OBJECTIVE. To evaluate the suppression of pituitary gonadotrophins and ovarian steroid hormone with the administration of triptorelin depot at 6-weekly intervals.

DESIGN. Prospective observational study.

SETTING. Obstetrics and gynaecology department of a public hospital, Hong Kong.

PATIENTS. Consecutive patients with endometriosis, as diagnosed by laparoscopy or laparotomy from June 1998 through February 1999.

INTERVENTION. Administration of four doses of triptorelin depot 3.75 mg either subcutaneously or intramuscularly every 6 weeks (21 patients), or conventional 4-weekly six-dose regimen (five patients).

MAIN OUTCOME MEASURES. Serum levels of 17-b-oestradiol, luteinizing hormone, and follicle-stimulating hormone; and pelvic pain symptoms.

RESULTS. For the patients receiving the extended-interval dosing regimen of triptorelin, the levels of oestradiol and luteinizing hormone, and the pain score were significantly reduced throughout the treatment period and up to 10 weeks after the injection of the last dose. The level of follicle-stimulating hormone increased slowly but was still significantly lower than pretreatment levels. The hormonal profile was similar to that of patients receiving the conventional regimen.

CONCLUSION. The use of the extended-interval dosing regimen of triptorelin depot results in a consistent hypo-oestrogenised state, which is similar to that achieved by the conventional regimen and which would be considered satisfactory for the medical treatment of pelvic endometriosis. The new regimen thus reduces the cost of treatment without compromising the effect on hormonal suppression.

Key words: Delayed-action preparations; Endometriosis/drug therapy; Estradiol/blood; FSH/blood; LH/blood; Triptorelin/administration & dosage

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OBJECTIVES. To study the profile of airlifted patients and their outcomes after arrival at the hospital, and to evaluate the appropriateness of their prehospital care and the decision to use aeromedical evacuation.

DESIGN. Prospective case series.

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

PATIENTS. All patients transported to the department by a helicopter of the Government Flying Service from June 1998 through November 1998.

MAIN OUTCOME MEASURES. Demographic data, sources and locations of referral, clinical features, triage category, interventions used, and outcome.

RESULTS. A total of 186 patients were transferred by helicopter during the 6-month study period. The 101 patients who had been transferred from a rural hospital or clinic were older (mean age, 50 years versus 35 years), comprised more females (55% versus 26%), had a higher overall mortality rate (19.8% versus 3.6%), and had a higher hospital admission rate (91.1% versus 37.6%) than the 85 patients who had been airlifted from the scene of an emergency. Neurological disorders were the most common presentation among interfacility transfers (21.8%). Among the 85 scene transfers, limb injuries (32.1%) and heat illnesses (24.4%) were the most common reasons for helicopter transport. Most interfacility transfers were appropriate, but 34.1% of patients who had been transferred from the scene of the emergency were later discharged and 21.1% refused consultation.

CONCLUSIONS. Scene and interfacility transfers by helicopter have different patient profiles, and a substantial proportion of scene transfers may be inappropriate. Guidelines such as field triage and helicopter dispatch criteria need to be established.

Key words: Air ambulances; Emergency medical services; Patient transfer; Transportation of patients; Wounds and injuries

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OBJECTIVE. To detect two novel mutations (C282Y and H63D) of the HFE gene in Chinese patients with hepatic iron overload. DESIGN. Multicentre retrospective study.

SETTING. Four public hospitals, Hong Kong.

PARTICIPANTS. Fifty Chinese patients who presented from January 1987 through December 1999 with hepatic iron overload from various causes.

MAIN OUTCOME MEASURES. The DNA from liver biopsy samples was tested for HFE mutations by restriction fragment length polymorphism analysis.

RESULTS. The sample DNA quality was unsatisfactory for analysis of the C282Y mutation in one case and the H63D mutation in nine cases. The C282Y mutation was not detected in any of the 49 satisfactory samples. Three of the 41 samples were heterozygous for the H63D mutation and only one was homozygous, giving an allele frequency of 6.1%. Of the three H63D-heterozygotes, one had beta-thalassaemia major, one had beta-thalassaemia minor, and one had hereditary spherocytosis. None of the 12 patients who were presumed to have primary haemochromatosis were positive for either mutation.

CONCLUSIONS. The classical form of human leukocyte antigen-linked hereditary haemochromatosis appears to be absent form this locality. The H63D mutation is found in a minority (9.8%) of the patients, in whom it may act synergistically with an erythropoietic factor.

Key words: Genes, MHC class I; Hemochromatosis/genetics; Hong Kong; Iron overload/genetics; Mutation, missense

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OBJECTIVE. To determine the patterns and the prevalence of microdeletions in the azoospermia factor subregions of the Y chromosome in Hong Kong Chinese men with severe male-factor infertility.

DESIGN. Controlled clinical study.

SETTING. Reproductive centre of a university teaching hospital, Hong Kong.

PARTICIPANTS. Fifty-eight men with severe male-factor infertility who participated in the in vitro fertilisation programme from May 1998 through March 1999, and 46 male volunteers with proven fertility.

MAIN OUTCOME MEASURES. Polymerase chain reaction analysis of DNA from peripheral blood lymphocytes using six loci spanning the AZFa, AZFb, and AZFc subregions of the Y chromosome.

RESULTS. No microdeletions were detected in the fertile controls or in patients with obstructive azoospermia. Deletions within the AZFc subregion were found in 9% (4/44) of men with non-obstructive azoospermia or severe oligospermia. Neither AZFa nor AZFb deletions were detected in any participants.

CONCLUSION. Deletions within the azoospermia factor subregions of the Y chromosome are associated with severe male-factor infertility in Hong Kong Chinese men.

Key words: Chromosome deletion; Infertility, male; Polymerase chain reaction; Y chromosome/genetics

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OBJECTIVES. To investigate the failure patterns and the prognostic factors following postoperative radiotherapy for salivary gland carcinoma.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Fifty patients who had non-disseminated salivary gland carcinoma and who received primary treatment from 1984 through 1993.

MAIN OUTCOME MEASURES. Demographic data, cancer T- and N-stages, histological type, site of origin, completeness of surgery, whether postoperative radiotherapy was given, and the clinical outcome.

RESULTS. Two (4%) patients had been treated with radiotherapy alone, six (12%) had undergone radical resection alone, and 42 (84%) had been radically treated by using both modalities. The 5-year overall survival and relapse-free survival rates were 78.4% and 63.1%, respectively. The free from local failure and free from distant metastasis rates at 5 years were 77.2% and 72.8%, respectively. The N-stage was a significant prognostic factor. The site of the primary tumour, T-stage, completeness of surgery, and use of postoperative radiotherapy were not significant independent prognosticators; however, among the T-stage tumours, the b-substage carcinomas had significantly fewer local failures (P=0.040) and better survival rates (P=0.038) than the a-substage carcinomas. There were seven (14%) locoregional failures without distant metastasis, seven (14%) cases of distant metastasis without locoregional failures, and four (8%) locoregional failures preceding distant metastasis; isolated regional relapse was rare (1/50; 2%). All regional failures (5/50; 10%) occurred ipsilateral to the primary lesion. There were no deaths due to lymphoepithelioma-like carcinoma or acinic cell carcinoma.

CONCLUSIONS. The N-stage is the main prognostic factor of overall survival, relapse- and metastasis-free recovery, and success of treatment for salivary gland carcinoma. Optimal locoregional treatment can help reduce distant metastasis, and the maximal use of postoperative radiotherapy may contribute to improved locoregional control. Elective ipsilateral neck radiotherapy is indicated for lymphoepithelioma-like carcinoma.

Key words: Combined modality therapy; Prognosis; Radiotherapy, high-energy; Salivary gland neoplasms/therapy; Survival analysis; Treatment outcome

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