OBJECTIVE. To review the demographic data, imaging features, and outcomes of paediatric haemangiomas.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. A total of 58 children diagnosed with haemangioma between 1998 and 2007.

MAIN OUTCOME MEASURES. Demographic data, imaging features, type of treatment received, and outcomes.

RESULTS. In all, 19 (33%) of these patients were males and 39 (67%) were females. Most of the lesions (64%) were in the head and neck region. Three (5%) of the patients were complicated by the Kasabach-Merritt syndrome; 21 underwent no imaging, and 37 had ultrasound and/or magnetic resonance imaging. In the majority (85%), ultrasound of the lesions revealed mixed echogenicity and/or phleboliths with variable colour Doppler patterns. On magnetic resonance imaging, most (87%) of the lesions were T1 iso- to hypo-intense and T2 hyperintense with slight heterogeneous signalling and revealed presence of central flow voids (vascular channels) or low-signal areas (fibrous tissue or calcification). In all, 85% appeared homogeneous while 15% showed heterogeneous enhancement. Of 58 patients, 39 (67%) patients received conservative treatment; the lesions resolved spontaneously in 34 (87%) patients, enlarged in 2 (5%), and remained static in 3 (8%). Interventions were directed at the lesions in 19 patients. These entailed surgical excision (n=7), argon laser therapy (n=3), and medical treatment (n=9). Of the latter patients, treatment included: systemic steroids (n=5), interferon (n=1), steroids and interferon (n=1), vincristine (n=1), and sclerotherapy (n=1). Partial or complete resolution of the lesions ensued in 15 (79%) of the patients, while their size remained static in four (21%).

CONCLUSION. Though ultrasound and magnetic resonance imaging features varied, the diagnosis of most haemangiomas could be confidently made by imaging. About 33% of haemangiomas underwent surgical/medical interventions, for which imaging was useful to monitor post-treatment progress.

Key words: Child; Hemangioma; Magnetic resonance Imaging; Soft tissue neoplasms; Ultrasonography, Doppler, color

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OBJECTIVE. To investigate the efficacy and safety of lidocaine nasal spray before nasogastric tube insertion in an emergency department.

DESIGN. Double-blind, randomised controlled study.

SETTING. Emergency department of a major regional hospital in Hong Kong.

PATIENTS. A total of 206 adult patients, for whom nasogastric tube insertion was indicated.

MAIN OUTCOME MEASURES. Primary outcome was discomfort gauged on a visual analogue scale, and Likert scale addressing difficulty of nasogastric tube insertion.

RESULTS. Compared with placebo spray use, lidocaine spray use was associated with less patient discomfort, and less difficulty in nasogastric tube insertion, both difference being statistically significant.

CONCLUSION. Intranasal lidocaine spray before nasogastric tube insertion was safe and effective in reducing patient discomfort related to the procedure.

Key words: Anesthetics, local; Intubation, gastrointestinal; Lidocaine; Lubrication; Pain measurement

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OBJECTIVE. To investigate the effect of antibiotic lock solutions for preventing catheter-related bacteraemia in patients receiving haemodialysis.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Consecutive patients from March 2006 to April 2007 who had central venous catheter insertion for haemodialysis in our centre were included in this historically controlled study. In all, 75 patients had catheters with heparin solution alone and 74 had catheters with a gentamicin antibiotic lock. The majority of catheters were non-tunnelled (95%). Cumulative catheter survival free of catheter-related bacteraemia in the two groups was compared.

RESULTS. Baseline characteristics in the two groups were similar apart from a slightly lower serum albumin level in those with gentamicin locks. There were 18 and five catheter-related bacteraemia episodes before and after recourse to gentamicin antibiotic locks, respectively. Staphylococcus aureus contributed to over half (65%) of the total bacteraemia episodes. Use of gentamicin antibiotic locks significantly reduced catheter-related bacteraemia episodes per 1000 catheter days from 4.6 to 1.5 (P=0.002). Kaplan-Meier survival analysis using the log rank test showed significantly better bloodstream infection-free survival associated with using gentamicin antibiotic locks (P=0.032). A similar survival advantage was associated with gentamicin antibiotic locks when the analysis was restricted to non-tunnelled catheters. There was no significant association of catheter-related bacteraemia with patient age, obesity, gender, baseline serum albumin level, or diabetes mellitus. No serious adverse events were attributable to the use of gentamicin antibiotic locks.

CONCLUSION. Use of gentamicin lock solutions effectively reduced catheter-related bacteraemia in haemodialysis patients, including those with non-tunnelled catheters.

Key words: Anti-infective agents; Bacteremia; Catheters, indwelling; Infection control; Renal dialysis

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OBJECTIVE. To examine early adolescent outcome of attention-deficit hyperactivity disorder in local Chinese children.

DESIGN. Cohort study.

SETTING. A university teaching hospital in Hong Kong.

PARTICIPANTS. A cohort of Chinese children with attention-deficit hyperactivity disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition) who attended a day hospital between January 1998 and December 2003.

MAIN OUTCOME MEASURES. Data on psychopathology, academic attainment, delinquency, substance use, and other psychosocial functioning collected from multiple informants and official records. Performances of subjects were compared with a group of community controls.

RESULTS. A total of 150 children with attention-deficit hyperactivity disorder were reassessed 6 years after initial intake assessment (mean age, 14 years; follow-up rate, 86%). Compared with the controls, their externalising and internalising disturbances were 4 and 1.5 times more common, respectively. Adolescents with attention-deficit hyperactivity disorder were more likely to smoke cigarettes and use illicit drugs. Their academic attainment was below age norms with more than one fourth repeating grades; 7% of them had been arrested by the police compared with none of the controls. They faced more difficulties in the family environment and social problem-solving. There were discrepancies between parent and patient reports about their attention-deficit hyperactivity disorder symptoms, and officially recorded youth reports of delinquency.

CONCLUSION. Local Chinese children with attention-deficit hyperactivity disorder are at significant risk of multiple forms of adolescent maladjustment. Their outcome profile is similar to that reported in the West.

Key words: Adolescent behavior; Attention deficit disorder with hyperactivity; Child behavior disorders; Follow-up studies; Juvenile delinquency

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OBJECTIVE. To investigate the prevalence and characteristics of abusive drug exposure among non-fatal motor vehicle driver casualties presenting to a designated trauma centre in Hong Kong.

DESIGN. Cross-sectional study.

SETTING. Designated trauma centre/regional accident and emergency department in Hong Kong.

SUBJECTS. Non-fatal motor vehicle driver casualties who presented to the trauma centre from 1 January 2007 to 31 December 2007.

MAIN OUTCOME MEASURES. Screening of abusive drug exposure using commercial bedside urine immunoassay kits.

RESULTS. Drug screening was performed in 395 injured drivers, 10% of whom tested positive for the drugs of interest. Ketamine was the most commonly detected abusive substance (found in 45% of the subjects). A significantly higher proportion of young drivers (aged <25 years) screened positive (odds ratio=2.3; 95% confidence interval, 1.0-5.2; P=0.04), with the rate being 21%. The presence of these drugs in urine was related to the time of occurrence of the crash; those occurring between midnight and dawn revealed a trend towards a higher proportion of casualties testing drug-positive (odds ratio=2.2; 95% confidence interval, 0.9-5.3; P=0.07). There were no significant differences in the frequency of persons testing positive for the screened drugs with respect to gender, class of motor vehicle driven, or the day of the week on which the crash occurred.

CONCLUSIONS. The prevalence of drugged driving among non-fatal casualties in our series of Hong Kong drivers was 10%. The frequency of such drivers testing positive for drugs was significantly higher in persons aged less than 25 years. These findings indicate a need to amend existing laws and implement on-site drug screening for suspected drugged drivers.

Key words: Accidents, traffic; Psychotropic drugs; Street drugs; Substance abuse detection; Substance-related disorders

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