Physicians' practice patterns of treating Helicobacter pylori-associated peptic ulceration in public hospitals in Hong Kong: questionnaire survey. Coordinator Group of the Quality Assurance Subcommittee (Medicine), Hospital Authority, Hong Kong

To survey the practice patterns of physicians in public hospitals in Hong Kong when treating Helicobacter pylori-associated peptic ulceration, the records of all patients from 22 medical units who had new peptic ulcers that had been diagnosed endoscopically during August 1996 were examined systematically. Patient data were entered on a one-page questionnaire. Five hundred and twelve patients with peptic ulceration were studied; 173 (34%) of whom had presented with gastro-intestinal bleeding. The Helicobacter pylori status had been determined in 449 (88%) patients, 280 (62%) of whom had subsequently tested positive for Helicobacter pylori. The biopsy urease test or histological examination had been performed for more than 95% of patients. Of 260 patients who had tested positive for Helicobacter pylori, 244 (94%) had received eradication therapy to eliminate this organism; a total of 291 patients, however, were receiving eradication therapy. The most commonly used regimen was proton pump inhibitor triple therapy (151 [52%] of 291 patients). Confirmation of the eradication of Helicobacter pylori had been planned for 152 (52%) of the 291 patients, whereas ulcer-healing drugs--mainly H2-receptor antagonists--had been prescribed for 87 (30%) patients after eradication. Curing Helicobacter pylori infection is therefore widely accepted in the management of peptic ulcer disease among physicians working in Hong Kong public hospitals.

The effect of age on the presentation of patients with tuberculosis

OBJECTIVE

To study the differences in presentation of young and elderly patients with tuberculosis (TB).

DESIGN

Between January 1991 and December 1992 all patients with TB diagnosed at the Department of Medicine, Prince of Wales Hospital, were recruited into the study. The following data were collected: body weight, coexisting medical problems, presenting symptoms, radiographic appearance, sputum results for acid-fast bacilli and peripheral blood biochemistry. The patients were divided into young ( < 65 years) and elderly ( > or = 65 years) age groups and differences in presentation of the 2 groups were analysed.

RESULTS

There were 78 young and 94 elderly patients with TB. The elderly patients had lower body weight, less haemoptysis but more non-specific complaints (25% vs 1%, P = 0.001). The chest radiographs in the elderly patients were less likely to have upper lobe infiltration (9% vs 37%, P = 0.0002) but more commonly had extensive infiltration of both lungs (17% vs 2%, P = 0.014). The only biochemical abnormality that was more common in the elderly was a low serum albumin level (64% vs 45%, P < 0.05).

CONCLUSION

Elderly patients with TB are more likely to present with non-specific complaints and atypical radiographic appearance. A high index of suspicion and prompt investigations in elderly patients may allow for earlier diagnosis and treatment of TB.

Sustained-release isradipine compared with spirapril in the treatment of elderly patients with isolated systolic hypertension

The benefits of treating isolated systolic hypertension (ISH) have been established, but the most appropriate choice of drug is still uncertain. For this reason, a sustained-release formulation of isradipine was compared with spirapril in a double-blind randomized study in elderly Chinese patients with ISH. The dosage was titrated if necessary after 4 weeks of treatment. The reduction in systolic/diastolic blood pressure after 8 weeks was similar for both treatments--20/10 mm Hg with isradipine versus 24/6 mm Hg with spirapril--measured in the supine position. There were no orthostatic symptoms and both treatments were well tolerated.