OBJECTIVES. To examine the presentation, workup, and surgical complications of substernal goitre.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Twenty-four mostly elderly patients (mean age, 60.1 years) who underwent thyroidectomy for substernal goitres between 2000 and 2003 (substernal goitres were defined as those having either a caudal mass transgressing the fourth thoracic vertebra or having more than 50% of their overall mass residing within the thorax).

MAIN OUTCOME MEASURES. Symptoms, histopathological diagnoses, morbidities, and complications.

RESULTS. Dyspnoea was the most common symptom (n=8, 33%). Three (12.5%) patients presented with acute airway obstruction; however, 13 (54.2%) were asymptomatic apart from the presence of cervical masses. Computed tomographic scans were performed on all but two patients. Malignancy was present in 12.6% of patients, or 16.8% if occult papillary carcinoma is included. Partial or full sternotomies were performed in two (8.3%) patients. Complications included recurrent laryngeal nerve injury (n=1, 2.7% of nerves at risk), transient hypoparathyroidism (n=2, 13.3% of patients at risk), haematoma (n=1, 2.7%), pneumonia (n=1, 2.7%), and wound infection (n=1, 2.7%). There was no operative mortality or permanent hypoparathyroidism. The complication rate was significantly lower in the asymptomatic patients (P=0.033 by Fisher's exact test); clinicopathological parameters were otherwise statistically comparable between the two groups.

CONCLUSIONS. There is rarely any mortality in thyroidectomy for substernal goitre, and the morbidity is also very low, especially in asymptomatic patients. In the absence of contra-indications, substernal goitre should be treated with early surgery rather than having it run the risk of acute airway distress or cancer.

Key words: Goiter, substernal; Hong Kong; Tomography, X-ray computed

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OBJECTIVES. To study children with cerebral palsy in Hong Kong, their neuroimpairment, activity limitation, and participation restriction in society. Parents' opinion on current medical and rehabilitation services was also sought.

DESIGN. Systematic survey using questionnaires.

SETTING. Four associations in Hong Kong: Child Assessment Service, Hong Kong Association for Parents of Children with Physical Disabilities, Association of Parents of the Severely Mentally Handicapped, and Hong Kong Physically Handicapped and Able-Bodied Association.

PARTICIPANTS. Parents of children with cerebral palsy.

MAIN OUTCOME MEASURES. Neuroimpairment, activity limitation, and participation restriction.

RESULTS. Information from 181 children with cerebral palsy was analysed. Among them, 56% were boys. The mean age was 7 years 6 months (standard deviation, 3 years 11 months). The most common diagnostic type was spastic cerebral palsy. Co-morbidities in children with cerebral palsy were common. Limitation in daily activities including mobility and self-care tasks was considerable and this posed great stress to parents when taking care of their children. Children's participation in both social and leisure activities was regarded as a low priority. A high percentage (70%) of parents reported difficulty in travelling. The reasons involved problems in transportation, building access (entry and exit), and attitudes of the general public. These environmental factors restricted the social participation of the children and their families. Over 75% of parents were satisfied with the current medical and rehabilitation services.

CONCLUSIONS. Children with cerebral palsy have multiple and complex needs. The findings of this study may serve as a reference for parents, service providers, and policy makers to work in partnership to achieve a more comprehensive health-care service for children with cerebral palsy and to facilitate better integration into the community.

Key words: Activities of daily living; Cerebral palsy; Developmental disabilities; Disability evaluation; Learning disorders

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OBJECTIVE. To describe the epidemiology, clinical characteristics, and management of Kawasaki disease in children in Hong Kong.

DESIGN. Retrospective survey of medical records from July 1994 to June 1997, and prospective data collection from July 1997 to June 2000.

SETTING. Hospitals with a paediatric unit in Hong Kong.

PATIENTS. Patients diagnosed with Kawasaki disease between July 1994 and June 2000 in public hospitals in Hong Kong.

MAIN OUTCOME MEASURES. Incidence of Kawasaki disease and coronary artery aneurysm rates.

RESULTS. A total of 696 cases of Kawasaki disease were reported. There were 435 (62.5%) boys and 261 (37.5%) girls giving a male to female ratio of 1.7:1. The age ranged from 1 month to 15 years 5 months with a median of 1.7 years. Infants (<1 year) constituted the largest group of patients (223,32.0%) and overall, 638 (91.7%) were younger than 5 years. Skin rash, conjunctivitis, and oral signs were among the principal clinical features present in over 80% of cases. Prominent cervical lymph nodes larger than 1.5 cm were less commonly found (24%). Coronary artery aneurysms or ectasia were present in 15.7% (109/696), 8.5% (59/696), and 5.0% (35/696) of patients at 2, 4, and 8 weeks, respectively. The incidence of Kawasaki disease per 100 000 children under 5 years was significantly higher in the prospective study period than in the retrospective period (39 vs 26, <0.001).

CONCLUSION. The incidence of Kawasaki disease is high in Hong Kong and is 39 per 100 000 children below 5 years of age. The coronary artery aneurysm prevalence is 5%. Intravenous gamma-globulin and high-dose aspirin is the mainstay of treatment.

Key words: Child; Coronary aneurysms; Incidence; Mucocutaneous lymph node syndrome

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OBJECTIVES. To determine the adequacy of care received from general practitioners by patients with sexually transmitted diseases or genitourinary symptoms.

DESIGN. Prospective study.

SETTING. Hong Kong.

PARTICIPANTS. Diagnoses and drug data obtained from logbooks submitted by doctors studying for the Diploma in Family Medicine and candidates for Fellowship examinations between 1999 and 2002.

MAIN OUTCOME MEASURES. Diagnosis or symptom of a sexually transmitted disease and prescribed treatment.

RESULTS. Sexually transmitted diseases and genitourinary symptoms accounted for 1.1% of the workload of these community doctors in Hong Kong. The majority of patients were young adult males. The overall standard of treatment was inadequate: both multi-pharmacy and inappropriate treatment was common; in up to 30% of cases, doctors ignored local or international guidelines.

CONCLUSION. Primary care doctors play an important role in the diagnosis and management of sexually transmitted diseases or genitourinary symptoms in Hong Kong. A high index of suspicion should be maintained and continuing education made available if doctors are to provide an equally high standard of care.

Key words: Primary health care; Quality of health care; Sexually transmitted diseases

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OBJECTIVE. To compare the anatomical and visual outcomes of primary idiopathic macular hole surgery using indocyanine green–assisted internal limiting membrane peeling versus no internal limiting membrane peeling.

DESIGN. Prospective randomised controlled clinical trial.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Fifty-one eyes of 49 Chinese patients with primary idiopathic macular hole were studied.

INTERVENTIONS. Patients were randomised to undergo pars plana vitrectomy with indocyanine green–assisted internal limiting membrane peeling (26 eyes) or surgery without internal limiting membrane peeling (25 eyes). Perfluorocarbon gas was used in all cases as internal tamponade.

MAIN OUTCOME MEASURES. Primary macular hole closure rate and best-corrected visual acuity.

RESULTS. The mean follow-up duration was 12 months (range, 6-23 months). Respectively to the indocyanine green–assisted internal limiting membrane peeling group and non–internal limiting membrane peeling group, the primary anatomical closure rate was 92.3% and 32.0% (P<0.001), whereas improvement in best-corrected visual acuity was 3.7 and 1.5 lines (P=0.002). More eyes in the first group (84.6%) had improvement of 2 or more lines of best-corrected visual acuity after surgery than in the second group (32.0%) [P<0.001]. Multivariate logistic regression showed indocyanine green–assisted internal limiting membrane peeling was the only significant predictor for primary closure of the macular hole (adjusted odds ratio=30.8).

CONCLUSION. Indocyanine green–assisted internal limiting membrane peeling in idiopathic macular hole surgery results in significantly better anatomical and visual outcomes compared with non–internal limiting membrane peeling in Chinese patients.

Key words: Basement membrane; Epiretinal membrane; Indocyanine green; Retinal perforations; Vitrectomy

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