A retrospective controlled analysis of the obstetrical and foetal outcome of 40 pregnancies complicated by maternal narcotic addiction are reported. An incidence of 1.8 in 1000 live births was observed in this study population. There were statistically significant differences between the pregnant addicts and the control group in terms of marital status, smoking habits, family income, antenatal booking time, incidence of sexually transmitted disease, preterm deliveries, number of male babies, number of small-for-date infants, incidence of neonatal jaundice, and postnatal visit defaulters. Pregnant addicts were also found to have an associated history of irregular menstruation, previous history of preterm deliveries and intrauterine growth retardation, abnormal cervical cytology, and antepartum anaemia. There was no difference in age, parity, past history of infertility, duration of labour, mode of delivery, third stage complications, puerperal complications, and neonatal complications between the two groups. A comprehensive programme is needed to provide education, medical surveillance, counselling, and support for this high-risk pregnancy group.

Video-assisted thoracoscopic surgery and interventional bronchoscopy represent different aspects of minimally invasive thoracic surgery. From September 1992 to February 1994, we successfully performed a total of 284 thoracoscopic procedures on 192 patients which consisted of 79 bleb eliminations and 105 mechanical pleurodesis; 26 wedge resections; eight wedge biopsies; six thoracic sympathectomies; six mediastinal mass resections; six pericardial windows; 16 guided pleural biopsies; eight guided drainages of empyema and haemothorax; 13 stagings of intrathoracic tumours; two explorations for penetrating thoracic trauma; seven talc insufflations, and two lobectomies. The median duration of post-operative chest tube drainage was two days and hospital stay four days. From April 1993 to April 1994 interventional bronchoscopy was performed on seven patients with obstructive tracheal and proximal bronchial lesions. Procedures consisted of three carbon dioxide laser reductions; two dilatations and carbon dioxide laser reductions, and two dilatations and placement of silicone Dumon stents. All patients showed immediate symptomatic improvement. We conclude that both procedures are safe and effective.

The experience of continuous ambulatory peritoneal dialysis in children of the Queen Mary Hospital for the past 11 years was reviewed. Seven boys and three girls (aged 4.3 to 15.9 years) were treated for a mean of 27 months (range 5 to 58 months). There was significant biochemical improvement and patients led an active life on continuous ambulatory peritoneal dialysis. The commonest complications were peritonitis, occurring on average once per 10 patient-months and mostly due to Staphylococcus spp. The median catheter survival time was 30 months. There were two technique failures due to fungal peritonitis which necessitated transfer to haemodialysis due to fungal peritonitis. The only mortality was due to concurrent cardiac disease. This review supports that children with renal failure in Hong Kong can be maintained on long term dialysis with a reasonable quality of life. However, significant morbidity due to infective and mechanical complications still exists. Continuous ambulatory peitonitis dialysis remains a temporary treatment modality while patients are waiting for renal transplantation.

Gonadotropin-releasing hormone agonists are commonly used to achieve pituitary and ovarian downregulation in preparation for in vitro fertilisation. The purpose of this study was to examine the efficacy of gonadotropin-releasing hormone agonists in achieving downregulation prior to the commencement of ovarian stimulation. After a three week pretreatment with the gonadotropin-releasing hormone agonists, a satisfactory response as determined by ultrasound, was achieved in 164/200 cycles (82.0%). Treatment was continued for up to five additional weeks in 35 of the remaining 36 cases. Ovarian suppression was achieved in nine of 11 cases after an additional week of treatment, in nine of 14 cases after two weeks and in two of 10 in the remainder. The results of this study suggest that downregulation will be achieved in over 80% of cases after a three week pretreatment with a gonadotropin-releasing hormone agonist, and a short prolongation of treatment may be worthwhile in those cases where downregulation is not achieved in the first instance.

Recent advances now allow detection of the homozygous states of alpha- and beta-thalassemia in early pregnancy, thus giving couples at risk the option of early abortion. However, at the Prince of Wales Hospital, no reduction has occurred in the number of births of infants with haemoglobin Bart's hydrops foetalis. A survey by us has revealed a total of 33 cases during the 7-year period from 1987 to 1993. Antenatal records were available for 20 of the 33 and none of these showed that a thalassemia risk had been recognized prior to the development of hydrops. In some cases mothers had failed to attend antenatal clinics early in pregnancy. However, in others, there was apparent failure of vigilance on the part of the doctors concerned, because the thalassemia risk was not identified and appropriate referral for prenatal diagnosis was not made. During the same period, only five new cases of Cooley's anaemia were diagnosed, mostly after the first year of life. Antenatal records were unavailable for review.