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Xu L, Shek KW, Wong KC, Tong KL, Hau MN. Megacolon as the presenting feature of multiple endocrine neoplasia type 2B: a case report. Hong Kong Med J 2020; 25:483-486. [PMID: 32127501 DOI: 10.12809/hkmj197827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- L Xu
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K W Shek
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K C Wong
- Department of Surgery, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K L Tong
- Department of Surgery, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - M N Hau
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
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Lo YJ, Fung A, Lai YL, Lau CH, Tong KL. Gastric Volvulus ‐ Two Ends of the Spectrum. Surg Pract 2018. [DOI: 10.1111/1744-1633.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- YJ Lo
- Surgical DepartmentQueen Elizabeth Hospital Hong Kong
| | - A Fung
- Surgical DepartmentQueen Elizabeth Hospital Hong Kong
| | - YL Lai
- Surgical DepartmentQueen Elizabeth Hospital Hong Kong
| | - CH Lau
- Surgical DepartmentQueen Elizabeth Hospital Hong Kong
| | - KL Tong
- Surgical DepartmentQueen Elizabeth Hospital Hong Kong
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Cheng HM, Tang HL, Poon CKY, Lau CL, Tong KL, Lam CM, Yim KF, Cheuk A, Lee W, Fung SKS. FP529THE EFFECT OF NOCTURNAL HOME HEMODIALYSIS ON LEFT VENTRICULAR HYPERTROPHY IN END STAGE RENAL DISEASE PATIENTS - A SIX YEARS STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hiu-Man Cheng
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Hon-Lok Tang
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Clara Ka-Yan Poon
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Chun-Leung Lau
- Cardiology Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Kwok-Lung Tong
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Chung-Man Lam
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Ka-Fai Yim
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Au Cheuk
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - William Lee
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Samuel Ka-Shun Fung
- Renal Unit, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
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Tang HL, Poon CKY, Lam BHS, Lee SH, Kong LL, Lee W, Cheuk A, Yim KF, Tong KL, Fung SKS. MP603OCCULT HEPATITIS B VIRUS INFECTION IN A COHORT OF HEMODIALYSIS PATIENTS IN HONG KONG. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw198.20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Duchenne J, Popara-Voica AM, Duchenne J, Aruta P, Teo HK, Onciul S, Miskowiec D, Onciul S, Rumbinaite E, Abellard JA, Turco A, Claus P, Vunckx K, Pagourelias E, Rega F, Gheysens O, Voigt JU, Croitoru A, Alexandru D, Geavlete DO, Popescu BA, Ginghina C, Jurcut R, Claus P, Turco A, Vunckx K, Pagourelias E, Haemers P, Van Puyvelde J, Gheysens O, Rega F, Voigt JU, Muraru D, Janei C, Haertel Miglioranza M, Cavalli G, Romeo G, Peluso D, Cucchini U, Iliceto S, Badano L, Kui SL, Chai SC, Leong KT, Tong KL, Muraru D, Miglioranza MH, Cucchini U, Dorobantu M, Iliceto S, Badano LP, Kupczynska K, Uznanska-Loch B, Kasprzak JD, Kurpesa M, Lipiec P, Muraru D, Miglioranza MH, Cucchini U, Dorobantu M, Iliceto S, Badano LP, Vaskelyte JJ, Lapinskas T, Karuzas A, Zvirblyte R, Viezelis M, Jonauskiene I, Gustiene O, Slapikas R, Trochu JN, Gueffet JP, Cueff C, De Groote P, Bauters C, Millaire A, Polge AS, Le Tourneau T. HIT Moderated Poster session: imaging in everyday practiceP143Relationship of FDG-PET and pressure-strain loops as novel measures of regional myocardial workload in LBBB-like dyssynchronyP144Cardiotoxicity of anti-vascular endothelial growth factor therapies: results of a pilot studyP145A new animal model of rapid pacing-induced dilated cardiomyopathy and LBBBP146Three-dimensional echocardiography assessment of the systolic variation of effective regurgitant orifice area in patients with functional tricuspid regurgitation: implications for quantificationP147Clinical prognostic value of myocardial mechanics using speckle-tracking echocardiography in patients post primary coronary intervention for acute ST- segment elevation myocardial infarctionP148Relationship between left atrial volumes and emptying fractions and parameters of infarct size and left ventricular filling pressures in survivors of st elevation myocardial infarctionP149Left atrial dysfunction assessed by two dimensional speckle tracking echocardiography in patients with impaired left ventricular ejection fraction and sleep-disordered breathingP150Left atrial morphological and functional remodeling early after ST elevation myocardial infarction insights from threedimensional echocardiographyP151Circumferential strain and strain rate at early stages of dobutamine speckle tracking imaging: are they enough to detect ischemia in patients with coronary artery disease?P152Pulmonary hypertension in hypertrophic cardiomyopathy: a rest and exercise echocardiography study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev261] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tang HL, Wong JHS, Poon CKY, Lau WY, Ma MKM, Cheng HM, Li JW, Wong SM, Tong KL, Choi BY, Cheng YL, Chau KF, Fung SKS. SP690ALTERNATE NIGHT NOCTURNAL HOME HEMODIALYSIS IN HONG KONG - A MULTICENTRE STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv200.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tang HL, Mak YF, Chu KH, Lee W, Fung SKS, Chan TYK, Tong KL. Minimal change disease caused by exposure to mercury-containing skin lightening cream: a report of 4 cases. Clin Nephrol 2013; 79:326-329. [PMID: 23537684] [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: 06/02/2023] Open
Abstract
Mercury is a known cause of nephrotic syndrome and the underlying renal pathology in most of the reported cases was membranous nephropathy. We describe here 4 cases of minimal change disease following exposure to mercury-containing skin lightening cream for 2 - 6 months. The mercury content of the facial creams was very high (7,420 - 30,000 parts per million). All patients were female and presented with nephrotic syndrome and heavy proteinuria (8.35 - 20.69 g/d). The blood and urine mercury levels were 26 - 129 nmol/l and 316 - 2,521 nmol/d, respectively. Renal biopsy revealed minimal change disease (MCD) in all patients. The use of cosmetic cream was stopped and chelation therapy with D-penicillamine was given. Two patients were also given steroids. The time for blood mercury level to normalize was 1 - 7 months, whereas it took longer for urine mercury level to normalize (9 - 16 months). All patients had complete remission of proteinuria and the time to normalization of proteinuria was 1 - 9 months. Mercury-containing skin lightening cream is hazardous because skin absorption of mercury can cause minimal change disease. The public should be warned of the danger of using such products. In patients presenting with nephrotic syndrome, a detailed history should be taken, including the use of skin lightening cream. With regard to renal pathology, apart from membranous nephropathy, minimal change disease should be included as another pathological entity caused by mercury exposure or intoxication.
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Affiliation(s)
- Hon-Lok Tang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China.
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Tang WM, Tong CK, Yu WC, Tong KL, Buckley TA. Outcome of adult critically ill patients mechanically ventilated on general medical wards. Hong Kong Med J 2012; 18:284-290. [PMID: 22865171] [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
OBJECTIVE. A significant number of critically ill mechanically ventilated patients are not admitted to the Intensive Care Unit but are cared for on general wards. This study looked at the outcome of these patients. DESIGN. Case series. SETTING. A 1100-bed tertiary hospital in Hong Kong. PATIENTS. All adult patients admitted in a 2.5-year period who received invasive mechanical ventilation on general medical wards without admission to Intensive Care Unit or other special care areas. INTERVENTIONS. Invasive mechanical ventilation. MAIN OUTCOME MEASURES. The observed number of deaths, the expected number of deaths as derived from the Mortality Probability Model II system admission model, and other morbidity measures. RESULTS. Among 755 patients studied, the observed number of deaths was 673, which amounts to a mortality of 89.1%. The expected number of deaths was 570. The risk-standardised mortality ratio was 1.18 (95% confidence interval, 1.09-1.28; P<0.0005). Patients with chronic obstructive pulmonary disease had the lowest mortality rate of 70.8% (P<0.005). The post-cardiac arrest subgroup had the highest mortality of 99.0%. CONCLUSIONS. There was a worse-than-predicted survival in the absence of Intensive Care Unit care for the critically ill patients who received mechanical ventilation on general wards. Patients with chronic obstructive pulmonary disease warranted more Intensive Care Unit admissions. Early discontinuation of invasive support should be seriously considered in the post-cardiac arrest patients.
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Affiliation(s)
- W M Tang
- Intensive Care Unit, Princess Margaret Hospital, Laichikok, Kowloon, Hong Kong.
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Chu KH, Cheuk A, Lee W, Yim KF, Tang HL, Fung KS, Lee KC, Tong KL, Chan HWH. Renal Bone Disease: 25-year Experience From a Single Center. Int J Organ Transplant Med 2010. [DOI: 10.1016/s1561-5413(10)60012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Tang HL, Tang CMK, Chu KH, Lee W, Cheuk A, Yim KF, Fung KS, Chan HWH, Tong KL. The first nocturnal home haemodialysis patient in Hong Kong. Hong Kong Med J 2008; 14:395-398. [PMID: 18840912] [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: 05/26/2023] Open
Abstract
We report our experience of the first use of nocturnal home haemodialysis in Hong Kong. The patient, a 40-year-old man with end-stage renal failure, was recruited into the Nocturnal Home Haemodialysis Programme at Princess Margaret Hospital in 2006. He received haemodialysis at home on alternate nights (3.5 sessions per week) for 5.5 to 6 hours per session. After 1 year of nocturnal home haemodialysis, his recombinant human erythropoietin requirement had been reduced by more than 50%. His serum phosphate level decreased by 35% and calcium phosphate product by 34%. After nocturnal home haemodialysis, his blood pressure control has been excellent and he was able to cease taking anti-hypertensive medications soon after commencing nocturnal home haemodialysis. Regression of his left ventricular hypertrophy has also been noted, with a 39% decrease in his left ventricular mass index. The haemodialysis adequacy index, weekly single-pool Kt/V, increased by 59% after switching to nocturnal home haemodialysis and his quality-of-life indices also showed significant improvement. Nocturnal home haemodialysis holds promise as an alternative dialytic therapy for patients on chronic haemodialysis in Hong Kong.
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Affiliation(s)
- H L Tang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
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Tang HL, Fung KS, Chu KH, Lee W, Cheuk A, Yim KF, Wai-Han Chan H, Tong KL. Conversion from Recombinant Human Erythropoietin to Once Every 4 Weeks Darbepoetin Alfa for Treatment of Renal Anemia in CAPD Patients. Int J Organ Transplant Med 2007. [DOI: 10.1016/s1561-5413(08)60004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, Fung KS, Chan HW, Tong KL. Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J 2006; 12:316-8. [PMID: 16912361] [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
A 34-year-old woman developed nephrotic syndrome after using a skin lightening cream that contained an extremely high level of mercury. Blood and urine mercury levels were elevated and a renal biopsy revealed minimal change disease. Membranous nephropathy was excluded using immunofluorescence and electron microscopy. Her proteinuria remitted 9 months after she stopped using the cosmetic cream. This is the first reported case in the English literature of proven minimal change disease secondary to mercury exposure. It is important that mercury poisoning due to cosmetic cream is considered in the differential diagnoses for any woman who presents with nephrotic syndrome.
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Affiliation(s)
- H L Tang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
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Tang HL, Wong SH, Chu KH, Lee W, Cheuk A, Tang CMK, Kong ILL, Fung KS, Tsang WK, Chan HWH, Tong KL. Sodium ramping reduces hypotension and symptoms during haemodialysis. Hong Kong Med J 2006; 12:10-4. [PMID: 16495583] [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: 05/06/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of sodium ramping (profiling) in reducing hypotensive episodes and symptoms during haemodialysis. DESIGN Prospective study. SETTING Regional hospital, Hong Kong. PATIENTS Thirteen patients who experienced frequent episodes of hypotension and/or symptoms such as cramps, dizziness, chest pain, nausea, vomiting, and headache during haemodialysis in the preceding 4 weeks. INTERVENTIONS Each patient was switched from standard haemodialysis with a constant dialysate sodium concentration of 135 to 140 mmol/L to a ramped sodium haemodialysis for a period of 4 weeks. During this time the dialysate sodium concentration was ramped linearly downwards from 150 mmol/L at the beginning of dialysis to 140 mmol/L at the end of dialysis. MAIN OUTCOME MEASURES Intradialytic hypotensive episodes, intradialytic symptoms, nursing interventions, systolic and diastolic blood pressures, and interdialytic weight gain. RESULTS A total of 248 haemodialysis sessions undertaken by 13 patients were analysed. Switching from constant sodium haemodialysis to ramped sodium haemodialysis resulted in a significant reduction in the number of intradialytic hypotensive episodes from 5.8 (standard deviation, 6.4) to 2.2 (3.3) [P<0.05], the total number of intradialytic symptoms from 7.1 (3.4) to 0.9 (1.3) [P<0.01], and nursing interventions from 11.3 (6.3) to 1.7 (3.9) [P<0.01]. Post-dialysis systolic and diastolic blood pressures were higher during ramped sodium haemodialysis compared with constant sodium haemodialysis (systolic blood pressure, 139 [standard deviation, 23] vs 133 [22] mm Hg, P<0.001; diastolic blood pressure, 77 [11] vs 74 [13] mm Hg, P<0.01), and there was a trend towards a smaller drop in blood pressure after dialysis. The interdialytic weight gain with sodium ramping haemodialysis was greater compared with constant sodium haemodialysis (3.1 [standard deviation, 1.0] vs 2.7 [1.1] kg, P<0.001). CONCLUSION Sodium ramping during haemodialysis effectively reduces hypotensive episodes and intradialytic symptoms. Post-dialysis blood pressure is better maintained. A side-effect of sodium ramping is a greater interdialytic weight gain.
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Affiliation(s)
- H L Tang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
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Yuen SK, Mak YF, Yim KF, Cheuk A, Chu KH, Lee W, Tang HL, Fung KS, Chan HWH, Tong KL. Early Experience of C4d Staining in Renal Graft Biopsies: Two Years' Experience. Int J Organ Transplant Med 2005. [DOI: 10.1016/s1561-5413(09)60212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yeung S, Tong KL, Tsang WK, Chan HWH, Chan A. Effects of Cyclosporine and Tacrolimus on the Pharmacokinetics of Mycophenolic Acid in Renal Transplant Recipients. Int J Organ Transplant Med 2005. [DOI: 10.1016/s1561-5413(09)60213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tang HL, Chu KH, Cheuk A, Tsang WK, Chan HWH, Tong KL. Renal tubular acidosis and severe hypophosphataemia due to toluene inhalation. Hong Kong Med J 2005; 11:50-3. [PMID: 15687517] [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: 05/01/2023] Open
Abstract
A 21-year-old woman developed severe muscle paralysis after sniffing toluene-containing thinner solution for 2 weeks. Her serum chemistries revealed severe hypokalaemia and a normal anion gap hyperchloraemic metabolic acidosis secondary to renal tubular acidosis. Her initial presentation mimicked hypokalaemic periodic paralysis, but toxicology screening of her blood and urine revealed the correct diagnosis of toluene poisoning. Her electrolyte and acid-base status returned to normal 4 days after cessation of toluene sniffing. On another occasion, apart from renal tubular acidosis, the patient also developed severe hypophosphataemia with the phosphate level decreasing to 0.15 mmol/L. Hypophosphataemia with such a low phosphate level after toluene poisoning has been rarely reported in the literature. Toluene inhalation can result in multiple electrolyte and acid-base abnormalities, and should be considered in the diagnosis of any young patient who presents with unexplained hypokalaemia and normal anion gap metabolic acidosis.
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Affiliation(s)
- H L Tang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Kowloon, Hong Kong.
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Yeung S, Tsang WK, Tong KL, Wong SH, Lee W, Tang HL, Chan HWH, Chan AYW. Primary immunosuppression with tacrolimus and low-dose mycophenolate mofetil in renal transplant recipients. Transplant Proc 2004; 36:2084-6. [PMID: 15518754 DOI: 10.1016/j.transproceed.2004.08.110] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Both tacrolimus and mycophenolate mofetil (MMF) are potent immunosuppressive agents used in combination for prevention of acute rejection in renal transplantation. We studied the efficacy and safety of tacrolimus/MMF-based primary immunosuppression as well as their pharmacokinetics (PK) in Chinese renal transplant recipients. Oral tacrolimus was initiated at about 0.2 mg/kg/d, dose which was adjusted to achieve target trough levels of 10 to 20 ng/mL at 3 months and 5 to 10 ng/mL thereafter. The patients also received MMF (0.5 g bid) and prednisolone. PK profiles were studied at 1 week, and 1, 3, and 6 months posttransplant. Blood samples were taken at 0 (predose), 20, 40, 60, 75, and 90 minutes and 2, 4, 6, 8, 10, and 12 hours postdose for each profile. Plasma MPA and whole blood tacrolimus levels were determined by HPLC and EMIT methods respectively. Eight patients were studied with mean follow-up of 16.1 +/- 2.4 months. One patient (12.5%) experienced a borderline acute rejection episode. Both 1-year graft and patient survival rates were 100%. Posttransplant diabetes, diarrhea, and hand tremor occurred in 12.5%, 12.5%, and 37.5%, respectively. No patient had an opportunistic infection. Tacrolimus trough concentrations showed a fair correlation with AUC(0-12h) (R(2) = 0.587). Mean MPA AUC values at 1, 3, and 6 months were 40.5 +/- 9.4, 44.4 +/- 17.3, and 57.2 +/- 20.7 mug*h/mL, respectively (P = .0486, n = 7). In conclusion, primary immunosuppression with tacrolimus, low-dose MMF (0.5 g bid), and prednisolone is effective and safe with adequate systemic MPA exposure in renal transplant recipients.
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Affiliation(s)
- S Yeung
- Department of Medicine, Tseung Kwan O Hospital, Kowloon, Hong Kong, China.
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Chu KH, Fung KS, Tsang WK, Chan HWH, Tong KL. Nocardia peritonitis: satisfactory response to intraperitoneal trimethoprim-sulfamethoxazole. Perit Dial Int 2003; 23:197-8. [PMID: 12713090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
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Yeung S, Lee W, Tong KL, Tsang WK, Chan HWH. Effect of mycophenolate mofetil on progression of chronic allograft nephropathy. Transplant Proc 2003; 35:176-8. [PMID: 12591355 DOI: 10.1016/s0041-1345(02)03848-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Yeung
- Division of Nephrology, Princess Margaret Hospital, Hong Kong, China.
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Affiliation(s)
- W K Tsang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
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Yeung S, Yue TT, Wong SH, Tsang WK, Tong KL, Chan HWH. Steroid reduction in renal transplant recipients. Transplant Proc 2003; 35:221-2. [PMID: 12591372 DOI: 10.1016/s0041-1345(02)03909-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- S Yeung
- Division of Nephrology, Princess Margaret Hospital, Hong Kong, China.
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Affiliation(s)
- W Lee
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, SAR, Hong Kong, China
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Tong KL, Lau YS, Teo WS. A case series of drug-induced long QT syndrome and Torsade de Pointes. Singapore Med J 2001; 42:566-70. [PMID: 11989578] [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: 02/24/2023]
Abstract
INTRODUCTION Torsade de Pointes (Tdp) is a form of polymorphic ventricular tachycardia in the setting of prolonged QT interval. Any drug that prolongs repolarisation, and hence QT interval, may cause Tdp. Predisposing factors of drug-induced Tdp include female sex, bradyarrhythmia and hypokalaemia. METHODS We retrospectively analysed the case notes of 13 patients with drug-induced LQTS from 1991 to 2000 from National Heart Centre and Changi General Hospital. RESULTS Causative drugs in the series were amiodarone (seven patients, 54%), sotalol (two patients), quinidine (one patient), phenothiazine (two patients) and astemizole (one patient). There were eight females and all were Chinese. The mean age was 72 +/- nine years. The patients commonly present with syncope (38%) and cardiac arrest (38%). The mean corrected QTC interval was 545 ms. The most common precipitating factor was hypokalaemia (31%). Nine patients require cardiopulmonary resuscitation and two patients (15%) died. Nine patients (69%) had underlying structural heart disease such as ischaemic heart disease, valvular heart disease and hypertensive heart disease. The left ventricular ejection fraction was normal in six patients. The onset of Tdp ranged from Day 2 to Day 5 in the seven patient with amiodarone-induced LQTS. These were inpatients who were given intravenous loading doses of amiodarone. Both patients with sotalol-induced LQTS were females on sotalol 80 mg and 240 mg per day with Tdp occurring on Day 2 and 10 months respectively. CONCLUSION Tdp is a potentially life-threatening arrhythmia. The list of torsadogenic drugs is ever expanding. Physicians need to know the drugs which can lead to Tdp. Careful assessment of risk-benefit ratio is important before prescribing such drugs. Amiodarone-induced Tdp is not uncommon in our local population. Initiation of a class III agent, especially amiodarone, should be done judiciously, with monitoring of the QT interval and avoidance of hypokalaemia.
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Affiliation(s)
- K L Tong
- Changi Genaral Hospital, Singapore
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Lam CW, Yuen YP, Lai CK, Tong SF, Lau LK, Tong KL, Chan YW. Novel mutation in the GRHPR gene in a Chinese patient with primary hyperoxaluria type 2 requiring renal transplantation from a living related donor. Am J Kidney Dis 2001; 38:1307-10. [PMID: 11728965 DOI: 10.1053/ajkd.2001.29229] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/11/2022]
Abstract
We identified a patient with primary hyperoxaluria type 2 (PH2) showing recurrent stone formation, nephrocalcinosis, end-stage renal failure, and rapid oxalate deposition after renal transplantation from a living related donor. Urinary organic acid analysis performed after renal transplantation confirmed the diagnosis of PH2. We analyzed the glyoxylate reductase/hydroxypyruvate reductase (GRHPR) gene of the patient. DNA sequencing of all nine exons and exon-intron boundaries showed a novel homozygous mutation deleting the last two nucleotides of exon 8, ie, 862delTG. This deletion results in a frameshift and introduction of a premature stop codon at codon 310, ie, Ala310Stop. One of the patient's sisters is heterozygous for this mutation, and the other sister, who is the donor, does not have this mutation. The rapid deposition of oxalate in the transplanted kidney indicates that the kidney is not a major site of oxalate production. The more favorable long-term prognosis of PH2 needs to be reevaluated now that the molecular basis of PH2 has been established. DNA-based diagnosis will facilitate carrier detection, prenatal diagnosis, genetic counseling, and selection of living related donors.
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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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Lo WK, Tong KL, Li CS, Chan TM, Wong AK, Ho YW, Cheung KO, Kwan TH, Wong KS, Ng FS, Cheng IK. Relationship between adequacy of dialysis and nutritional status, and their impact on patient survival on CAPD in Hong Kong. Perit Dial Int 2001; 21:441-7. [PMID: 11757826] [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: 02/23/2023] Open
Abstract
OBJECTIVE Superior patient survival on continuous ambulatory peritoneal dialysis (CAPD) with 3 x 2-L exchanges has been reported from Hong Kong. This study examined the relationship between indices of dialysis adequacy and nutrition and patient survival on CAPD in Hong Kong. DESIGN A cross-sectional study on prevalent CAPD patients. Patients were assessed for indices of dialysis adequacy and nutritional status with a composite nutritional index (CNI). Patients were then followed for 24 months. Survival data were analyzed according to adequacy indices and nutritional status. SETTING All prevalent CAPD patients in nine dialysis centers in Hong Kong as of 1 April 1996. MAIN OUTCOME MEASURE Mortality. RESULTS 937 patients were assessed: 68.2% were using 3 x 2-L exchanges per day; mean age was 54.6 +/- 13 years. Mean total Kt/V was 1.83 +/- 0.42 and total creatinine clearance was 55.6 +/- 19.5 L/week/1.73 m2. 19% of patients were moderately to severely malnourished according to the CNI. There was no significant correlation between indices of adequacy and serum albumin or CNI. The 1- and 2-year patient survival from the time of assessment was 90.9% and 79.8%. There was a trend toward better survival in patients with Kt/V greater than 2.0, but it was not statistically significant. Peritoneal Kt/V did not impact survival in anuric patients. Malnourished patients had poorer survival than patients who were better nourished (p = 0.0259). After adjusting for age and diabetes, CNI was predictive of mortality but Kt/V and creatinine clearance were not. CONCLUSIONS This study demonstrates the importance of nutritional status over adequacy indices in predicting patient survival. There was a lack of correlation between nutritional status and conventional indices of dialysis adequacy.
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Affiliation(s)
- W K Lo
- Renal Unit of Tung Wah Hospital, University of Hong Kong, Hong Kong.
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Tong KL, Ding ZP. Isolated non-compaction of ventricular myocardium: a report of three cases. Ann Acad Med Singap 2001; 30:539-41. [PMID: 11603143] [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: 02/21/2023]
Abstract
INTRODUCTION Isolated non-compaction of ventricular myocardium (INVM) is a rare disorder of myocardial morphogenesis in the absence of other cardiac anomalies. Both sporadic and sex-linked recessive forms have been described. It can be identified with two-dimensional echocardiography. CLINICAL PICTURE We report a series of 3 cases of adult males with INVM in June 2000. Clinical manifestations were congestive cardiac failure with severely depressed left ventricle systolic function and stroke. One patient had biventricular INVM. CONCLUSION Early diagnosis of INVM is important as it is associated with a high incidence of cardiac failure, ventricular arrhythmia and remobilisation. Anticoagulation and screening of first-degree relatives is advisable.
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Affiliation(s)
- K L Tong
- Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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27
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Tong KL, Ding ZP, Chua T. Leopard syndrome. Singapore Med J 2001; 42:328-31. [PMID: 11599630] [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: 02/21/2023]
Abstract
The Leopard syndrome is a complex of multisystemic congenital abnormalities characterised by lentiginosis, electrocardiographic conduction abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth and deafness (sensorineural). Hypertrophic cardiomyopathy, though not included in the mnemonic, is often associated. Although the Leopard syndrome is rare, it is important to recognise it since it can be associated with serious cardiac disease. It is advisable to follow up patients with Leopard syndrome for new onset of cardiac abnormalities and to monitor the progression of existing cardiac disease. We present a case report and review of the literature of this syndrome.
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Affiliation(s)
- K L Tong
- Department of Cardiology, National Heart Centre, Singapore
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Yeung S, Tong KL, Tsang WK, Tang HL, Fung KS, Chan HW, Chan AY, Chan L. Determination of mycophenolate area under the curve by limited sampling strategy. Transplant Proc 2001; 33:1052-3. [PMID: 11267186 DOI: 10.1016/s0041-1345(00)02326-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S Yeung
- Division of Nephrology, Princess Margaret Hospital, Hong Kong, People's Republic of China
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Wenzel CL, Tong KL, Rost TL. Modular construction of the protoderm and peripheral root cap in the "open" root apical meristem of Trifolium repens cv. Ladino. Protoplasma 2001; 218:214-224. [PMID: 11770437 DOI: 10.1007/bf01306610] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Roots with open apical organization are defined by not having specific tiers of initial cells in the root apical meristem; those with closed apical organization have specific initial tiers to which all cell files can be traced. An example of the clear organization of closed roots is the development protocol of the root cap and protoderm. The key event in differentiating these tissues is the T-division, a periclinal division of the root cap/protoderm (RCP) initial that establishes a module. Each module comprises two packets, the protoderm and peripheral root cap. Consecutive T-divisions of the same RCP initial produce up to five modules on average in a lineage of cells in white clover (Trifolium repens cv. Ladino), with all lineages around the circumference of the root dividing in "waves" to form one module prior to the next. On average, clover has approximately 32 axial protoderm and peripheral root cap cells in each module, and 32 RCP lineages. The occurrence of RCP T-divisions in white clover, a root with open apical organization, and the subsequent modular construction of the root cap and protoderm, provides a link between open and closed roots and suggests a common developmental feature that most roots of seed plants may share independent of their root meristem organization type. The open apical organization of the white clover root varies from roots with closed apical organization in that the RCP initials occur in staggered positions instead of connected to discrete tiers, and the peripheral root cap and columella daughter cells form additional layers of cells. White clover also forms root hairs on all protoderm cells irrespective of their position relative to the underlying cortical cells.
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Affiliation(s)
- C L Wenzel
- Section of Plant Biology, University of California, One Shields Avenue, Davis, CA 95616, USA
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Affiliation(s)
- W K Tsang
- Renal Unit, Department of Medicine, Princess Margaret Hospital, Hong Kong, People's Republic of China
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Affiliation(s)
- S Yeung
- Department of Medicine, Division of Nephrology, Princess Margaret Hospital, Hong Kong, People's Republic of China
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32
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Affiliation(s)
- S Yeung
- Division of Nephrology, Department of Medicine, Princess Margaret Hospital, Kowloon, Hong Kong, People's Republic of China.
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Tsang WK, Tong KL, Yeung S, Lee W, Chan HW. Efficacy and safety of mycophenolate mofetil in different dosages in Asian renal allograft recipients. Transplant Proc 2000; 32:1755-6. [PMID: 11119921 DOI: 10.1016/s0041-1345(00)01389-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- W K Tsang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung, Hong Kong, People's Republic of China
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Zhang J, Tong KL, Li PK, Chan AY, Yeung CK, Pang CC, Wong TY, Lee KC, Lo YM. Presence of donor- and recipient-derived DNA in cell-free urine samples of renal transplantation recipients: urinary DNA chimerism. Clin Chem 1999; 45:1741-6. [PMID: 10508119] [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: 02/14/2023]
Abstract
BACKGROUND Previous studies have indicated that microchimerism is present in body tissues, peripheral blood, and plasma of recipients after organ transplantation. We hypothesize that donor-derived DNA may also be present in cell-free urine of renal transplant recipients and that the concentrations of urine DNA may be correlated with graft rejection. METHODS Thirty-one female patients who had renal transplantation were enrolled in the study. In women with male organ donors, the SRY gene on the Y chromosome was used as a marker for donor-derived DNA. Real-time quantitative PCR for the SRY and beta-globin genes was carried out on cell-free urinary DNA from these patients. Serial urine samples from a female renal transplant recipient undergoing an acute rejection episode were also collected and analyzed with the beta-globin quantitative PCR system. RESULTS SRY sequences were detected in the urine of 14 of 17 female patients with male organ donors. None of the 14 patients with female organ donors had detectable SRY sequences in urinary DNA. The median fractional concentration of donor-derived DNA was 8.7% (interquartile range, 1.9-26.4%). During the acute rejection episode, urinary concentrations of the beta-globin gene were markedly increased, with the concentrations returning rapidly to normal following antirejection treatment. CONCLUSIONS Our results demonstrate that urinary DNA chimerism is present following renal transplantation. The measurement of urinary DNA using quantitative PCR may be useful for the diagnosis and monitoring of graft rejection.
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Affiliation(s)
- J Zhang
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
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35
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Affiliation(s)
- C Sauder
- Vancouver General Hospital, British Columbia, Canada
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Li PK, Szeto CC, Law MC, Chau KF, Fung KS, Leung CB, Li CS, Lui SF, Tong KL, Tsang WK, Wong KM, Lai KN. Comparison of double-bag and Y-set disconnect systems in continuous ambulatory peritoneal dialysis: a randomized prospective multicenter study. Am J Kidney Dis 1999; 33:535-40. [PMID: 10070918 DOI: 10.1016/s0272-6386(99)70191-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [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: 10/22/2022]
Abstract
We performed a multicenter, single-blinded, prospective randomized study on the use of a double-bag disconnect system (B) versus a Y-set disconnect system (Y). The peritonitis rate, exit site infection, clinical outcome, and patients' acceptance to the procedure were assessed. A total of 120 new end-stage renal failure patients of three regional hospitals were randomized: 60 each to the B and the Y systems. The results of 60 patients on the B system and 51 on the Y system were analyzable. They were followed up for a median of 16 months. Peritonitis rates for the B and the Y systems were 33.5 and 29.4 patient-months per episode, respectively. Exit site infection rates for the B and Y systems were 17.4 and 16.0 patient-months per episode, respectively. Four catheters were removed in each group. Patients on the B system were hospitalized for 2.1 days per patient per year related to peritonitis and exit site infection, and those on the Y system were hospitalized for 1.2 days. There was no significant difference between the B and Y systems in the incidences of peritonitis (all causes and those due to coagulase-negative staphylococci), exit site infection, and in hospitalization days. However, there was a higher percentage of gram-positive infections in the Y system (52%) than in the B system (32%) and a lower percentage of gram-negative infections in the Y system (16%) than in the B system (32%). Patients on the B system had a better acceptance of the procedure than patients on the Y system, as assessed by a six-item, 10-point questionnaire (total score, 43.1 +/- 10.2 v 37.6 +/- 9.4; P < 0.005 at 1 month; 44.6 +/- 9.1 v 39.8 +/- 8.6; P < 0.01 at 6 months). From this study, it is concluded that the B and Y systems are similar in the incidences of peritonitis and exit site infection, although the B system is better accepted by patients. This is probably the first multicenter randomized study comparing the double-bag and Y-set disconnect system using only new patients who had never used other systems of continuous ambulatory peritoneal dialysis.
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Affiliation(s)
- P K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
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37
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Affiliation(s)
- J S Yeung
- Division of Nephrology, Princess Margaret Hospital, Hong Kong, China
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38
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Affiliation(s)
- W K Tsang
- Department of Medicine, Princess Margaret Hospital, Hong Kong, China
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39
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Cheng IK, Fang GX, Chau PY, Chan TM, Tong KL, Wong AK, Li CS, Lo WK, Cheung KO, Kumana CR. A randomized prospective comparison of oral levofloxacin plus intraperitoneal (IP) vancomycin and IP netromycin plus IP vancomycin as primary treatment of peritonitis complicating CAPD. Perit Dial Int 1998; 18:371-5. [PMID: 10505557] [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: 02/14/2023] Open
Abstract
OBJECTIVE To compare the therapeutic efficacy of daily oral levofloxacin plus intermittent intraperitoneal (IP) vancomycin (group 1) versus daily IP netromycin and intermittent IP vancomycin (group 2) in the primary treatment of peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD). DESIGN A randomized multicenter prospective open-label comparative clinical study. SETTING University and Hospital Authority hospitals in Hong Kong. PATIENTS All CAPD patients who developed bacterial or culture-negative peritonitis beyond 28 days of a previous episode and without evidence of septicemia, associated tunnel infection, or known sensitivity to trial medications were accepted into the clinical trial. RESULTS A total of 101 patients entered the trial. The primary cure rate was 74.5% for group 1 and 73.6% for group 2. Baseline culture results appeared to influence the clinical outcome: the primary cure rate for culture-negative, gram-positive, and gram-negative episodes was 83.3%, 78.6%, and 42.9% for group 1 and 69.1%, 76.9%, and 71.3% for group 2, respectively. The primary cure rate also varied considerably among individual centers and was particularly noticeable in group 1. In the latter group, it correlated closely with in vitro levofloxacin resistance which in turn correlated closely with previous exposure to fluoroquinolones. CONCLUSION Oral levofloxacin in combination with intermittent IP vancomycin has comparable efficacy to IP netromycin combined with intermittent IP vancomycin as primary treatment in CAPD peritonitis, but is simpler and more cost-effective to administer. It may be recommended as primary therapy in centers with relatively low exposure and, therefore, low background resistance to fluoroquinolones.
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Affiliation(s)
- I K Cheng
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Thumboo J, Fong KY, Chng HH, Koh ET, Chia HP, Leong KH, Koh WH, Howe HS, Leong KP, Wong MH, Chew SM, Chai P, Goh LH, Goon TJ, Lau TC, Lim WS, Pek WY, Tong KL, Yang WL, Feng PH, Boey ML. The effects of ethnicity on disease patterns in 472 Orientals with systemic lupus erythematosus. J Rheumatol Suppl 1998; 25:1299-304. [PMID: 9676760] [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: 02/08/2023]
Abstract
OBJECTIVE To determine the effects of ethnicity on disease manifestations in Oriental patients with systemic lupus erythematosus (SLE) and to describe the risk of developing renal or central nervous system (CNS) involvement with time. METHODS A retrospective study of 472 patients with SLE seen at the only Rheumatology Unit in Singapore. The effect of ethnicity on selected disease manifestations at diagnosis was assessed after adjusting for demographic variables using multiple logistic regression. The probability of developing selected disease manifestations with time was determined using the Kaplan-Meier product limit method. RESULTS At diagnosis, Malays had a higher risk of renal or CNS involvement than Chinese (OR 2.26, 95% CI 1.21 to 4.21, and OR 3.07, 95% CI 1.01 to 9.34, respectively), and Indians a lower risk of malar rash and a higher risk of oral ulcers than Chinese (OR 0.30, 95% CI 0.13 to 0.68, and OR 2.90, 95% CI 1.45 to 7.34, respectively). The prevalence of renal or CNS involvement in the entire cohort increased with time, reaching 75.6% (95% CI 66.1% to 85.0%) and 16.7% (95% CI 11.7% to 21.6%), respectively, after 18 years of disease. CONCLUSION Ethnicity influenced disease manifestations at diagnosis in this cohort of Oriental patients with SLE. Renal or CNS involvement developed in previously unaffected patients up to 18 years after diagnosis, highlighting the need for continued vigilance in patients with lupus.
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Affiliation(s)
- J Thumboo
- Department of Rheumatology and Immunology, Tan Tock Seng Hospital, National University of Singapore, Singapore
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41
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42
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Lee CC, Tong KL, Howe HS, Lam MS. Vibrio vulnificus infections: case reports and literature review. Ann Acad Med Singap 1997; 26:705-12. [PMID: 9494683] [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: 02/06/2023]
Abstract
Vibrio vulnificus is an emerging opportunistic pathogen that is responsible for one of the most fulminant food-borne diseases in immunocompromised hosts. The infection should be suspected in patients with underlying liver disorders who present with a prominent skin rash, hypotension and septic parameters especially if they give a history of seafood or shellfish ingestion. Awareness and early recognition of this infection will result in a better outcome for the patient.
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Affiliation(s)
- C C Lee
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
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Tsang WK, Ho YW, Tong KL, Chan WH, Chan A. Safety, tolerability, and pharmacokinetics of Sandimmun Neoral: conversion study in stable renal transplant recipients. Transplant Proc 1996; 28:1330-2. [PMID: 8658681] [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: 02/01/2023]
Affiliation(s)
- W K Tsang
- Department of Medicine, Princess Margaret Hospital, Hong Kong
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Tong KL, Lien CY. Do pharmaceutical representatives misuse their drug samples? Can Fam Physician 1995; 41:1363-6. [PMID: 7580385 PMCID: PMC2146346] [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: 01/26/2023]
Abstract
OBJECTIVE To determine the extent to which pharmaceutical representatives misuse their samples. DESIGN Voluntary questionnaire survey. SETTING A family practice office. PARTICIPANTS Pharmaceutical representatives visiting the office during a 3-month period. MAIN OUTCOME MEASURES Number of surveyed representatives who self-medicated, provided samples of prescription drugs to nonphysicians, or exchanged drugs with other representatives; classes of prescription drugs most commonly used; and beneficiaries. RESULTS Of the 27 representatives surveyed, 16 (59.2%) have provided prescription drug samples to individuals other than physicians. Thirteen (48.1%) either self-medicated or provided samples to friends or relatives. Seven (25.9%) have exchanged drug samples with other representatives. Eleven (40.7%) of the 27 surveyed had not sampled prescription drugs themselves, given them to others, or exchanged drugs with other representatives. The most commonly sampled drugs were nonsteroidal anti-inflammatory drugs. Drug samples were most often given to friends and spouses. CONCLUSION Self-medication and giving samples to nonphysicians were practised by almost 60% of surveyed representatives. Representatives usually caution recipients, however, and there are very few complications. Drugs with potential for abuse or dependence and cardiovascular medications were rarely used.
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Abstract
BACKGROUND The natural course of adult hepatitis B virus (HBV)-related membranous nephropathy in areas where HBV infection is endemic (characterized by vertical and horizontal transmission of HBV in early childhood) has not been fully defined. METHODS We evaluated the clinical features, pathological findings, serologic profiles, therapeutic responses, and prognoses of 21 patients with adult-onset HBV-related membranous nephropathy. The patients were followed for a mean of 60 months (range, 12 to 108). Only patients with evidence of glomerular capillary deposition of hepatitis B e antigen (HBeAg) in a renal-biopsy specimen were included. RESULTS The clinical features and serologic studies suggested that the patients had acquired chronic HBV infection in early childhood; moreover, other causes of membranous nephropathy had been excluded. All were seropositive for hepatitis B surface antigen and had high titers of antibody to hepatitis B core antigen at first clinical presentation. HBeAg was detected in the serum of 17 patients (81 percent), yet only 3 had even slightly increased plasma alanine aminotransferase levels. The clinical response to therapy with interferon alfa was disappointing; only one of the five patients treated had a complete remission with seroconversion to antibody to HBeAg. Contrary to reports of studies in children, spontaneous remission of the nephrotic syndrome or proteinuria was uncommon in the adults with HBV-related membranous nephropathy whom we studied. Proteinuria and HBV antigenemia persisted in untreated patients. During the follow-up period, 29 percent of the patients had progressive renal failure and 10 percent required maintenance dialysis therapy. CONCLUSIONS The course of HBV-related membranous nephropathy in adults in areas where HBV is endemic is not benign. Regardless of treatment, the disease has a slowly but relentlessly progressive clinical course in approximately one third of patients.
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Affiliation(s)
- K N Lai
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin
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Abstract
The clinicopathologic data of 237 Chinese patients with IgA nephropathy from Hong Kong are reviewed in an attempt to identify the features pertinent to Chinese patients. Although the nephropathy is commonest in the 26-35 year age group, 11% of the IgA nephritic patients were children below 16 years. The male predilection reported in Caucasian populations is not observed and the male:female ratio is 0.94 in our series. The commonest renal manifestation is microscopic hematuria (25%) and 19% of the patients present with macroscopic hematuria, not infrequently synpharyngitic. Nephrotic syndrome occurs in 15% of our patients and proteinuria more than 1 gm/day is documented in 58% of these IgA nephritic patients. The degree of proteinuria does not correlate with prognosis. A small proportion of these nephrotic patients respond to steroid therapy, suggesting a variant of IgA nephropathy that resembles lipoid nephrosis in its steroid-responsiveness. Seventeen percent of the patients (18/104) are hepatitis B virus carriers and 61% of these patients demonstrate viral antigens in their renal biopsies, indicating that hepatitis B virus infection may sometimes play a pathogenetic role.
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Affiliation(s)
- K N Lai
- Department of Medicine, Chinese University of Hong Kong
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Abstract
A retrospective analysis of all renal biopsies (961) performed in two regional hospitals in Hong Kong during 1977-1985 revealed that IgA nephropathy was the most frequently encountered glomerulopathy. Lipoid nephrosis (minimal change nephrotic syndrome) remained the commonest cause of nephrotic syndrome in children. The frequencies of mesangiocapillary glomerulonephritis, focal glomerulosclerosis, and idiopathic membranous nephropathy were lower than in other populations. Membranous nephropathy was frequently associated with hepatitis B virus antigenemia, especially in children. Other chronic infections did not have a significant pathogenetic role in glomerular diseases. Lupus nephritis was the commonest secondary glomerular disease in our study, and over seventy percent of the renal biopsies showed advanced pathologies with either diffuse proliferative glomerulonephritis or membranous nephropathy.
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Affiliation(s)
- F M Lai
- Renal Unit, Prince of Wales Hospital, Hong Kong
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48
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Lai KN, Lai FM, Chan KW, Chow CB, Tong KL, Vallance-Owen J. The clinico-pathologic features of hepatitis B virus-associated glomerulonephritis. Q J Med 1987; 63:323-33. [PMID: 3685245] [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: 01/06/2023]
Abstract
The frequency of hepatitis B surface antigen (HBsAg) was studied in the sera of 311 patients with various forms of primary glomerulonephritis and 43 patients with lupus nephritis. HBs antigenaemia was detected in 69 of the 311 patients (22 per cent) with primary glomerulonephritis and this prevalence of HBsAg carrier was significantly higher than that in the general population (p less than 0.001). These patients had no clinical or biochemical findings to suggest acute or chronic liver disease. A higher HBs antigenaemia carrier rate was not observed in patients with lupus nephritis. Three glomerulopathological entities, membranous nephropathy, IgA nephropathy, and mesangial proliferative glomerulonephritis, were found to be associated with a higher prevalence of HBs antigenaemia compared with the general population (p less than 0.001). Glomerular deposits of HBsAg and/or hepatitis core antigen (HBcAg) were detected in 41, 61, and 60 per cent of renal biopsy specimens from patients with membranous nephropathy, IgA nephropathy, and mesangial proliferative glomerulonephritis associated with persistent HBs antigenaemia respectively. During the mean study period of 40 months (range 12-180), 14 per cent of these patients with hepatitis-associated glomerulonephritis developed progressive renal failure, although none required maintenance dialysis. Our study suggests that hepatitis B virus antigenaemia may play a significant role in the development of specific forms of glomerulonephritis and that these hepatitis B virus-associated glomerulonephritides can run an indolent but relentless progressive clinical course.
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Affiliation(s)
- K N Lai
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong
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