Laparoscopy for the treatment of women with endometrial cancer

ABSTRACT
Hong Kong Med J 2003;9:108-12 | Number 2, April 2003
ORIGINAL ARTICLE
Laparoscopy for the treatment of women with endometrial cancer
L Liauw, YN Chung, CW Tsoi, CP Pang, KB Cheung
Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong
 
 
OBJECTIVE. To evaluate the use of a laparoscopic approach for the management of endometrial cancer.
 
DESIGN. Retrospective study.
 
SETTING. Regional hospital, Hong Kong.
 
SUBJECTS AND METHODS. Individual medical records of patients with preoperative histological diagnosis of endometrial carcinoma from January 2000 to December 2001 were reviewed and the data analysed.
 
MAIN OUTCOME MEASURES. Success of laparoscopic-assisted surgical staging, intraoperative and postoperative morbidity, and length of hospital stay.
 
RESULTS. Laparoscopic surgery was successful for 93.3% (28 of 30) patients. Two patients were converted to laparotomy. The mean operating time was 102 minutes (standard deviation, 16 minutes) and the mean operative blood loss was 280 mL (standard deviation, 137 mL). The mean hospital stay was 5 days (standard deviation, 2.3 days). The intra-operative and postoperative complication rate was 16.7%, including vaginal tear, injury to the inferior epigastric vessel, lymphocyst, and pulmonary embolism.
 
CONCLUSION. This study illustrated that a laparoscopic approach is feasible for endometrial cancer surgery and may be considered as the primary treatment modality in skilled hands. This approach should be offered to women with endometrial cancer without contraindications for laparoscopic surgery if experienced endoscopic surgeons are available. Prophylaxis for venous thromboembolism and the use of retroperitoneal drainage may be helpful in decreasing the perioperative morbidity.
 
Key words: Endometrial neoplasms; Hysterectomy; Laparoscopy; Surgery
 
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Ambulatory stapled haemorrhoidectomy: a safe and feasible surgical technique

ABSTRACT
Hong Kong Med J 2003;9:103-7 | Number 2, April 2003
ORIGINAL ARTICLE
Ambulatory stapled haemorrhoidectomy: a safe and feasible surgical technique
WL Law, HM Tung, KW Chu, FCW Lee
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
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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Early extubation after transthoracic oesophagectomy

ABSTRACT
Hong Kong Med J 2003;9:98-102 | Number 2, April 2003
ORIGINAL ARTICLE
Early extubation after transthoracic oesophagectomy
FHY Yap, JYW Lau, GM Joynt, PT Chui, ACW Chan, SSC Chung
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
OBJECTIVE. To assess patient outcome following transthoracic (Ivor-Lewis) oesophagectomy and the effects of epidural analgesia and early extubation compared with overnight sedation and ventilation.
 
DESIGN. Retrospective study.
 
SETTING. University teaching hospital, Hong Kong.
 
SUBJECTS AND METHODS. A retrospective review of patients undergoing oesophagectomy during two periods, 1990 to 1994 (n=65) and 1995 to 1998 (n=83), was completed. In the latter period, factors associated with early extubation were also evaluated.
 
RESULTS. Between 1990 and 1994, only three (4.6%) of 65 patients were extubated early compared with 34 (41.0%) of 83 patients between 1995 and 1998 (P<0.001). Comparing these two periods, there were no differences in respiratory complications or hospital mortality. In the period 1995 to 1998, more patients who were extubated early had received epidural analgesia (85% versus 41%, P<0.001). There were no differences between the early and late extubation groups in terms of respiratory complications and hospital mortality. Patients extubated early had shorter stays in the intensive care unit (1 versus 2 days, P=0.005). Epidural analgesia was an independent factor associated with early extubation (odds ratio=9.4; 95% confidence interval, 2.8-31.2).
 
CONCLUSION. After transthoracic oesophagectomy, early extubation is safe and can lead to a shorter stay in the intensive care unit. Epidural analgesia appears to facilitate early extubation.
 
Key words: Analgesia, epidural; Esophagectomy; Mortality; Postoperative complications; Ventilation
 
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Clinical profiles of human immunodeficiency virus–associated lymphoma in Hong Kong

ABSTRACT
Hong Kong Med J 2003;9:91-7 | Number 2, April 2003
ORIGINAL ARTICLE
Clinical profiles of human immunodeficiency virus–associated lymphoma in Hong Kong
YK Mak, CH Chan, CKP Li, MP Lee, YW Tsang
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
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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Tuberculosis in Hong Kong—patient characteristics and treatment outcome

ABSTRACT
Hong Kong Med J 2003;9:83-90 | Number 2, April 2003
ORIGINAL ARTICLE
Tuberculosis in Hong Kong—patient characteristics and treatment outcome
CM Tam, CC Leung, K Noertjojo, SL Chan, M Chan-Yeung
Tuberculosis and Chest Service, Department of Health, 99 Kennedy Road, Wanchai, Hong Kong
 
 
OBJECTIVES. To identify the general characteristics of patients with tuberculosis, and to evaluate their treatment outcomes.
 
DESIGN. Retrospective study.
 
SETTING. Tuberculosis and Chest Service, Department of Health, Hong Kong.
 
SUBJECTS AND METHODS. All patients with tuberculosis registered for treatment from 1 January 1996 to 31 December 1996 were included in the study. Information was extracted from their medical records at treatment commencement and at 12 and 24 months after treatment was instigated. Data gathered included demographic data, past treatment, site of disease, case category, treatment regimen, bacteriological status, and treatment outcome.
 
RESULTS. There were 5757 patients for analysis. Approximately one third of patients were aged 60 years or older, and 69.1% were male. Pulmonary disease alone occurred in 77.7% of patients, while both pulmonary and extrapulmonary diseases occurred in 8.6%. New patients comprised 84.6% of cases, and 16.3% had concomitant illnesses. There was excess risk of disease among patients who were male, elderly, or who had silicosis. Only 0.1% of patients were co-infected with human immunodeficiency virus infection. Among the 5757 cases evaluated, 1324 (23.0%) were new patients with a positive sputum smear, 299 (5.2%) were patients who were retreated with a positive sputum smear, and 4134 (71.8%) were new or retreatment patients with a negative sputum smear. The overall treatment completion rates at 12 and 24 months were 80.4% and 84.8%, respectively. Males and patients aged 60 years or older had lower treatment completion rates. Non-adherence, transfer to other services, and mortality among the elderly were key factors influencing treatment outcomes. Co-morbidity was associated with better case-holding, and this more than compensated for its effect on prolongation of treatment and mortality.
 
CONCLUSIONS. There was an excess risk of tuberculosis among male and elderly patients, who also had a less favourable outcome. Active screening of clearly identified risk groups may be appropriate but requires the completion of more in-depth studies and careful cost-effectiveness analyses. Further efforts with respect to case-holding are indicated to address treatment defaulting and transfer rates.
 
Key words: Demography; Disease management; Treatment outcome; Tuberculosis
 
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Renal impairment in patients with multiple myeloma

ABSTRACT
Hong Kong Med J 2003;9:78-82 | Number 2, April 2003
ORIGINAL ARTICLE
Renal impairment in patients with multiple myeloma
CC Chow, KL Mo, CK Chan, HK Lo, KS Wong, JCW Chan
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
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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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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