OBJECTIVE. To review the diagnostic yield of flexible sigmoidoscopy in patients presenting with bright red rectal bleeding.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

SUBJECTS AND METHODS. Patients who underwent flexible sigmoidoscopy between January 1995 and April 1996 for investigation of bright red rectal bleeding were recruited. The extent of the endoscopic examination, complications, and endoscopic findings were recorded.

RESULTS. A total of 1052 patients were included in the study. The mean length of endoscopic examination was 55 cm. There were no complications attributed to the procedure. Thirteen (1.2%) patients aged from 41 to 87 years were found to have malignant tumours that were not palpable on digital examination. All the tumours were moderately differentiated adenocarcinoma. Two patients had synchronous liver metastasis at presentation. Adenomatous polyps were detected in 81 (7.7%) patients, of whom 76 were older than 40 years. The majority of polyps were tubular adenomas associated with mild or moderate dysplasia. Other endoscopic findings included hyperplastic and juvenile polyps, proctocolitis, diverticulosis, irradiation colitis, ischaemic colitis, rectal ulcers, and infective colitis. The overall diagnostic yield was 21.1%. No mucosal lesion was detected by flexible sigmoidoscopy in 78.9% of patients in whom the rectal bleeding was due to either haemorrhoids or anal fissure.

CONCLUSIONS. Cancer was detected in 1.2% and adenomatous polyps in 7.7% of patients with bright red rectal bleeding using flexible sigmoidoscopy. All cancers and 94% of adenomatous polyps were detected in patients older than 40 years. Flexible sigmoidoscopy appears to be a valuable initial investigation for bright red rectal bleeding in patients older than 40 years.

Key words: Colorectal neoplasms; Sigmoidoscopy

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OBJECTIVES. To investigate the prevalence and pattern of impacted teeth and associated pathologies in the Hong Kong Chinese population.

SETTING. The Reception and Primary Care Clinic, Prince Philip Dental Hospital, Hong Kong.

DESIGN. Retrospective study.

SUBJECTS AND METHODS. The records of 7486 patients were examined to determine whether the chief complaints were related to impacted teeth and associated pathologies, which were investigated using panoramic radiographs. Results. A total of 2115 (28.3%) patients presented with at least one impacted tooth. Among the 3853 impacted teeth, mandibular third molars were the most common (82.5%), followed by maxillary third molars (15.6%), and maxillary canines (0.8%). Approximately 8% of mandibular second molars associated with impacted third molars had periodontal bone loss of more than 5 mm on their distal surfaces. Caries were also found on the same surfaces in approximately 7% of the second molars. Approximately 30% of patients with dental impaction had symptoms, and 75% had complaints limited to one side of the mouth.

CONCLUSIONS. The prevalence of impacted teeth was high, and there was a predilection for impacted third molars in the mandible. More than 50% of maxillary third molars had erupted, creating potential trauma of the pericoronal tissues of the partially erupted mandibular third molars. Caries and periodontal diseases were commonly seen in relation to the impacted third molars, whereas cystic pathology and root resorption were rarely observed.

Key words: Chinese; Prevalence; Tooth, impacted

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OBJECTIVE. To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure.

DESIGN. Prospective non-randomised study.

SETTING. University affiliated hospitals, Hong Kong.

SUBJECTS AND METHODS. Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study. Twenty-four patients had the procedure in an ambulatory setting and the other 24 were treated as in-patients. The symptoms, operative details, postoperative complications, length of hospital stay, pain scores, analgesic requirements, and patient satisfaction scores were collected. Comparison was made between those patients undergoing ambulatory surgery and those treated as in-patients.

RESULTS. There were 25 women and 23 men in the study. The mean age was 46.6 years (standard deviation, 12.1 years). The mean operating time was 29.3 minutes (standard deviation, 9.9 minutes). An incomplete ‘doughnut’ after stapling was found in one patient. There were no other adverse intra-operative events or complications. Postoperative morbidities occurred in eight patients but none required further surgery. One patient in the day-surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2). There were no differences in the postoperative complications, pain scores, analgesic requirements, and patient satisfaction scores between the two groups. The total mean hospital stay was significantly shorter for those undergoing day-surgery stapled haemorrhoidectomy (0.46 versus 1.9 days, P<0.01). The mean follow-up period was 4.6 months (standard deviation, 4.0 months). All patients reported symptomatic improvement during this time and there was no incidence of faecal incontinence. One patient had a soft stricture, one had a fissure, and two had residual skin tags. All of these problems were conservatively managed, without the need for further surgical procedures.

CONCLUSIONS. Stapled haemorrhoidectomy is a safe and effective operation for haemorrhoids. It is a feasible procedure to perform as day-surgery. The hospital stay can be significantly shortened, thus reducing the costs associated with inpatient care.

Key words: Ambulatory surgical procedures; Hemorrhoids; Postoperative complications

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OBJECTIVE. To identify the clinical and prognostic features of human immunodeficiency virus–associated lymphoma in the local population with a view to designing more effective treatment strategies.

DESIGN. Retrospective review.

SETTING. Referral hospital, Hong Kong.

SUBJECTS AND METHODS. All patients (n=10) with human immunodeficiency virus–associated lymphoma managed at Queen Elizabeth Hospital from January 1995 to December 2001.

RESULTS. All patients were men with a median age of 39 years. The median CD4 cell count at the time of diagnosis of lymphoma was 0.056 x 109/L. All tumours were diffuse large B-cell lymphomas, with the exception of one systemic Burkittlike lymphoma. Systemic lymphoma was diagnosed in seven patients and three had primary central nervous system lymphoma. Combined antiretroviral therapy was continued or given to five of the six patients who received some form of chemotherapy or radiotherapy treatment. Of the two patients with primary central nervous system lymphoma who received whole brain irradiation therapy, one patient survived 41 months in clinical remission after diagnosis and the other patient died of sepsis while in partial remission 19 months after diagnosis. The four patients with systemic lymphoma who received standard- or reduced-dose chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone had a median survival of 3 months.

CONCLUSION. The clinical profiles of these patients were similar to those of patients with human immunodeficiency virus–associated lymphoma in western countries. The overall survival of patients was poor with conventional chemoradiotherapy. Other innovative treatment approaches should be investigated to prolong the survival of this patient group.

Key words: Case management; Epidemiology; Hong Kong; Human immunodeficiency virus; Lymphoma, AIDS-related

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OBJECTIVES. To determine the incidence of multiple myeloma in the Eastern District of Hong Kong Island, the degree of renal impairment at presentation, and its relationship with haematological and biochemical parameters and survival.

DESIGN. Retrospective study.

SUBJECTS AND METHODS. Patients with myeloma who were admitted to a regional hospital in Hong Kong from January 1994 to March 2000 were included. Demographic data, type and stage of multiple myeloma, degree of renal impairment, haematological and biochemical parameters, and survival data were analysed.

RESULTS. There were 64 patients (28 male, 36 female) in the study. The incidence rate for multiple myeloma in this group was 1.78 per 100 000 population. Immunoglobulin G (53.1%) was the most common type of multiple myeloma seen, followed by immunoglobulin A (29.7%), light-chain (12.5%), and immunoglobulin D (4.7%). Nineteen (29.7%) patients had serum creatinine levels of greater than 177 µmol/L at presentation. Renal impairment was more common in patients with light-chain multiple myeloma (P=0.081). The serum creatinine level was not significantly correlated with haemoglobin level (r= –0.21), platelet count (r=0.04), serum calcium level (r=0.08), or albumin level (r= –0.03). The median survival time for patients with multiple myeloma was 592 days (95% confidence interval, 229-955). Serum creatinine level at presentation was significantly associated with survival (P=0.017). Patients with a creatinine level of less than 400 µmol/L had longer survival (P=0.042). Infection was the most common cause of death (32.8%).

CONCLUSION. The incidence rate noted was comparable to other published studies. Renal impairment at resentation was common in patients with multiple myeloma and was associated with poor survival.

Key words: Dialysis; Kidney failure; Multiple myeloma; Survival

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