ISOLATED ACTH DEFICIENCY PRESENTING WITH BILATERAL FROZEN SHOULDER

We describe a 55—year—old female who presented witha 1—year history of tiredness, depression and painfulstiff joints. The most striking clinical abnormality was bilateralfrozen shoulders, local corticosteroid treatment of which providedthe first diagnostic clue. She was found to have profound diminutionof plasma cortisol secondary to an isolated deficiency of ACTH.There was no obvious cause for this. Steroid replacement eradicatedher lethargy within 3 months and evidence of frozen shouldersresolved completely. KEY WORDS: Shoulder pain, Cortisol, Corticotrophin releasing factor, ACTH, Hydrocortisone     

Evaluation of the efficacy of a hospital-based asthma education programme in patients of low socioeconomic status in Hong Kong

BACKGROUND: Good asthma control requires optimal medical treatment in conjunction with appropriate self-management. In the West, the effectiveness of patient education on improving self-management has been well documented. However, data amongst Asian populations are lacking. We performed a pilot study to evaluate the efficacy of a hospital based education programme aimed at improving self-management skills and reducing morbidity in a Chinese population with low socioeconomic status and education level. METHODS: Our asthma education programme was a low-cost programme conducted in essence by specialist respiratory nurses. Patients attending our asthma clinic were instructed during a two-hour educational session on the pathophysiology of asthma, its potential triggers, the appropriate use of medications including proper inhaler techniques, and the self-management of their disease. These instructions were reinforced by video sessions at subsequent outpatient clinic attendance when patients' inhaler and peak flow techniques were checked by the same nurses and their self-management plan re-examined by the attending physicians. Asthma knowledge, inhaler technique, FEV1 and peak expiratory flow (PEF), and patients' self-rating of their asthma were determined at baseline, 6 months and 1 year after the intervention. Morbidity was assessed by the numbers of hospitalizations, unscheduled visits to family physicians and accident and emergency department attendance, courses of oral steroid used and days off work or school at baseline and 1 year. RESULTS: Two hundred and thirty patients were recruited for the study, 83% completing the entire assessment period. The group demonstrated significant improvements in lung function: the mean FEV1 +/- SD increased from 63.6 +/- 20.6% of predicted values at baseline to 68.5 +/- 22.3% at 6 months and 68.6 +/- 22.8% at 1 year (P < 0.05), and the mean PEF +/- SD increased from 64.6 +/- 23.0% of predicted values at baseline to 75.4 +/- 27.0% at 6 months and 76.8 +/- 24.5% at 1 year(P < 0.001). There were also significant improvements in inhaler technique (P < 0.01), asthma knowledge (P < 0.001), patients' self-rating of their asthma (P < 0.05), and reductions in the numbers of hospitalizations (P < 0.01), visits to family physicians (P < 0.001) and accident and emergency department attendance (P < 0.001) during the study period. Patients with moderate to severe asthma as defined by an FEV1 of < 80% of predicted values were most likely to benefit from the programme. CONCLUSIONS: We conclude that patient education is likely to be an essential component in the holistic approach to the management of asthma even amongst Asian populations of low socioeconomic status and education level. Further studies using randomised controlled trials are necessary to consolidate our findings.     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.     

THERMAL ACTIVATION OF PEROXIDASE FROM TOBACCO LEAF MESOPHYLL CELL WALLS

Cell wall-bound peroxidase isolated from tobacco leaf mesophll cell walls was found to consist of two isoenzymes (P₁ and P₂). Each exists in the form of a single subunit with the same molecular weight (35 000) as determined by Sodium dodecyl sulphate (SDS) polyacrylamide gel electrophoresis. Both isoenzymes exhibited maximum activities at 70°. P₁ increased to 265% and P₂ to 140% of the activities assayed at 27°; below this temperature the two isoenzymes had the same specific activity. On hydrolysis, P₁ showed a carbohydrate content of 26.22% when the monosaccharides were analyzed by gas liquid chromatography; P₂ gave 21.45%.     

光谱核型分析联合微阵列比较基因组杂交诊断15号环状染色体综合征

目的 探讨联合应用光谱核型分析技术(spectral karyotyping,SKY)和微阵列比较基因组杂交技术(microarray-based comparative genomic hybridization,array-CGH)在诊断复杂疑难的环状染色体畸变中的价值.方法 对1例常规G显带染色体核型分析疑诊为46,XY,r(15)?的8岁男性生长发育迟缓患儿依次应用SKY及array-CGH技术常规进行制片杂交,并通过相应的显微摄像系统和计算机软件分析结果.结果 SKY技术明确了该患儿环状染色体来源于15号染色体,array-CGH技术明确患儿15q26.3末端存在约594 kb的缺失,染色体基因位点编码范围为99689349-100282878.结论 联合应用现代分子细胞遗传学技术可以从细胞到分子水平精确诊断复杂疑难的环状染色体病例,是常规染色体核型分析的有益补充,也有利于细胞遗传学向分子水平深入.     

Anti-N-methyl-d-aspartate receptor encephalitis in children: Incidence and experience in Hong Kong

Aim

The study aims to analyze the incidence, clinical features, investigation findings and treatment outcomes of anti-N-methyl-d-aspartate receptor encephalitis in children from Hong Kong.

Echocardiographic mapping of left ventricular resynchronization during cardiac resynchronization therapy procedures

Background Cardiac resynchronization therapy （CRT） is an effective electrical therapy for patients with moderate to severe heart failure and cardiac dyssynchrony. This study aimed to investigate the degree of acute left ventricular （LV） resynchronization with biventricular pacing （BVP） at different LV sites and to examine the feasibility of performing transthoracic echocardiography （TTE） to quantify acute LV resynchronization during CRT procedure. Methods Fourteen patients with NYHA Class Ⅲ-Ⅳ heart failure, LV ejection fraction 〈35%, QRS duration 〉120 ms and septal-lateral delay （SLD） 〉60 ms on tissue Doppler imaging （TDI）, underwent CRT implant. TDI was obtained from three apical views during BVP at each accessible LV site and SLD during BVP was derived. Synchronicity gain index （Sg） by SLD was defined as （I＋（SLD at baseline - SLD at BVP）/SLD at baseline）. Results Seventy-two sites were studied. Positive resynchronization （R＋, Sg〉1） was found in 42 （58%） sites. R＋ was more likely in posterior or lateral than anterior LV sites （66% vs. 36%, P 〈0.001）. Concordance of empirical LV lead implantation sites and sites with R＋ was 50% （7/14）. Conclusions The degree of acute LV resynchronizaUon by BVP depends on LV lead location and empirical implantation of LV lead results in only 50% concordance with R＋. Performing l-rE during CRT implantation is feasible to identify LV sites with positive resynchronization.