OBJECTIVES. To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones.

DESIGN. Retrospective study.

SETTING. Regional minimal access surgery training centre in Hong Kong.

PATIENTS. Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005.

MAIN OUTCOME MEASURES. Demographic information, reasons for failed endoscopic retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality.

RESULTS. A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months.

CONCLUSIONS. Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.

Key words: Cholangiopancreatography, endoscopic retrograde; Cholecystectomy, laparoscopic; Common bile duct/surgery; Gallstones/surgery; Sphincterotomy, endoscopic

View this abstract indexed in MEDLINE:

OBJECTIVES. To investigate the prevalence of cerebral palsy in local children aged 6 to 12 years and to evaluate service utilisation by those children who attend mainstream schools.

DESIGN. Cross-sectional survey.

SETTING. Mainstream primary schools and special needs schools in Hong Kong.

PARTICIPANTS. Headmasters or headmistresses of special needs schools, and various organisations that provide services to children with cerebral palsy in the school year September 2003 to June 2004.

MAIN OUTCOME MEASURES. Prevalence of cerebral palsy and support services used by children with cerebral palsy who attend a mainstream school.

RESULTS. Of 435 572 children, 578 with cerebral palsy were identified. The overall point prevalence was 1.3 per 1000 children. The age-specific prevalence rate varied from 1.04 to 1.50 per 1000 children. Approximately 38% of children with cerebral palsy attended a mainstream school. Among those studying in special needs schools, 96% attended a school for the physically handicapped or a school for the severely mentally handicapped. Among 219 children with cerebral palsy in mainstream schools, 57 (26%) received educational support, and 134 (61%) received out-patient therapy support. Only 12% received both supporting services. No educational or therapeutic support was received by 26% of children.

CONCLUSIONS. Compared with overseas data, the low prevalence of cerebral palsy detected in local children in this investigation may be due to the differences in study design or a genuinely low prevalence. Setting up a cerebral palsy registry could help monitor the local prevalence of this childhood disability more accurately, thereby providing more reliable information for planning support services for this subgroup of children.

Key words: Cerebral palsy; Children; Prevalence; Survey

View this abstract indexed in MEDLINE:

OBJECTIVE. To study the clinical experience acquired by trainee anaesthesiologists after 6 years of training in Hong Kong.

DESIGN. Retrospective observational study.

SETTING. Recognised anaesthesiology training posts in the Hong Kong Hospital Authority.

PARTICIPANTS. All anaesthesiology trainees who sat the Exit Assessment between January 2001 and June 2002 after completing more than 48 months of anaesthetic training.

MAIN OUTCOME MEASURES. Anaesthetic experience of trainees.

RESULTS. All data provided by 25 trainees were computed for analysis. Each trainee administered a mean of 2668 anaesthetics over a 6-year period, including 57 anaesthetics for thoracic surgery, 15 for cardiac surgery, 213 for caesarian section (34% under general anaesthesia), and 100 for neurosurgical operations. The paediatric anaesthesia exposure involved a mean of 12 neonates and 180 children who were younger than 4 years. Apart from cardiac and thoracic anaesthesia, there was no statistical difference in subspecialty anaesthetic experience among trainees from different parent hospitals.

CONCLUSION. The current training system provides sufficient anaesthetic experience in terms of case variety and subspecialty case numbers. There was uneven exposure to cardiac, thoracic, and paediatric anaesthesia. An accurate logbook that is reviewed regularly by a supervisor will help ensure adequate subspecialty exposure. An electronic logbook will facilitate a more comprehensive reviewing process.

Key words: Anesthesiology/education; Medical audit; Records

View this abstract indexed in MEDLINE:

OBJECTIVE. To investigate the management of hypertension by private doctors in Hong Kong.

DESIGN. Self-administered questionnaire survey.

SETTING. Hong Kong.

PARTICIPANTS. Private doctors from all districts in Hong Kong selected by simple random sampling from the website of “The Hong Kong Doctors Homepage” from March to June 2005.

MAIN OUTCOME MEASURES. Practice of blood pressure measurement and the treatment prescribed to hypertensive patients.

RESULTS. A total of 225 (46%) completed questionnaires were analysed. Only 24.4% of the respondents measured blood pressure in all new patients aged above 18 years. A total of 28.0% of doctors reported that hypertensive status was unknown in over 30% of their patients prior to their first clinic visit when it was consequently diagnosed. Calcium channel blockers (31%), angiotensin-converting enzyme inhibitors (28.5%), diuretics (27.5%), and beta-blockers (21.2%) were the most commonly prescribed antihypertensive medication. Drug efficacy was the reason cited by more than half (56.9%) of doctors for selecting a given drug. Public education about hypertension was considered insufficient by 66.2% of doctors and 32% believed that self-medication would have a very significant effect on drug compliance.

CONCLUSIONS. In private clinics, blood pressure measurement should become a routine procedure. There is a need to raise public awareness of hypertension.

Key words: Hypertension; Primary health care; Private practice; Questionnaires

View this abstract indexed in MEDLINE:

OBJECTIVE. To compare the level of pain experienced by patients during transrectal ultrasound-guided prostatic biopsy using intrarectal 2% lidocaine gel versus plain lubricant gel.

DESIGN. Prospective double-blind randomised controlled trial.

SETTING. Regional hospital, Hong Kong.

PATIENTS. From March 2002 to December 2003, patients who underwent ultrasound-guided prostate biopsy at a Geriatric Urology Centre.

MAIN OUTCOME MEASURES. Pain and discomfort scores measured by horizontal visual analogue scales.

RESULTS. A total of 338 consecutive patients were randomised to lidocaine gel or plain lubricant gel groups. The two groups were statistically similar in demographic and disease characteristics. There were no significant statistical differences in pain or discomfort score in the lidocaine gel and plain lubricant groups—pain score: 1.75 versus 1.79 (P=0.66) on day 0 and 0.21 versus 0.15 (P=0.97) on day 1; discomfort score: 0.79 versus 0.77 (P=0.86) on day 0 and 0.12 versus 0.12 (P=0.76) on day 1. No major complications were recorded in this cohort.

CONCLUSIONS. Transrectal ultrasound-guided trucut biopsy of the prostate can be safely performed with no anaesthesia in Chinese patients. Pain and discomfort are minimal. It was found that 2% lidocaine gel has no statistical therapeutic or analgesic benefit over plain lubricant gel.

Key words: Anesthesia; Lidocaine; Pain measurement; Prostatic neoplasms; Ultrasonography, interventional

View this abstract indexed in MEDLINE: