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Biomedical subjects

S F Lui

Publications and source records attributed to S F Lui.

At least 37 records · Page 2Linked to original sources
PubMed2000

Factors predicting outcome of fungal peritonitis in peritoneal dialysis: analysis of a 9-year experience of fungal peritonitis in a single center.

Fungal peritonitis causes significant morbidity and mortality for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We retrospectively reviewed 70 episodes of fungal peritonitis in a single center over the last 9 years in 896 CAPD patients. Seventy percent of the episodes of fungal peritonitis were caused by Candida species, among which 50% were Candida parapsilosis. As a result of fungal peritonitis, 44% of the patients died, whereas further peritoneal dialysis failed in 14%, requiring a change to long-term hemodialysis. Only 37% managed to continue CAPD. The remaining 5% either underwent transplantation or were lost to follow-up. We identified the factors associated with poor outcome, namely mortality and technique failure. The presence of abdominal pain, bowel obstruction, and a catheter remaining in situ were significantly associated with greater mortality. Abdominal pain, antibiotic use within 3 months before fungal peritonitis, and complication by bowel obstruction were associated with greater technique failure. In choosing antifungal agents with catheter removal, oral fluconazole alone appears equally as effective as combined oral fluconazole with 5-flucytosine for peritonitis caused by Candida species. For peritonitis caused by species other than Candida, the choice of antifungal therapy needs to be individualized, based on fungal species and sensitivities.

Antifungal Agents↗
PubMed1999

Comparison of double-bag and Y-set disconnect systems in continuous ambulatory peritoneal dialysis: a randomized prospective multicenter study.

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.

Adult↗
PubMed1998

Effective treatment of high-grade lymphoproliferative disorder after renal transplantation using autologous lymphocyte activated killer cell therapy.

Posttransplantation lymphoproliferative disorders (PTLD) is not uncommon and can occur in 2% to 5% of solid organ recipients on immunosuppression. Epstein-Barr virus (EBV) infection or reactivation and intensive anti-T lymphocyte treatment are important pathogenetic factors for a large proportion of these disorders. Nonclonal lesions with polymorphous histology have a potential for regressing when the immunosuppressants are reduced or stopped. Clonal tumors with a monomorphous histology carry a poor prognosis, and the mortality rate for monoclonal lymphoma has been reported as high as 80%. We report a renal transplant recipient who developed high-grade monoclonal lymphoma only 4 months after a live-donor transplantation. The tumor was EBV positive. Reduction of immunosuppressants resulted in minimal regression of the tumor. The patient was treated with adoptive immunotherapy using ex vivo generation of autologous lymphocyte activated killer (LAK) cells. She had leukapheresis, and autologous peripheral blood mononuclear cells were obtained and cultured in interleukin-2 (IL-2)-rich medium for 9 to 10 days. The IL-2-activated LAK cells were reinfused into the patient without any systemic administration of IL-2. The patient experienced no side effects during the infusion. There was no rejection episode, and the renal function of the patient remained stable after treatment. Computed tomography scan performed 2 months after the infusion showed marked regression of the lesions in the liver and spleen. Five months later, magnetic resonance imaging showed complete resolution of the tumor lesions. Ultrasonography 13 months after the LAK cell infusion showed no lesion. The allograft function was not affected after treatment. Adoptive immunotherapy using IL-2-activated autologous LAK cells was effective in treating this renal transplant patient with EBV-positive high-grade lymphoma. The patient's kidney allograft functioned well without any rejection.

Adult↗
PubMed1998

Long-term treatment of lupus nephritis with cyclosporin A.

We evaluated the efficacy and safety of long-term treatment with cyclosporin A (CSA) in type IV lupus nephritis. Seventeen patients with biopsy-proven WHO type IV lupus nephritis were enrolled in a prospective, open study. Twelve of the 17 completed 48 months of treatment with CSA and prednisolone. Three patients required the addition of azathioprine, at 12, 38 and 47 months, respectively, for cutaneous disease flare with refractory rashes. One patient was lost to follow-up at 40 months. The mean +/- SD duration of treatment was 43.2 +/- 10.1 months (range 15.7-48 months). A significant reduction of proteinuria and a significant rise in serum albumin were noted 1 month after initiation of treatment. Improvement was maintained throughout the study except for three patients who relapsed with recurrence of nephrotic syndrome. There were no significant changes in serum creatinine level or creatinine clearances throughout the study. Repeat renal biopsy at 12 months following treatment with CSA showed histological improvement, with WHO type II changes in all 17 patients accompanying significant reduction in activity indices. Patients with baseline haemoglobin (Hgb) levels < 12 g/dl showed significant improvement. Serum C3 and C4 levels were not changed significantly. Corticosteroid-sparing effects were noted. Side-effects included hypertension, gum hypertrophy and mild hirsuitism, but were not serious. Combination therapy using CSA and prednisone is effective and safe for long-term treatment in lupus patients with WHO type IV nephritis.

Adult↗
PubMed1998

Treatment of pulmonary embolism by subcutaneous low-molecular-weight heparin in a hemodialysis patient.

Low-molecular-weight heparin (LMWH) has been used in the prophylaxis and treatment of deep vein thrombosis. Data regarding the efficacy of this drug without subsequent use of oral anticoagulant in the treatment of pulmonary embolism is limited. Pulmonary embolism may complicate the use of central venous catheter in hemodialysis. We report a case of acute submassive pulmonary embolism complicating a central venous hemodialysis catheter in a dialysis patient. After the catheter was removed, the patient was treated successfully with subcutaneous injection of LMWH for three months. We conclude that LMWH is safe and effective for treatment of pulmonary embolism in patient on hemodialysis.

Adult↗
PubMed1998

Treatment of Takayasu's aortitis with percutaneous transluminal angioplasty and wall stent--a case report.

The authors describe a young woman who developed severe toxemia during pregnancy, requiring emergency lower segment cesarian section at 27 weeks of gestation. Postpartum angiography showed a discrete stenotic lesion of the abdominal aorta proximal to the origin of the renal artery. Angioplasty was performed, followed by the insertion of a wall stent at the site of the stenosis. Her hypertension control improved dramatically after the stenting. This is, so far, the first reported case using a wall stent following angioplasty to relieve abdominal aortic stenosis due to Takayasu's arteritis.

Adult↗
PubMed1998

Factors associated with active systemic lupus erythematosus after endstage renal disease.

OBJECTIVE: Activity of systemic lupus erythematosus (SLE) often declines after patients reach endstage renal disease (ESRD). However, extrarenal activity is not uncommon, especially during the first few years of dialysis. We reviewed the clinical course of SLE patients with ESRD treated in our unit over the past 10 years, and tried to identify factors associated with postdialysis activity. METHOD: A retrospective study of 18 patients with SLE (6 males) who received maintenance dialysis in our center from 1987 to 1996. Their clinical details, organ system manifestations, serologic profile, and treatment were reviewed. Patients with and without lupus flares after maintenance dialysis were compared. RESULTS: Duration of followup was 43.4 +/- 32.7 months before dialysis and 33.8 +/- 28.9 months afterwards (4 hemodialysis, 14 peritoneal dialysis). Nine patients experienced 32 lupus postdialysis flares. The frequency was 0.63 flare per patient-year. Twenty flares (62.5%) developed within the first year of dialysis. Compared with the other 9 patients who had no flares, patients with flares were younger (median age at diagnosis of SLE 24 vs 33 years; median age when dialysis was initiated 26 vs 37 years; p < 0.05 both, Mann-Whitney U test) and more likely to have history of seizure (6 in 9 vs 1 in 9 patients, p < 0.05, Fisher's exact test). There was a trend that patients with history of serositis and vasculitis were also associated with postdialysis activity, although this was not statistically significant. CONCLUSION: Postdialysis flare of SLE is not uncommon, particularly during first year of dialysis. Younger patients and those with history of seizure may have higher risk of postdialysis lupus flare. Careful followup is warranted, especially in potential transplant recipients.

Adolescent↗
PubMed1997

Xanthomonas maltophilia peritonitis in uremic patients receiving continuous ambulatory peritoneal dialysis.

Xanthomonas maltophilia peritonitis has been only occasionally reported in patients receiving continuous ambulatory peritoneal dialysis. We present a series of six cases of peritonitis caused by such bacteria, accounting for 1.5% of all peritonitis episodes encountered in our renal unit over the past 5 years. Recent bacterial peritonitis treated with broad-spectrum antibiotics was the major risk factor, and the outcome was poor with medical treatment alone. Secondary peritonitis, especially fungal, was common and probably related to the prolonged course of antibiotics. All patients eventually required removal of the catheter, either because the effluent failed to clear up or because of secondary peritonitis. We suggest that X maltophilia peritonitis be treated with double antibiotics as soon as it is diagnosed. To prevent the development of superimposed infection after prolonged administration of antibiotics, the Tenckhoff catheter should be removed if the peritonitis fails to respond to a short course of antibiotics.

Adult↗
PubMed1997

Highly successful long-term outcome of kidney transplantation in Chinese recipients: an enhancing race effect?

We report on 352 cadaveric kidney transplants and 294 living related transplants performed over a 25-yr period among the Chinese population of Hong Kong. There is a marked preference for transplanting male patients, especially from living donors, and we argue that this represents a cultural phenomenon within the Chinese population. The 10-yr graft survivals for related and cadaveric transplants are 86.2% and 67.4%, respectively. These figures are appreciably higher than corresponding figures in Caucasian populations. We show beneficial effects of using cyclosporin A, minimizing the cold ischemia time and avoiding very young and very old donors. There is a clear benefit of transplanting kidneys with zero or one mismatched HLA antigen against the recipient but no stepwise decrease in outcome as the number of mismatched antigens increases. There is close concordance between the outcome of living related grafts with zero, one, and two mismatched haplotypes against the recipient and no observable benefit of haplotype matching. We show that Chinese renal transplant recipients in other centers also have better long-term graft outcome than Caucasians, both for cadaveric and living related transplants. We draw attention to the existence of a detrimental "race effect" in other studies when Black recipients are compared with Caucasians and consider whether an enhancing race effect exists for Chinese or whether the better outcome reflects different underlying diseases in Chinese.

Actuarial Analysis↗
PubMed1996

Common occurrence of an antiidiotypic antibody that recognizes T14+ anti-DNA antibodies in patients with systemic lupus erythematosus.

OBJECTIVE: To investigate whether antibodies to a T14 anti-DNA antibody can be found in patients with systemic lupus erythematosus (SLE). METHODS: Seventy-six serum samples (37 from patients with SLE) were randomly selected from among sera submitted for routine antinuclear antibody testing. Short, overlapping peptides based on the partial VH (variable region of the heavy chain) sequence of the T14 antibody were synthesized on multipins and screened for reactivity with SLE sera. In addition, selected peptides from T14 and related proteins were synthesized in bulk and screened for reactivity with both SLE and control sera. A monoclonal antibody was generated to determine the prevalence of the T14 idiotype (T14+ Id) in the different study populations. RESULTS: Antibodies were detected by a peptide based on the third complementarity-determining region (CDR3) of the T14 protein in 15 (41%) of 37 patients with SLE or 15 (54%) of 28 who had anti-DNA antibodies, in 3 (9%) of 34 patients without anti-DNA antibodies (9 of whom had SLE), and in 6 (10%) of 57 healthy controls. In SLE sera, the antiidiotypic (anti-Id) responses (IgM and IgG) correlated well with the anti-DNA responses (IgG), and both responses correlated well with the T14+ Id activity in SLE sera. Control peptides based on the 18/2 (16/6+ Id) and S107 proteins detected low antibody activities in SLE sera, attributable to cross-reactivity with the T14 peptide. A peptide based on an unrelated human antibody was not reactive with these sera. CONCLUSION: Anti-Id antibodies directed to T14 VHCDR3 were found commonly in the sera of patients with SLE, and they appeared to be induced by the anti-DNA antibodies present in the sera. Based on these findings, these secondary antibodies may be pathogenic in SLE.

Adolescent↗
PubMed1996

Acute renal failure induced by angiotensin converting enzyme inhibitor in a patient with polyarteritis nodosa.

We report a patient who presented with malignant hypertension and renal failure. He was treated with lisinopril, spironolactone, and nifedipine retard for blood pressure control. Subsequent renal function showed further deterioration, but it then improved after withdrawal of the angiotensin converting enzyme inhibitor (ACE I). The diagnosis of classical polyarteritis nodosa was established with aneurysmal dilatation demonstrable in the renal vasculature. His renal impairment improved further following immunosuppressive therapy and the disease has remained inactive 4 years after first presentation. This is the first reported case of acute renal failure associated with the use of ACE I in polyarteritis nodosa.

Acute Kidney Injury↗
PubMed1995

Deception and self-harm in the quest for freedom: an audit of Vietnamese boat people admitted to a regional hospital in Hong Kong.

OBJECTIVES: To document the medical problems of detained Vietnamese boat people admitted to hospital in Hong Kong, and to identify the medical problems or features that may indicate an intention to abscond. DESIGN AND SETTING: A retrospective review of the records of all Vietnamese boat people admitted to the Medical Unit of the Prince of Wales Hospital, Hong Kong, between 1 October 1993 and 30 September 1994. RESULTS: 614 Vietnamese boat people were admitted during the 12 months (comprising 3% of total admissions). 92 (15%) of these absconded from hospital after admission (compared with 0.06% for all other admissions). Gastrointestinal bleeding, clinical sepsis, drug overdose and spontaneous pneumothorax were the most common presentations among those who absconded. One-third (33.8%) of the 80 patients whose symptoms indicated gastrointestinal bleeding had insignificant endoscopic findings. Needle puncture marks were found in nine of the 75 patients with unexplained bacteraemia and in five of the 12 patients with spontaneous pneumothorax. CONCLUSIONS: Clinicians who provide medical care to Vietnamese boat people should be aware of the high incidence of absconding from hospital and that self-inflicted injuries are not uncommon and may identify intending absconders.

Adult↗
PubMed1995

Renal failure and heatstroke.

We report a fatal case of heatstroke in an obese boy who developed multi-organ failure. Six other cases of exertional heatstroke admitted to our hospital over the last 5 years were also reviewed. All of them showed some degree of renal impairment. The causes of renal failure are multifactorial, with rhabdomyolysis being the major mechanism. All cases except one responded to alkaline diuresis without the need for dialysis. Continuous venovenous hemofiltration appeared to be a good alternative in hemodynamically unstable patients. Renal function recovered completely after varying intervals in all surviving cases. Interestingly, rhabdomyolysis in our heatstroke patients was usually associated with hypokalemia or normokalemia instead of hyperkalemia. Mortality in our series was largely related to the long duration of hyperthermia and coma, the severity of disseminated intravascular coagulation, and the presence of cardiogenic shock and severe acidosis.

Acute Kidney Injury↗
PubMed1995

Microscopic polyarteritis has a poor prognosis in Chinese.

OBJECTIVE: To analyze retrospectively the clinical course and outcome of 10 consecutive Chinese patients with microscopic polyarteritis (MPA) admitted to our hospital over a period of 3 years. METHODS: Ten patients with MPA who presented 1990-93 were studied. Their serum antineutrophil cytoplasmic autoantibody levels were assayed. RESULTS: The male to female ratio was 1:1 and the mean age was 61 years. Eight patients (80%) had renal impairment on presentation and 5 of them (50%) were dialysis dependent. Seven patients (70%), during their clinical course, had pulmonary hemorrhage. Six patients (60%) had hypoxic lung disease requiring ventilatory support. All 10 patients were pANCA positive; 8 patients were tested for antimyeloperoxidase antibody and were all positive. Seven patients were treated with immunosuppressants consisting of steroid and cyclophosphamide with additional plasma exchange. Nine patients died after a mean survival of 9 months (range 1-33); causes of death were respiratory failure (5), infection (2), uremia (one), and stroke (one). The ANCA level reflected the disease activity of the vasculitis. CONCLUSION: MPA in Chinese patients appeared to be a more severe disease with a poor prognosis. This may be related to the older age group, and the more frequent and severe pulmonary and renal manifestations of MPA in these patients.

Adult↗
PubMed1995

The interaction of fluvastatin and cyclosporin A in renal transplant patients.

A possible interaction between fluvastatin, a new HMG CoA reductase inhibitor, and cyclosporin A (CsA) was studied in 16 stable renal transplant patients with dyslipoproteinemia despite dietary control. They entered a 12-week study period: 4-week baseline, 4-week placebo and 4-week fluvastatin treatment (20 mg daily). Weekly trough whole blood CsA concentrations were measured by monoclonal antibody immunoassay. Serial renal and liver function tests and creatine phosphokinase (CPK) were monitored. The mean trough levels of CsA during fluvastatin treatment were 115.6 micrograms/l compared with 114.3 micrograms/l and 113.3 micrograms/l in the baseline and placebo period, respectively. Apart from a small decrease in serum albumin level (from a mean of 38.6 g/l to 37.9 g/l), there were no significant changes in renal and liver functions or CPK levels. No adverse effects were reported. Fluvastatin (20 mg daily) may be used safely without extra monitoring of blood CsA concentrations in renal transplant patients.

Adult↗
PubMed1995

IgA nephropathy: a rare lesion in systemic lupus erythematosus.

We describe three patients with a well-established clinical diagnosis of systemic lupus erythematosus in whom the renal biopsy lesion unexpectedly is diagnostic of IgA nephropathy, not superimposed with any features of lupus nephritis. Whereas the clinical presentation and follow-up of renal disease in these patients indicate a relatively indolent course, the extrarenal manifestations of systemic lupus erythematosys have been relatively severe, and one patient died of systemic infection. IgA nephropathy hitherto has not been described in patients with systemic lupus erythematosus, and such an observation stresses that atypical glomerular lesions in these patients should raise the possibility of a nonlupus glomerulopathy.

Adult↗