Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population

ABSTRACT
Hong Kong Med J 2003;9:25-30 | Number 1, February 2003
ORIGINAL ARTICLE
Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population
N Samman, H Mohammadi, J Xia
Oral and Maxillofacial Surgery, The University of Hong Kong, Prince Philip Dental Hospital
 
 
OBJECTIVE. To obtain normative data for cephalometric measurements of the upper airway in the local Chinese population.
 
DESIGN. Observational study.
 
SETTING. University department and teaching hospital out-patient clinic.
 
SUBJECTS AND METHODS. Subjects included 74 healthy patients, 29 males (age range, 18-35 years) and 45 females (age range, 16-42 years), with normal skeletal facial profile, no history of snoring, sleep apnoea, upper airway disease, tonsillectomy or adenoidectomy, obesity, or pathology in the pharynx. Twenty cephalometric airway measurements, including size of the tongue, soft palate, nasopharynx, oropharynx, hypopharynx, and relative position of the hyoid bone and valleculae were obtained. Landmarks on cephalometric radiographs were digitised and measurements were made using a specially designed computer programme. Error analysis of measurements was performed and comparison of measurements according to sex was made.
 
RESULTS. Significant sex dimorphism was seen for the majority of measurements, with the exception of minimal depth of the airway, oropharyngeal depth of the airway, and the soft palate angle with the hard palate.
 
CONCLUSION. A minimum sagittal dimension of the upper airway was evident despite differences in measurements between sexes. Findings from this study should be a useful reference for the assessment of sleep apnoea in the local population.
 
Key words: Epilepsy; Magnetic resonance imaging; Surgery
 
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Role of magnetic resonance imaging for preoperative evaluation of patients with refractory epilepsy

ABSTRACT
Hong Kong Med J 2003;9:20-4 | Number 1, February 2003
ORIGINAL ARTICLE
Role of magnetic resonance imaging for preoperative evaluation of patients with refractory epilepsy
ACF Hui, JMK Lam, YL Chan, KM Au-Yeung, KS Wong, R Kay, WS Poon
Division of Neurology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital
 
 
OBJECTIVE. To investigate the magnetic resonance imaging characteristics of patients with refractory epilepsy and the relationship to progression to surgery.
 
DESIGN. Prospective observational study.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. Patients undergoing preoperative evaluation for epilepsy surgery.
 
MAIN OUTCOME MEASURE. Cranial magnetic resonance imaging findings, correlation with electroencephalographic results, and percentage of patients who were considered suitable candidates for surgery.
 
RESULTS. Structural abnormalities associated with refractory epilepsy in 100 consecutive patients were mesial temporal sclerosis (30%), neocortical sclerosis (23%), vascular malformation (7%), neuronal migration disorders (7%), and tumours (5%). Normal brain scans were found for 28% of patients. Fourteen of 30 (46%) patients with medial temporal lobe lesions at magnetic resonance imaging were suitable candidates for surgery compared with 8/42 (19%) patients with extrahippocampal lesions (odds ratio=3.7; 95% confidence interval, 1.3-10.6; P<0.012).
 
CONCLUSION. Mesial temporal sclerosis was the most common pathology in patients with refractory epilepsy. At the Prince of Wales Hospital, for patients who have undergone a basic magnetic resonance imaging protocol and surface electroencephalography, the result of cranial magnetic resonance imaging is an important determinant for whether patients will undergo surgery.
 
Key words: Epilepsy; Magnetic resonance imaging; Surgery
 
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Managing older patients with urinary retention in the Continence Clinic

ABSTRACT
Hong Kong Med J 2003;9:15-9 | Number 1, February 2003
ORIGINAL ARTICLE
Managing older patients with urinary retention in the Continence Clinic
JKH Luk, MW Tam, MCS Ho, FHW Chan
Department of Medicine and Geriatrics, Fung Yiu King Hospital
 
 
OBJECTIVE. To evaluate the effectiveness of the Continence Clinic for managing retention of urine in older patients.
 
DESIGN. Retrospective study.
 
SETTING. Continence Clinic, Fung Yiu King Hospital, Hong Kong.
 
SUBJECTS AND METHODS. Case notes of 58 patients seen at the Fung Yiu King Hospital Continence Clinic from October 1997 to September 2001 were reviewed. The patients had retention of urine with post-void residual volume of more than 200 mL, retention of urine requiring catheterization, or had catheters for unknown reasons.
 
RESULTS. Urodynamic study performed for 22 (38%) patients showed that 12 had detrusor underactivity, six had detrusor hyperactivity with impaired contraction, and four had bladder outlet obstruction. Among the patients who were initially catheterized, the success rate for gradually stopping reliance on urinary catheterization was 84%. The success rate was higher among those who did not undergo urodynamic study than among those who had the study done (95% versus 67%; P=0.03). Reduction in post-void residual volume was observed at the last clinic visits (P<0.0001). Moreover, significant decreases in post-void residual volume were found both for patients who did and did not have urodynamic study.
 
CONCLUSION. Most of the older patients with urinary retention with or without indwelling catheters were treated successfully in the Continence Clinic by appropriate medical therapy. Urodynamic study can be performed for selected patients when managing urinary retention.
 
Key words: Aged; Urinary retention
 
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Prospective randomised controlled trial comparing laparoscopic and open colposuspension

ABSTRACT
Hong Kong Med J 2003;9:10-4 | Number 1, February 2003
ORIGINAL ARTICLE
Prospective randomised controlled trial comparing laparoscopic and open colposuspension
WC Cheon, JHL Mak, JYS Liu
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital
 
 
OBJECTIVE. To compare the efficacy, safety, complications, and short-term outcome of laparoscopic and open colposuspension in women with genuine stress incontinence.
 
DESIGN. Randomised controlled trial.
 
SETTING. Urogynaecology unit in a public hospital, Hong Kong
 
SUBJECTS AND METHODS. Ninety patients with urodynamically proven genuine stress incontinence. Forty-three patients were randomly allocated to receive open colposuspension and 47 to undergo laparoscopy. All patients had reassessment within 1 year of the operation.
 
MAIN OUTCOME MEASURES. Objective and subjective measures and complication rates.
 
RESULTS. There was no significant difference in the duration of stress incontinence, mean preoperative pad test results, or proportion with pre-existing detrusor instability. Among patients in the laparoscopic group, the mean operating time was significantly longer (42.0 minutes versus 29.3 minutes; P<0.0001), while the mean blood loss was significantly less (124.7 mL versus 326.9 mL; P=0.001). Subjective and objective success rates within 1 year were similar for patients in the open and laparoscopic groups (86.0% versus 80.9%; P=0.58, and 86.0% versus 85.1%; P=1.00, respectively). There was no significant difference in the rate of complications, including de novo detrusor instability and an obstructive voiding pattern, enterocele, or dyspareunia.
 
CONCLUSION. Laparoscopic colposuspension is a feasible alternative to the open approach. The operating time is longer but the short-term cure rate is comparable with that of the open approach.
 
Key words: Laparoscopy; Urinary incontinence, stress
 
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Management of child abuse in Hong Kong: results of a territory-wide interhospital prospective surveillance study

ABSTRACT
Hong Kong Med J 2003;9:6-9 | Number 1, February 2003
ORIGINAL ARTICLE
Management of child abuse in Hong Kong: results of a territory-wide interhospital prospective surveillance study
Hong Kong Medical Coordinators on Child Abuse
 
 
OBJECTIVES. To study suspected child abuse among children in hospital in terms of clinical characteristics and the outcome of multidisciplinary case conferences.
 
DESIGN. Prospective observational study.
 
SETTING. All public hospitals in Hong Kong with a paediatric department.
 
METHODS. Anonymous data were prospectively collected from July 1997 to June 1999 using a standard report form for each case of suspected child abuse. The characteristics of the incidents and factors influencing the conclusion at the multidisciplinary case conference were studied.
 
RESULTS. Data for 592 cases of suspected child abuse were evaluated. Two hundred and eighty-seven of the children were boys and 305 were girls. The mean age was 7.3 years (range, 0-16.7 years). Physical abuse, alone or in combination with other forms of maltreatment, accounted for 277 (86.6%) of the 320 substantiated cases. Either, or both, biological parents comprised 71.3% of the perpetrators. Seven (1.2%) children died. Of the 540 children about whom a multidisciplinary case conference was held, abuse was established for 281 (52.0%) children. Abuse was more likely to be established if the victim had been known to a childcare agency (odds ratio=2.2; 95% confidence interval, 1.4-3.5), the abuse was not sexual (odds ratio=2.7; 95% confidence interval, 1.4-5.0), or if the child was seen at a hospital that handled more than 100 cases of suspected abuse during the study period (odds ratio=3.6; 95% confidence interval, 2.4-5.4).
 
CONCLUSION. Child abuse identified in the hospital setting is predominantly physical in nature and death is not uncommon. Appraisal of suspected child abuse by multidisciplinary case conference appears to be influenced by the region of Hong Kong in which the case was handled.
 
Key words: Case management; Child abuse; Mongoloid race; Hong Kong
 
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Use of the low-dose corticotropin stimulation test for the diagnosis of secondary adrenocortical insufficiency

ABSTRACT
Hong Kong Med J 2002;8:427-34 | Number 6, December 2002
ORIGINAL ARTICLE
Use of the low-dose corticotropin stimulation test for the diagnosis of secondary adrenocortical insufficiency
CH Choi, SC Tiu, CC Shek, KL Choi, FKW Chan, PS Kong
Department of Medicine, Queen Elizabeth Hospital
 
 
OBJECTIVE. To assess the clinical utility and safety of the low-dose corticotropin stimulation test in the diagnosis of secondary adrenocortical insufficiency.
 
DESIGN. Prospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PARTICIPANTS. Seventy-two Chinese patients with suspected secondary adrenocortical insufficiency.
 
MAIN OUTCOME MEASURE. Serum cortisol response during the low-dose corticotropin stimulation test, using the insulin tolerance test as the gold standard.
 
RESULTS. The 30-minute cortisol level during the low-dose corticotropin stimulation test was most closely correlated (r=0.79) with the peak cortisol level achieved during the insulin tolerance test. The optimum sensitivity and specificity of the low-dose corticotropin stimulation test were obtained at a cut-off value of 550 nmol/L or more for the 30-minute cortisol level. Using the insulin tolerance test as the gold standard for comparison, the low-dose corticotropin stimulation test had a sensitivity of 97%, a specificity of 78%, a positive predictive value of 81%, and a negative predictive value of 97% at this cut-off value. The positive likelihood ratio was 4.4 and the negative likelihood ratio 0.04.
 
CONCLUSION. The low-dose corticotropin stimulation test, using the cortisol response at 30 minutes after synacthen 1 µg is a safe, convenient, and sensitive method for screening abnormalities of the hypothalamic-pituitary-adrenocortical axis in Chinese patients suspected of having secondary adrenocortical insufficiency.
 
Key words: Adrenal gland hypofunction; Corticotropin; Diagnosis
 
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Metabolic control of diabetes in a diabetes centre

ABSTRACT
Hong Kong Med J 2002;8:419-26 | Number 6, December 2002
ORIGINAL ARTICLE
Metabolic control of diabetes in a diabetes centre
WMS Lam, JKY Li, AYS Leung, WK Kwan
Department of Medicine and Geriatrics, Yan Chai Hospital
 
 
OBJECTIVE. To examine the effectiveness of a diabetes centre in restoring metabolic control in patients with poorly controlled diabetes.
 
DESIGN. Retrospective review of medical records.
 
SETTING. Diabetes centre of a district hospital, Hong Kong.
 
PARTICIPANTS. Patients with poorly controlled diabetes referred to a diabetes centre.
 
MAIN OUTCOME MEASURES. Primary endpoints were mean change in glycated haemoglobin levels and the number of patients who achieved glycated haemoglobin levels of 7.0% or lower, 7.5% or lower, and 8.0% or lower, respectively. Complementary endpoints were serial changes in body weight, blood pressure, and lipids.
 
RESULTS. One hundred and eighty-five patients, predominantly with type 2 diabetes (94.6%), were reviewed. Median duration since diagnosis of diabetes was 8 years (interquartile range, 4.3-11.8 years). Seventy-three patients had a body mass index of 25 kg/m2 or higher. The baseline and latest glycated haemoglobin levels were 10.4% (standard deviation, 2%) and 8.2% (1.4%), respectively; mean reduction was 2.2% (95% confidence interval, 1.9-2.5; P<0.0005). Eighty-one patients were discharged after a median 32 weeks of follow-up. Their mean glycated haemoglobin level on discharge was 7.5% (0.8%), and the mean reduction was 2.8% (95% confidence interval, 2.4-3.3; P<0.0005). The cumulative percentages of discharged patients who achieved glycated haemoglobin levels of less than 7.0%, 7.5%, and 8.0% were 30.9%, 53.1%, and 77.8%, respectively. Newly diagnosed diabetes (P=0.006) was the only factor which predicted a favourable glycaemic response.
 
CONCLUSION. The Diabetes Centre provided effective management for a heterogeneous group of patients referred with poorly controlled diabetes.
 
Key words: Diabetes mellitus; Hemoglobin A, glycosylated; Hong Kong; Program evaluation
 
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Laparoscopic incisional hernioplasty utilising on-lay expanded polytetrafluoroethylene DualMesh: prospective study

ABSTRACT
Hong Kong Med J 2002;8:413-7 | Number 6, December 2002
ORIGINAL ARTICLE
Laparoscopic incisional hernioplasty utilising on-lay expanded polytetrafluoroethylene DualMesh: prospective study
H Lau, NG Patil, WK Yuen, F Lee
Department of Surgery, University of Hong Kong Medical Centre, Tung Wah Hospital
 
 
OBJECTIVE. To evaluate the early outcomes of laparoscopic incisional hernioplasties using on-lay GORE-TEX DualMesh.
 
DESIGN. Prospective study.
 
SETTING. Medical centre of a regional hospital, Hong Kong.
 
SUBJECTS AND METHODS. Between June 2000 and October 2001, 11 consecutive patients underwent attempted laparoscopic incisional hernioplasties at the University of Hong Kong Medical Centre. A prospective collection of perioperative data and assessment of postoperative outcomes was performed.
 
RESULTS. Laparoscopic incisional hernioplasty was successfully performed for 10 (91%) patients. One patient was converted to open repair because of extensive adhesions within the peritoneal cavity. The overall mean operative time was 107 minutes. Five (45%) patients were found to have more than one hernial defect after reduction of the hernial contents. Eight (73%) patients were discharged within 2 days after operation. Postoperative morbidities included wound bruising (n=4), seroma (n=2), and prolonged suture site pain (n=1). All postoperative morbidities resolved spontaneously without intervention. With a mean follow-up of 3 months, no early recurrence was detected.
 
CONCLUSION. Early outcomes of laparoscopic incisional hernioplasty utilising GORE-TEX DualMesh were promising. This technique confers the advantages of minimal access surgery and allows clear identification of multiple hernial defects. Extensive adhesion, which does not allow the establishment of pneumoperitoneum, is a condition that precludes the safe performance of laparoscopic repair.
 
Key words: Hernia, ventral; Laparoscopy; Polytetrafluoroethylene; Surgical mesh
 
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Endoscopic transnasal orbital decompression for thyrotoxic orbitopathy

ABSTRACT
Hong Kong Med J 2002;8:406-10 | Number 6, December 2002
ORIGINAL ARTICLE
Endoscopic transnasal orbital decompression for thyrotoxic orbitopathy
APW Yuen, KYW Kwan, E Chan, AWC Kung, KSL Lam
Division of Otorhinolaryngology, Department of Surgery, Queen Mary Hospital
 
 
OBJECTIVE. To evaluate the efficacy of endoscopic transnasal orbital decompression alone for thyrotoxic orbitopathy.
 
DESIGN. Retrospective review of consecutive procedures.
 
SETTING. Tertiary referral otorhinolaryngology centre.
 
PATIENTS. Twenty-three eyes of 14 patients.
 
INTERVENTION. Endoscopic transnasal orbital decompression.
 
MAIN OUTCOME MEASURES. Proptosis reduction, intra-ocular pressure reduction, exposure keratitis reduction, visual acuity improvement, and complication rate.
 
RESULTS. There were no surgical complications for the 23 orbital decompressions.Proptosis reduction was achieved in 22 (96%) eyes. The mean proptosis reduction was 4.6 mm (median, 5.0 mm; range, 1.0-8.0 mm). The postoperative intra-ocular pressure decreased after surgical decompression in 20 (87%) eyes with a mean reduction of 11 mm Hg (median, 6 mm Hg; range, 1-35 mm Hg). Of the 15 eyes with incomplete closure of the eyelid before the operation, 11 (73%) had complete eyelid closure after surgical decompression. Of the other four eyes that had incomplete closure, the gaps were reduced. The visual acuity was improved for 16 (70%) eyes with a median improvement of 3 Snellen lines (range, 1-8 lines).
 
CONCLUSION. Endoscopic transnasal medio-inferior orbital wall decompression is a safe and adequate treatment for thyrotoxic orbitopathy with proptosis, exposure keratitis, and visual loss.
 
Key words: Hong Kong; Incidence; Thromboembolism; Venous thrombosis
 
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Venous thromboembolism in the Chinese population—experience in a regional hospital in Hong Kong

ABSTRACT
Hong Kong Med J 2002;8:400-5 | Number 6, December 2002
ORIGINAL ARTICLE
Venous thromboembolism in the Chinese population—experience in a regional hospital in Hong Kong
HSY Liu, BCS Kho, JCW Chan, FMF Cheung, KY Lau, FPT Choi, WC Wu, TK Yau
Department of Medicine, Pamela Youde Nethersole Eastern Hospital
 
 
OBJECTIVE. To estimate the incidence and determine the characteristic features of venous thromboembolism in the Hong Kong Chinese population.
 
DESIGN. Retrospective study.
 
SETTING. Regional hospital, Hong Kong.
 
SUBJECTS AND METHODS. Data were collected during a period of four years (1997-2000). Patients with duplex doppler ultrasonography or venography-documented venous thromboembolism and new episodes of deep vein thrombosis were identified from Department of Diagnostic Radiology records. Patients with high-probability ventilation-perfusion scans were identified from Department of Nuclear Medicine records and these scans were taken as evidence of pulmonary embolism. Patients with intermediate-probability ventilation-perfusion scans, with pulmonary embolism documented by either pulmonary angiography or spiral computed tomography scan, were also included in the study. Patients with autopsy-verified fatal pulmonary embolism were identified from Department of Pathology records. Patients with deep vein thrombosis at other sites were sought from patient discharge diagnostic coding data. Medical records were reviewed for patient characteristics and conditions associated with the development of venous thromboembolism.
 
RESULTS. Three hundred and seventy-six Chinese patients had venous thromboembolism during the study period. Of these, 352 had peripheral deep vein thrombosis, five had deep vein thrombosis at other sites (cerebral sinus and portal vein thrombosis), 40 had pulmonary embolism (26 had concomitant deep vein thrombosis), and six had fatal pulmonary embolism shown at autopsy.
 
CONCLUSION. The calculated annual incidence of venous thromboembolism in Hong Kong Chinese people was estimated at 16.6 events per 100 000 population, which is lower than incidence rates reported in Caucasians. The four conditions most commonly associated with venous thromboembolism were medical illness, malignancy, orthopaedic surgery, and intravenous drug use. Conditions associated with venous thromboembolism in patients younger than 45 years included intravenous drug use, thrombophilia, pregnancy, and the use of oral contraceptives.
 
Key words: Hong Kong; Incidence; Thromboembolism; Venous thrombosis
 
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