OBJECTIVES. To investigate the epidemiology of surgical site infection in cardiac surgery patients operated on in 2006.

DESIGN. Retrospective study of a case-control sample.

SETTING. Cardiac surgery unit of a university teaching hospital in Hong Kong.

PATIENTS. Cardiac surgery patients with surgical site infection were matched by procedure type, sex, and year of surgery with non-infected patients.

MAIN OUTCOME MEASURES. Identification of risk factors for surgical site infection.

RESULTS. The infected and non-infected cardiac surgery patients did not differ in age, sex, or smoking history; however, patients with surgical site infection were significantly heavier (mean body mass index, 26.6 vs 23.9 kg/m²), P<0.046). Almost 41% of the subjects had a history of diabetes mellitus, there being a significantly greater proportion among infected than non-infected patients (53.1% vs 28.1%, P<0.042). All 37 of the patients without a diagnosis of diabetes had normal (ie <8 mmol/L) preoperative glucose levels, but 99% of them yielded evidence of subsequent glycaemic dysfunction during or after surgery. Overall, 50% of the patients had a blood transfusion during the operation, with infected patients significantly more likely to have been transfused than the non-infected ones (65.6% vs 34.4%, P<0.008).

CONCLUSIONS. There appears to be a relationship between surgical site infection in cardiac surgery patients and pre-existing (diagnosed and covert) diabetes mellitus and blood transfusion. Future studies should consider these factors in relation to surgical site infections, both in the wider surgical population and from a risk-minimisation perspective.

Key words: Blood transfusion; Cardiac surgical procedures; Diabetes mellitus; Risk factors; Surgical wound infection

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OBJECTIVE. To evaluate the early and mid-term results of the first 100 elective endovascular repairs for abdominal aortic aneurysms.

DESIGN. Retrospective analysis of prospectively collected data.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. The first 100 patients with infrarenal abdominal aortic aneurysms who underwent elective endovascular repair.

MAIN OUTCOME MEASURES. Peri-operative data, mortality and morbidities as well as the follow-up details were recorded. Cumulative data on endoleaks, clinical failures, secondary procedures, and survival were evaluated with Kaplan-Meier analyses.

RESULTS. There were 85 men and 15 women, with a mean age of 75 (range, 50-90) years. Failed implantations due to access difficulty occurred in two patients during the same period, giving a technical success rate of 98%. The mean aneurysm diameter was 6.2 cm. Access site injury requiring repair occurred in four (4%) of the patients, while wound problems were the most common complications (11%). The median hospital stay was 6 days, and there were two hospital deaths, giving a hospital mortality rate of 2%. During a mean follow-up of 36 (standard deviation, 24) months, there were three aneurysmal ruptures and four elective open conversions, with only one aneurysm-related death after hospital discharge. At 3 years, the cumulative rates of freedom from any endoleak, freedom from primary failure, freedom from secondary failure, freedom from secondary procedures, and survival were 60%, 84%, 89%, 88%, and 78%, respectively.

CONCLUSIONS. The early and mid-term results of elective endovascular repair for abdominal aortic aneurysms appear promising. The procedure is effective in preventing aneurysm-related death in the mid-term. Nevertheless, the importance of constant surveillance cannot be over-emphasised, as clinical failures and ruptures are still a concern.

Key words: Aortic aneurysm, abdominal; Aortic rupture; Treatment outcome; Vascular surgical procedures

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OBJECTIVE. To study the childhood renal disease pattern based on the renal biopsy histology in a local paediatric tertiary renal centre.

DESIGN. Retrospective study.

SETTING. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong.

PATIENTS. All patients who underwent real-time ultrasound-guided closed renal biopsy from 1 April 1997 to 31 March 2007 were included.

RESULTS. A total of 209 renal biopsies were performed, 162 on native kidneys and 47 on grafts. In the native group, major indications were renal manifestations secondary to systemic diseases (34%), followed by idiopathic nephrotic syndrome (28%) and haematuria (27%). In 94% the histopathology revealed glomerular diseases. Among the primary glomerular diseases, thin glomerular basement membrane disease, immunoglobulin A nephropathy, minimal change disease, and focal segmental glomerulosclerosis accounted for most. In all, 37% of patients with steroid-resistant nephrotic syndrome had focal segmental glomerulosclerosis and its relative incidence was increased when compared to previous studies. Minimal change disease and minimal change disease with mesangial immunoglobulin M deposits accounted for the majority of steroid dependent and frequent relapsers. Among patients with isolated microscopic haematuria, 73% had thin glomerular basement membrane disease, while patients with concomitant haematuria and proteinuria had a wide variety of pathology. In the kidney graft group, acute graft dysfunction was due to acute rejection in 38% of the patients, followed by calcineurin inhibitor toxicity in 14%. Chronic allograft nephropathy caused chronic allograft dysfunction in the majority of cases. Post-transplant proteinuria was caused by recurrence of the primary renal disease in all of our patients.

CONCLUSION. This study provides updated epidemiological information for childhood renal disease and a change in the pattern of disease was observed.

Key words: Biopsy; Glomerulonephritis, IGA; Glomerulosclerosis, focal segmental; Kidney transplantation; Nephrotic syndrome

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OBJECTIVE. To examine the risk factors for human immunodeficiency virus (HIV) transmission among attendees of public sexually transmitted infection clinics in Hong Kong.

DESIGN. Retrospective matched case-control study.

SETTING. All public sexually transmitted infection clinics in Hong Kong.

PATIENTS. All public sexually transmitted infection clinic attendees’ records from January 1995 to December 2002 were reviewed.

MAIN OUTCOME MEASURES. HIV sero-positivity in corresponding clinic attendees.

RESULTS. A total of 196 HIV-positive cases among 149 336 sexually transmitted infection clinic attendees were recruited into the study. Multivariate analysis using conditional logistic regression revealed that HIV infection was associated with the following factors: belonging to non-Chinese ethnic groups (mainly South-East Asian) [odds ratio=9.32; 95% confidence interval, 3.27-26.55], coexisting syphilis (other than primary) [5.67; 1.66-19.36], current non-gonococcal urethritis (2.10; 1.08-4.07), current genital warts (1.94; 1.10-3.43), history of prior sexually transmitted infection (2.19; 1.29-3.72), having casual sex with friends (2.89; 1.07-7.80), and casual sex in Mainland China (1.91; 1.04-3.49). Sexual orientation was also considered to be a potential risk factor, as only those who tested positive reported to be homosexual or bisexual.

CONCLUSION. Sexually transmitted disease patients represent an identifiable group who are at high risk of HIV infection. This study found that there were certain factors which increased the risk of HIV infection among patients attending public sexually transmitted infection clinics. Targeted interventions should therefore be offered to such high-risk individuals, so as to prevent and control HIV transmission.

Key words: HIV infections; Risk factors; Sexual behavior; Sexually transmitted diseases

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OBJECTIVE. To examine the relation between perceived overprotection and the psychological states of cerebral palsy patients and their primary caretakers in Hong Kong.

DESIGN. Cross-sectional survey, in which data of 14 pairs of cerebral palsy patients and their caretakers were analysed.

SETTING. Duchess of Kent Children's Hospital, Hong Kong.

PARTICIPANTS. Cerebral palsy patients and their primary caretakers in Hong Kong.

MAIN OUTCOME MEASURES. Perceived overprotection and psychological states.

RESULTS. Nearly two thirds of the 14 patients (mean age of 15 years) and 86% of the 14 primary caretakers (mean age of 47 years) perceived various levels of overprotection. For both patients and caretakers, perceived overprotection was positively associated with anxiety and unhappiness. The patients' and caretakers' psychological states and perception of overprotection were not related to the actual motor ability of the patients. Perceived overprotection of the patients was not related to that of the caretakers.

CONCLUSION. Caretakers should be mindful that a well-meaning move may have undesirable consequences. More support and child-rearing education should be considered for caretakers.

Key words: Caregivers; Cerebral palsy; Parent-child relations

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