OBJECTIVE. To review the autopsies performed at a university-affiliated teaching hospital over a 12-month period.

DATA SOURCES. Records of autopsies performed at a university-affiliated teaching hospital during 1997, and Medline literature search (1966-1998).

STUDY SELECTION. The key words used in the literature search were 'autopsy' and 'audit'.

DATA EXTRACTION. Data were extracted and analysed by the authors. Any discrepant cases (in which the final diagnoses were either unexpected or not made before death) were identified from the hospital records.

DATA SYNTHESIS. Interest in autopsy results has increased, owing to the greater emphasis on medical audit and quality assurance procedures. Of the yearly total of 403 autopsies, 332 cases were reviewed; the discrepancies found were classified as either major or minor, according to their effect on the clinical outcome. The major and minor discrepancy rates were 23% and 9%, respectively. In 2% of cases, the cause of death was due to complications resulting from surgical intervention. These discrepancy rates were comparable to the figures quoted in the literature.

CONCLUSION. Autopsy is a valid medical quality-assurance mechanism in Hong Kong.

Key words: Autopsy/standards; Coroners and medical examiners; Diagnostic errors; Quality assurance, health care

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OBJECTIVE. To review the recent advances in the management of depression and psychopharmacology.

DATA SOURCES. Medline and non-Medline literature search.

STUDY SELECTION. The following key words were used: depression/therapy, depressive disorders, antidepressant, psychopharmacology, and mental health services. Years of study: 1988 to 1998.

DATA EXTRACTION. Original articles, review papers, meta-analyses, and relevant book chapters were reviewed.

DATA SYNTHESIS. Recent advances in research on depression have confirmed that it is a common, recurrent, and disabling medical disorder. The latest epidemiological studies from the United States suggest that its lifetime prevalence is more than 17%, while a lower, but still substantial, proportion of Chinese people have the same disorder. The highly recurrent nature and conspicuous morbidity of depression call for the continuation of antidepressant treatment beyond the initial resolution of symptoms. For the first episode of depression, 6 to 9 months of adequate antidepressant treatment is indicated. For patients with recurrent depression, maintenance therapy for several years is needed. The increasingly widespread use of selective serotonin re-uptake inhibitors and other newer antidepressants has increased the direct drug cost, but the total health care expenditure may not be raised and may even be reduced.

CONCLUSIONS. Proper recognition and management of depression at both the clinical and health care policy levels are urgently needed.

Key words: Antidepressive agents; Depression/therapy; Depressive disorder; Health policy; Mental health services; Recurrence

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OBJECTIVE. To review the systemic chemotherapy regimens for pancreatic cancer.

DATA SOURCES. Medline and non-Medline literature search (1966-1999).

STUDY SELECTION. The following key words were used: pancreatic carcinoma; chemotherapy; antineoplastic agent; fluorouracil; gemcitabine.

DATA EXTRACTION. Reports of phase II studies, randomised controlled studies, and preclinical studies were reviewed.

DATA SYNTHESIS. Less than 20% of patients are suitable candidates for surgery; for the remainder, palliative chemotherapy is of only marginal benefit. Combining fluorouracil with folinic acid or interferon has not led to any significant improvement in tumour response or the patient survival rate. The early encouraging results with combination chemotherapy have not been confirmed in subsequent controlled studies. New approaches include immunotherapy and novel cytotoxic drugs. In vitro studies of monoclonal antibodies have shown promise but have failed to show clinical efficacy. Recently, gemcitabine has been shown to be more effective than fluorouracil in delivering pain relief and reducing disease-related symptoms.

CONCLUSIONS. Systemic chemotherapy is generally ineffective in increasing the survival time of patients with pancreatic cancer. Future clinical investigations concerning treatment should focus on gemcitabine-based combination chemotherapy or combined modality treatment with radiotherapy.

Key words: Antineoplastic agents/therapeutic use; Deoxycytidine/analogs & derivatives; Pancreatic neoplasms; Survival rate

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OBJECTIVE. To review the donor and recipient selection criteria, surgical techniques, perioperative and post-operative management, and complications of lung/heart-lung transplantation.

DATA SOURCES. Medline and Non-Medline search of the relevant English literature, local data, and personal experience.

STUDY SELECTION. Studies containing supporting evidence were selected.

DATA EXTRACTION. Data were extracted and analysed independently by the authors.

DATA SYNTHESIS. Lung/heart-lung transplantations are considered only for patients who have progressively disabling and end-stage disease. Numerous investigations of the recipient and rigorous matching between the donor and recipient are required. Factors such as maintaining the donor’s haemodynamic stability, graft preservation, effective perioperative immunosuppression, and careful postoperative monitoring are key to a successful transplantation. Follow-up should include the home-monitoring of body weight, temperature, and spirometry, as well as regular chest X-rays, pulmonarty function tests, and blood tests. So far, two double and two single lung transplantations, and one heart-lung transplantation have been performed in Hong Kong.

CONCLUSION. Lung transplantation is an invaluable treatment modality for patients with end-stage lung disease.

Key words: Graft survival; Heart-lung transplantation; Intraoperative care; Lung transplantation; Patient selection; Postoperative complications; Treatment outcome

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OBJECTIVE. To review the relationship between cerebral palsy and the birth process.

DATA SOURCES. Medline and non-Medline literature search and personal experience.

STUDY SELECTION. Articles that commented on the routinely used markers of foetal distress, such as abnormal foetal heart rate, meconium-stained liquor, and foetal acidosis.

DATA EXTRACTION. Data were extracted and reviewed independently by both authors.

DATA SYNTHESIS. The use of meconium alone as a predictor of cerebral palsy has a high false-positive rate of up to 99.6%. No specific foetal heart rate pattern that can accurately predict subsequent neurological impairment, and a low Apgar score is not by itself an indication of intrapartum asphyxia. The presence of encephalopathy in a neonate after birth and the association of multi-organ system dysfunction are important clues to the prior occurrence of foetal asphyxia.

CONCLUSION. Cerebral palsy can be caused by asphyxia associated with the birth process. To be able to attribute cerebral palsy to peripartum asphyxia, there should be a sequence of signs during labour, delivery, and the perinatal period. Honest and sympathetic discussion between the obstetrician, paediatrician, and parents is critical throughout the counselling process.

Key words: Apgar score; Asphyxia neonatorum; Brain damage, chronic; Cerebral palsy

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