Biomedical subjects

S F Lui

Publications and source records attributed to S F Lui.

At least 55 records · Page 3Linked to original sources

PubMed1995

Dermatofibrosarcoma protuberans in a renal transplant patient.

Dermatofibrosarcoma protuberans in an unusual soft tissue tumour with a propensity for local recurrence and rarely metastatic spread. Given its indolent course it may be mistaken for atypical scarring or a keloid growth. Early diagnosis and prompt wide local resection of this entity are required in order to prevent a local recurrence. We report a patient who developed locally invasive dermatofibrosarcoma protuberans 4 years after a successful renal transplantation. Although other forms of sarcoma have been reported as a complication of organ transplantation and immunosuppression, this pathology has, so far, not been reported in a transplant recipient.

Adult↗

PubMed1995

A comparison of the effect of enalapril and metoprolol on renal function, potassium balance, lipid profile, cardiac function, exercise tolerance and quality of life in hypertensive dialysis patients.

26 patients with hypertension while on hemodialysis or continuous ambulatory peritoneal dialysis for end-stage renal diseases were treated first with enalapril and then changed to metoprolol. Both drugs were shown to be similarly effective in controlling blood pressure. There was no difference between the two drugs in their effects on renal function, potassium balance, lipid profile, cardiac function, exercise tolerance, and quality of life. Mild worsening of anemia was observed during treatment with enalapril. No serious side effects were reported. Use of enalapril is safe in the treatment of hypertension in dialysis patients.

Adult↗

PubMed1994

CD4-positive cells from patients with IgA nephropathy demonstrate increased mRNA of cytokines that induce the IgA switch and differentiation.

IgA nephropathy (IgAN) is characterized by raised serum IgA1 and mesangial IgA1 deposits. We have previously shown increased T-cell activation in IgAN. Recently, transforming growth factor-beta (TGF-beta) has been shown to induce IgA isotype switch at a clonal level and interleukin 5 (IL5) promotes differentiation into IgA-bearing B cells. In the present study we have examined the TGF-beta and IL5 mRNA expression by mitogen-activated CD4-positive T cells from patients with IgAN (n = 25), patients with other primary nephritides (CGN) (n = 24), and healthy control subjects (n = 25). The cytokine genes were analysed by reverse transcription (RT)-polymerase chain reaction (PCR) and were semi-quantitated by normalizing the differences occurring during RT and PCR using a housekeeping gene, beta-actin. CD4-positive T cells from IgA nephritic patients expressed a higher level of IL5 mRNA than healthy controls (P < 0.01) and patients with CGN (P < 0.005). CD4-positive T cells from IgA nephritic patients expressed a higher level of TGF-beta mRNA than healthy controls (P < 0.01) but no difference was demonstrated on comparison with CGN patients. Elevated TGF-beta mRNA expression in patients with CGN probably reflects its other important function as a 'sclerogenic' factor involved in the glomerulosclerosis found in these nephritides. Our data suggest that there is increased expression of cytokine genes which induce the IgA isotype switch and differentiation; these immunological abnormalities may be important in the pathogenesis of IgAN.

Adult↗

PubMed1994

Use of home automated intermittent peritoneal dialysis in the treatment of end stage renal failure.

We report our retrospective analysis of 16 uraemic patients who were treated with home automated intermittent peritoneal dialysis (IPD) from 1988 to 1993. Six patients were diabetic. The mean age was 58.5 years. The reasons for home automated IPD were: old age, poor eyesight, low intelligence or poor dexterity, family or patient request and old stroke. It took an average of 8.8 sessions to train the helper. The mean frequency of the home IPD was once every 5.8 days with a mean volume of 48 litres of dialysate used during each dialysis. There were 3 peritonitis episodes making the peritonitis rate once every 93 patient months. Four patients were still on home IPD and two were transplanted. Ten patients died of stroke, myocardial infarction, tuberculosis, chronic obstructive lung disease or suicide. A low plasma albumin is the only significant parameter in the early mortality group. Such high mortality can be accounted for by the fact that patients were older and forty per cent were diabetic. We conclude that home automated IPD can be an alternative for some patients in whom other modes of dialysis are difficult.

Adult↗

PubMed1994

Recurrent acute pancreatitis induced by isoniazid.

A 31-year-old man on haemodialysis who developed recurrent attacks of acute pancreatitis during the treatment of pulmonary tuberculosis is presented. The pancreatitis rapidly subsided once isoniazid was withdrawn, but the problem recurred again upon reintroduction of the drug. There was no further recurrence during successful treatment with full doses of rifampicin and pyrazinamide for 1 year.

Acute Disease↗

PubMed1994

Primary glomerulonephritis with detectable glomerular hepatitis B virus antigens.

The glomerular pathology and hepatitis B virus (HBV) antigens in renal biopsies were investigated in 100 consecutive patients with both primary glomerulonephritis and positive serology for hepatitis B surface antigen (HBsAg). Glomerular HBV antigens including HBsAg, hepatitis B core antigen (HBcAg), and hepatitis B e antigen (HBeAg) were examined in frozen tissue using both polyclonal and monoclonal antibodies. HBV serology and glomerular antigens were correlated. Using monoclonal antibodies, at least one of the three HBV antigens was detectable in glomeruli in 39% of the cases. These findings correspond mainly to detectable glomerular HBsAg and HBeAg in 22.3 and 28.4% of cases, respectively. A good correlation was found between glomerular and serum HBeAg but not observed for HBsAg. Serum HBcAg was not examined and not correlated with glomerular staining. When the diagnosis of HBV-related glomerulonephritis was based strictly on detectable glomerular antigens, three distinctive morphologies were identified: membranous nephropathy, mesangiocapillary glomerulonephritis, and mesangial proliferative glomerulonephritis with immunoglobulin A (IgA) deposits (IgA nephropathy). Each of these lesions may be seen in pure form or occasionally in overlapping form leading to double glomerulopathies. Glomerular HBeAg and HBsAg were associated with subepithelial and mesangial immune complexes, respectively. Rare overlap between membranous nephropathy and IgA nephropathy further emphasized the distinctive pathology of HBV-related glomerulonephritis and the independent etiological role of HBeAg and HBsAg. In other glomerulonephritis, which rarely demonstrated glomerular HBV antigens, the pathogenetic role of chronic HBV infection remains to be proven.

Adolescent↗

PubMed1994

Use of antineutrophil cytoplasmic autoantibodies in diagnosing vasculitis in a Chinese patient population.

Antineutrophil cytoplasmic autoantibodies (ANCA) have been used as markers of systemic vasculitides, including microscopic polyarteritis (MPA) and Wegener's granulomatosis. The diagnostic potential of ANCA assays together with antibodies against the neutrophil enzymes myeloperoxidase (MPO) and proteinase 3 for detecting a systemic vasculitis was tested in a Chinese patient population. 672 sera were received for ANCA assay, and ANCA detected by indirect immunofluorescence was positive in 73 sera from 42 patients. Of the 42 patients, 3 had cytoplasmic ANCA, while 39 had a perinuclear pattern. There was no patient with Wegener's granulomatosis. Two cytoplasmic ANCA positive patients suffered from ulcerative colitis. Another cytoplasmic ANCA positive patient was a carrier of human immunodeficiency virus. Of the 39 perinuclear ANCA positive patients, 10 had MPA. Eight of them were tested for anti-MPO antibody, and all were positive. Other immune disorders that were perinuclear ANCA positive included: 13 patients with systemic lupus erythematosus, 3 with mixed connective tissue disease, 1 with Goodpasture's syndrome, 2 with inflammatory bowel disease, and 2 patients with IgA nephropathy. Anti-MPO antibody was not specific for MPA, and 7 out of the 13 patients with systemic lupus erythematosus were anti-MPO antibody positive. Our study suggests that ANCA and anti-MPO antibody are not specific for MPA in a Chinese population. They would alert the clinician of the possibility of vasculitis, but a clinicopathological correlation is essential in making the diagnosis.

Adolescent↗

PubMed1994

Imipenem/cilastatin sodium in the treatment of continuous ambulatory peritoneal dialysis-associated peritonitis.

Imipenem/cilastatin sodium is a new thienamycin class of antibiotic with a broad spectrum of bactericidal activities. It may be a suitable single first-line therapy for the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Fifty episodes of CAPD peritonitis were treated with imipenem/cilastatin sodium. On presentation, all patients were given an intravenous loading dose of 1 g of imipenem/cilastatin sodium followed by intraperitoneal imipenem/cilastatin sodium for 10 days. During 1989 (30 episodes), 20 mg imipenem/cilastatin sodium was added to each 2-liter bag of peritoneal dialysis (PD) fluid for 10 days. The primary response rate as defined by polymorphonuclear neutrophils < 100/ml in PD fluid was 90%. Unfortunately, 17% of the peritonitis relapsed within 14 days of stopping antibiotic. The complete cure rate without relapse was therefore 73%. During 1990 (20 episodes), 100 mg imipenem/cilastatin sodium was added to each 2-liter bag of PD fluid for 10 days. The primary response rate was 95%, the complete cure rate without relapse was 85%. Imipenem/cilastatin sodium is an effective single first-line antibiotic for the treatment of peritonitis in CAPD.

Cilastatin↗

PubMed1994

Circulating leukocyte-endothelial adhesion molecules in IgA nephropathy.

There is accumulating evidence that leukocyte-endothelial adhesion molecules are important in inflammatory injury in being involved in the primary step of entrapment and migration of leukocytes to the site of inflammation. We have used an antigen capture ELISA to measure the levels of circulating intercellular adhesion molecule-1 (cVCAM-1), vascular cell adhesion molecule-1 (cVCAM-1) and E selectin (cE selectin) in the peripheral blood of 33 patients with IgA nephropathy (IgAN) during clinical quiescence and 24 healthy controls. The serum levels of cICAM-1 and E selectin in IgA-nephritic patients were not different from that of healthy controls but the cVCAM-1 level was significantly elevated in IgAN despite a lack of clinical activity (p = 0.008). The differential rise of circulating leukocyte-endothelial adhesion molecules in IgAN probably reflects the origins and nature of these molecules as well as the specific immunological profile of IgAN. There was no correlation between the levels of these three circulating adhesion molecules. When the patients with IgA nephropathy were stratified according to the severity of their glomerular and interstitial lesions, there was an apparent increase in cE selectin and cVCAM-1 associated with increased histopathologic grading. The changes in endothelial adhesion molecules during clinical exacerbation were studied in 10 patients. Coinciding with synpharyngitic macrohematuria, there was a significant rise of cVCAM-1 and cE selectin (p = 0.046 and p = 0.016, respectively) but no similar rise was observed in cICAM-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Adhesion↗

PubMed1994

Adverse interaction between warfarin and indomethacin.

A 57-year-old man developed spontaneous skin bruising and haematuria during combined therapy with warfarin and indomethacin. Due to the potential effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the anticoagulant action of warfarin and platelet function, patients receiving both warfarin and NSAIDs should have their prothrombin time monitored very closely. Also, the risk of gastrointestinal haemorrhage with any NSAIDs must always be remembered.

Drug Interactions↗

PubMed1994

Severe hypercalcaemia associated with miliary tuberculosis.

Hypercalcaemia is uncommon among patients with pulmonary tuberculosis in Hong Kong, possibly because of the low dietary calcium intake in this population. We report here a case of severe hypercalcaemia in a patient with miliary tuberculosis and impaired renal function. We suggest that tuberculosis should be excluded in any febrile patient with hypercalcaemia, particularly in countries where it is still a common condition and an important cause of hypercalcaemia.

Adult↗

PubMed1994

Pulmonary hemorrhage. A fatal manifestation in IgA nephropathy.

Two patients with asymptomatic IgA nephropathy (IgAN) and a third patient with chronic renal failure due to IgAN died following a recent onset of dyspnea, hemoptysis, and pulmonary infiltrates. In all cases, the cause of death was respiratory failure attributed to either bronchopneumonia or pulmonary edema. However, no infectious agent was identified. In all three patients, the diagnoses of IgAN and idiopathic pulmonary hemorrhage were established at postmortem examination. Acute alveolar hemorrhage was present in two patients. All three patients had heavy alveolar hemosiderin-laden macrophages, and capillaritis was recognized in two of them. The occurrence of fatal pulmonary hemorrhage in patients with IgAN is rare. Our findings suggested an immune complex-mediated pulmonary injury that was possibly related to the systemic nature of IgAN.

Adult↗

PubMed1993

Effect of lovastatin on serum lipid profile in the treatment of dyslipoproteinaemia in uraemic patients on continuous ambulatory peritoneal dialysis.

BACKGROUND: Dyslipoproteinaemia is an important risk factor for cardiovascular disease in uraemic patients on continuous ambulatory peritoneal dialysis (CAPD). Lovastatin is an HMG Coenzyme A reductase inhibitor which is useful in treating non-uraemic patients with hypercholesterolaemia. AIMS: We conducted a single blind cross-over study versus placebo in 10 CAPD patients to examine the effect of lovastatin (20-40 mg) on the serum lipid profile and its safety in uraemic patients. METHODS: Treatment phases were of eight weeks' duration. Each four weeks' measurements were made of serum total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), VLDL-cholesterol (VLDL-C), Apolipoprotein A1 & B (Apo A1 & Apo B) and Lipoprotein (a). After eight weeks, lovastatin significantly reduced TC by 29% from 6.7 +/- 0.3 (mean +/- S.E.M.) to 4.8 +/- 0.1 mmol/L, LDL-C by 41% from 4.6 +/- 0.3 to 2.7 +/- 0.1 mmol/L and Apo B by 32% from 116 +/- 7 to 78 +/- 3 mg/dl (p < 0.01). HDL-C increased by 8% from 1.2 +/- 0.1 to 1.3 +/- 0.2 mmol/L after eight weeks' therapy (p < 0.05). TG decreased by 18% from 1.9 +/- 0.4 to 1.6 +/- 0.3 mmol/L (p < 0.05). There was no significant difference in changes of other lipid profiles between placebo and drug. No adverse effects of the drug were noted during treatment and the liver function and muscle enzymes were not significantly altered by either drug therapy or placebo. RESULTS: Lovastatin appears to be a safe and useful drug in effectively treating dyslipoproteinaemia in CAPD patients.

Female↗

PubMed1993

Plasma exchange in the treatment of early recurrent focal glomerulosclerosis after renal transplantation. Report and review.

We report a 29-year-old female with recurrent focal glomerulosclerosis (FGS) presenting as heavy proteinuria immediately following renal transplantation. From day 13 after transplantation, daily plasma exchange was performed 6 times. Proteinuria decreased from 13 to 0.2 g/day after plasma exchange and remained to be less than 0.1 g/day even 20 months thereafter. Our review of the literature on the use of plasma exchange in treating recurrent FGS suggests this procedure is not useful in patients whose allograft biopsy showed advanced glomerular sclerotic lesions. We propose early plasma exchange may be a therapeutic option in those patients who have no sclerotic lesions in their allograft biopsy.

Adult↗

PubMed1993

Diabetic patients with IgA nephropathy and diabetic glomerulosclerosis.

Eleven diabetic patients with biopsy-proven IgA nephropathy were studied. Seven exhibited coexistence of both IgA nephropathy and diabetic glomerulosclerosis and the remaining four patients had IgA nephropathy without diabetic lesion. The clinicopathological features and follow-up of those patients with IgA nephropathy surperimposed on diabetic glomerulosclerosis were compared with a similar group of patients with diabetic glomerulosclerosis alone. Our observation suggests that the occurrence of both glomerulopathies was fortuitous with IgA nephropathy coexisting with or preceding diabetic glomerulosclerosis. There was no apparent causal relationship between the two glomerulopathies. The renal outcome is poor in both groups of patients and is possibly related to diabetic glomerulosclerosis.

Adult↗

PubMed1993

Correction of anemia using self-administered daily subcutaneous erythropoietin in uremic patients on continuous ambulatory peritoneal dialysis.

We studied the effects of self-administered, daily, low-dose, subcutaneous (SC) erythropoietin (EPO) therapy in 15 uremic patients on continuous ambulatory peritoneal dialysis (CAPD) for 16 weeks to assess its efficacy and safety. The patients had baseline hemoglobin (Hb) levels of < 8 g/dl and were started on 10 u/kg/day of beta-EPO. The dosage of EPO was adjusted every 4 weeks according to hematological response. The patients learned to inject into their thighs themselves. Hb increased significantly from 6.6 +/- 0.2 g/dl (mean +/- SEM) at week 0 to 9.0 +/- 0.3 at week 8 and 10.0 +/- 0.4 at week 16 (p < 0.0001). Hematocrit (Hct) increased significantly from 0.20 +/- 0.01 at week 0 to 0.27 +/- 0.01 at week 8 and 0.29 +/- 0.001 at week 16 (p < 0.0001). The mean EPO dose was 10 u/kg/day at week 0 and 10.5 +/- 0.4 at week 8 and 10.3 +/- 0.5 at week 16. After minor adjustments in antihypertensive therapy had been made no significant differences in mean arterial blood pressure were noted. Six of 15 patients required increased dosage of antihypertensive drugs. All patients were given oral iron supplements. There was a significant decrease in percentage of transferrin saturation and 10 patients required additional intravenous iron supplements. There was no significant difference in the serum levels of creatinine, albumin, potassium, phosphate and urate with EPO treatment. There were no local complications at the sites of injection and the injections themselves were quite painless.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Acute renal failure in hepatitis B virus-related membranous nephropathy with mesangiocapillary transition and crescentic transformation.

We report the first case of hepatitis B virus (HBV)-related membranous nephropathy (MN) that progressed to crescentic transformation superimposed on a mixed membranous and mesangiocapillary glomerulonephritis. The patient developed acute renal failure, which partially responded to pulse methylprednisolone therapy, and subsequently recovered after plasma exchange.

Acute Kidney Injury↗

PubMed1992

Use of recombinant erythropoietin in thalassemic patients on dialysis.

We studied the therapeutic benefit of recombinant human erythropoietin (rHuEPO) in dialysis patients with thalassemia minor. Four of the 40 randomly selected patients (22 on hemodialysis [HD], 18 on continuous ambulatory peritoneal dialysis [CAPD]) were identified to be thalassemic prior to a trial of rHuEPO (alpha-thalassemia trait in three and beta-thalassemia minor in one). All patients were initially treated with rHuEPO at a dose of 100 +/- 25 U/kg/wk subcutaneously depending on the hemoglobin level. EPO injections were continued for 16 weeks with further adjustments of the doses according to the hemoglobin level increases attained. All nonthalassemic patients reached a target hemoglobin of 10 g/dL at week 16, with an average maintenance dose of 120 +/- 7.8 U/kg/wk, but the hemoglobin was increased by only 1 g/dL in the thalassemic patients receiving 175 U/kg/wk. Following cessation of rHuEPO therapy for 6 weeks, all four thalassemic patients and 18 randomly selected nonthalassemic patients received a fixed dose of rHuEPO 4,000 U/wk (equivalent to 80 U/kg/wk) for 16 weeks. The hemoglobin remained unchanged in the thalassemic patients, but a progressive and significant increase of hemoglobin was observed in the nonthalassemic patients. At the last phase of the study, the thalassemic patients received rHuEPO at a dose of 100 or 125 U/kg/wk with 4-weekly increments of 25 U/kg/wk until their hemoglobin reached 10 g/dL. One patient developed uncontrolled hypertension with a dose of 150 U/kg/wk, and one reached the target hemoglobin at a dose of 200 U/kg/wk.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗