OBJECTIVES. To study the epidemiology of occupational hand injuries and associated social and industrial factors.

DESIGN. For this retrospective case series of patients with occupational hand injuries, case records were retrieved to gather data. In addition, all the subjects were interviewed by a single interviewer using a predesigned questionnaire.

SETTING. Division of Hand Surgery, Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong.

PATIENTS. A total of 250 patients with occupational hand injuries were treated during the period from 1999 to 2001. This period was chosen to obtain 10 years of follow-up data to assess return to work and any secondary injuries.

MAIN OUTCOME MEASURES. Personal particulars (gender, age, marital status, education level, length of stay in Hong Kong, type of employment, wage system, personal habits, family size, number of breadwinners, income), type of industry and mode of injury, causes of injury according to the worker, work conditions, type of injury, and treatment given.

RESULTS. Two groups of workers in our study had more occupational hand injuries, namely those with less than 1 year of experience on a new job and immigrants from China. Factors associated with a large proportion of occupational hand injuries were male gender with personal risk factors (smoking and regular consumption of alcohol, long working hours), and in the case of machine operators, inadequate training and use of safety devices.

CONCLUSION. Occupational hand injuries lead to loss of working hours and compensation. For prevention, the workplace should be made into a safer and work-friendly environment. Workers should also have sufficient training.

Key words: Accidents, occupational; Hand injuries; Life style; Risk factors; Wounds and injuries

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OBJECTIVE. Inflammation of the optic nerve (optic neuritis) and its sheath (optic perineuritis) can have similar initial clinical presentations. They are less well-defined in the Chinese than in Caucasians, and the aetiology of optic neuritis may also differ depending on ethnicity. The aim of our study was to document the clinical features of acute/subacute optic neuritis/optic perineuritis in Chinese patients.

DESIGN. Retrospective case series.

SETTING. Hong Kong Eye Hospital, Hospital Authority.

PATIENTS. Records of all patients presenting to the Hong Kong Eye Hospital between 2005 and 2008, with their first episode of optic neuritis/optic perineuritis with onset of symptoms within 30 days, were reviewed.

MAIN OUTCOME MEASURES. Disease aetiology, clinical features and outcomes.

RESULTS. Twenty-nine patients were included (M:F=13:16), with a mean age of 46 years at presentation. Among these, 25 had optic neuritis and four had optic perineuritis; four presented with bilateral optic neuritis. Among the optic neuritis group, 17 (68%) were idiopathic, seven (28%) were related to multiple sclerosis, and one (4%) had neuromyelitis optica. Poor visual outcome in the optic neuritis group was associated with poor visual acuity at presentation and poor visual acuity at the nadir.

CONCLUSION. Optic perineuritis and neuromyelitis optica-related optic neuritis were more commonly encountered in our study of Hong Kong Chinese patients than in Caucasian populations. Even in Chinese patients with 'typical' optic neuritis, neuroimaging and further investigations may be warranted to exclude optic perineuritis/neuromyelitis optica, since Chinese ethnicity is itself an atypical feature. Where neuro-imaging is not readily available, intravenous methylprednisolone may be considered as initial treatment to cover both optic neuritis/optic perineuritis in patients with severe visual loss.

Key words: Multiple sclerosis; Optic nerve; Optic neuritis; Visual acuity

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OBJECTIVES. To determine current trends for different modes of delivery in twin pregnancies, factors affecting the mode of delivery, and associated outcomes.

DESIGN. Retrospective cohort study.

SETTING. A public hospital in Hong Kong.

PARTICIPANTS. All twin pregnancies booked at Kwong Wah Hospital during a 3-year period from 1 April 2006 to 31 March 2009.

RESULTS. Of 197 sets of twins, 35 (18%) were delivered vaginally and 162 (82%) by caesarean section (47% were emergencies and 53% elective). In all, 32 (37%) of the elective and 21 (28%) of the emergency caesarean sections were in response to maternal requests. Vaginal delivery was more common in mothers with a history of vaginal delivery and monochorionic diamniotic twins. Women who conceived by assisted reproduction or those who had a tertiary education were more likely to deliver by caesarean section. The type of conception and the presentation of the second twin were statistically significant factors affecting maternal choice on the mode of delivery. Maternal age did not affect the choice of delivery mode. Except for the higher frequency of sepsis and cord blood acidosis in second twins delivered vaginally, there were no significant differences in neonatal morbidity between the groups that attempted vaginal delivery or requested caesarean sections. All the women who had compression sutures or hysterectomy to control massive postpartum haemorrhage were delivered by caesarean section.

CONCLUSION. A high caesarean section rate observed in our cohort was associated with maternal requests for this mode of delivery. The type of conception and the presentation of the second twin were statistically significant factors affecting maternal choice on mode of delivery. Women's requests for caesarean delivery out of the concern for their babies are not supported by current evidence. In response to a woman with a twin pregnancy requesting caesarean delivery, the pros and cons of vaginal deliveries and caesarean sections should be fully explained before the woman's autonomy is respected.

Key words: Cesarean section; Delivery, obstetric; Pregnancy, multiple; Reproductive techniques, assisted; Twins

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OBJECTIVE. To evaluate the efficacy and safety of a new generation of 2.45-GHz microwave to ablate hepatocellular carcinoma by surgical approach.

DESIGN. Case series with prospective follow-up.

SETTING. A university teaching hospital in Hong Kong.

PATIENTS. From March 2009 to January 2011, 26 consecutive patients (19 men and 7 women) with a median age of 63 (range, 49-79) years with hepatocellular carcinoma were recruited. Five (19%) of the patients had recurrent hepatocellular carcinoma after previous treatment.

INTERVENTION. Microwave ablation for hepatocellular carcinomas (one tumour, n=24; two tumours, n=2) using a laparoscopic (n=16) or open approach (n=10).

MAIN OUTCOME MEASURES. Operative mortality and morbidity, rate of incomplete ablation, recurrence rate, and survival rate.

RESULTS. The median tumour diameter was 3.8 cm (range, 2.0-6.0 cm). Complications occurred in five (19%) of the patients; only one was ablation-related, and there was no operative mortality. One (4%) of the patients experienced incomplete ablation. Recurrent tumours were noted in 11 (42%) of the patients (5 were local, 2 were remote, and 4 were multifocal) after a median follow-up of 14 (range, 4-26) months. The failure rate for local disease control was 23%, and was 14% if patients with recurrent hepatocellular carcinoma were excluded. All but one patient survived until the time of censorship. The mean survival was 25 (standard deviation, 1) months.

CONCLUSION. This new-generation microwave technique is safe and effective for local ablation of hepatocellular carcinoma. It is a valuable treatment option for patients who are not candidates for hepatectomy.

Key words: Ablation techniques; Carcinoma, hepatocellular; Liver neoplasms; Microwaves

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OBJECTIVE. To report our experience with the first series of serial transverse enteroplasty operations (a novel bowel-lengthening procedure for patients with short bowel syndrome).

DESIGN. Case series.

SETTING. A tertiary paediatric surgery referral centre in Hong Kong.

PATIENTS. Four patients with short bowel syndrome aged 11 months to 14 years underwent serial transverse enteroplasty between November 2007 and June 2010.

RESULTS. A total of six such serial procedures were performed; two patients had repeated operations. Median pre-serial transverse enteroplasty small bowel length was 17.5 cm. The median increase in small bowel length was 90%. One patient experienced transient postoperative intestinal obstruction that resolved after conservative management. The median postoperative follow-up period was 31 months. The median enteral nutrition tolerance increased from 24% to 47%. The median weight-for-age z score increased by 0.55, and the median weight-for-height z score increased by 0.98. One patient had successfully weaned off parenteral nutrition.

CONCLUSION. Serial transverse enteroplasty is a feasible and safe treatment for short bowel syndrome patients, which helps to improve enteral nutrition and promote growth. Repeated serial transverse enteroplasty can be performed in patients with ultra-short bowel lengths. Follow-up is necessary to assess the long-term outcomes.

Key words: Intestinal obstruction; Intestine, small; Reconstructive surgical procedures; Short bowel syndrome

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