body weight, age, or creatinine clearance. Interindividual variability in lithium clearance was substantially reduced to a coefficient of variation of 24.6% from 33.3% when lean body mass was considered. The combined plasma and urine data indicate that the rate and extent of lithium absorption were similar to those of earlier studies in Caucasian subjects on a standard lithium dosage.
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Affiliation(s)
- Y K Wing
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
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Cheng YL, Shek CC, Wong AK, Wong FK, Chau KF, Li CS. A partial dialysate collection method. Int J Artif Organs 1997; 20:14-7. [PMID: 9062826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study validates Ing's partial dialysate collection method, which employs proportionate collection using a side tube capped with a small-gauge plastic needle. The urea nitrogen and creatinine levels of the small representative fraction of spent dialysate collected in the above fashion are undistinguishable from those obtained from the total spent dialysate. The estimated urea nitrogen removed during hemodialysis using this approach is similar to that using the total dialysate collection method; Ing's method is simple and useful in quantifying the dialysis dosage and in its assessment of the nutritional status of patients on hemodialysis.
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Affiliation(s)
- Y L Cheng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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Tomlinson B, Mak TW, Tsui JY, Woo J, Shek CC, Critchley JA, Masarei JR. Effects of fluvastatin on lipid profile and apolipoproteins in Chinese patients with hypercholesterolemia. Am J Cardiol 1995; 76:136A-139A. [PMID: 7604789 DOI: 10.1016/s0002-9149(05)80036-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effects of fluvastatin treatment on lipid profile and apolipoproteins were assessed in a group of 31 Chinese patients with hypercholesterolemia, maintained on a constant low-fat diet. Some patients had the additional cardiovascular risk factors of hypertension and non-insulin-dependent diabetes mellitus, and 6 patients had familial hypercholesterolemia. Baseline lipid levels were measured after a 4-week placebo period, and these were repeated after 4 weeks of treatment with fluvastatin 20 mg daily, and after 4 weeks of treatment with fluvastatin 40 mg daily. Total cholesterol, low density lipoprotein cholesterol, and apolipoprotein (apo) B were each reduced to the same extent with the 2 doses of fluvastatin (-20%, -26%, and -20%, respectively). Triglycerides and very low density lipoprotein cholesterol were also reduced by about 12% with the 2 doses of fluvastatin. Apo A-I was increased by 7% and high density lipoprotein cholesterol (HDL-C) was increased by 10% with the 40 mg dose. The increase in HDL-C was due to increases in both HDL2-C (18%) and HDL3-C (7%). Lipoprotein(a) levels did not show any significant change with the 2 doses of fluvastatin in this short-term study. One patient developed reversible asymptomatic elevation of liver enzymes with the higher dose of fluvastatin; otherwise the drug was well tolerated and no patients had to be withdrawn from the study.
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Affiliation(s)
- B Tomlinson
- Department of Clinical Pharmacology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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Affiliation(s)
- G W Wong
- Department of Pediatrics, Chinese University of Hong Kong, Shatin, New Territories
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Chan TY, Chan CH, Shek CC. The prevalence of hypercalcaemia in pulmonary and miliary tuberculosis--a longitudinal study. Singapore Med J 1994; 35:613-5. [PMID: 7761888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We studied the prevalence of hypercalcaemia in 34 Chinese patients with pulmonary (n = 32) or miliary (n = 2) tuberculosis. None of these subjects were given vitamin D or calcium supplements. Plasma calcium levels were measured at presentation and at 1- to 2-monthly intervals after treatment. During the 6-month study period, two patients (6%) developed hypercalcaemia (plasma calcium greater than 2.51 mmol/l), as compared to figures of 16% to 28% in the United States and India. By correcting the plasma calcium to a normal albumin, five (15%) of our patients were hypercalcaemic, as compared to a figure of 48% in Greece. Apart from variations in methodology, discrepancies in the reported prevalence of hypercalcaemia in tuberculosis may be due to differences in sun exposure, and vitamin D and calcium intake.
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Affiliation(s)
- T Y Chan
- Department of Clinical Pharmacology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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Abstract
Four Chinese female patients who suffered from manic-depressive disorder and underlying autoimmune thyroiditis developed transient episodes of thyrotoxicosis during maintenance lithium therapy. Endocrinologically speaking, three of them had "Hashitoxicosis", while the other had silent lymphocytic thyroiditis. Albeit rare among Western patients, such lithium-associated thyroid dysfunctions appeared to be more likely to occur in Hong Kong Chinese. They seemed to involve multiple aetiological factors, such as autoimmune thyroid disease, the toxic and immunomodulatory roles of lithium and perhaps genetic and dietary factors. Because of their self-limiting nature, the importance of avoiding unnecessary and potentially deleterious antithyroid treatment is emphasised.
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Affiliation(s)
- C C Chow
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT
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Panesar NS, Yeung VT, Chan JC, Shek CC, Nicholls MG, Cockram CS. 17 alpha-Hydroxylase deficiency with persistence of müllerian ducts in a genotypic male and paradoxical aldosterone secretion. Postgrad Med J 1993; 69:159-62. [PMID: 8506204 PMCID: PMC2399616 DOI: 10.1136/pgmj.69.808.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report a case of congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency in a Chinese genotypic male patient. Despite the male genotype, normal female external genitalia were present and with the introduction of cyclical oestrogen therapy withdrawal bleeding occurred, confirming the presence of functional endometrial tissue. We believe this to be the first report of persistent Mullerian duct structures in a genotypic male with 17 alpha-hydroxylase deficiency. It could be explained by either impaired secretion or impaired action of anti-Mullerian hormone. Further, contrary to the usual finding of suppressed aldosterone secretion, this patient had measurable levels of plasma aldosterone.
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Affiliation(s)
- N S Panesar
- Department of Chemical Pathology, Chinese University of Hong Kong, Shatin, N.T
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Chan TY, Chan CH, Shek CC, Davies PD. Hypercalcemia in active pulmonary tuberculosis and its occurrence in relation to the radiographic extent of disease. Southeast Asian J Trop Med Public Health 1992; 23:702-4. [PMID: 1298076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The prevalence of hypercalcemia in tuberculosis in Hong Kong and its occurrence in relation to the radiographic extent of disease were studied in 57 patients with sputum smear (n = 44) and/or culture positive (n = 13) pulmonary tuberculosis and in five patients with military tuberculosis prior to treatment. Only one (1.6%) patient had a corrected plasma calcium level above the reference range for our laboratory. There was a positive relationship between the corrected plasma calcium levels and the radiographic extent of disease (r = 0.37), p < 0.01). As the occurrence of hypercalcemia in tuberculosis is known to be influenced by the calcium intake, our finding of a low prevalence of "absolute" hypercalcemia in Hong Kong could be related to the low dietary calcium intake in these subjects.
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Affiliation(s)
- T Y Chan
- Department of Clinical Pharmacology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT
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Abstract
Fifty Chinese psychiatric patients on chronic lithium treatment and the same number of sex- and age-matched control outpatients were assessed by a thyroidologist and underwent laboratory investigations. Lithium patients had a higher rate of goitres (50% vs 10%, P < 0.0001) and a higher mean TSH level (P < 0.005) than controls. Thyroid antibodies were detected in 7 older manic-depressive patients as opposed to 1 control, but not in patients with recurrent unipolar mania. Five patients, but no controls, had single or multiple episodes of hyperthyroidism, which was followed in 2 of them by biochemical hypothyroidism. It is suggested that variations in iodine status, dietary goitrogens, immunogenetic makeup and their complex interactions with chronic lithium treatment may contribute to ethnically different patterns of thyroid abnormalities.
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Affiliation(s)
- S Lee
- Department of Psychiatry, Chinese University of Hong Kong, Shatin
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Chan EL, Lau E, Shek CC, MacDonald D, Woo J, Leung PC, Swaminathan R. Age-related changes in bone density, serum parathyroid hormone, calcium absorption and other indices of bone metabolism in Chinese women. Clin Endocrinol (Oxf) 1992; 36:375-81. [PMID: 1424171 DOI: 10.1111/j.1365-2265.1992.tb01463.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study the age-related changes in bone density, serum parathyroid hormone, calcium absorption and other indices of calcium metabolism in Chinese women who habitually have a low calcium intake. DESIGN Cross-sectional study. SUBJECTS One hundred and fifty-six healthy Chinese women aged 20-83 years. None were on any medication or vitamin supplements. Subjects over the age of 60 years were all living in a hostel; younger subjects were nurses or subjects attending a family clinic for minor illnesses. MEASUREMENTS Fasting blood and urine samples were collected for biochemical measurements and calcium absorption was measured using 45Ca by the method of Marshall and Nordin. Bone density was measured by dual energy X-ray densitometry (Norland X R20 X-ray bone densitometer) at the left hip and lumbar spine. Serum parathyroid hormone was measured by a chemiluminometric assay. RESULTS Plasma ionized calcium concentration, alkaline phosphatase, bicarbonate, plasma creatinine and serum B2 microglobulin were significantly higher in the elderly than in the young, whereas plasma phosphate and the anion gap were higher in the young. Urinary excretion of calcium, phosphate and hydroxyproline were all higher in older women. Plasma parathyroid hormone concentration was positively correlated with age even after taking into account the decline in renal function (as indicated by the rise in B2 microglobulin (r = 0.506, P less than 0.001). Serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were not lower in the older women. Fractional calcium absorption from an oral load of radiolabelled calcium was significantly lower in the older women and 37% of the older women were below the 2.5 percentile found in the younger women. Bone density measured by dual energy X-ray densitometry was also significantly lower in the elderly. CONCLUSION In Chinese women there is an increase in PTH and a decrease in calcium absorption with age in spite of the presence of normal vitamin D metabolites.
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Affiliation(s)
- E L Chan
- Department of Chemical Pathology, Prince of Wales Hospital, Shatin, NT, Hong Kong
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