Effect of weight reduction on the severity of lower urinary tract symptoms in obese male patients with benign prostatic hyperplasia: a randomized controlled trial.

PURPOSE: We assessed whether weight reduction is an effective intervention for the management of lower urinary tract symptoms (LUTS) and investigated the relationship between obesity and LUTS. MATERIALS AND METHODS: This was a prospective randomized controlled trial that enrolled obese men older than 50 years with LUTS. The study period was 52 weeks. All patients received standardized alpha-adrenergic blocker therapy for the treatment of benign prostatic hyperplasia (BPH) during the run-in period. Patients were randomized to receive either a standardized prerecorded video program on the general principle of weight reduction or a comprehensive weight reduction program. Patients were assessed at different time points with symptom assessment, uroflowmetry, transrectal ultrasound, and metabolic assessment. RESULTS: Sixty-five patients were allocated to each study arm. After the study period, no significant difference in weight reduction was found between the two arms. When the pre- and postintervention parameters were compared, none were statistically different between the 2 arms, namely nocturia, International Prostate Symptom Score, quality of life assessment, and uroflowmetry parameters. When the whole study population was taken as a single cohort, these parameters were also not significantly different between the group with a body mass index of 25 to <30 kg/m(2) and the group with a BMI of 30 to 35 kg/m(2). CONCLUSIONS: We found no association between obesity and LUTS. This could have been due to the less marked weight difference in our cohort. Whereas weight reduction may be an effective measure to improve LUTS, the implementation of a successful program remains a challenge.

Inherited metabolic diseases in the Southern Chinese population: spectrum of diseases and estimated incidence from recurrent mutations.

Inherited metabolic diseases (IMDs) are a large group of rare genetic diseases. The spectrum and incidences of IMDs differ among populations, which has been well characterised in Caucasians but much less so in Chinese. In a setting of a University Hospital Metabolic Clinic in Hong Kong, over 100 patients with IMDs have been seen during a period of 13 years (from 1997 to 2010). The data were used to define the spectrum of diseases in the Southern Chinese population. Comparison with other populations revealed a unique spectrum of common IMDs. Furthermore, the incidence of the common IMDs was estimated by using population carrier frequencies of known recurrent mutations. Locally common diseases (their estimated incidence) include (1) glutaric aciduria type 1 (∼1/60,000), (2) multiple carboxylase deficiency (∼1/60,000), (3) primary carnitine deficiency (∼1/60,000), (4) carnitine-acylcarnitine translocase deficiency (∼1/60,000), (5) glutaric aciduria type 2 (∼1/22,500), (6) citrin deficiency (∼1/17,000), (7) tetrahydrobiopterin-deficient hyperphenylalaninaemia due to 6-pyruvoyl-tetrahydropterin synthase deficiency (∼1/60,000), (8) glycogen storage disease type 1 (∼1/150,000). In addition, ornithine carbamoyltransferase deficiency and X-linked adrenoleukodystrophy are common X-linked diseases. Findings of the disease spectrum and treatment outcome are summarised here which may be useful for clinical practice. In addition, data will also be useful for policy makers in planning of newborn screening programs and resource allocation.

Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services.

BACKGROUND: Chlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance. METHODS: We describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander ('Aboriginal') status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16-29 years and for chlamydia testing and positivity. RESULTS: Data were included from 16-29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%). CONCLUSIONS: Higher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.

Laparoscopic bariatric surgery: a five-year review.

OBJECTIVE: To review our results of laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass for the treatment of morbid obesity. DESIGN: Prospective cohort study. SETTING: Bariatric Surgery Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. PATIENTS: All patients consisted of those referred to our Combined Obesity Clinic (to provide multidisciplinary weight management for severely obese patients) during the period July 2002 to December 2007. For patients who received bariatric surgeries as treatment of morbid obesity, peri-operative data, postoperative weight change, and co-morbidity improvements were collected and prospectively reviewed. RESULTS: During the study period, 531 patients attended our Clinic for treatment of obesity. Their mean (standard deviation) body weight was 96 (22) kg, mean body mass index was 36 (6) kg/m(2), mean age was 40 (10) years, and 64% were female. Of these patients, 94 (18%) underwent bariatric surgery, which included: laparoscopic adjustable gastric banding (n=57), laparoscopic sleeve gastrectomy (n=30), and laparoscopic gastric bypass (n=7). Adverse events occurred in 11 (12%) of these 94 patients, but there was no operative mortality. At 2 years, the mean percentage weight loss for patients having laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass were 34%, 51% and 61%, respectively. After operative treatment, obesity-related co-morbidities including metabolic syndrome, type 2 diabetes, hypertension, and sleep apnoea had also improved significantly. CONCLUSION: Through a multidisciplinary weight management programme and various bariatric procedures, favourable results can be achieved in Chinese patients with severe obesity.

[Effectiveness and safety of intragastric balloon for treatment of morbid obesity].

OBJECTIVE: To evaluate the effectiveness and safety of intragastric balloon (IGB) for the treatment of obese Chinese. METHODS: IGB was placed into the stomachs of 48 Chinese patients in Hong Kong, 13 males and 35 females; aged 39 +/- 9 (18 - 65), with the mean baseline body weight (BW) of 106 +/- 26 kg and mean body mass index (BMI) of (40 +/- 9) kg/m(2), 34 (70.8%) with coexistent obesity-related morbidities, who failed to respond to other weight reducing treatment, via routine gastroscopy under intravenous conscious sedation. Restricted balanced diet with 1200 kcal/day and exercise of 150 minutes/week were prescribed after the balloon placement. The IGB was removed endoscopically after at most 180 days. Follow-up was conducted once a week during the first month and then once a month. RESULTS: The median hospital stay and treatment duration were 1 (IQR 1:2.25) day and 174 (IQR 166:181) days respectively. The BW, BMI, and waist circumference were significantly decreased after the IGB placement (all P < 0.01) with the mean BW loss of (13 +/- 7) kg, mean BMI loss of (5 +/- 3) kg/m(2), mean excessive body weight loss of (45 +/- 36)%, and mean waist circumference loss of (12 +/- 8) cm. 66.7% of the patients were satisfied with the treatment. No serious complication related to IGB was noted. CONCLUSION: IGB is a safe and effective device that achieves moderate weight loss in obese Chinese.

Intragastric balloon in ethnic obese Chinese: initial experience.

BACKGROUND: We evaluated the effectiveness and safety of intragastric balloon (IGB) for the treatment of obesity in ethnic Chinese in Hong Kong. METHODS: 15 Chinese patients (10 females; median age 40 years (range 21-58)) completed IGB treatment over a 10-month period since November 2004. Median baseline body weight (BW) and BMI were 100.1 (range 78.5-170.3) kg and 39.4 (range 29.6-56.9) kg/m2 respectively. Coexistent obesity-related morbidities were present in 80% of patients. The Bioenterics Intragastric Balloon (BIB) was employed, and all placement and removal were performed endoscopically under intravenous conscious sedation. A restricted balanced diet (approximately 1200 kcal/day) and 150 minutes/week of moderate-intensity exercise were prescribed after balloon placement in a multidisciplinary approach. Outcome measures were collected and assessed in a prospective manner. RESULTS: Median procedure time was 25 (range 19-45) minutes and median hospital stay was 2 (range 1-6) days. Median BW and BMI loss were 15.3 (range 5.3-30.9) kg and 5.6 (range 1.9-12.5) kg/m2 after IGB. The median waist circumference (WC) loss was 9 (range 4-23) cm, and 66.7% of patients were highly satisfied with the treatment. No serious complication related to IGB was observed. CONCLUSION: IGB is a safe and effective device that achieves moderate weight loss in obese ethnic Chinese patients.