OBJECTIVE. To analyse the performance of opportunistic breast screening in local Well Women Clinics during the 5-year period from 1998 to 2002, with reference to international as well as our own earlier experience (1991 to 1993 to 1995).

DESIGN. Prospective study.

SETTING. Well Women Clinics in regional Hong Kong hospitals.

PARTICIPANTS. Women attending the Well Women Clinics of the Tung Wah Group of Hospitals for breast cancer screening.

MAIN OUTCOME MEASURES. All screening-detected breast cancers.

RESULTS. After 46 637 screening mammograms and excluding palpable masses detected by the patients themselves, 232 women were detected with cancers, yielding a crude detection rate of 5.0 per 1000. Age range for cancer detection was 35 to 72 (median, 49) years. Clinic staff detected palpable lumps in 83 patients, constituting 36% of the detected cancers, of which 15 (6.5% of all detected cancers) were not identified by mammography. The cancer detection rate was 5.9 per 1000 in the age-group 40-49 years and 3.7 per 1000 in those 50 years or older. The cancer detection rate was 58.5 per 1000 in the high-risk group (aged <40 years with positive family history). The minimal cancer detection rate was 2.2 per 1000, representing 45% of all cancers whose pathology was available to us. Ductal carcinoma in situ comprised 28% of all such cancers. Our recall rates were 4.6% for additional views only, 3.3% for ultrasound only, and 2.3% for both. Positive predictive values for abnormal mammograms and biopsies were 4.9% and 26.0%, respectively.

CONCLUSION. Mammographic screening has been reported to reduce mortality up to 35% in western countries. However, data concerning Asian Chinese populations are meagre. Our Well Women Clinics pioneered large-scale self-referred breast screening in Hong Kong. Despite the lower incidence of breast cancers than in Occidental populations, our screening programme performed comparably to those in the West, and has improved over time. Our screening service for self-referred women detected breast cancers even at an early stage, which facilitated a better prognosis and more treatment options, whilst appearing to be highly acceptable to our community. Besides, it could provide training and expertise in breast radiology and mammography, which are essential prerequisites for establishing population screening.

Key words: Mammography; Ultrasonography, mammary

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OBJECTIVES. To determine the outcomes after first-ever stroke, including mortality, dependence, and recurrence.

DESIGN. Retrospective study on a prospectively collected cohort.

SETTING. Regional hospital, Hong Kong.

PATIENTS. A cohort of 755 patients presented to our hospital from 1996 to 1998 with their first-ever stroke.

MAIN OUTCOME MEASURES. Mortality and stroke recurrence rate at 30 days, 1 year, and 5 years from the onset of the stroke. Dependence in activity of daily living at 5 years from the onset of stroke.

RESULTS. The mortality rate was 15.1% at 30 days, 22.5% at 1 year, and 39.7% at 5 years from the onset of the first-ever stroke. The rate of stroke recurrence was 0.9% at 30 days, 7.0% at 1 year, and 21.2% at 5 years from the onset of first-ever stroke. Among patients presenting with ischaemic strokes, 109 (20.6%) had a recurrence, of which 92 (84%) were ischaemic strokes and 17 (16%) were haemorrhagic. Among patients presenting with intracerebral haemorrhage, 25 (23.1%) had a recurrence, of which 12 (48%) were haemorrhagic strokes and 13 (52%) patients were ischaemic. After 5 years, 11% of the patients were dependent in terms of activity of daily living.

CONCLUSIONS. The long-term prognosis after first-ever stroke is poor—5 years after their stroke, 39.7% of patients had died and 10.7% were dependent in terms of activity of daily living; 136 (21%) who survived at least 30 days after the initial stroke, had a recurrence within 5 years.

Key words: Cerebrovascular accident; Ischemic attack, transient; Prognosis; Recurrence; Treatment outcome

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OBJECTIVE. To review the management and outcome of babies with antenatally diagnosed congenital cystic adenomatoid malformation.

DESIGN. Retrospective cohort review.

SETTING. Tertiary neonatal care unit at Queen Mary Hospital and antenatal diagnostic centre at Tsan Yuk Hospital.

PATIENTS. Consecutive patients with antenatally suspected congenital cystic adenomatoid malformation in their concepti among antenatal patients attending Tsan Yuk Hospital from 1994 to 2002. Twentyfour of 33 cases were referred to Queen Mary Hospital for postnatal management and for whom comprehensive records were available for analysis in 23.

INTERVENTIONS. Postnatal interventions in their babies included investigational imaging for congenital cystic adenomatoid malformation and surgery.

MAIN OUTCOME MEASURES. Antenatal and postnatal outcome, as well as pathology of the excised lesions.

RESULTS. Antenatal outcome: termination of pregnancy in two cases and spontaneous abortion in one; in-utero regression was documented in nine cases and in one hydropic change was apparent. Postnatal outcome: only eight of 20 babies born alive had symptoms in neonatal period. Two developed serious infective complications in infancy, one with documented in-utero regression. Pulmonary parenchymal abnormalities were detected on computed tomography of the thorax in six of seven cases with normal or non-specific chest radiograph findings. Among nine cases with in-utero regression, congenital cystic adenomatoid malformation was confirmed by operative histology in five and abnormal computed tomography findings in three. Fifteen babies underwent surgical excision, one of whom died because of severe pre-existing pulmonary hypoplasia and nine endured minor postoperative complications. A favourable outcome was documented at a mean follow-up of 22 months (range, 2 months-7 years).

CONCLUSIONS. In-utero regression of congenital cystic adenomatoid malformation on antenatal ultrasound may not represent genuine resolution. Computed tomographic thorax should be considered in all newborns with antenatally diagnosed congenital cystic adenomatoid malformation, and if confirmed early operation before first hospital discharge is recommended.

Key words: Cystic adenomatoid malformation of lung, congenital; Prenatal diagnosis; Treatment outcome

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OBJECTIVES. Using polymerase chain reactions, this study aimed to evaluate the incidence of neonatal chlamydial conjunctivitis in our region of Hong Kong and explore any association between such conjunctivitis and nasopharyngeal colonisation with Chlamydia trachomatis.

DESIGN. Prospective epidemiological study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Consecutive patients with neonatal conjunctivitis presenting to our hospital were recruited from May 2004 to April 2005 inclusive. Both eyes were investigated separately for Chlamydia trachomatis by polymerase chain reaction, direct immunofluorescent assay, and cell culture by two assigned ophthalmologists. Neonates diagnosed to have ocular Chlamydia trachomatis infection were subjected to additional nasopharyngeal investigations. Complete sets of ocular and nasopharyngeal investigations were also undertaken 1 week after oral erythromycin treatment to confirm complete eradication of Chlamydia trachomatis.

RESULTS. Of 192 patients with neonatal conjunctivitis, 24 were diagnosed to have chlamydial conjunctivitis. Fifteen of them had nasopharyngeal colonisation with Chlamydia trachomatis. Among the 20 neonatal chlamydial conjunctivitis patients that completed the follow-up study, one suffered treatment failure. None had clinically diagnosed systemic Chlamydia trachomatis infection 3 months after oral erythromycin.

CONCLUSIONS. The incidence of neonatal chlamydial conjunctivitis in our region of Hong Kong was 4 in 1000 live births, of whom 63% had nasopharyngeal presence of Chlamydia trachomatis. Owing to the high rate of nasopharyngeal isolation and possibility of treatment failure, post-treatment ocular and nasopharyngeal polymerase chain reaction testing for Chlamydia trachomatis may be considered to confirm complete eradication.

Key words: Chlamydia infections; Chlamydia trachomatis; Conjunctivitis, bacterial; Nasopharyngeal diseases; Polymerase chain reaction

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OBJECTIVES. To review the accuracy of fine-needle aspiration cytology in diagnosing non-toxic thyroid nodules and determine what factors are predictive of malignancy in patients with indeterminate cytology results.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients with non-toxic thyroid nodules undergoing thyroidectomy from December 1999 to December 2003.

MAIN OUTCOME MEASURES. Sensitivity, specificity, positive and negative predictive value of fine-needle aspiration cytology, predictive factors for malignancy in patients with indeterminate fine-needle aspiration cytology results.

RESULTS. The sensitivity, specificity, positive predictive value, and negative predictive value of fine-needle aspiration cytology were 54%, 100%, 100%, and 75% respectively. For the 92 patients with fine-needle aspiration cytology reported as 'indeterminate for malignancy' aspiration cytology subgroup (P=0.005) and age (P=0.001) were significant risk factors for diagnosing malignancy.

CONCLUSIONS. Fine-needle aspiration cytology has high positive predictive value for thyroid cancer, enabling us to 'rule-in' malignant lesions with confidence. Among those with indeterminate fine-needle aspiration cytology, atypical cell lesions and age greater than 40 years conferred increased risk of malignancy.

Key words: Biopsy, needle; Frozen sections; Predictive value of tests; Thyroid nodule

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