OBJECTIVE. To evaluate the perioperative outcomes of pancreaticoduodenectomy in a tertiary referral centre in Hong Kong.

DESIGN. Retrospective case series.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. One hundred and forty patients who underwent pancreaticoduodenectomy from July 1989 through June 2001.

MAIN OUTCOME MEASURES. Mortality and morbidity.

RESULTS. Overall hospital mortality among 140 patients was 2.9% (n=4), and 30-day operative mortality was 2.1% (n=3). There was no significant difference in the hospital mortality rate between 43 elderly patients aged 70 years or older and 97 younger patients (2.3% versus 3.1%). The overall morbidity rate was 38.6% (n=54). Intra-abdominal abscess (13.6%) and pancreaticojejunal anastomotic leakage (12.9%) were the two most common complications. Presence of co-morbid illness (risk ratio, 2.823; 95% confidence interval, 1.541-4.385; P=0.01), preoperative cholangitis (risk ratio, 2.565; 95% confidence interval, 1.166-5.643; P=0.02), and intra-operative blood loss ?.5 L (risk ratio, 2.236; 95% confidence interval, 1.132-6.213; P=0.03) were independent risk factors for postoperative morbidity.

CONCLUSIONS. Pancreaticoduodenectomy is associated with a low risk of operative death when performed in a tertiary referral setting in Hong Kong. The postoperative morbidity rate remains high, however. Further improvement by reducing intra-operative blood loss may help curtail the high postoperative morbidity.

Key words: Morbidity; Mortality; Pancreaticoduodenectomy

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OBJECTIVE. To report the experience with liver transplantation at the Queen Mary Hospital from 1991 to 2000.

DESIGN. Retrospective study.

SETTING. Liver transplant centre of a University teaching hospital, Hong Kong.

PATIENTS. One hundred and forty-eight patients (127 adults and 21 children) who underwent a total of 155 liver transplants using 75 cadaver grafts (full-size, 67; reduced-size, 5; split, 3) and 80 living donor grafts (left lateral segment, 15; left lobe, 6; right lobe, 59) from October 1991 to December 2000 were reviewed.

MAIN OUTCOME MEASURES. Graft and patient survival rate.

RESULTS. The most common disease indications for liver transplantation were chronic hepatitis B–related liver disease (n=74) in adults and biliary atresia (n=14) in children. Eighteen patients had hepatocellular carcinoma. Forty-eight (31%) liver transplants (three ABO-incompatible) were performed in high-urgency situations for patients requiring intensive care. The proportion of living donor liver transplants was 47.7% in adults and 73.9% in children. The overall 1-year and 5-year patient survival rates were 82% and 77%, respectively. The survival of high-risk recipients, such as those with fulminant hepatic failure (80%), chronic hepatitis B (81%), or hepatocellular carcinoma (94%), was not inferior to that of other patients.

CONCLUSION. Over the last decade, the promotion of (cadaver) organ donation through public education coupled with innovative techniques in living donor liver transplantation have enabled a liver transplantation programme to be established in Hong Kong with gratifying results.

Key words: Liver transplantation; Treatment outcome

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OBJECTIVE. To evaluate the ability of patients to recall information provided during a preoperative visit.

DESIGN. Qualitative study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Sixty patients scheduled for elective surgery under general anaesthesia or central neuro-axial block.

MAIN OUTCOME MEASURES. Satisfactory recall of preoperative information, defined as the ability to remember at least 75% of adverse effects described.

RESULTS. Fifty-nine (98.3%) patients were satisfied with the preoperative information. Forty-two (70%) patients rated anaesthetic complications as important. At the interview on the day of the operation, 57 (95%) patients had satisfactory recall of the information provided. Eighty-five percent of patients remembered that the information was provided by an anaesthesiologist. After the operation, of those who experienced adverse effects, 48 (96%) patients remembered being told to anticipate the adverse anaesthetic event. Univariate analysis found that age, sex, education level, occupation, and the modality of anaesthesia did not affect patient recall of preoperative information on the day of surgery or 1 day postsurgery.

CONCLUSION. There was satisfactory recall of preoperative information by the majority of patients in the study. Most patients expressed satisfaction with the information provided.

Key words: Anesthesia; Memory/drug effects; Recall

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OBJECTIVES. To evaluate performance characteristics of the newly available handheld combined glucose and ketone meter for beta-hydroxybutyrate measurement.

DESIGN. Laboratory method evaluation.

MAIN OUTCOME MEASURES. Accuracy of beta-hydroxybutyrate measurement and effect of acetoacetate interference at clinically important beta-hydroxybutyrate levels.

RESULTS. Deming regression analysis of beta-hydroxybutyrate measurements assessed by the ketone sensor and a laboratory enzymatic method revealed a coefficient of determination of 0.989 (P<0.001). Passing-Bablok regression analysis showed a linear relationship between the two methods, ie Y= –0.32+1.13X. The 95% confidence interval of the slope and y-intercept were: slope=1.13 (95% confidence interval, 1.04 to 1.22); intercept= –0.32 (95% confidence interval, -0.59 to -0.06). The Bland-Altman plot showed a small proportional bias between the two methods. The mean bias ±2 standard deviations was between -0.53 and 0.67 mmol/L. Beta-hydroxybutyrate measurements made by the sensor were linear up to 6 mmol/L. Replicate analysis of two samples spiked with 3.6 mmol/L and 0.8 mmol/L of beta-hydroxybutyrate resulted in coefficients of variation of 3.3% and 13%, respectively. The presence of acetoacetate caused a negative interference in beta-hydroxybutyrate measurement. Beta-hydroxybutyrate recovery was 97.0% and 90.7% when the ketone body ratios were 6:1 and 3:1, respectively.

CONCLUSION. The analytical performance of the sensor, when operated according to manufacturer’s instructions, could meet the needs of point-of-care beta-hydroxybutyrate measurement. Additional clinical studies are needed to assess the benefits of introducing such an assay in a clinical setting.

Key words: 3-Hydroxybutyric acid; Ketones; Point-of-care systems

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OBJECTIVE. To identify risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage.

DESIGN. Retrospective study.

SETTING. Regional obstetric unit, Hong Kong.

SUBJECTS AND METHODS. Women delivered at Princess Margaret Hospital between 1 January 1990 and 31 December 1997. Possible risk factors for preterm delivery among women with placenta praevia and antepartum haemorrhage including onset, pattern, and severity of vaginal bleeding; presence of uterine contractions on admission; and type of placenta were assessed.

RESULTS. Three risk factors for preterm delivery were identified from univariate analysis. These included second trimester vaginal bleeding (odds ratio=4.19; 95% confidence interval, 1.29-13.66), the presence of uterine contractions on admission (odds ratio=4.00; 95% confidence interval, 1.57-10.19), and a haemoglobin decrease of more than 20 g/L (odds ratio=3.00; 95% confidence interval, 1.00-9.04). Using the logistic regression model, second trimester vaginal bleeding and the presence of uterine contractions were found to be independent risk factors for delivery before 36 weeks.

CONCLUSION. Preterm delivery is increased in women with placenta praevia and antepartum haemorrhage who have second trimester vaginal bleeding or the presence of uterine contractions. This high-risk group may benefit from close in-patient monitoring and more aggressive management.

Key words: Labor, premature; Placenta praevia; Uterine hemorrhage

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