Browsing by Author "Hon, Kam Lun"

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    Central Hypoventilation: A Case Study of Issues Associated with Travel Medicine and Respiratory Infection
    (2015-07-29) Hon, Kam Lun; Leung, Alexander K. C.; Li, Albert M. C.; Ng, Daniel K. K.
    Aim. We presented the case of a child with central hypoventilation syndrome (CHS) to highlight issues that need to be considered in planning long-haul flight and problems that may arise during the flight. Case. The pediatric intensive care unit (PICU) received a child with central hypoventilation syndrome (Ondine’s curse) on nocturnal ventilatory support who travelled to Hong Kong on a make-a-wish journey. He was diagnosed with central hypoventilation and had been well managed in Canada. During a long-haul aviation travel, he developed respiratory symptoms and desaturations. The child arrived in Hong Kong and his respiratory symptoms persisted. He was taken to a PICU for management. The child remained well and investigations revealed no pathogen to account for his respiratory infection. He went on with his make-a-wish journey. Conclusions. Various issues of travel medicine such as equipment, airline arrangement, in-flight ventilatory support, travel insurance, and respiratory infection are explored and discussed. This case illustrates that long-haul air travel is possible for children with respiratory compromise if anticipatory preparation is timely arranged.
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    Chlamydial pneumonia: a creepy neonatal disease
    (Hindawi Publishing Corporation, 2013-01-16) Hon, Kam Lun; Leung, Alexander K.C.
    We present a case of neonatal chlamydial pneumonitis to illustrate that a high index of suspicion is necessary to make the diagnosis so that treatment can be promptly instituted. The child was afebrile and the only symptom was a cough. The respiratory equations are calculated to understand the respiratory physiology. There was no overt abnormality with ventilation, oxygenation, compliance, resistance, or ventilation-perfusion mismatch despite radiographic abnormality. The literature is searched to review if treatment with a systemic macrolide antibiotic is needed in an otherwise asymptomatic neonate with chlamydial pneumonitis.
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    Complications of bezoar in children: What is new?
    (Hindawi Publishing Corporation, 2013-09-11) Hon, Kam Lun; Cheng, Jean; Chow, Chung Mo; Cheung, Hon Ming; Cheung, Kam Lau; Tam, Yuk Him; Leung, Alexander K.C.
    A bezoar is a mass found trapped in the gastrointestinal system. The condition may be associated with pica, especially in developmentally retarded children. Clinical manifestations are usually nonspecific. Endoscopic diagnosis and removal of the foreign materials is often indicated. Occasionally, severe complications may occur. We report two cases to illustrate the clinical features and complications in these children. In the first case, a reliable history was not obtained in the developmentally delayed girl which precluded prompt diagnosis, but the grossly dilated stomach on plain abdominal radiograph gave clues to an underlying insidious mechanical obstruction of upper gastrointestinal tract. In the second case of a normal child, the unrelenting symptoms and weight loss prompt further investigations which revealed the diagnosis. Literature on pediatric bezoar is reviewed. Oesophagoduodenoscopy is the investigation of choice for diagnostic confirmation, but surgical facilities must be available to deal with acute complications.
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    Cupping therapy may be harmful for eczema: a Pubmed search
    (Hindawi Publishing Corporation, 2013-09-09) Hon, Kam Lun; Luk, David Chi Kong
    Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers. S. aureus colonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of  “cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families.
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    Delayed Presentation of Congenital Diaphragmatic Hernia with Acute Respiratory Distress: Challenges in Diagnosis and Management
    (2020-07-26) Hon, Kam Lun; Fung, Ronald C. M.; Leung, Alexander K. C.
    Delayed presentation of congenital diaphragmatic hernia (CDH) with acute respiratory distress beyond the newborn period may poise challenges in diagnosis and management. We report a 3-month-old infant who presented with acute-onset respiratory distress and left congenital diaphragmatic hernia that was relieved with thoracoscopic repair. CDH must be differentiated from pneumothorax or pulmonary cyst. Erroneous diagnosis and treatment with thoracocentesis could be disastrous. Pediatricians and surgeons must be aware of this condition to allow early diagnosis and expeditious management. Subcutaneous emphysema should not be misdiagnosed as pneumothorax and management is expectant.
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    Dyshidrotic eczema
    (Enliven Archive, 2014-09-16) Leung, Alexander K.C.; Barankin, Benjamin; Hon, Kam Lun
    Dyshidrotic eczema, also known as dyshidrotic dermatitis or pompholyx, is characterized by pruritic, tense, deep-seated vesicles mainly on the palms and lateral surfaces of the fingers. In the chronic phase, scaling, desquamation, fissuring, and, sometimes, lichenification may be seen. The peak age of onset is between 20 and 30 years of age. The sex incidence is approximately equal. Most cases are idiopathic. Predisposing factors include atopy, contact allergens, contact irritants, dermatophyte infection, allergy to ingested metal, hyperhidrosis, prolonged use of protective gloves, intravenous immunoglobulin, psychological stress, and smoking. Although the disease is benign, it tends to run a chronic and relapsing course. Successful treatment requires a systemic multipronged approach that consists of avoidance of triggering factors, optimal skin care, pharmacotherapy during acute exacerbations, and education of patients/caregivers. Ultrapotent topical corticosteroids are the mainstay of pharmacotherapy.
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    Late Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?
    (2017-10-01) Hon, Kam Lun; Chan, King Hang; Ko, Pak Long; So, King Woon; Leung, Alexander K. C.
    We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.
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    Neonatal Abdominal Hemangiomatosis: Propranolol beyond Infantile Hemangioma
    (2016-03-27) Nip, Siu Ying Angel; Hon, Kam Lun; Leung, Wing Kwan Alex; Leung, Alexander K. C.; Choi, Paul C. L.
    Hemangioma is the most common vascular tumor of infancy; presentation is often as cutaneous infantile hemangioma (IH). Cutaneous hemangioma is a clinical diagnosis. Most IHs follow a benign course, with complete involution without treatment in the majority of cases. Visceral hemangioma often involves the liver and manifests as a life-threatening disorder. Hepatic hemangiomas may be associated with high output cardiac failure, coagulopathy, and hepatomegaly which generally develop between 1 and 16 weeks of age. Mortality has been reportedly high without treatment. We report a rare case of a male infant with neonatal hemangiomatosis with diffuse peritoneal involvement, which mimicked a malignant-looking tumor on imaging, and discuss therapeutic options and efficacy. Propranolol is efficacious for IH but generally not useful for other forms of vascular hemangiomas, tumors, and malformations. In our case of neonatal peritoneal hemangiomatosis, propranolol appears to have halted the growth and possibly expedite the involution of the hemangiomatosis without other treatments.
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    Neonatal Lupus Erythematosus
    (Hindawi Publishing Corporation, 2012-08-02) Hon, Kam Lun; Leung, Alexander K.C.
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    Persistent Salmon Patch on the Forehead and Glabellum in a Chinese Adult
    (2014-05-14) Leung, Alexander K. C.; Barankin, Benjamin; Hon, Kam Lun
    Salmon patches are present in approximately 44% of all neonates. The lesions tend to fade with time and those on the glabellum, eyelids, nose, and upper lip are rarely detected after the age of 6. We report a 33-year-old Chinese female with a salmon patch on the forehead and glabellum. To our knowledge, the occurrence of a salmon patch on the forehead and glabellum in adulthood has not been reported. The persistent salmon patch on the face of an adult is benign and not associated with any neurocutaneous syndrome or underlying vascular abnormality. The color of the lesion can be ameliorated with laser therapy if cosmesis is a concern.
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    Septicemia in a Neonate following Therapeutic Hypothermia: The Literature Review of Evidence
    (2013-09-04) Hon, Kam Lun; Li, Joshua J. X.; Cheng, Bernadette L. Y.; Leung, Alexander K. C.
    We report a term neonate with hypoxic ischemic encephalopathy who underwent a 72-hour therapeutic hypothermia. He developed unstable body temperature associated with coagulase negative staphylococcus septicemia 2 weeks later which was promptly treated with intravenous antibiotics and made a good recovery. PubMed (a service of the U.S. National Library of Medicine) was searched for the terms “therapeutic hypothermia” and “septicemia,” with limits activated (humans, English, age 0–18 years). There were only 6 randomized controlled trials, 1 non-randomized controlled trial, 1 retrospective cohort, and 1 case-control trial, which showed no definite evidence of increased risk of septicemia or neutrophil dysfunction in infants following hypothermia therapy.
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    Septicemia in a neonate following therapeutic hypothermia: the literature review of evidence
    (Hindawi Publishing Corporation, 2013-07-31) Hon, Kam Lun; Li, Joshua J.X.; Cheng, Bernadette L.Y.; Leung, Alexander K.C.
    We report a term neonate with hypoxic ischemic encephalopathy who underwent a 72-hour therapeutic hypothermia. He developed unstable body temperature associated with coagulase negative staphylococcus septicemia 2 weeks later which was promptly treated with intravenous antibiotics and made a good recovery. PubMed (a service of the U.S. National Library of Medicine) was searched for the terms “therapeutic hypothermia” and “septicemia,” with limits activated (humans, English, age 0–18 years). There were only 6 randomized controlled trials, 1 non-randomized controlled trial, 1 retrospective cohort, and 1 case-control trial, which showed no definite evidence of increased risk of septicemia or neutrophil dysfunction in infants following hypothermia therapy.
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    Successful Treatment of Drug-Resistant Seizures Secondary to Ring 20 Mosaicism with Perampanel as an Add-On Antiepileptic Drug
    (2022-05-26) Ling, Janet; Yeung, Wai Lan; Hon, Kam Lun; Lo, Ivan F. M.; Luk, Ho-Ming; Fung, Cheuk Wing; Leung, Alexander K. C.
    We report a girl with drug-resistant seizures, progressive behavioral changes, and cognitive decline. Investigations showed abnormal EEG with frequent high-voltage bifrontotemporal sharp and slow waves, especially during sleep. Seizures were difficult to control, despite the usage of various antiepileptic drugs. Perampanel as an add-on antiepileptic drug appeared efficacious. Due to the recognizable pattern of seizures and EEG findings, a karyotype study was performed which revealed 46 chromosomes with a ring 20 chromosome mosaicism. Ring 20 chromosome is associated with drug-resistant refractory seizures, cognitive decline, and behavioral problems. This case highlights the difficulty and challenge faced in managing drug-resistant refractory seizures associated with ring 20 chromosome. While ring 20 chromosome is often underdiagnosed, one should have a high index of awareness and suspicion of such rare epilepsy syndrome, so that an early diagnosis can be made.