Search

Purpose Drug-induced agranulocytosis is a rare but life-threatening adverse drug reaction. Its epidemiology in Chinese is largely unknown. This study aimed to estimate the incidence, mortality, and risk of the drugs associated with agranulocytosis in Hong Kong Chinese. Methods A population-based case-control study was conducted using the Clinical Data Analysis and Reporting System, a database managed by the Hong Kong Hospital Authority. Patients with drug-induced agranulocytosis from 1 January 2004 to 31 December 2013 were identified. World Health Organization causality assessment was used to evaluate the possible drug aetiology of each case. Odd ratios (ORs) of the drug exposure were calculated using exact conditional logistic regression. Results 155 cases of drug-induced agranulocytosis were identified. Mean age was 51.4 years and 95 cases were female. Incidence rate was estimated to be 2.2 cases per million person-years and the all-cause mortality of patients with drug-induced agranulocytosis was 3.9%. Among the cases, the most common associated drug groups were antithyroid drugs (41.9%), antimicrobials (20%), anticonvulsants (10.3%), and antipsychotics (6.5%). Carbimazole had the highest risk of agranulocytosis (adjusted OR 416.7, 95% Confidence Interval (CI) 51.5 – 3372.9) with an incidence of 9.2 (95% CI 6.9 - 12.1) per 10,000 users and 3.6 (95% CI 2.7 - 4.8) per 10,000 user-years. Other drugs with significant risk included cephalosporins, clozapine, penicillins, phenytoin, and propyl thiouracil. Conclusions The incidence and mortality in Hong Kong Chinese were relatively low compared to Caucasians. Antithyroid drugs were the most common Its epidemiology in Chinese is largely unknown. This study aimed to estimate the incidence, mortality, and risk of the drugs associated with agranulocytosis in Hong Kong Chinese. Methods A population-based case-control study was conducted using the Clinical Data Analysis and Reporting System, a database managed by the Hong Kong Hospital Authority. Patients with drug-induced agranulocytosis from 1 January 2004 to 31 December 2013 were identified. World Health Organization causality assessment was used to evaluate the possible drug aetiology of each case. Odd ratios (ORs) of the drug exposure were calculated using exact conditional logistic regression. Results 155 cases of drug-induced agranulocytosis were identified. Mean age was 51.4 years and 95 cases were female. Incidence rate was estimated to be 2.2 cases per million person-years and the all-cause mortality of patients with drug-induced agranulocytosis was 3.9%. Among the cases, the most common associated drug groups were antithyroid drugs (41.9%), antimicrobials (20%), anticonvulsants (10.3%), and antipsychotics (6.5%). Carbimazole had the highest risk of agranulocytosis (adjusted OR 416.7, 95% Confidence Interval (CI) 51.5 – 3372.9) with an incidence of 9.2 (95% CI 6.9 - 12.1) per 10,000 users and 3.6 (95% CI 2.7 - 4.8) per 10,000 user-years. Other drugs with significant risk included cephalosporins, clozapine, penicillins, phenytoin, and propyl thiouracil. Conclusions The incidence and mortality in Hong Kong Chinese were relatively low compared to Caucasians. Antithyroid drugs were the most common implicated drug class and carbimazole had the highest risk of agranulocytosis.

Background and objectives Photo-aging in Chinese often presents with benign pigmentary lesions. Q-switched lasers for pigmentary lesions in Asians had reported a risk of post-inflammatory hyperpigmentation (PIH) up to 25%. Longer pulse widths in the millisecond domains were advocated with reduced risk of PIH. Recently, picosecond lasers of various wavelengths were introduced with proven efficacy in tattoo removal. The objective of this study is to assess the efficacy and safety of a novel picosecond 755-nm alexandrite laser for the treatment of benign pigmented lesions in Asians retrospectively. Methods A list of all patients who received picosecond 755-nm alexandrite laser treatment at a private dermatology center in Hong Kong was included. Those who had any other laser or topical treatment during the period of picosecond laser treatment were excluded. The age, skin phototype, type of pigmentary lesion, number of treatments performed was recorded. The baseline and most recent standardized photographs were assessed by trained physicians for comparison. A score of 0–4, representing poor 0–24%, fair 25–49%, good 50–74%, excellent 75–95%, and complete 95%+ improvement was given. Adverse events associated with the laser treatment were also recorded. All patients were followed up until 6 months after the last laser session. Results A total of 13 subjects were included in the present study. The number of treatment sessions received ranged from one to seven. The benign pigmentary lesions consist of Nevus of Ota, cafe-au-lait patches, lentigines, Becker's nevus, Hori's macules, and nevus spilus. Among patients with Nevus of Ota, one patient achieved complete clearance after four treatments and two other patients had excellent clearance after three and four sessions, respectively. Patients with cafe-au-lait had fair to good clearance after one to seven treatment sessions. One patient who has Hori's macules was resistant to laser treatments and a fair response was achieved after eight treatments. In the present series, two patients (4.8%) developed transient hypopigmentation, which had improved upon subsequent follow-up in both cases and none had post-inflammatory hyperpigmentation. Conclusions The novel picosecond 755-nm alexandrine laser is effective for the treatment of benign pigmentary lesions in Chinese, especially for the clearance of Nevus of Ota. Picosecond laser appears to be associated with a much lower risk of PIH for treatment of pigmentary lesions in Asians. Lasers Surg. Med. 48:23–29, 2016. © 2015 Wiley Periodicals, Inc.

Background and Objective Several studies have been published on the first generation non-thermal focused ultrasound with an average improvement of 0–3.95 cm reported [1,2]. We aim to investigate the efficacy of the second-generation non-thermal focused ultrasound device with a combined radiofrequency hand piece. With the addition of radiofrequency energy, the temperature of the adipose tissue is raised before focused ultrasound is applied. This facilitates the mechanical disruption of fat cells by focused ultrasound. Study Design and Methods Twenty subjects were recruited and underwent three treatments biweekly. Caliper reading, abdominal circumference, and standardized photographs were taken with the Vectra® system at all visits. We aim to have the subjects stand and hold the same position and the photograph taken after exhalation. Caliper and circumference measurements carry uncertainty. It is impossible to eliminate all uncertainties but can be improved by having the same trained physician assistant perform the measurement at the same site and taking an average of three readings. Pain score and satisfaction were recorded by means of the visual analogue scale. The efficacy is defined by a statistically significant improvement in circumferential improvement based on intention-to-treat analysis. Results Seventeen subjects completed the treatment schedule. Abdominal circumference showed statistically significant improvement at 2 weeks post-second treatment (P = 0.023) and almost all subsequent follow-ups. Caliper readings were statistically significant at 2 weeks post-second treatment (P = 0.013) and almost all follow-ups. The mean pain score reported was 2.3 on the visual analog scale and 6% were unsatisfied with the overall treatments. Six incidents of wheal formation appeared immediately after treatment all of which subsided spontaneously within several hours. Conclusion The combination non-thermal focused ultrasound and radiofrequency device is effective for improving body contour in Asians. Lasers Surg. Med. 48:203–207, 2016. © 2015 Wiley Periodicals, Inc.

Background and Objectives High-intensity focused ultrasound (HIFU) is a noninvasive technology for body contouring. HIFU is focused within the subcutaneous adipose tissue, causing coagulative necrosis and cell death. The objective of this study is to evaluate the effectiveness of a HIFU device for sculpting of the abdomen. Materials and Methods The system has a set focal depth of 1.3 cm. Twelve subjects with adipose thickness no less than 2.5 cm who met the screening criteria were recruited. Each subject received one treatment to the abdomen. The total fluence used per site was 150–165 J/cm2 with a mean of 161 J/cm2. The waist circumference at iliac crest and the point of maximum circumference were recorded at baseline, 4, 8, and 12 weeks post-treatment, as well as their weight and BMI. Subjects' rating on comfort level and satisfaction were collected via questionnaires at every follow-up. Standardized photographs were also taken with the Canfield System® at each visit. Results Seven out of 12 subjects were satisfied with the outcome and 9 out of 12 would recommend this treatment to their friends and family. There was statistically significant improvement in the waist circumference measured at both the iliac crest (P-value 0.013, 0.002, 0.005) and maximum waistline (P-value 0.003, 0.034, 0.023) at 4, 8, 12 weeks post-treatment. Spearman's rho for correlation of energy level versus improvement showed that at 12 weeks post-treatment follow-up, the improvement significantly correlated with the total fluence per treatment (P-value 0.041). The higher the total fluence delivered, the larger the decrease in waist circumference. Conclusions High-intensity focused ultrasound effectively decreases waist circumference in Chinese. The higher the total fluence delivered, the larger the decrease in waist circumference was observed. Lasers Surg. Med. 46:263–269, 2014. © 2014 Wiley Periodicals, Inc.

A 70-year-old woman presented with a 4-month history of right leg ulcers (upper left panel). Biopsy showed infiltration by abnormal medium to large size lymphoid cells (upper left middle panel, haematoxylin eosin). There was no obvious angiocentricity or angioinvasion. The abnormal lymphoid cells were positive for cytoplasmic CD3 epsilon (upper right middle panel, immunoperoxidase), CD56 (upper right panel), and T-cell intracellular antigen-1. In-situ hybridization for EpsteinBarr virus encoded RNA was positive. Overall features were consistent with extranodal natural killer (NK)/T-cell lymphoma, nasal type. She was treated with chemotherapy. After the second course, blistering skin eruptions occurred over the trunk, buttocks and legs (lower left panel). A skin biopsy revealed erythema multiforme-like areas with scattered cytoid bodies (white arrow) throughout all levels of the epidermis, and areas with pemphigus vulgaris-like changes showing early suprabasal acantholysis (black arrow) (lower right panel). Direct immunofluorescence studies showed weak intercellular and basement membrane staining with both C3 and IgG, confirming the diagnosis of paraneoplastic pemphigus (PNP). She deteriorated progressively and died 3 months after presentation despite immunosuppression and further chemotherapy. Paraneoplastic pemphigus characteristically presents as painful oral and mucosal ulcerations, with concomitant skin involvement simulating pemphigus vulgaris or erythema multiforme. Bronchiolitis obliterans may occur and can be fatal. PNP is caused by serum autoantibodies against epithelial proteins, particularly the plakin family, leading to epithelial injury in the skin, and mucosal and bronchial linings. Therefore, the underlying neoplasms are almost exclusively of B-cell lineage. However, T-cells and CD56+ NK cells have also been postulated to be effectors of PNP. This case illustrated the rare association between NK cell lymphoma and PNP, suggesting therefore that NK cells might be involved in the pathogenesis of PNP. Clinicians should also be alert to the possibility of PNP in lymphomas not of B-cell lineage.