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

View this abstract indexed in MEDLINE:

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

View this abstract indexed in MEDLINE:

OBJECTIVES. To assess the validity (face validity and criterion-related validity) and reliability (test-retest reliability and internal consistency) of a Cantonese (the Chinese dialect predominantly used in Guangdong Province) version of the Cardiff Acne Disability Index.

DESIGN. Questionnaire study.

SETTING. Two secondary schools in Hong Kong.

PARTICIPANTS. The Chinese Cardiff Acne Disability Index was translated according to international guidelines including forward-backward translation, reconciliation, and cognitive debriefing. A questionnaire, which was composed of the resultant Chinese Cardiff Acne Disability Index and the Cantonese Dermatology Life Quality Index (for those aged more than 16 years) or the Cantonese Children's Dermatology Life Quality Index (for those aged 16 years or less) was administered to 85 eligible secondary school students.

MAIN OUTCOME MEASURES. Establishing face validity, criterion-related validity, internal consistency, and test-retest reliability by standard testing.

RESULTS. The face validity was satisfactory. The strength of the relationship between the Chinese Cardiff Acne Disability Index and Dermatology Life Quality Index was large (gammas=0.58) and significant (P=0.004). The strength of relationship between the Chinese Cardiff Acne Disability Index and Cantonese Dermatology Life Quality Index was also large (gammas=0.72) and significant (P<0.001). Regarding internal consistency, Cronbach's alpha was 0.763. Thirty-three students completed the test-retest reliability test, and the resulting correlation of the first and second administration of the Chinese Cardiff Acne Disability Index was strong (gammas=0.795, P<0.001). The intra-class correlation coefficient was satisfactory (0.784, P<0.001).

CONCLUSION. The Chinese Cardiff Acne Disability Index was equivalent to the original English version, and constitutes a valid and reliable tool for day-to-day clinical use.

Key words: Acne vulgaris; Disability evaluation; Quality of life; Questionnaires; Translating

View this abstract indexed in MEDLINE:

OBJECTIVES. To review the oesophagogastroduodenoscopy findings in children with severe neurological impairment and 'normal' children, over a 7-year period from 2000 to 2007.

DESIGN. Retrospective study.

SETTING. Paediatric Unit of Caritas Medical Centre, Hong Kong.

MAIN OUTCOME MEASURES. The frequencies of Helicobacter pylori status, peptic ulceration, and oesophagitis were compared. The diagnostic value of oesophagogastroduodenoscopy in these two groups of children was also examined.

PATIENTS. Patient data were retrieved from the Hospital Authority Clinical Management system, excluding those under surgical care. The children were divided into two groups: 'normal' and neurologically impaired. Their demographic data, indications for oesophagogastroduodenoscopy, endoscopy diagnoses, and Helicobacter pylori status were compared, as was the diagnostic value of oesophagogastroduodenoscopy.

RESULTS. From 2000 to 2007, 223 oesophagogastroduodenoscopies were performed in 176 patients aged 3 to 22 years; 134 were performed in 'normal' children (median age, 14; range, 3-22 years) and 89 in neurologically impaired children (median age, 12; range, 3-20 years). The three most common indications in 'normal' children were: epigastric pain (60%), gastro-intestinal bleeding (13%), and vomiting (7%). In neurologically impaired children, they were gastro-intestinal bleeding (51%), assessment for percutaneous endoscopic gastrostomy (27%), and follow-up for previous lesions (9%). Among 'normal' children, 14 had duodenal ulcers (associated with Helicobacter pylori in 13), but no patients had gastric ulcers or oesophagitis. Among neurologically impaired children, one had a Helicobacter pylori–negative duodenal ulcer, and four had gastric ulcers (three were Helicobacter pylori–positive). Twenty-four neurologically impaired children had oesophagitis. Neurologically impaired children had significantly more oesophagitis and gastric ulcers (P<0.001 and P=0.004, respectively) but less duodenal ulcers (P=0.024). In 111 children who had gastric biopsies, the Helicobacter pylori infection rate was 35% (31% in 'normal' children and 43% in the neurologically impaired). The diagnostic value was 37% in 'normal' children and 81% in the neurologically impaired (P<0.001). The overall diagnostic value of oesophagogastroduodenoscopy was 50%.

CONCLUSION. The clinical presentation and endoscopic findings in 'normal' and neurologically impaired children were discrepant. Oesophagogastroduodenoscopy appeared to confer greater diagnostic value in neurologically impaired than 'normal' children. Diagnostic values in our unit were comparable to reports from western studies.

Key words: Child; Gastritis; Helicobacter infections; Helicobacter pylori; Stomach ulcer

View this abstract indexed in MEDLINE:

OBJECTIVES. Objective To investigate the demographics and clinical outcomes of intimate partner violence victims presenting to an emergency department.

DESIGN. Retrospective, observational study.

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

PATIENTS. Adults presented with intimate partner violence during years 1999 to 2004.

RESULTS. We assessed 1695 victims of intimate partner violence with a mean age of 39 (range, 18-84) years, of whom 87% were female. Most of the patients were in the age-group of 31 to 40 years and the overall male-to-female ratio was 1:7. In Tin Shui Wai and Yuen Long districts, such cases appeared to be on the increase. Nearly two thirds (65%) of all the victims presented to the emergency department outside the office hours of medical social workers. Approximately 10% had been abused once before, and 40% more than twice. The head (39%), face (30%), upper limbs (37%), and lower limbs (17%) were commonly the injured parts. The majority (73%) had mild injuries; severe injuries being relatively less common. The latter included lacerations or cuts (6.6%), nasal bone fractures (0.3%), limb fractures (0.8%), and ruptured tympanic membranes (0.9%). In-patient management was undertaken for 8% of the victims, due to physical injury in 68% of these individuals and psychological trauma in the remaining 32%. The hospital admission rate dropped from 12% in 2001 to 4% in 2004.

CONCLUSIONS. Variations in demographic data had a significant impact on future service planning and management of intimate partner violence. Accident and Emergency Department and Emergency Medicine Ward services together with extended social worker support could provide timely, multidisciplinary care to meet the various needs of victims and subsequently reduce hospital admissions.

Key words: Battered women; Domestic violence; Emergency medical services; Prevalence; Spouse abuse

View this abstract indexed in MEDLINE: