OBJECTIVE. To determine the results of scan-directed unilateral neck exploration for primary hyperparathyroidism.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients who underwent parathyroid surgery for primary hyperparathyroidism between January 2000 and December 2007 were included.

MAIN OUTCOME MEASURES. The demographic, imaging, biochemical, and pathological data, as well as surgical outcomes were analysed according to the treatment received.

RESULTS. A total of 78 patients were included in this study; 65 underwent unilateral neck exploration with image guidance by ultrasonography or technetium Tc99m sestamibi scan. The scan sensitivity for localising the side of the lesion was 66% for ultrasound scans, 71% for technetium Tc99m sestamibi scans, and 85% for both scans used in combination. Pathological analysis showed that 95% (74/78) of the patients had a single parathyroid adenoma, two had hyperplasia of four glands, one had a double adenoma, and one a parathyroid carcinoma. Among the patients undergoing scan-directed unilateral neck exploration, one defaulted follow-up, while the remaining 64 patients achieved normal calcium levels at a median follow-up of 6 months.

CONCLUSION. Scan-directed unilateral neck exploration is a safe alternative form of treatment for patients with primary hyperparathyroidism, with a cure rate similar to conventional therapy.

Key words: Hyperparathyroidism; Parathyroidectomy; Sensitivity and specificity; Technetium Tc99m sestamibi

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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.

Key words: Bariatric surgery; Gastrectomy; Gastric bypass; Laparoscopy; Obesity, morbid

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OBJECTIVES. To evaluate the clinical significance of Trichomonas vaginalis detected in Papanicolaou (Pap) smears in our local population.

DESIGN. Retrospective study.

SETTING. A sexually transmitted disease clinic in Hong Kong.

PATIENTS. All patients having Pap smear, wet mount microscopy, and high vaginal swab culture performed in Tuen Mun Social Hygiene Clinic from April 2005 to December 2006 were recruited.

MAIN OUTCOME MEASURES. Sensitivity, specificity, positive and negative predictive values of the Pap smear for the diagnosis of Trichomonas vaginalis.

RESULTS. A total of 209 patients had the diagnosis of Trichomonas vaginalis in the study period. From among these, the results of 149 patients who had Pap smears, wet mount microscopy, and high vaginal swab culture performed were used in the analysis. Sixty cases were excluded because treatments were initiated before the consultation or because the Pap smear had not been done. Among the Trichomonas vaginalis cases with positive Pap smears, 58% (85/146) were symptomatic and 41% (60/146) had concomitant sexually transmitted disease. The respective sensitivity and specificity of the Pap smear in our study were: 98% (128/131; 95% confidence interval, 94-100%) and 96% (440/458; 94-98%). In total, 128 patients were defined as true positives by wet mount microscopy or culture, while 18 were defined as false positives. In our study population, the positive predictive value was 88% (128/146; 95% confidence interval, 82-93%). On comparing the clinical features of patients with true-positive and false-positive Pap smears, the odds ratio for the presence of symptoms and concomitant sexually transmitted disease was 1.9 (95% confidence interval, 0.7-5.1) and 2.0 (0.7-5.8), respectively. There were no statistically significant differences in the univariate analysis by Chi squared testing.

CONCLUSION. Treatment for vaginal trichomoniasis is recommended if Trichomonas vaginalis is detected in a Pap smear.

Key words: Sensitivity and specificity; Sexually transmitted diseases; Trichomonas vaginalis; Trichomonas vaginitis; Vaginal smears

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OBJECTIVE. To examine the safety and efficacy of endovenous laser obliteration to treat varicose vein in a day surgery setting, using sedation and local anaesthesia.

DESIGN. Prospective study.

SETTING. Day surgery centre in a regional hospital in Hong Kong.

PATIENTS. A total of 24 patients with duplex-confirmed long saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment from July to November 2007 in a single day surgery centre. Adjuvant phlebectomy and injection sclerotherapy were performed in the same session if indicated. All patients had postprocedural venous duplex scan and clinic assessment on day 7 and day 10 respectively.

MAIN OUTCOME MEASURES. Procedure success rate, unplanned hospital admissions and re-admissions, major complications, and long saphenous vein obliteration rate.

RESULTS. A total of 31 limbs of the 24 patients were treated with endovenous laser varicose vein treatment under local anaesthesia and sedation. The procedural success rate was 100%. All but two patients were admitted on the day of treatment and none were re-admitted. The patients' mean visual analogue pain score for the whole procedure was 2.3 (standard deviation, 1.5; range, 0-5). Post-procedural duplex scans showed 100% thrombosis of the treated long saphenous veins with no deep vein thrombosis. There were no skin burns or instances of thrombophlebitis. Induration of the treated long saphenous vein was relatively common (54%). The majority of the patients (54%) experienced mild discomfort in the early postoperative period.

CONCLUSION. Endovenous laser varicose vein treatment performed under local anaesthesia and sedation in a day surgery setting is safe, and yields satisfactory clinical and duplex outcomes.

Key words: Ambulatory surgical procedures; Laser therapy; Saphenous vein; Varicose vein

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OBJECTIVE. To evaluate the incidence of deep venous thrombosis in critically ill, Intensive Care Unit patients of Chinese ethnicity.

DESIGN. Prospective, observational study.

SETTING. Intensive Care Unit in a Hong Kong teaching hospital.

PATIENTS. Consecutive adult Chinese medical patients not receiving pharmacological or mechanical prophylaxis for deep venous thrombosis.

MAIN OUTCOME MEASURES. Compression and duplex Doppler ultrasound examinations of the lower limbs within 24 hours of admission and twice weekly thereafter during their Intensive Care Unit stay. After discharge, a 1-week follow-up investigation was also performed. Demographic data and risk factors for deep venous thrombosis were prospectively recorded.

RESULTS. Over a 9-month study period, 80 patients were investigated. Deep venous thrombosis was detected by ultrasound examination in 15 (19%) of the patients (95% confidence interval, 14-23%). Nine of 15 had isolated below-knee deep venous thrombosis, and of these, five had bilateral involvement. Characteristics of patients with or without deep venous thrombosis were similar. Of the 15 patients who had a positive ultrasound examination, only four (27%) had clinical signs of deep venous thrombosis. Of the 65 patients without a positive ultrasound examination, only two (3%) had positive clinical signs (P=0.01). This yielded a moderate positive likelihood ratio of 9 (95% confidence interval, 2-43) and a small negative likelihood ratio of 0.76 (95% confidence interval, 0.56-1.03). There were no cases of pulmonary embolism. Hospital mortality in those with and without deep venous thrombosis was 33% and 28%, respectively.

CONCLUSIONS. In the absence of prophylaxis, the incidence of deep venous thrombosis in Chinese medical Intensive Care Unit patients is lower than that reported in similar Caucasian patients, but higher than expected. As clinical features are not able to reliably exclude the presence of deep venous thrombosis, early routine prophylaxis for deep venous thrombosis in Chinese medical Intensive Care Unit patients should be considered.

Key words: Critical care; Pulmonary embolism; Thromboembolism; Ultrasonography; Venous thrombosis

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