Correlation of colposcopic anogenital findings and overall assessment of child sexual abuse: prospective study

ABSTRACT
Hong Kong Med J 2004;10:378-83 | Number 6, December 2004
ORIGINAL ARTICLE
Correlation of colposcopic anogenital findings and overall assessment of child sexual abuse: prospective study
PCH Cheung, CH Ko, HYM Lee, LMC Ho, WWK To, PLS Ip
Department of Paediatrics and Adolescent Medicine, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong
 
 
OBJECTIVE. To examine the relationship between colposcopic anogenital findings and overall assessment of sexual abuse.
 
DESIGN. Prospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. Seventy-seven children (mean age, 6.5 years; range, 6 months-16 years) referred consecutively for sexual abuse evaluation between July 1999 and June 2002 were included.
 
MAIN OUTCOME MEASURES. Colposcopic anogenital findings (categorised as normal, non-specific, concerning for abuse, or clearly abnormal) were correlated with the overall assessment of likelihood of abuse (classified as no evidence of abuse, possible abuse, probable abuse, or definite abuse). The sensitivity and specificity of clearly abnormal findings in detecting definite abuse were computed, and the diagnostic impact of colposcopy findings were expressed as likelihood ratios.
 
RESULTS. Anogenital findings were normal in 45% of patients, non-specific in 29%, concerning for abuse in 13%, and clearly abnormal in 13%. Seven of the 16 confirmed cases of sexual abuse had normal or non-specific findings. Overall assessment showed that 46% of all patients had no evidence of abuse, 20% had cases of possible abuse, 13% had cases of probable abuse, and 21% had cases of definite abuse. The sensitivity and specificity of abnormal anogenital findings in detecting definite abuse were 56.3% and 98.4%, respectively. Colposcopy showed a fair correlation with the overall assessment of abuse (weighted kappa, 0.245). The diagnostic impact of normal, non-specific, concerning, and clearly abnormal findings in terms of likelihood ratios were 0.23, 1.12, 0.00, and 34.30, respectively.
 
CONCLUSIONS. Anogenital findings are often normal or non-specific in sexual abuse. In general, colposcopy examination findings do not directly reflect the final diagnosis. A category-4 finding on colposcopy is very helpful in confirming definite abuse, whereas other findings do not rule out the diagnosis.
 
Key words: Anus/injuries; Child abuse, sexual; Genitalia, female; Colposcopy
 
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Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study

ABSTRACT
Hong Kong Med J 2004;10:373-7 | Number 6, December 2004
ORIGINAL ARTICLE
Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study
PYY Lau, WCS Meng, AWC Yip
Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
 
 
OBJECTIVE. To compare stapled haemorrhoidectomy with open diathermy haemorrhoidectomy in Chinese patients with respect to the postoperative pain, symptom control, and manometric alterations.
 
DESIGN. Prospective randomised controlled trial.
 
SETTING. A regional general surgical unit, Hong Kong.
 
PATIENTS. Twenty-four patients with second- or third-degree haemorrhoids or who have had failed medical treatment.
 
INTERVENTION. Open diathermy haemorrhoidectomy or stapled haemorrhoidectomy.
 
MAIN OUTCOME MEASURES. Structured questionnaire for symptoms, anorectal manometry, transrectal ultrasound, and postoperative pain.
 
RESULTS. Stapled haemorrhoidectomy compared with open diathermy haemorrhoidectomy resulted in similar postoperative pain and drug requirements. Postoperative control of prolapse symptoms was significantly better with open diathermy haemorrhoidectomy than with stapled. The control of other symptoms was similar with regard to bleeding, pain, pruritis, and incontinence scores. Anorectal manometry showed a decrease in the maximum resting pressure and maximum squeeze pressure in both groups, but the decrease was only significant in the stapled haemorrhoidectomy group.
 
CONCLUSIONS. Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy for the treatment of haemorrhoids, but with the exception of skin tag prolapse. There is a need for long-term follow-up for the changes in manometric parameters after haemorrhoidectomy.
 
Key words: Hemorrhoids; Pain, postoperative; Surgical stapling; Manometry
 
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Impact of severe acute respiratory syndrome on anxiety levels of front-line health care workers

ABSTRACT
Hong Kong Med J 2004;10:325-30 | Number 5, October 2004
ORIGINAL ARTICLE
Impact of severe acute respiratory syndrome on anxiety levels of front-line health care workers
E Poon, KS Liu, DL Cheong, CK Lee, LYC Yam, WN Tang
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
OBJECTIVE. To identify anxiety levels among front-line health care workers during the 2003 severe acute respiratory syndrome outbreak.
 
DESIGN. Questionnaire survey.
 
SETTING. Regional hospital, Hong Kong.
 
PARTICIPANTS. All hospital staff were given a questionnaire; administrative staff who had not had any patient contact served as controls.
 
MAIN OUTCOME MEASURES. Levels of contact with patients who had severe acute respiratory syndrome were measured and correlated with anxiety levels as determined by the State-Trait Anxiety Inventory.
 
RESULTS. Of 4252 questionnaires distributed between May and June 2003, 2040 (48.0%) were returned and 1926 (45.3%) were valid for analysis. Overall, 534 (27.7%) respondents had had contact with patients with severe acute respiratory syndrome. Anxiety scores ranged from 20 to 80, and mean (standard deviation) scores were higher among staff who had had contact with patients with severe acute respiratory syndrome than among those who had not (52.6 [10.5] versus 49.8 [10.1], respectively; P<0.01). Mean anxiety levels were higher among workmen, health care assistants, and nurses than among administrative staff controls or doctors (P<0.01). Anxiety scores were correlated with burnout scores (Pearson’s correlation coefficient, 0.52-0.59) and with discomfort from wearing protective gear (0.21-0.32).
 
CONCLUSION. Severe acute respiratory syndrome has likely stressed the public health care system. Prediction and early identification of adverse factors in a crisis situation would allow early implementation of interventions to reduce and counteract the impact of this stress.
 
Key words: Anxiety; Burnout, professional; Health personnel; Severe acute respiratory syndrome; Stress
 
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Suicides in general hospitals in Hong Kong: retrospective study

ABSTRACT
Hong Kong Med J 2004;10:319-24 | Number 5, October 2004
ORIGINAL ARTICLE
Suicides in general hospitals in Hong Kong: retrospective study
TP Ho, MSM Tay
Department of Psychiatry, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
OBJECTIVE. To describe the characteristics of suicidal patients and their suicidal acts occurring in general wards.
 
DESIGN. Retrospective study.
 
SETTING. All general public hospitals in Hong Kong.
 
PATIENTS. Survey data based on hospital records of patients who died of suicide or who attempted suicide in general wards between 2000 and 2002 were studied.
 
MAIN OUTCOME MEASURES. Demographic information, medical history, and circumstances of the suicidal acts.
 
RESULTS. Twenty-six hospitals reported a total of 166 suicidal acts, which included 34 completed suicides, corresponding to 9.46 attempted suicides and 1.93 completed suicides per 100 000 admissions. Most suicidal acts occurred in medical wards. Patients were, on average, in their mid-50s, predominantly male, and had been admitted because of physical problems. Fewer than 20% were admitted because of attempted suicide. A significant proportion of suicide attempters used potentially lethal suicide methods in the wards. Wide ranges of objects were used in the suicidal acts. Completed suicides tended to occur after midnight and in the ward toilet. Patients who went missing and then committed suicide acts did so in the first few hours of leaving the hospital. The timing of suicidal acts varied greatly with the reasons of admission.
 
CONCLUSION. Prevention efforts in general wards are unlikely to be effective if they simply focus on patients admitted for attempted suicide, or on the restriction of suicide means. For patients admitted to general wards because of attempted suicide, the risk is highest just after admission; hence, these patients have to be monitored closely. A high degree of alertness to the possibility of depression and suicidal risk among general ward patients is required.
 
Key words: Hospitals, general; Inpatients/statistics & numerical data; Suicide
 
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Short-stay in-patient rehavilitation of elderly patients with chronic obstrutive pulmonary disease: prospective study

ABSTRACT
Hong Kong Med J 2004;10:312-8 | Number 5, October 2004
ORIGINAL ARTICLE
Short-stay in-patient rehavilitation of elderly patients with chronic obstrutive pulmonary disease: prospective study
SPS Ip, YF Leung, KL Choy
Room 818, Grand Tower, 639 Nathan Road, Kowloon, Hong Kong
 
 
OBJECTIVES. To evaluate the effectiveness of a short-stay in-patient rehabilitation programme.
 
DESIGN. Prospective case-control cohort study.
 
SETTING. Regional medical centre, Hong Kong.
 
PATIENTS. One hundred and thirty symptomatic elderly patients with chronic obstructive pulmonary disease who had been treated for an acute respiratory illness in 1998. They were divided into two groups: the conventional treatment group, which received no rehabilitation (n=65), and the rehabilitation group (n=65).
 
INTERVENTION. A short-stay in-patient rehabilitation programme was implemented, which included assessment, patient and caregiver education, an exercise regimen, physiotherapy, occupational therapy, and case conference.
 
MAIN OUTCOME MEASURES. Length of stay, hospital re-admission rate, and admission-free interval.
 
RESULTS. The mean length of stay in the rehabilitation ward was 6.2 days. The rate of hospital re-admission was significantly higher in the conventional treatment group than in the rehabilitation group, both within 28 days of discharge home (relative risk=3.33; 95% confidence interval, 2.32-4.56; P=0.019) and at 100 days after discharge (relative risk=2.47; 95% confidence interval, 1.78-3.48; P<0.001). The admission-free interval was significantly longer in the rehabilitation group than in the conventional treatment group (1.13 years vs 0.86 years; P<0.001).
 
CONCLUSION. A short-stay in-patient rehabilitation programme is effective in reducing hospital re-admission rates. This type of rehabilitation service may be important for elderly patients, as well as for patients with more advanced disease and more functional deficits than others.
 
Key words: Inpatients; Length of stay; Lung disease, obstructive/rehabilitation; Outcome assessment (health care); Pulmonary disease, chronic obstructive
 
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The prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting: cross-sectional study

ABSTRACT
Hong Kong Med J 2004;10:307-11 | Number 5, October 2004
ORIGINAL ARTICLE
The prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting: cross-sectional study
TKW Tam,LPK Cheng, DMW Lau, TC Lai, WY Lai, KK Ng, MY Ng, CW Kong, LCY Tsang
Professional Development and Quality Assurance, Department of Health, 2/F Ngautaukok Jockey Club Clinic, 60 Ting On Street, Ngautaukok, Hong Kong
 
 
OBJECTIVES. To determine the prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting, and to study the association between various risk factors and the presence of microalbuminuria.
 
DESIGN. Cross-sectional community-based study.
 
SETTING. Four primary care clinics, Hong Kong.
 
PATIENTS. All patients with type II diabetes mellitus who regularly attended the clinics between May 2002 and March 2003.
 
MAIN OUTCOME MEASURES. Patients’ demographic data, the proportion with microalbuminuria (measured using a spot urine test), and the association between this condition and risk factors for diabetic nephropathy (via correlation and multivariable logistic regression analysis).
 
RESULTS. The mean age of the 1161 patients in the sample population was 58.0 years. The mean duration of diabetes mellitus was 5.7 years, and the mean level of glycated haemoglobin was 7.4%. A total of 13.4% of the patients had microalbuminuria. Having the condition was significantly associated with advanced age, female sex, poor glycaemic control, and coexisting hypertension in both correlation and regression analyses. No significant association with ever smoking was found.
 
CONCLUSION. Early screening for incipient diabetic nephropathy and aggressive management of modifiable risk factors in a primary care setting may be important in optimising the renal outcome of patients with type II diabetes mellitus.
 
Key words: Diabetes mellitus, type II; Diabetic nephropathies; Hemoglobin A, glycosylated; Neutropenia
 
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Arterial embolisation in intractable primary post-partum haemorrhage: case series

ABSTRACT
Hong Kong Med J 2004;10:301-6 | Number 5, October 2004
ORIGINAL ARTICLE
Arterial embolisation in intractable primary post-partum haemorrhage: case series
ML Tsang, WC Wong,KY Kun,CM Tai, TK Ng,KY Lau, TP Wong
Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
OBJECTIVE. To evaluate the efficacy and safety of arterial embolisation in the management of intractable primary post-partum haemorrhage.
 
DESIGN. Retrospective case series.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. Nine patients aged 28 to 39 years who were treated for severe primary post-partum haemorrhage between October 2000 and January 2003.
 
INTERVENTION. Emergency transcatheter arterial embolisation.
 
MAIN OUTCOME MEASURES. Clinical outcome and complications.
 
RESULTS. All nine arterial embolisations successfully arrested the haemorrhage. The main cause of primary post-partum haemorrhage was uterine atony. No serious complication arose, although one patient experienced slight numbness of the right leg. Normal menstruation resumed in all patients, except for the one who had had a hysterectomy as initial treatment. One patient became pregnant 1 year after embolisation. Patients were followed up for 10 months.
 
CONCLUSION. In our experience, arterial embolisation is safe and efficacious, and is the treatment of choice for patients with intractable primary post-partum haemorrhage.
 
Key words: Embolization; Gelatin sponge, absorbable; Postpartum hemorrhage
 
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Clinical features of hereditary spinocerebellar ataxia diagnosed by molecular genetic analysis

ABSTRACT
Hong Kong Med J 2004;10:255-9 | Number 4, August 2004
ORIGINAL ARTICLE
Clinical features of hereditary spinocerebellar ataxia diagnosed by molecular genetic analysis
KK Lau, K Lam, KL Shiu, KM Au, TH Tsoi, AYW Chan, HL Li, B Sheng
Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Road, Laichikok, Hong Kong
 
 
OBJECTIVE. To assess the frequency and clinical features of different types of hereditary spinocerebellar ataxia in Hong Kong.
 
DESIGN. Cross-sectional study using a questionnaire and clinical examination, with the majority of the information retrospectively collected.
 
SETTING. Three regional hospitals, Hong Kong.
 
PARTICIPANTS. All patients with spinocerebellar ataxia that was confirmed by molecular genetic tests between January 2001 and October 2003.
 
MAIN OUTCOME MEASURES. History, latest physical examination results, clinical investigation results, and genetic profiles.
 
RESULTS. A total of 16 Chinese patients had received diagnoses of spinocerebellar ataxia. These patients had spinocerebellar ataxia type 1 (n=3), spinocerebellar ataxia type 3 (Machado-Joseph disease; n=12), and dentatorubro-pallidoluysian atrophy (n=1). The most common manifestation was ataxia (15/16), followed by pyramidal signs (12/16). Other features such as bulbar dysfunction, ophthalmoplegia, neuropathy, and cognitive impairment were present but variable.
 
CONCLUSIONS. The clinical manifestations of different types of spinocerebellar ataxia overlap, and genetic study is necessary to confirm the diagnosis. The frequency of spinocerebellar ataxia type 3 is greater than that of other types among these Chinese patients. The age of onset of this type may correlate inversely with the number of CAG repeats.
 
Key words: Epidemiology; Friedreich ataxia; Genetic diseases, inborn; Machado-Joseph disease; Spinocerebellar ataxia
 
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Correlation between serum level of neuron-specific enolase and long-term functional outcome after acute cerebral infarction: prospective study

ABSTRACT
Hong Kong Med J 2004;10:251-4 | Number 4, August 2004
ORIGINAL ARTICLE
Correlation between serum level of neuron-specific enolase and long-term functional outcome after acute cerebral infarction: prospective study
YC Wu, YB Zhao, CZ Lu, J Qiao, YJ Tan
Department of Neurology, First People's Hospital of Shanghai Jiao Tong University, 85 Wu Jin Road, Shanghai 200080, PRC
 
 
OBJECTIVE. To determine the value of measuring serum levels of neuron-specific enolase in predicting extent of disease and short- and long-term functional outcome after acute cerebral infarction.
 
DESIGN. Prospective study.
 
SETTING. Neurology departments at two university teaching hospitals, Shanghai.
 
PATIENTS. Thirty-eight patients who presented for acute cerebral infarction between October 1998 and October 2000 were divided into two groups: those whose infarction extended to the cerebral cortex in the carotid artery region (cortical group) and those with an infarction in the subcortical carotid artery region (subcortical group).
 
MAIN OUTCOME MEASURES. Using a solid-phase enzyme immunoassay, we measured serum levels of neuron-specific enolase on admission and on days 2, 3, and 15. Infarct volume was measured by computed tomography on day 5. The Activities of Daily Living scale was used to assess the clinical outcome at 1-, 3-, and 6-month follow-up after onset.
 
RESULTS. Mean (standard deviation) serum neuron-specific enolase levels were significantly higher among patients with acute cerebral infarction than among controls (18.48 [16.61] ng/mL versus 9.00 [2.70] ng/mL; P<0.001). The neuron-specific enolase level was also higher in the cortical group than in the subcortical group (33.54 [29.71] ng/mL versus 15.97 [5.91] ng/mL; P<0.01). Levels peaked after 2.11 (0.86) days and correlated positively with the infarct volume (r=0.81; P<0.01) and negatively with clinical outcome at 1 month (r= –0.37; P<0.05), 3 months (r= –0.45; P<0.01), and 6 months (r= –0.65; P<0.001), as assessed on the Activities of Daily Living scale.
 
CONCLUSION. Serum neuron-specific enolase levels after cerebral infarction may be a useful marker to predict infarct volume and short- or long-term functional outcome.
 
Key words: Cerebral infarction; Phosphopyruvate hydratase; Prognosis
 
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Ethical attitudes of intensive care physicians in Hong Kong: questionnaire survey

ABSTRACT
Hong Kong Med J 2004;10:244-50 | Number 4, August 2004
ORIGINAL ARTICLE
Ethical attitudes of intensive care physicians in Hong Kong: questionnaire survey
HY Yap, GM Joynt, CD Gomersall
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To examine the practice and ethical attitudes of intensive care doctors in Hong Kong and to compare findings with those from European studies.
 
DESIGN. Structured questionnaire survey, modified from a similar questionnaire used in Europe.
 
SETTING. Eleven publicly funded intensive care units in Hong Kong.
 
PARTICIPANTS. Ninety-five doctors practising in intensive care units.
 
RESULTS. Of the sixty-five respondents, sizeable proportions indicated that the admission of patients to the intensive care unit is often (25%) or sometimes (51%) limited by bed availability. About 69% to 86% of doctors admit patients with limited prognosis or poor quality of life, although all felt that these admissions should be more restricted. ‘Do-not-resuscitate’ orders are applied by almost all respondents, and 52% and 89% of respondents would discuss such orders with the patient or with the family, respectively. The withholding and withdrawal of therapy from patients with no chance of recovery to a meaningful life is common in Hong Kong (99% and 89%, respectively). A total of 83% respondents involved patients or families in the decision to limit therapy, compared with less than half in Europe overall. When the family wanted aggressive life-support despite doctors’ recommendations to limit therapy, 62% of the respondents would still withhold therapy while only 9% would withdraw therapy. More than 60% of doctors feel comfortable talking to patients’ relatives about limitation of therapy. Approximately 75% felt that euthanasia is unacceptable. Most respondents (94%) reported that medical programmes should include more extensive discussion on ethical issues.
 
CONCLUSION. The ethical attitudes of intensive care doctors in Hong Kong are similar to those of counterparts in Europe. However, Hong Kong doctors tend to involve families more often in the discussion of end-of-life issues.
 
Key words: Decision making; Ethics, medical; Euthanasia, passive; Intensive care units; Withholding treatment
 
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