OBJECTIVE. To study the effectiveness and safety of non-invasive positive-pressure ventilation in the management of acute respiratory failure.

DESIGN. Prospective study.

SETTING. Regional public hospital, Hong Kong.

PATIENTS. One hundred and eighty-nine haemodynamically stable adult Chinese patients with acute respiratory failure (119 men and 70 women; mean age, 71.2 years [range, 18-92 years]) who were treated with non-invasive positive-pressure ventilation as the primary mode of ventilatory assistance from 1 January 1996 to 31 December 1998.

MAIN OUTCOME MEASURES. Arterial blood gas measurements, respiratory rate, airway pressures used, use of endotracheal intubation, and standardised mortality ratio.

RESULTS. Fifty-two patients had hypoxaemic respiratory failure (group I); 97 had hypercapnic respiratory failure (group II); and 40 had either type with advanced co-morbidities and were not planned to receive endotracheal intubation (group III). For groups I and II, the overall mean duration of non-invasive positive-pressure ventilation was 56.2 hours. Improvements in gas exchange were seen in approximately 71% of these patients, endotracheal intubation was not needed for 82%, and the standardised mortality ratio was 0.86. The hospital survival rate was approximately 93% in non-intubated patients and 41% in intubated patients. Predictors of success were reduction in respiratory rate within 6 hours (P<0.005), and (for hypercapnic respiratory failure) increased pH and reduced arterial carbon dioxide tension within 24 hours (P<0.005). Patients with pneumonia had significantly higher failure rates (P<0.05). Group III patients were older, had higher Acute Physiology and Chronic Health Evaluation II scores, and required longer ventilatory support, but their gas exchange response rate was 68%. The only complication of treatment was minor facial skin abrasions.

CONCLUSION. Non-invasive positive-pressure ventilation is effective in treating haemodynamically stable patients with acute respiratory failure and causes few and minor complications.

Key words: Intubation, intratracheal; Lung disease, obstructive; Positive-pressure respiration; Respiratory distress syndrome, adult; Treatment outcome

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OBJECTIVE. To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women.

DESIGN. Prospective longitudinal study involving self-report questionnaires and face-to-face interviews.

SETTING. University teaching hospital, Hong Kong.

PARTICIPANTS. Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997.

MAIN OUTCOME MEASURES. Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales.

RESULTS. Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn.

CONCLUSION. Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.

Key words: Depression, postpartum; Female; Mass screening/methods; Pregnancy complications; Psychiatric status rating scales

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OBJECTIVE. To review local experience of neoadjuvant chemotherapy in breast cancer.

DESIGN. Retrospective study.

SETTING. Public hospital, Hong Kong.

PATIENTS. Seventeen patients who presented from August 1988 through April 1997 with locally advanced breast cancer, which was treated with neoadjuvant chemotherapy.

RESULTS. The clinical response rate was 71% and two of the 12 patients who responded to chemotherapy achieved complete remission. Three patients had their tumours downstaged sufficiently to allow them to undergo breast conservation surgery after neoadjuvant chemotherapy. None of these three patients has so far had a local recurrence of disease.

CONCLUSION. Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer and thus enables breast conservation surgery to be performed on patients who are initially not suitable for this procedure.

Key words: Antineoplastic agents, combined; Breast neoplasms/surgery; Neoadjuvant therapy; Neoplasm recurrence, local; Neoplasm staging

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OBJECTIVES. To compare the contributions of patients, emergency physicians, and surgeons in the delay of diagnosis and treatment of appendicitis, and the effects of delay on disease stage and complication rate.

DESIGN. Retrospective study.

SETTING. Accident and emergency department of a district public hospital, Hong Kong.

PATIENTS. All patients undergoing emergency appendectomy between August 1998 to September 1999.

MAIN OUTCOME MEASURES. Patient delay in presentation, emergency physician delay in hospital admission, and surgeon delay in performing the operation; operative findings; and postoperative complications.

RESULTS. Of 158 patients undergoing emergency operation, 14 had no pathological diagnosis and four had a diagnosis other than that of acute appendicitis. Of the 140 pathologically confirmed cases of appendicitis, the mean emergency patient delay was greater in advanced appendicitis than it was in simple appendicitis (42.0 hours versus 24.9 hours; P<0.005). The mean emergency physician delay in advanced appendicitis was also greater than it was in simple appendicitis (17.9 hours versus 5.8 hours; P<0.05). The difference in the mean surgeon delay in simple (10.9 hours) and advanced (16.3 hours) appendicitis, however, was not significant. The mean emergency physician delay showed a significant association with the postoperative complication rate (P=0.05). The delay was mainly because of a failure to diagnose the condition and admit the patient at the first visit to the accident and emergency department (22.1%). The diagnostic accuracy showed a significant association with the level of experience of the emergency physician involved (P<0.05).

CONCLUSION. There should be a higher index of suspicion, better surgical training, and better senior supervision at accident and emergency departments, to avoid preventable morbidity and mortality in acute appendicitis.

Key words: Acute disease; Appendectomy; Appendicitis/surgery; Appendicitis/diagnosis; Emergency medical services; Time factors

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OBJECTIVE. To analyse the epidemiology of heart failure in Hong Kong, 1997.

DESIGN. Retrospective study with 1-year follow-up.

SETTING. Accident and emergency departments of 11 hospitals of the Hospital Authority, Hong Kong.

PATIENTS. All patients admitted to hospital in 1997 with heart failure as the primary diagnosis, as shown in their discharge summaries.

MAIN OUTCOME MEASURES. Demographic data, incidence and prevalence of heart failure, and survival status up to 1 year.

RESULTS. There were 4589 new and 1614 old cases of heart failure that required hospital admission in 1997. The largest age-group was the 75- to 84-year group; 85% of the patients were older than 65 years and 56% of the patients were female. The incidence of heart disease increased with age, approximately doubling with each decade of age and reaching an annual incidence of 14 per 1000 men and 20 per 1000 women older than 85 years. The 1-year mortality rate also increased with age, reaching 40% for patients older than 85 years (overall, 32%).

CONCLUSION. Heart failure is a common problem and has high mortality, especially in elderly patients. Detailed analyses of the aetiology and early preventive measures are needed to alleviate the problem.

Key words: Age factors; Heart failure, congestive; Hong Kong/epidemiology; Incidence; Mortality; Prevalence

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