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C Y Tse

Publications and source records attributed to C Y Tse.

18 recordsLinked to original sources
PubMed2003

Breaking bad news: a Chinese perspective.

The amount of information received by terminal cancer patients about their illness varies across different countries. Many Chinese families object to telling the truth to the patient and doctors often follow the wish of the families. However, a population study in Hong Kong has shown that the majority wanted the information. To address this difference in attitudes, the ethical principles for and against disclosure are analysed, considering the views in Chinese philosophy, sociological studies and traditional Chinese medicine. It is argued that the Chinese views on autonomy and nonmaleficence do not justify non-disclosure of the truth. It is recommended that truth telling should depend on what the patient wants to know and is prepared to know, and not on what the family wants to disclose. The standard palliative care approach to breaking bad news should be adopted, but with modifications to address the 'family determination' and 'death as taboo' issues.

Attitude to Death↗
PubMed2001

Influenza A infection is an important cause of febrile seizures.

OBJECTIVES: To compare the incidence of febrile seizures in children hospitalized for influenza A infection with parainfluenza and adenovirus infection and to examine the hypothesis that children hospitalized for influenza A (variant Sydney/H3N2) during the 1998 season in Hong Kong had more frequent and refractory seizures when compared with other respiratory viruses, including the A/Wuhan H3N2 variant that was present in the previous year. METHODS: Medical records of children between 6 months and 5 years of age admitted for influenza A infection in 1998 were reviewed. For comparison, records of children of the same age group with influenza A infection in 1997, and with parainfluenza and adenovirus infections between 1996 and 1998 were reviewed. Children who were afebrile or who had an underlying neurologic disorder were excluded. RESULTS: Of children hospitalized for influenza A in 1998 and 1997, 54/272 (19.9%) and 27/144 (18.8%) had febrile seizures, respectively. The overall incidence of febrile seizures associated with influenza A (19.5%) was higher than that in children hospitalized for parainfluenza (18/148; 12.2%) and adenovirus (18/199; 9%) infection, respectively. In children who had febrile seizures, repeated seizures were more commonly associated with influenza A infection than with parainfluenza or adenovirus infection (23/81 [28%] vs 3/36 [8.3%], odds ratio [OR] 4.3, 95% confidence interval: 1.2 to 15.4). Alternatively, children with influenza A infection had a higher incidence (23/416, 5.5%) of multiple seizures during the same illness than those with adenovirus or parainfluenza infection (3/347, 0.86%; OR 6.7, 95% confidence interval: 2.0-22.5.) The increased incidence of febrile seizures associated with influenza A was not attributable to differences in age, gender, or family history of febrile seizure. Multivariate analysis, adjusted for peak temperature and duration of fever, showed that hospitalized children infected with infection A had a higher risk of febrile seizures than those who were infected with parainfluenza or adenovirus (OR 1.97). Influenza A infection was a significant cause of febrile seizure admissions. Of 250 and 249 children admitted to Queen Mary Hospital for febrile seizures in 1997 and 1998, respectively, influenza A infection accounted for 27 (10.8%) admissions in 1997 and 54 (21.7%) in 1998. During months of peak influenza activity, it accounted for up to 35% to 44% of febrile seizure admissions. In contrast, parainfluenza, adenovirus, respiratory syncytial virus, and influenza B had a smaller contribution to hospitalizations for febrile seizures, together accounting for only 25/250 (10%) admissions in 1997 and 16/249 (6.4%) in 1998. CONCLUSION: The influenza A Sydney variant (H3N2) was not associated with an increased risk of febrile seizures when compared with the previous influenza A Wuhan variant (H3N2) or H1N1 viruses. However, in hospitalized children, influenza A is associated with a higher incidence of febrile seizures and of repeated seizures in the same febrile episode than are adenovirus or parainfluenza infections. The pathogenesis of these observations warrants additional studies. Complex febrile seizures, particularly multiple febrile seizures at the time of presentation, have been thought to carry an adverse long-term prognosis because of its association with a higher incidence of epilepsy. Repeated febrile seizures alone, particularly if associated with influenza A infection, may not be as worrisome as children with complex febrile seizures because of other causes, which requires additional investigation. This may subsequently have an impact on reducing the burden of evaluation in a subset of children with complex febrile seizures.

Adenoviridae Infections↗
PubMed2000

Effects of an extended-interval dosing regimen of triptorelin depot on the hormonal profile of patients with endometriosis: prospective observational study.

OBJECTIVE: To evaluate the suppression of pituitary gonadotrophins and ovarian steroid hormone with the administration of triptorelin depot at 6-weekly intervals. DESIGN: Prospective observational study. SETTING: Obstetrics and gynaecology department of a public hospital, Hong Kong. PATIENTS: Consecutive patients with endometriosis, as diagnosed by laparoscopy or laparotomy from June 1998 through February 1999. INTERVENTION: Administration of four doses of triptorelin depot 3.75 mg either subcutaneously or intramuscularly every 6 weeks (21 patients), or conventional 4-weekly six-dose regimen (five patients). MAIN OUTCOME MEASURES: Serum levels of 17-beta-oestradiol, luteinizing hormone, and follicle-stimulating hormone; and pelvic pain symptoms. RESULTS: For the patients receiving the extended-interval dosing regimen of triptorelin, the levels of oestradiol and luteinizing hormone, and the pain score were significantly reduced throughout the treatment period and up to 10 weeks after the injection of the last dose. The level of follicle-stimulating hormone increased slowly but was still significantly lower than pretreatment levels. The hormonal profile was similar to that of patients receiving the conventional regimen. CONCLUSION: The use of the extended-interval dosing regimen of triptorelin depot results in a consistent hypo-oestrogenised state, which is similar to that achieved by the conventional regimen and which would be considered satisfactory for the medical treatment of pelvic endometriosis. The new regimen thus reduces the cost of treatment without compromising the effect on hormonal suppression.

Adult↗
PubMed1999

Acute bereavement care in the emergency department: does the professional-supported volunteers model work?

The aims of our study were to study the early impact of bereavement and to evaluate the effectiveness of the bereavement care given by our multidisciplinary team to close relatives of a sudden death, measured by the intensity of grief reaction (Texas Revised Inventory of Grief). The study sample consisted of close relatives of patients certified dead at the accident and emergency department (AED) between March 1996 and February 1997. The relatives received immediate care at the AED and were supported continually by the members of the bereavement care team. The control sample (without acute bereavement care) consisted of close relatives contacted by the liaison nursing officer in the previous year. The intensity of grief reactions were assessed by the volunteer grief counsellors at 6 months. The mean score of the intensity of grief reactions were 41.8 and 34.6 in the control (n = 11) and study (n = 18) groups respectively among high risk sample (p = 0.04). However, in the low risk sample, the mean scores were 35.3 and 30.2 in the control (n = 18) and study (n = 25) groups respectively (p = 0.11). Our study suggests that the bereavement care was especially effective in reducing the intensity of the grief at 6 months in the high risk group.

Adolescent↗
PubMed1998

Early diagnosis of primary human herpesvirus 6 infection in childhood: serology, polymerase chain reaction, and virus load.

Qualitative and quantitative polymerase chain reaction (PCR) for human herpesvirus 6 (HHV-6) DNA in whole blood and plasma was correlated with serology and clinical assessment in 143 children hospitalized for undifferentiated febrile illness to evaluate options for diagnosis of primary HHV-6 infection on the acute blood specimen. PCR and serology for HHV-7 were done in parallel to define serologic cross-reactions. Using HHV-6 seroconversion as the reference standard, detection of HHV-6 DNA in whole blood in the absence of antibody in the plasma was the most reliable evidence of primary HHV-6 infection. Detection of HHV-6 DNA in plasma and a high virus load in whole blood (>3.3 log10 copies/5 microL) had a sensitivity of 90% and 100%, respectively, in diagnosing primary HHV-6 infection. However, both were occasionally found in patients with other infections, possibly associated with HHV-6 reactivation. Maternal antibody may confound interpretation of serology in patients under 3 months of age.

Antibodies, Viral↗
PubMed1998

Is in-patient management of diastolic blood pressure between 90 and 100 mm Hg during pregnancy necessary?

A randomised controlled trial was performed at the Queen Elizabeth Hospital to compare the effects and acceptance of routine in-patient versus out-patient management of diastolic blood pressure between 90 and 100 mm Hg in pregnant women. There were no significant differences in the establishment of the diagnosis of hypertension, development of severe hypertension or proteinuric hypertension, the number of women requiring obstetric interventions, or the neonatal outcome between the two groups. Antenatal hospital stay for the in-patient group, however, was more than twice as long as for the out-patient group (difference in mean stay, 3.7 days; 95% confidence interval, 1.3-6.2). The number of hospitalisations in the in-patient group was almost four times greater than that in the out-patient group (difference in mean number of hospitalisations, 1.7; 95% confidence interval, 1.2-2.2). The two groups did not differ in their levels of satisfaction of the overall management of blood pressure. Nevertheless, a greater proportion of women preferred to choose the same type of care among the out-patient group than among the in-patient group if they had hypertension in a future pregnancy (83.7% versus 51.2%; P<0.001). More women were dissatisfied about the number of admissions than on the frequency of out-patient care (40.5% versus 16.3%; P<0.001). We conclude that in-patient care, day care, or home monitoring should be individualised.

Journal Article↗
PubMed1995

Streptococcus suis infection in Hong Kong.

Twenty-five patients were admitted to two hospitals in Hong Kong for Streptococcus suis infection between 1984 and 1993. Among them, 15 (60%) had an occupational exposure to pigs or pork, and four had a clear history of skin injury up to 16 days before admission. Examination of the cerebrospinal fluid of 21 patients confirmed the presence of meningitis in every case; the remaining four patients who did not have lumbar punctures had each presented with arthritis, bronchopneumonia, endocarditis and pyrexia without neck stiffness. The only fatality was a patient admitted in septicaemic shock with evidence of meningitis and disseminated intravascular coagulation. Of the 24 survivors, 16 (67%) acquired varying degrees of hearing loss as a result of meningitic involvement. All the isolates of S. suis were sensitive to penicillin or ampicillin, which was used alone or in combination with other antibiotics for every patient. Two patients had a relapse of symptoms when penicillin was stopped, but were successfully treated after the antibiotic was resumed for a total of 6 weeks. Over 100 cases of S. suis infection have been described previously, with a geographic distribution heavily biased towards Northern Europe and Southeast Asia. Lack of awareness of this unique zoonosis may be a reason why it is not diagnosed more readily elsewhere.

Adult↗
PubMed1994

Risk factors for acute myocardial infarction in a southern Chinese population.

Although the mortality rate from coronary artery disease in Hong Kong is only one-fourth of that of northern Europe and the United States, the disease has been and remains the second major cause of death (after all cancers combined). Beginning in 1987, we have conducted a case-control study of acute myocardial infarction in four Hong Kong hospitals. This study, one of the biggest case-control studies conducted in the Chinese population of both men and women, confirms the importance of several risk factors--cigarette smoking, history of hypertension, history of diabetes, body fatness, and lack of physical activity--previously described in data collected in western populations. In addition, more adverse childhood experience was also found to be an important risk factor of acute myocardial infarction. Further research in appropriate intervention measures in education in the prevention and cessation of smoking, the control of blood pressure, diabetes, and overweight, and adequate exercise could significantly help reduce the risk of acute myocardial infarction in the Hong Kong Chinese population.

Aged↗
PubMed1993

Lipids, lipoproteins and other coronary risk factors in Chinese male survivors of myocardial infarction.

OBJECTIVE: To assess the importance of an abnormal lipid profile as a risk factor in relation to non-biochemical risk factors, and to define the risk levels for lipid, lipoprotein and apolipoprotein in a Chinese population. PATIENTS AND METHODS: Serum lipids, lipoproteins, apolipoproteins and other cardiovascular risk factors were studied in 89 Chinese men 3 months after acute myocardial infarction and 56 controls. RESULTS: Cases had higher mean total cholesterol (TC), LDL- and VLDL-cholesterol, triglycerides and apolipoprotein B (Apo B), and lower mean HDL-cholesterol and apolipoprotein AI (Apo AI). Mean BMI was also higher, as was the prevalence of smokers and subjects with a history of hypertension. In univariate analysis, the odds ratios for TG > or = 1.6 mmol/l, LDL-cholesterol > or = 4.1 mmol/l, VLDL-cholesterol > or = 0.73 mmol/l, Apo B > or = 104 mg/dl were of the same order of magnitude as being a current smoker, having a BMI > or = 24.3 kg/m2, and a history of hypertension. High HDL-cholesterol (> or = 1.39 mmol/l) and Apo AI (> or = 139 mg/dl) were protective factors. The odds ratios for successively higher quartile values of cholesterol were not statistically significant. Multiple logistic regression identified smoking habit, history of hypertension, obesity, high Apo B and low Apo AI concentrations as independent risk factors for myocardial infarction. CONCLUSIONS: In a Chinese population, low serum Apo AI and high Apo B are risk factors for myocardial infarction of a comparable magnitude to smoking, hypertension and obesity.

Apolipoprotein A-I↗
PubMed1992

Recombinant tissue plasminogen activator in acute myocardial infarction in the Chinese in Hong Kong.

Eighty-nine consecutive Chinese patients (69 males, 20 females) with acute myocardial infarction treated by 100 mg recombinant tissue plasminogen activator (7 intracoronarily, 82 intravenously) at 3.7 +/- 1.0 h after onset, and intravenous heparin or dipyridamole therapy started at 3 h, were studied prospectively. Their mean age was 59.6 +/- 10.6 yr. Forty-six patients (51.7%) had anterior and 39 patients (43.8%) had inferior infarcts. Clinical evidence of reperfusion were seen in 63 patients (70.8%), while new complications included hypotension (5.6%), heart failure (6.7%), cardiac arrhythmias (76.4%) majority of which are related to reperfusion and self-remitting, haematoma around vascular access sites (23.6%), melaena (3.3%) and cerebral infarction (2.2%). Maximal changes in coagulation profiles were seen at 3 h, including a decrease in fibrinogen by 64.2% and an increase in fibrin degradation products by 47 times. The changes in haemostatic variables were not related to body weight or bleeding complications. Nine patients (10.1%) had recurrence of angina and 6 patients (6.9%) died due to pump failure and reinfarction. Angiogram at 14 days confirmed TIMI 2 or 3 patency of infarct-related arteries in 63 out of 73 (86.3%) patients, with a mean global ejection fraction of 52.5 +/- 12.4%. Nearly all survivors could maintain class I-II functional status after discharge. The safety and promise of recombinant tissue plasminogen activator for acute myocardial infarction in the Chinese were confirmed.

Adult↗
PubMed1992

Recombinant tissue-plasminogen activator (rt-PA) in acute myocardial infarction in the Chinese in Hong Kong.

Eighty-nine consecutive Chinese patients (69 males, 20 females) with acute myocardial infarction treated by 100 mg recombinant tissue-plasminogen activator (rt-PA) (7 intracoronarily, 82 intravenously) at 3.7 +/- 1.0 hours after onset, and intravenous heparin or dipyridamole therapy started at 3 hours, were studied prospectively. Their mean age was 59.6 +/- 10.6 years. Forty-six patients (51.7%) had anterior and 39 patients (43.8%) had inferior infarcts. Clinical evidence of reperfusion was seen in 63 patients (72.8%), while new complications included hypotension (5.6%), heart failure (6.7%), cardiac arrhythmias (76.4%), hematoma around vascular access sites (23.6%), melena (2.2%) and cerebral infarction (2.2%). Maximal changes in coagulation profiles were seen at 3 hours, including a decrease in fibrinogen (by 64.2%), an increase in FDP by 11.7 times and D-dimers by 4.4 times. Nine patients (10.1%) had recurrence of angina and 6 patients (6.9%) died due to pump failure (5) and reinfarction (1). Angiogram at 14 days confirmed TIMI (2 or 3) patency of infarct related arteries in 62/81 (76.5%) patients, with a mean global ejection fraction of 52.5 +/- 12.4%. Nearly all survivors could maintain class I-II functional status after discharge. The safety and promises of rt-PA for acute myocardial infarction in the Chinese were confirmed.

Adult↗
PubMed1991

Sclerosing peritonitis complicating prolonged use of chlorhexidine in alcohol in the connection procedure for continuous ambulatory peritoneal dialysis.

Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiologies. We have documented 14 cases of SP in 18 patients who had used chlorhexidine in alcohol (ChA) in the connection procedure for CAPD. Thirteen died. Nine of the 14 patients had been transferred to hemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer - even the 5 who were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They presented at around 5 years (30-80 months) after commencement of CAPD. Most deaths were related to intestinal obstruction. Four other patients with a comparable duration of ChA exposure were continued on CAPD with the Travenol Spike System (TSS), without further exposure to ChA. They were all asymptomatic of SP after 9-12 months. Comparing the 2 groups of asymptomatic patients, those transferred to TSS had a much better outcome after 9 months than those transferred to HD or renal transplantation (P = 0.0476). We suggest that ChA is the main cause of SP in our patients and that continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD to prevent the progression of SP.

Adult↗
PubMed1990

Sclerosing peritonitis complicating continuous ambulatory peritoneal dialysis with the use of chlorhexidine in alcohol.

Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiology. We have documented 14 cases of SP in 18 CAPD patients using chlorhexidine in alcohol (ChA) in the connection procedure; 13 died. Nine of the 14 patients had been transferred to haemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer even though 5 of them were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They present at around 5 years (30-80 months) after commencement of CAPD. Four other patients with a comparable duration of ChA exposure were continued on CAPD with a Travenol Spike System (TSS) without further exposure to ChA. They were all asymptomatic of SP after 9-12 months. Comparing the 2 groups of asymptomatic patients at 9 months after transfer, those transferred to TSS have a much better outcome than those transferred to HD or renal transplantation (P = 0.0476). We concluded that ChA is the main cause of SP in our patients and continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD in preventing the progression of SP.

Adult↗
PubMed1988

Serious sequelae of delayed diagnosis of endobronchial tuberculosis.

We report three cases of pulmonary tuberculosis in whom the diagnosis of the endobronchial component was missed initially. Despite proper chemotherapy, one patient had bronchostenosis leading to acute respiratory failure and death, the second developed collapse of the left lung, while failure of endotracheal intubation for general anaesthesia was the immediate problem faced by the third patient.

Adult↗
PubMed1988

The prevalence and pattern of pulmonary thromboembolism in the Chinese in Hong Kong.

The prevalence and clinical pattern of pulmonary thromboembolism was studied by a multifaceted approach. This documented the occurrence of pulmonary thromboembolism among the Chinese and confirmed an increasing incidence in Hong Kong, although comparatively it was still much lower (about one-tenth) than that found in western communities. Their clinical pattern, regarding presentation, risk factors, clinical features and response to thrombolytic therapy, conformed well with those reported in the west, but perhaps appeared in a milder form. The strong association of pulmonary thromboembolism with varicose veins and immobilisation would appeal for recommending routine heparinisation in Chinese patients having these combinations. Our findings will stimulate more interest in the comparative study of the haematological profile and the ethnic particulars of the Chinese.

Adult↗