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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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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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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OBJECTIVES. To examine the utilisation pattern of accident and emergency services and to study the possible impact of a user-fee policy on non-emergency attendances in Hong Kong.

DESIGN. Retrospective study.

METHODS. Four different scenarios are postulated to examine the impact on the number of accident and emergency attendances of a user-fee policy from 2000 to 2029. Patient volume data of accident and emergency attendances for 2000 were made available by the Hospital Authority of Hong Kong.

RESULTS. Non-emergency use of the accident and emergency service is the main cause of over-utilisation and contributes to more than 70.0% of its use. Only 22.0% of patients attending accident and emergency departments were admitted to a ward for further treatment. By 2029, the number of accident and emergency attendances would increase by more than 47.0% if the present utilisation pattern prevails. However, if patients at triage levels 3, 4, and 5 were discouraged from using the accident and emergency service, the number of attendances would decrease by 76.4%.

CONCLUSION. The proposed user-fee policy would act as a deterrent by preventing unnecessary use of accident and emergency services. However, the use of out-patient services may be increased as a result and attendance should be carefully monitored. Community health education and civic education relating to abuse of accident and emergency services would be effective in reducing over-utilisation of these services.

Key words: Emergency service, hospital; Health care reform; Social welfare

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OBJECTIVES. To identify factors affecting cervical and breast cancer screening attendance among women aged 44 to 55 years by comparing self-reported uptake of cervical smear and clinical breast examination between patients and a population sample.

DESIGN AND SETTING. Telephone survey and audit of clinic records to confirm patients’ self-report.

PARTICIPANTS. Two thousand and sixty-seven women identified through random telephone dialling from the residence directory and 319 patients ever-registered at a family practice teaching clinic.

MAIN OUTCOME MEASURES. Uptake of cervical smear and clinical breast examination.

RESULTS. The proportion of patients undergoing cervical smear tests and clinical breast examination in the previous 12 months were 35.4% and 22.6%, respectively, for randomly selected women, while the figures were 47.2% and 50.6%, respectively, for patients. Record audit confirmed high rates of screening for patients according to evidence-based protocols (85.1% had had a cervical smear within 3 years). For women in the random sample (mean age, 48.9 years; standard deviation, 3.3 years), those who were older, postmenopausal, not receiving hormone therapy, educated to primary level, and with no chronic diseases were least likely to have had screening. For clinic patients (mean age, 47.9 years; standard deviation, 2.8 years), lower education level was the only variable associated with no recent smears.

CONCLUSIONS. Healthy perimenopausal and postmenopausal women in the community with lower educational level and not receiving hormone therapy were more likely to be underscreened. Attendance of 44- to 55-year-old women at a family medicine clinic that actively promotes preventive medicine was associated with high screening uptake.

Key words: Colorectal neoplasms; Hepatectomy; Survival analysis

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