OBJECTIVE. To study the injury pattern of children admitted for management of severe trauma or thermal injury.

DESIGN. Retrospective review.

SETTING. Paediatric intensive care unit of a regional hospital, Hong Kong.

PATIENTS. Twenty-eight children were admitted under this category from July 1996 to December 1999.

MAIN OUTCOME MEASURES. Mechanisms, severity, and circumstances of injury.

RESULTS. Road traffic accident was the most common cause of admission, followed by thermal injury, accidental fall, and non-accidental injury. However, non-accidental injury children were admitted in a significantly more severe condition, as measured by the paediatric risk of mortality score, than those admitted for the other three reasons. Non-accidental injury was also associated with significantly higher morbidity and mortality than the other causes of admission.

CONCLUSIONS. During the 42-month study period, trauma and thermal injury accounted for 7% of all admissions to the paediatric intensive care unit. Road traffic accident was the most common reason, while non-accidental injury accounted for the most serious injury. Detailed analysis of all these cases identified certain preventable risk factors.

Key words: Child; Intensive care units, pediatric; Wounds and injuries

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OBJECTIVES. To evaluate the use of a picture archiving and communication system and user satisfaction in order to further improve its quality.

DESIGN. Prospective study.

SETTING. Medical college hospital, Japan.

MATERIALS AND METHODS. An automated computerised method was used to collect the data from March 1999 to February 2000.

MAIN OUTCOME MEASURES. Each workstation automatically recorded data on the rank of the user, purpose of use, use of postprocessing tools, and user satisfaction.

RESULTS. The number of resident users in the radiology reading room increased and those outside the reading room decreased, but the number of staff users changed little. The purpose of use and the use of postprocessing functions in the reading room were not significantly different from those outside it (P=0.179 and P=0.269, respectively). The average numbers of images accessed to per workstation monthly in the reading room, the general practice ward, and the gastroenterology ward were 1081, 970 and 741, respectively. Only 12 images in the orthopaedic surgery out-patient clinic and 70 images in the orthopaedic surgery ward, however, were accessed per month. The percentages of satisfied users decreased both inside and outside the reading room. The degree of satisfaction of users in the reading room was significantly different from that outside it (P=0.004). The most common reason for dissatisfaction was the length of time necessary to retrieve images.

CONCLUSIONS. It is necessary to shorten response times of picture archiving and communication system workstations. Repeated data collection and evaluation, however, are also important.

Key words: Diagnostic imaging; Information storage and retrieval; Radiology; Radiology information system

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OBJECTIVES. To compare and contrast clinical characteristics and outcomes of hepatoblastoma or hepatocellular carcinoma in paediatric patients.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS AND METHODS. Medical records of 22 paediatric patients with hepatoblastoma (n=11) or hepatocellular carcinoma (n=11) admitted to Queen Mary Hospital between 1989 and 2000 were reviewed. Data gathered included demographic data, results of liver function tests, hepatitis A, B, and C titres, and alpha-foetoprotein levels, and imaging studies including chest X-ray, ultrasound study, computed tomography scan, and magnetic resonance imaging/hepatic angiogram for tumour staging and resectability.

RESULTS. The mean age of patients with hepatoblastoma was 18 months (range, 5 months to 3 years), while that of patients with hepatocellular carcinoma was 10.2 years (range, 2 to 16 years). Females predominated in the hepatoblastoma group (female:male, 8:3) and males in the hepatocellular carcinoma group (male:female, 10:1). None of the patients with hepatoblastoma were hepatitis B surface antigen positive, in contrast to 64% of the hepatocellular carcinoma group. Only 45% of the hepatocellular carcinomas were resectable at presentation and this figure remained unchanged following chemotherapy. A total of 91% of hepatoblastomas were resectable, four at presentation, and a further six after chemotherapy. Tumour rupture was more common in patients with hepatoblastoma than in those with hepatocellular carcinoma (36% versus 9% of cases, respectively). Mortality rates were considerably higher among the hepatocellular carcinoma group than the hepatoblastoma group in this series.

CONCLUSION. Childhood hepatoblastoma and hepatocellular carcinoma differ with respect to age and tumour stage at presentation, hepatatis B surface antigen status, tendency to rupture, chemosensitivity, and prognosis.

Key words: Leg; Pulmonary embolism; Ultrasonography, Doppler, duplex; Venous thrombosis

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OBJECTIVE. To assess the predictive power of various parameters on the final outcome of ulcerated diabetic feet among the Hong Kong Chinese population.

DESIGN. Retrospective cohort study.

SETTING. Regional public hospital, Hong Kong. Patients: Medical records of 340 diabetic patients with foot ulcers (535) who were referred to the Diabetic Foot Clinic between July 1995 and June 2000 were reviewed.

MAIN OUTCOME MEASURES. Demographic and clinical data, including assessment of the foot and blood parameters.

RESULTS. Increasing age, wound depth, the presence of ischaemia, a low albumin level, and the lack of simultaneous ulceration were determined by stepwise logistic regression analysis to be the most significant independent predictors of an unfavourable outcome.

CONCLUSIONS. Major amputation is more likely to occur in elderly patients, with progressive wound depth, and in the presence of ischaemia. A low albumin level was also noted to be an independent predictor of major amputation in the population studied.

Key words: Amputation; Diabetes mellitus; Diabetic foot; Hong Kong; Prognosis

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OBJECTIVE. To study the effects of proton pump inhibitors in reducing vomiting, gastrointestinal bleeding, and chest infections in institutionalized neurologically impaired children with gastroesophageal reflux.

DESIGN. Prospective study.

SETTING. A regional hospital, Hong Kong.

PATIENTS. Neurologically impaired children with refractory gastroesophageal reflux.

MAIN OUTCOME MEASURES. Episodes of vomiting, gastrointestinal bleeding, and pneumonia in the baseline and proton pump inhibitor treatment periods.

RESULTS. Nine children received proton pump inhibitor therapy for a median duration of 81 days. Mean reflux index was 9.3% (standard deviation, 5%). Dosage of omeprazole used was 1.0-2.3 mg/kg/d. Vomiting was reduced significantly with proton pump inhibitor treatment (median vomiting index [baseline]=0.4, median vomiting index [proton pump inhibitors]=0.2; P<0.05). No significant decrease in gastrointestinal bleeding or chest infection was observed.

CONCLUSION. Proton pump inhibitors significantly reduced vomiting episodes in neurologically impaired children with gastroesophageal reflux.

Key words: Child; Gastroesophageal reflux; Omeprazole; Vomiting

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