OBJECTIVE. To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003.

MAIN OUTCOME MEASURES. Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed.

RESULTS. A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted.

CONCLUSION. All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Key words: Arthroscopy; Joint instability; Recurrence; Shoulder dislocation

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OBJECTIVES. To review the management of primary immunodeficiency and discuss recent advances in genetic analysis.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Children diagnosed with primary immunodeficiency and followed up in the immunology clinic during the period 1988 to 2003.

MAIN OUTCOME MEASURES. Demographic data, co-morbidities and treatment of patients, outcome and complications; identification of disease by genetic mutations.

RESULTS. Medical records of a total of 117 patients (72 male, 45 female) diagnosed with primary immunodeficiency in the Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong during the past 15 years (1988-2003) were reviewed. All patients were followed up in the immunology clinic. Some patients had been referred from the private sector or other hospitals for immunological workup. Six categories of primary immunodeficiency were identified: predominantly humoral defect (n=50), predominantly cellular defect (n=22), combined humoral and cellular defect (n=5), phagocytic defect (n=18), complement disorders (n=4), and others (n=18). Although infection was the underlying cause of most co-morbidities and mortality, autoimmune (n=7) and allergic (n=23) manifestations were common. In addition, three patients developed lymphoma. Recent advances in the genetic diagnosis of several types of primary immunodeficiency were also reviewed: X-linked Wiskott-Aldrich syndrome, X-linked chronic granulomatous disease, X-linked agammaglobulinaemia, X-linked lymphoproliferative syndrome, leukocyte adhesion disease type I, and X-linked hyperimmunoglobulin M syndrome. This provides an invaluable means of understanding the molecular basis of primary immunodeficiency and has important clinical applications.

CONCLUSIONS. Co-morbidities like autoimmune disease and allergic disease are common in patients with primary immunodeficiency and should be carefully evaluated. Likewise, a diagnosis of primary immunodeficiency should be considered when evaluating patients with these conditions. Rapid progress in the field of molecular genetics will enable definite and early diagnosis, and more importantly, potential curative therapy to be administered.

Key words: Allergy and immunology; Autoimmune diseases; Genetic diseases, X-linked; Immunologic deficiency syndromes

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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

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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

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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

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