OBJECTIVE. To evaluate results from surgical release of trigger thumbs in children in a regional hospital cluster in Hong Kong.

DESIGN. Descriptive case series.

SETTING. A regional hospital cluster, Hong Kong.

PATIENTS. Data from 1993 to 2009 on 180 children with 209 trigger thumbs were collected. Analyses into gender, predominance of thumb, age of onset, associated abnormalities and family history, symptoms and signs, surgical outcomes, and postoperative complications were carried out retrospectively.

RESULTS. There were 92 girls and 88 boys having trigger thumbs (1.05:1). In all, 29 (16%) of the children presented with bilateral trigger thumbs, while the right thumb was singly involved in 81 (45%) and the left thumb in 70 (39%) of the children. The mean age of onset was 19 months; only 20% were diagnosed before the age of 1 year. Only nine (5%) of the children were associated with congenital diseases and none had a positive family history of trigger thumb. Flexion deformity was the major presenting feature, other than triggering or pain. A nodule and flexion deformity were very commonly observed during physical examination. More than 95% of the operated thumbs with transverse incision acquired a good range of movement with a scarcely apparent scar. A residual flexion deformity was evident in only 4%, mostly in children who underwent surgical release under the age of 1 year.

CONCLUSION. Surgical release is recommended for children with trigger thumbs aged more than 1 year, which attains satisfactory results with minimal complications.

Key words: Bone diseases; Child; Congenital abnormalities; Thumb; Trigger finger disorder

View this abstract indexed in MEDLINE:

OBJECTIVE. To assess the accuracy of the Association of Coloproctology of Great Britain and Ireland scoring system in predicting the 30-day mortality after surgery for colorectal cancer in Hong Kong elderly (aged 80 years or more) patients.

DESIGN. Early mortality outcome audit in a historical cohort.

SETTING. Queen Elizabeth Hospital, Hong Kong.

PATIENTS. All Chinese patients (aged 80 years or more) who underwent elective or emergency surgery for colorectal cancer in the Department of Surgery between January 2005 and December 2009.

MAIN OUTCOME MEASURES. Receiver operating characteristic curve analyses were used to estimate the predictive ability of the score.

RESULTS. In all, 180 patients with colorectal cancer were included in this review. The overall 30-day and hospital mortality rates were 29/180 (16%) and 31/180 (17%), respectively. The Association of Coloproctology of Great Britain and Ireland score was significantly higher among patients who died within 30 days (4.2 vs 3.1, P=0.0001), and was the only independent predictor for 30-day mortality by logistic regression (P=0.009; odds ratio=2.555; 95% confidence interval, 1.277-4.932). The mean score of this study population was 3.22 (median, 3.10), giving a predicted 30-day mortality rate of 16.0 to 17.4%, which corresponded with an observed 30-day mortality of 16.1% encountered in this study. The score had a significantly larger area under the curve for the 30-day mortality rates (odds ratio=0.811; 95% confidence interval, 0.722-0.849) as compared to the American Society of Anesthesiologists score (0.664; 0.589- 0.735) [P=0.0001].

CONCLUSION. The Association of Coloproctology of Great Britain and Ireland scoring system can accurately predict the 30-day mortality rate of elderly Hong Kong Chinese patients (aged 80 years or more) operated on for colorectal cancer.

Key words: Aged, 80 and over; Colectomy; Colorectal neoplasms; Survival rate

View this abstract indexed in MEDLINE:

OBJECTIVES. To examine the characteristics of chronic obstructive pulmonary disease patients of the Kwai-Tsing area, Hong Kong, and the chronic treatments they received.

DESIGN. Cross-sectional survey.

SETTING. Four clinic settings in Hong Kong: Respiratory Specialist Clinic, Princess Margaret Hospital (group 1); Medical Specialist Clinics, Princess Margaret Hospital (group 2); General Outpatient Clinics, Princess Margaret Hospital (group 3); South Kwai Chung Chest Clinic, Department of Health (group 4).

PATIENTS. Thirty physician-diagnosed chronic obstructive pulmonary disease patients in each of the above groups with post-bronchodilator 1-second forced expiratory volume/forced vital capacity ratios of less than 70% predicted values, who had been followed up at any of the participating clinics for at least 6 months.

RESULTS. There were 111 male and nine female patients. The median age was 72.5 years and 79% had at least one medical co-morbidity. The mean duration of their chronic obstructive pulmonary disease was 9.8 years, and their mean post-bronchodilator 1-second forced expiratory volumes were 45% (for males) and 58% (for females) of predicted values. There were significantly fewer stage I and more stage IV patients in group 1. Influenza vaccination coverage within the previous 1 year was 54% and did not differ significantly between groups. Chronic obstructive pulmonary disease education was given significantly more often to group 1 patients. Short-acting beta agonists were used to treat all patients but long-acting bronchodilators and pulmonary rehabilitation were used almost exclusively in group 1. Overall, long-acting bronchodilators and pulmonary rehabilitation were offered to 16% and 5%, respectively, of those for whom these were indicated (according to international guidelines).

CONCLUSION. In general there was insufficient education and under-treatment for chronic obstructive pulmonary disease patients. Management of such patients warrants improvements by way of increased accessibility to structured education programmes, pulmonary rehabilitation programmes, long-acting bronchodilator drugs, and respiratory specialist care.

Key words: Airway obstruction; Forced expiratory volume; Lung diseases, obstructive; Pulmonary disease, chronic obstructive; Vital capacity

View this abstract indexed in MEDLINE:

OBJECTIVES. For diagnosing neuropathic pain, a simple 6-item patient-completed identification pain questionnaire has been validated among Caucasians. We aimed to study the validity and reliability of this questionnaire among Hong Kong Chinese patients.

DESIGN. Questionnaire survey.

SETTING. Two pain clinics and two neurology clinics in Hong Kong.

PATIENTS. Patients with either neuropathic pain or nociceptive pain were recruited randomly from the four clinics. The patients completed the questionnaire themselves and the diagnosis of neuropathic pain and nociceptive pain was made by the pain specialists. We determined the optimal cutoff, positive and negative predictive values, sensitivity, specificity, the area under the receiver operating characteristic curve, and test-retest reliability of the translated version.

RESULTS. Among the 92 participants, 60 (65%) had neuropathic pain and 32 (35%) had nociceptive pain. At an optimal cutoff score of 3 or higher, the positive predictive value was 87% while the negative predictive value was 55%, and it correctly classified 71% of cases. The specificity and sensitivity were 81% and 65%, respectively. The area under the curve was 0.78 (P<0.001). Test-retest reliability in the 10 randomly selected patients showed a good intraclass correlation of 0.72.

CONCLUSION. The Chinese Identification Pain Questionnaire is a valid and reliable scale that may be used as an initial diagnostic tool for neuropathic pain among Hong Kong Chinese patients.

Key words: Neuralgia; Pain measurement; ROC curve; Reproducibility of results; Sensitivity and specificity

View this abstract indexed in MEDLINE:

OBJECTIVE. To retrospectively analyse the outcome of patients who underwent investigation by small bowel enema in a local centre.

DESIGN. Case series.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All patients referred for small bowel enema in a local hospital from 1 January 1999 to 31 December 2009 were identified; respective findings from imaging and clinical records were reviewed.

RESULTS. A total of 341 patients were referred for small bowel enema, of whom 289 successfully completed the examination. There were 211 patients whose small bowel enema findings were considered normal and 78 were regarded as abnormal. The sensitivity of this investigation was 73% and its specificity was 91%. The respective positive and negative predictive values were 66% and 93%.

CONCLUSIONS. The selection of patients by clinicians with specific indications for small bowel enema is essential for making effective use of small bowel enema as an investigative tool.

Key words: Enema; Intestinal obstruction; Intestine, small; Sensitivity and specificity

View this abstract indexed in MEDLINE: