OBJECTIVE. To review the results of arthroscopic treatment of popliteal cysts in our centre and analyse outcomes including complications.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. From July 2007 to July 2009, 11 patients with symptomatic popliteal cysts were treated arthroscopically. All of them had preoperative magnetic resonance imaging to confirm the diagnosis, identify the valvular opening, and the associated intra-articular pathology. We used the Rauschning and Lindgren criteria for evaluation.

RESULTS. Intra-articular pathology like cartilage degeneration and meniscus tear were commonly associated with popliteal cysts. All patients achieved symptomatic improvement after treatment and the recurrence rate was low. No major complications were encountered. We failed to identify (and correct) any valvular opening in one patient.

CONCLUSION. From our experience, we conclude that arthroscopic treatment of popliteal cyst with correction of the valvular opening and treatment of associated intra-articular pathology is effective and safe.

Key words: Arthroscopy; Joint diseases; Knee joint; Popliteal cyst; Treatment outcome

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OBJECTIVES. Atopic eczema is a chronic relapsing skin disease associated with atopy, and characterised by reduced skin hydration, impaired skin integrity (transepidermal water loss), and poor quality of life. Proper emollient usage is an important facet of its management. This study aimed to establish an approach to evaluate the efficacy of using an emollient over a 4-week period.

DESIGN. Prospective observational study.

SETTING. A paediatric dermatology out-patient clinic of a university teaching hospital in Hong Kong.

PATIENTS. Consecutive new patients aged 5 to 18 years with atopic eczema diagnosed according to Hanifin and Rajka's criteria were recruited from March to August 2009. They or their parents were instructed to liberally apply the test emollient to the flexures and areas affected with eczema, twice daily. Outcome assessments were repeated 2 and 4 weeks later.

MAIN OUTCOME MEASURES. Skin hydration and transepidermal water loss in the right forearm (2 cm below antecubital flexure), and disease severity (SCORing Atopic Dermatitis index) and Children's Dermatology Life Quality Index. At the end of the study period, a global assessment of treatment was recorded.

RESULTS. Thirty-three patients with atopic eczema were recruited and treated with applications of a pseudoceramide-containing cream (Curel, Kao, Japan). The mean age of the patients (16 males and 17 females) was 12 (standard deviation, 4) years. Four weeks following the use of the cream, skin hydration improved significantly and fewer patients were using topical corticosteroids. In these patients, there was no deterioration in transepidermal water loss, eczema severity, or quality of life.

CONCLUSION. The pseudoceramide cream improved skin hydration but not severity or quality of life over a 4-week usage.

Key words: Child; Dermatitis, atopic; Eczema; Emollients; Water loss, insensible

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OBJECTIVE. To evaluate and compare the laboratory and clinical outcomes of vitrification with slow-freezing method for cryopreservation of embryos and blastocysts in an in-vitro fertilisation programme.

DESIGN. Retrospective analysis of all the 104 cycles of frozen embryo and blastocyst replacements from 2003 to 2008 and all the 149 cycles with embryos or blastocysts for vitrification from 2006 to 2009.

SETTING. Hospital-based Licensed Assisted Reproduction Treatment Centre in Hong Kong.

PARTICIPANTS. All participants having frozen embryos or blastocysts transfer from 2003 to 2008.

INTERVENTIONS. Surplus embryos and blastocysts after fresh transfer were cryopreserved by vitrification method.

MAIN OUTCOME MEASURES. Cryosurvival rate after freeze-thawing of early cleavage embryos and blastocysts by the two cryopreservation methods of slow-freezing and vitrification, and the pregnancy rate, implantation rate, delivery rate and live-birth rate achieved.

RESULTS. Cryosurvival rates of both vitrified blastocysts (79%) and early cleavage-stage embryos (88%) were significantly higher, as compared with the slow-freezing groups (57% and 72% respectively, both P<0.05). Pregnancy rates, delivery rates, and implantation rates were all significantly higher with vitrification regardless of the embryo types. Both implantation and live-birth rates were higher (31%, odds ratio=14 and 27%, odds ratio=11, respectively) per vitrified blastocyst transferred as compared with slow-freezing (both 3%).

CONCLUSION. Vitrification improved clinical outcomes of both frozen embryos and especially blastocyst transfers. It conferred upon both blastocysts and embryos better developmental potential after the vitrify-thaw procedure.

Key words: Blastocyst; Cryopreservation; Embryo implantation; Freezing; Pregnancy rate

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OBJECTIVE. To examine the attitudes of Hong Kong Chinese elders with chronic disease with regard to advance directives and life-sustaining treatment.

DESIGN. Cross-sectional questionnaire survey.

SETTING. Medical unit of a regional teaching hospital in Hong Kong.

PARTICIPANTS. In-patients aged 60 years or above with chronic disease.

MAIN OUTCOME MEASURES. Demographic profiles and attitudes towards advance directives and life-sustaining treatment.

RESULTS. A total of 219 elderly patients completed the questionnaire. Their mean age was 73 (standard deviation, 8) years; 133 (61%) were female. The majority had neither heard about advance directives (81%), nor discussed the issue with others (73%) before participating in this study. After they were informed of the concept of advance directives, about half (49%) said they would consider using it if it is legislated in Hong Kong. The respondents generally supported the withholding or withdrawing of life-sustaining treatment in medically futile situations. In all, 55% of them believed that the patient alone should make the decision on withholding or withdrawing life-sustaining treatment, if competent to do so. If the patient became not competent, 44% believed that the individual's family alone should make such a decision.

CONCLUSION. The fact that most of the respondents had never heard about advance directives or discussed the concept with others points to a lack of knowledge and to the necessity to step up public education about such issues.

Key words: Advance directives; Chronic disease; Decision making; Ethics, medical; Life support care

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OBJECTIVES. To determine the trends in incidence and mortality of cervical cancer patients diagnosed during 1997 to 2006, and to describe stage-specific survival using population-based cancer registry data.

DESIGN. Retrospective, population-based study.

SETTING. Hong Kong.

PATIENTS. All patients diagnosed with cervical cancer between 1997 and 2006. Patients eligible for survival analysis were followed up till 31 December 2007.

MAIN OUTCOME MEASURES. Age-standardised incidence and mortality rates and average annual percent changes in these parameters were calculated using the Poisson regression model. Survival was expressed as relative survival rate using a period approach. Hazard ratios of mortality including 95% confidence intervals for certain variables were estimated using the Cox proportional hazards model.

RESULTS. During the 10-year period of the study, overall annual incidence and mortality rates decreased by 4.2% and 6.0%, respectively. Significant rates of reduction were observed in all age-groups except those younger than 45 years. The reduction in incidence of squamous cell carcinoma (3.6% annually) was less than that of adenocarcinoma (5.2%) and other histological types (6.8%). In all, 3807 (86.4%) of the patients were included in survival analysis. The overall 5-year relative survival rate was 71.3% (95% confidence interval, 69.5-73.1%), while the values for stages I, II, III, and IV were 90.9%, 71.0%, 41.7%, and 7.8%, respectively. Age, stage, and histology were independent prognostic factors. Survival of stage IA patients was as good as that of the general population.

CONCLUSIONS. As in other industrialised countries, the incidence and mortality rate of cervical cancer were decreasing. Stage-specific population-based cancer survival was available for the first time, and was useful as an indicator of cancer control. Collaboration between public and private sectors to further improve the follow-up data could provide more comprehensive surveillance information.

Key words: Epidemiologic studies; Incidence; Prevalence; Survival analysis; Uterine cervical neoplasms

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