OBJECTIVES. To review the treatment of benign prostatic hyperplasia in Hong Kong.

DESIGN. Questionnaire study and review of previous presentations at the Hong Kong Urological Association meetings.

SETTING. Urology centres in the public sector, Hong Kong.

PARTICIPANTS. Thirteen public urology centres replied to the questionnaire survey. Thirty-two papers on benign prostatic hyperplasia presented at past annual scientific meetings of the Hong Kong Urological Association were identified. This would provide an overview of the development of surgical interventions for the treatment of benign prostatic hyperplasia carried out in Hong Kong.

RESULTS. Most known surgical techniques have been practised in Hong Kong. Many ‘minimally invasive procedures’ have now fallen out of favour. Some newer techniques are now available and have produced favourable results. Nonetheless, transurethral resection of the prostate remains the standard surgical intervention in 12 of 13 centres in Hong Kong.

CONCLUSION. Transurethral resection of the prostate remains the technique of choice for the treatment of benign prostatic hyperplasia in Hong Kong. New techniques should be comprehensively studied and evaluated before being introduced into regular practice.

Key words: Data collection; Prostatic hyperplasia; Surgery

View this abstract indexed in MEDLINE:

OBJECTIVE. To test the feasibility of needlescopic cholecystectomy using a two-port technique with 3-mm miniaturised instruments.

DESIGN. Prospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. One hundred consecutive patients undergoing elective cholecystectomy from September 2001 to August 2002.

INTERVENTION. Two-port needlescopic cholecystectomy all performed or supervised by a single laparoscopic surgeon.

MAIN OUTCOME MEASURES. Conversion of the procedure, the operating time, postoperative analgesic requirement, pain score using the 10-cm visual analog scale, complications, and the postoperative stay. To determine the technical difficulty of this new technique, the data from the first 50 patients were compared with those of the latter 50. Outcome variables were also compared with a group of 58 patients operated on with the standard two-port laparoscopic cholecystectomy in a previous randomised trial.

RESULTS. One conversion to open cholecystectomy was reported. Three patients required the enlargement of epigastric port to a size of 5 mm and six patients required an additional port to complete the operation. The median operating time was 62 minutes (range, 33-168 minutes). The median pain score was 3.5 (range, 0-9) and the median postoperative stay was 2 days (range, 1-14 days). Six patients had postoperative complications. When the first 50 patients were compared with the latter 50, there were no differences in the conversion rate, operating time, complication rate, and duration of hospital stay. However, the latter 50 patients had significantly lower pain scores (median, 3.5 vs 4.9; P=0.007) and faster resumption of diet (median, 5 vs 9 hours; P<0.001). The median operating time of needlescopic cholecystectomy was notably longer (62 vs 46 minutes; P<0.001) compared with that of the two-port laparoscopic cholecystectomy. Patients undergoing needlescopic cholecystectomy had a better resumption of diet (median, 5 vs 7 hours; P<0.001) and less postoperative pain (overall pain score, median, 3.5 vs 4.8; P=0.052) than the two-port laparoscopic cholecystectomy group. Pain scores at individual port sites were also lower in needlescopic cholecystectomy group (umbilical port: median, 3 vs 4.4, P=0.015; epigastric port: median, 2.0 vs 3.6, P=0.036).

CONCLUSION. Two-port needlescopic cholecystectomy is technically feasible and may further improve the surgical outcomes in terms of postoperative pain and cosmesis. It can be considered for routine practice by surgeons who are familiar with the two-port laparoscopic cholecystectomy technique.

Key words: Cholecystectomy, laparoscopic; Fiber optics; Laparoscopes; Miniaturization; Needles

View this abstract indexed in MEDLINE:

OBJECTIVES. To assess the usefulness, relative ease of administration, and patient acceptance of the clock drawing test as well as the time and change test for detecting dementia in Chinese elderly adults.

DESIGN. Prospective case-controlled study.

SETTING. Memory clinic and geriatric clinic of a district hospital, Hong Kong.

PARTICIPANTS. A convenient sample of 85 subjects aged 65 years or older attending the two clinics during the period from September 2002 to June 2003.

MAIN OUTCOME MEASURES. The clock drawing test scored according to Lam’s method; the time and change test with modification to the making change task; and the Chinese version of the Mini-Mental State Examination.

RESULTS. Demented subjects were matched with non-demented ones with respect to age, sex, educational level, and co-morbidity status. The clock drawing test had a comparable sensitivity (89.4%) but a lower specificity (47.1%) when compared with that of the Chinese version of the Mini-Mental State Examination (96.0 and 76.5%, respectively). In contrast, the time and change test had a lower sensitivity (62.7%) but higher specificity (94.1%). Both tests took significantly less time to complete than the Chinese version of the Mini-Mental State Examination. All except four subjects completed the clock drawing test while all subjects accepted the time and change test well.

CONCLUSIONS. The Chinese version of the Mini-Mental State Examination is still the best among the three tests despite the longer time to completion. The clock drawing test may be a good alternative to the Mini-Mental State Examination as an effective screening test for dementia when time does not permit. The time and change test, although time-saving, is not suitable to be used alone because of its low sensitivity.

Key words: Aged; Chinese; Dementia; Mental status schedule

View this abstract indexed in MEDLINE:

OBJECTIVE. To study the incidence of microbial contamination at the bone bank of the United Christian Hospital.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. A total of 151 patients (33 men and 118 women) who underwent hip arthroplasty surgery and from whom femoral head allografts were retrieved between January 1994 and March 2000; and 81 patients in whom allografts were implanted.

MAIN OUTCOME MEASURES. Bone biopsies were taken from the femoral head and used to detect any microbial contamination that might have occurred during removal and after storage. The rates of infection among recipients and donors were also assessed.

RESULTS. Of the 151 allografts, 94 non-contaminated allografts were implanted by the end of the study. Fourteen (9.3%) heads showed positive culture results after retrieval and were discarded. Four (4.3%) of the 94 stored allografts that were implanted tested positive for microbial growth, but the recipients of these allografts did not develop any clinical infection. Three (3.2%) had wound infections after implantation of the stored allografts although the grafts had previously been tested negative for any microbial contamination.

CONCLUSION. Our centre has a low allograft contamination rate. The wound infection rate among recipients was also low. The culture of a bone biopsy sample is a reliable method to detect contamination of bone grafts. However, the contamination rate among stored allografts should prompt orthopaedics departments to review allograft handling procedures, so as to minimise the chance of contamination.

Key words: Bone banks; Bone transplantation; Femur head; Freezing

View this abstract indexed in MEDLINE:

OBJECTIVE. To evaluate the clinical efficacy and outcomes of percutaneous cholecystostomy as an alternative treatment option for elderly and critically ill patients who have acute cholecystitis.

PATIENTS AND METHODS. The medical records of patients who underwent emergency percutaneous cholecystostomy at the North District Hospital, Hong Kong from September 1999 to July 2002 were reviewed. Indications for the procedure, patient demographics, and other clinical details were recorded.

RESULTS. A total of 25 patients (10 male, 15 female) with a median age of 81 years (range, 39-97 years) presented with acute cholecystitis and underwent percutaneous cholecystostomy with ultrasound guidance. Two patients required emergency cholecystectomy on day 1 after the procedures because of deteriorating conditions. The rest of the patients clinically improved after drainage. There was no major periprocedural complication, and four patients had their catheter accidentally dislodged but did not require re-insertion. There were five inpatient mortalities, although the majority of these deaths were from unrelated illness. Subsequently, only six patients underwent elective cholecystectomy, one open and five laparoscopic. Two patients were offered percutaneous endoscopic cholecystolithotripsy, one defaulted and the other could not tolerate the procedure. Eleven patients declined further intervention due to the high surgical risks, three of these patients developed biliary symptoms, one had acute cholecystitis, and the other two had cholangitis. The rest of patients had no symptoms related to the gallstones. The median follow-up period was 81 weeks (range, 27-162 weeks).

CONCLUSION. Percutaneous cholecystostomy is a viable treatment option for elderly and critically ill patients presenting with acute cholecystitis. It has a high success rate with minimal procedure-related complications. Elective cholecystostomy is the treatment of choice for low-risk patients after the initial acute cholecystitis.

Key words: Cholecystectomy; Cholecystostomy

View this abstract indexed in MEDLINE: