OBJECTIVE. To determine the incidence and clinical characteristics of non-melanoma skin cancer in Hong Kong Chinese patients.

DESIGN. Retrospective study.

SETTING. Social Hygiene Services, Hong Kong.

PATIENTS. Records of 528 Chinese patients with a histological diagnosis of non-melanoma skin cancer from 1990 to 1999 were reviewed.

MAIN OUTCOME MEASURES. Demographic data, site and clinical type of cancer, predisposing factors, history, recurrence, and the development of new skin cancers.

RESULTS. Non-melanoma skin cancer is uncommon but not rare among the Chinese population in Hong Kong. The incidence of newly diagnosed basal cell carcinoma in 1990 was 16.0 per 10,000 new skin case attendances and, in 1999, the incidence was 31.8 per 10,000 new skin case attendances. The corresponding figures for squamous cell carcinoma in 1990 and 1999 were 6.9 and 11.6 per 10,000 new skin case attendances. The incidence of basal cell carcinoma among the Hong Kong Chinese population in 1990 and 1999 was 0.32 and 0.92 per 100,000, respectively, whereas that of squamous cell carcinoma was 0.16 and 0.34 per 100,000, respectively. Demographic data and the site distribution of non-melanoma skin cancer were comparable to those reported in Caucasians living in North America and Europe, but different from those in Caucasians living in Australia and Hawaii. Pigmented basal cell carcinoma was the most common type of non-melanoma skin cancer (60.1%) in Chinese patients, in contrast with rodent ulceration in Caucasian. Multiple skin cancers, recurrence, and subsequent new skin cancers were less frequently observed than in studies of Caucasians.

CONCLUSION. When compared with reported findings in Caucasians, Chinese patients show differences in the clinical type and multiplicity of lesions, predisposing factors, recurrence and subsequent new skin cancer rates for non-melanoma skin cancer. Pigmented basal cell carcinoma seems to be an important differential diagnosis with regard to pigmented lesions in the Chinese population.

Key words: Carcinoma, basal cell; Carcinoma, squamous cell; Incidence; Risk factors; Skin neoplasms/epidemiology

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OBJECTIVE. To determine the frequency of rearrangement of the myeloid-lymphoid leukaemia gene in acute leukaemia in Hong Kong Chinese children.

DESIGN. Immunophenotyping, cytogenetic, and molecular analysis.

SETTING. Regional hospital, Hong Kong.

PARTICIPANTS. Bone marrow or peripheral blood samples were taken from 27 children aged 16 years or younger with acute leukaemia, from September 1995 through February 1998.

MAIN OUTCOME MEASURES. Gene rearrangement was analysed by Southern blotting of HindIII digestion products of mononuclear cell DNA, followed by hybridisation with the myeloid-lymphoid leukaemia P/S4 probe. Nested reverse transcription-polymerase chain reaction analysis was performed to detect and characterise duplication of the myeloid-lymphoid leukaemia gene.

RESULTS. Only one (4%) of 23 children whose marrow or peripheral blood samples contained adequate material for genetic study showed rearrangement in the myeloid-lymphoid leukaemia gene. No children were positive for partial tandem duplication of the myeloid-lymphoid leukaemia gene.

CONCLUSION. Myeloid-lymphoid leukaemia gene rearrangement is rare in Hong Kong Chinese children with acute leukaemia.

Key words: Child; Chromosomes; Gene rearrangement; Hong Kong; Leukemia, lymphocytic, acute/genetics; Leukemia, myeloid/genetics

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OBJECTIVE. To study the epidemiological, clinical, and microbiological features of Plesiomonas shigelloides infection in Hong Kong.

DESIGN. Retrospective study.

SETTING. Infectious Disease Unit of a district hospital, Hong Kong.

PATIENTS. Patients with laboratory-confirmed cases of Plesiomonas shigelloides infection between 1 January 1995 and 31 December 1998.

MAIN OUTCOME MEASURES. Epidemiological and clinical data, antibiotic sensitivity, and clinical outcome.

RESULTS. There was an increasing trend in the number of isolates of Plesiomonas shigelloides obtained and the prevalence of the bacterium. A total of 197 isolates were obtained from 188 patients, and most isolates (172; 87.3%) were obtained during the summer. Clinical and epidemiological data were available for 167 patients (85 males, 82 females). Patient age ranged from 1 month to 95 years; the mean and median ages of the patients older than 15 years were 51.0 and 40.5 years, respectively (n=132). Only 35 (21.0%) of the 167 patients had a history of travel outside Hong Kong, whereas 21 (12.6%) had a history of consuming seafood or uncooked food; 39 (23.4%) had underlying medical conditions. Most patients (165; 98.8%) had symptoms of Plesiomonas shigelloides infection. Nine (5.4%) patients had had chronic diarrhoea for more than 2 weeks; watery and bloody diarrhoea was discharged by 122 (73.1%) and 42 (25.1%) of the patients, respectively. All 197 Plesiomonas shigelloides isolates were sensitive to ofloxacin, or levofloxacin and ceftriaxone. Resistance or partial resistance was recorded for ampicillin (72%), tetracycline (67%), co-trimoxazole (12%), and chloramphenicol (5%). The majority of patients (142/167; 85.0%) had self-limiting cases of infection, but 25 patients were given antibiotics for more severe symptoms at the time of presentation; there were two deaths.

CONCLUSIONS. The occurrence of Plesiomonas shigelloides infection in Hong Kong is increasing, although most cases of are self-limiting.

Key words: Diarrhea/microbiology; Gastroenteritis; Gram-negative bacterial infections; Plesiomonas/drug effects

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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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