This prospective, randomised, double blind study examined the efficacy of intrathecal morphine for post-operative analgesia in Chinese patients undergoing surgery to repair fractured hips. There were a total of 40 American Society of Anesthesiologists physical status grade I to IV patients scheduled for surgery following a fractured neck of the femur. Patients were randomised to a control group in which they received subarachnoid plain 0.5% bupivacaine, 2.2 mL, and normal saline, 0.4 mL, giving a total volume of 2.6 mL, or to a study group in which they received plain 0.5% bupivacaine, 2.2 mL, and preservative-free morphine, 0.2 mg, diluted with normal saline to a total volume of 2.6 mL. Patients were monitored for up to 24 hours by staff blinded to group allocation. The level of pain was assessed by a visual analogue pain score and the time of first request for analgesia was noted. The results show the median pain-free period in the control group was nine hours (range, 2-24 hours), while it was 24 hours (range, 16-24 hours) in the morphine group, a significant difference (P<0.05). No major complications were reported. Intrathecal morphine is a useful technique for giving post-operative pain relief, especially in the elderly, in whom many other techniques cannot be safely used.

A retrospective review was performed of all women who had undergone operation for a tubal pregnancy at the Prince of Wales Hospital, Hong Kong, from November 1992 to March 1994. One hundred and five patients were included-611 were managed by laparoscopy and 44 by laparotomy. There were no differences in age, parity, gestational age, frequency of previous ectopic pregnancy, or laparotomy between the two groups. Sixty per cent of patients in the laparotomy group had a diagnostic laparoscopy prior to the laparotomy. The laparoscopy group had a lower incidence of haemoperitoneum (45.9% vs 75.0%, P<0.05). There was no difference in the mean operating time. The laparoscopic approach was associated with a significant reduction in: intra-operative blood loss (46.7 76.8 mL vs 213.4 149.3 mL. P<0.001), post-operative analgesia requirement (odds ratio 0.08, 95% CI, 0.02-0.32), post-operative morbidity (odds ratio 0.27, 95% CI, 0.12-0.58), length of hospital stay (2.9 2.2 days vs 5.1 1.2days, P<0.001) and recuperation period (11.0 9.3days vs 21.7 8.5 days, P<0.001). Operative laparoscopy has the advantage of combining diagnostic and therapeutic procedures in a single operation, and is a better approach than laparotomy in the management of tubal pregnancy.

Adult inpatients with injuries to the hand admitted to the Department of Orthopaedics and Traumatology of the Prince of Wales Hospital, Hong Kong, from June 1992 to May 1993 were surveyed (n=533). The causes of injury, mechanisms involved, and the nature of injuries were recorded. The injuries were further graded according to four different scales. It was found that 65% of the injuries were sustained at work, 15% in domestic environments, 7.6% during sports or recreational activities, and 6.5% in traffic accidents. Injuries caused by heavy machinery amounted to 26.7% and the electric saw was the second most common cause of injury accounting for 9.4% of injuries. Crush injuries occurred in 37.8%. The incidence of hand injury is estimated to be 600 per 100,000 population annually. The pattern of hand injuries bears some similarities and differences to published series. A comparison with data obtained in Hong Kong in the 1970s shows that major changes have occurred. We need continual surveillance of hand injury patterns.

Ice-skating is a popular sport in Hong Kong. Since the opening of our hospital, we have observed a special pattern of injury related to ice-skating. Individuals have had a wide range of injuries including fractures and deep tissue lacerations, many of which have needed operative intervention. Public awareness of the risks remains low. The pattern and mechanisms of injury, management modalities, and contributing factors to the injuries are discussed. Preventive measures and socioeconomic implications are also discussed.

Urinary incontinence is a common problem among the elderly, especially those admitted to acute care hospitals. A study investigating this problem was conduced in the geriatric wards of the Tuen Mun Hospital, Tuen Mun, from 26 October 1995 to 9 November 1995. Fifty of 139 (36%) patients had urinary incontinence with a male to female ratio of 1:15. Patients with urinary incontinence were found more often to have mobility problems and a higher institutionalisation rate than did continent patients. Dementia and cerebrovascular accident were also found to be associated with this problem. Although it is a common problem, none had been evaluated or treated before. Most of the caregivers thought that urinary incontinence was a normal ageing process and used diapers to treat this problem.