OBJECTIVE. To study the clinical outcomes of patients with invasive or non-invasive breast cancer after breast conservation treatment.

DESIGN. Retrospective study.

SETTING. Clinical oncology department of a public hospital, Hong Kong.

PATIENTS. Two hundred and three patients who received postlumpectomy radiotherapy in Pamela Youde Nethersole Eastern Hospital between January 1994 and June 1999.

INTERVENTIONS. Adjuvant radiotherapy with or without systemic adjuvant treatment.

MAIN OUTCOME MEASURES. Actuarial local control rate, progression-free survival rate, disease-specific survival rate, and cosmetic score.

RESULTS. The median follow-up of the whole group was 3.5 years. Two out of the 25 patients with carcinoma-in-situ only developed local recurrence; the 5-year actuarial local control rate was 91.3%. Among the 178 patients with invasive cancer, seven suffered local recurrence and 12 developed distant metastases without local failure. The 5-year actuarial local control, progression-free survival, and disease-specific survival rates for patients with invasive cancer were 95.5%, 85.8%, and 95.2%, respectively. The risk of local recurrence was significantly increased in younger patients (age <40 years) and those with positive final margins. Cosmetic scores were rated good to excellent by 95.6% of patients.

CONCLUSIONS. The early clinical outcomes of our patients are comparable to that in large overseas trials, which have demonstrated the equivalence of mastectomy and breast conservation treatment in terms of survival. In addition to mastectomy, with or without breast reconstruction, breast conservation treatment should be offered as an alternative in suitable Chinese women. To maximise local control, further excision or mastectomy is recommended for patients with positive final margins.

Key words: Breast neoplasms; Mastectomy; Radiotherapy

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OBJECTIVES. To investigate the total daily energy expenditure and physical activity pattern of a group of obese and non-obese Hong Kong children.

DESIGN. Cross-sectional study.

SETTINGS. University teaching hospital, Hong Kong.

PARTICIPANTS. Eighteen obese children aged 6 to 17 years and 18 age- and sex-matched non-obese children in the local Hong Kong community.

MAIN OUTCOME MEASURES. Total daily energy expenditure and physical activity pattern were estimated for 3 days using the heart rate monitoring. Body composition was measured by dual-energy X-ray absorptiometry.

RESULTS. In obese children, both total fat mass and fat-free mass were greater than in non-obese children. Total daily energy expenditure and its sleep and sedentary components were higher in absolute terms (by 42%, 43%, and 126%, respectively) for obese children. When normalised for body weight, the basal metabolic rate was no different between obese and non-obese children, while the total daily energy expenditure of the obese children was significantly lower (by 22%) than that of non-obese children. When normalised for fat-free mass, basal metabolic rate and the sedentary component of total daily energy expenditure were significantly higher in obese children. Obese children spent 12% less time asleep, but 51% more time in sedentary activity and 30% less time physically active—a ratio of active-to-sedentary waking time of 0.6 for obese children and 1.9 for non-obese children.

CONCLUSIONS. Although the basal metabolic rate may be influenced by body composition, the finding of a normal basal metabolic rate when normalised for body weight suggests that an intrinsic difference of metabolic rate is not a major contributory cause of obesity. The study pointed particularly to the potential benefit of increasing physical exercise time relative to sedentary activities to reduce the prevalence of childhood obesity. Obese and non-obese children had similar basal metabolic rate when adjusted by fat-free mass and fat mass. Obese children spent more time in sedentary activities.

Key words: Body composition; Child; Energy metabolism; Exercise; Obesity

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OBJECTIVES. To study the morbidity and mortality patterns of transfusion-dependent thalassaemia major patients in Hong Kong, and compare the outcomes of these patients according to different periods of birth.

DESIGN. Retrospective study.

SETTING. Paediatric departments of three regional hospitals, Hong Kong.

SUBJECTS AND METHODS. Medical records of thalassaemia major patients were reviewed. Data gathered included demographic and survival data, complications of iron overload, repeated transfusion, and bone marrow transplantation; the probability of survival of three cohorts was also estimated.

RESULTS. Two hundred and thirty-two patients were studied at a median age of 15.5 years (range, 1.4-30.3 years). There were 60 patients born before 1980 (cohort 1), 117 patients born between 1980 and 1989 (cohort 2), and 55 patients born after 1989 (cohort 3). The median age of starting desferrioxamine was 8 years, 4 years, and 3 years for cohorts 1, 2, and 3, respectively. Cardiomyopathy, diabetes mellitus, and hypothyroidism occurred in 15.1%, 8.6%, and 6.9% of patients with thalassaemia major, respectively. The above complications developed in 5% to 12% of cohort 2 patients. Delayed puberty was present in 38.4% and hormonal replacement for gonadal failure was required in 29.7% of evaluable patients. Short stature was common and the median height standard deviation score was -1.63. Twenty patients had died, and cardiomyopathy was the leading cause of death, followed by complications of bone marrow transplantation. The probability of survival beyond the age of 20 years was 87.6%.

CONCLUSION. Despite the use of iron chelation in the past two decades, severe complications of iron overload still occurred even in those who started chelation therapy early. Cardiomyopathy was the leading cause of death, while endocrinopathies and short stature were common complications especially in teenagers and adults.

Key words: Beta-thalassemia; Morbidity; Mortality

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OBJECTIVE. To review the results of day-case procedures performed for inguinal hernia or hernia-hydrocele complex in Chinese children.

DESIGN. Retrospective study.

SETTING. Day Surgery Centre of a district hospital, Hong Kong.

PATIENTS. Medical records of 255 consecutive paediatric patients admitted to the Day Surgery Centre for inguinal herniotomy between July 1993 and December 1997 were reviewed. A telephone survey was conducted to assess any long-term morbidity relating to the operation.

MAIN OUTCOME MEASURES. Patient demographics, success of day-case herniotomy, short-term and long-term morbidity.

RESULTS. There were 230 boys and 25 girls with a mean age of 8.8 years (range, 3 months to 18 years). Seven patients had bilateral herniotomy for bilateral hernia and 14 had circumcision for co-existing phimosis. Eight boys developed recurrence and three had a contralateral inguinal hernia. Postoperative ascent of the testis occurred in three patients, one of whom required orchidopexy. The unplanned admission rate was 1.6%, all for poor pain control. There were four herniotomy wound complications (two haematomas and two infections) and two circumcision wound haemorrhages.

CONCLUSIONS. Day-case inguinal herniotomy is safe and acceptable to Chinese children. Given these satisfactory results, paediatric patients with inguinal hernia can be safely managed with ambulatory surgery performed by suitably experienced surgeons.

Key words: Ambulatory surgical procedures; Hernia, inguinal

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OBJECTIVE. To evaluate the outcomes of severely burned patients treated at a regional burns unit and to develop a predictive model for survival and length of hospital stay for major burn patients in Hong Kong.

DESIGN. Retrospective study.

SETTING. Burns unit of a regional public hospital, Hong Kong.

PATIENTS. Two hundred and eighty-six severely burned patients treated from March 1993 to February 2000.

MAIN OUTCOME MEASURES. Details of demographics, mechanism of burn, extent of burn, incidence of inhalation injury, length of hospital stay, and mortality rate were recorded and entered into a database. Stepwise logistic regression and linear regression were applied to develop a predictive model for mortality and morbidity, respectively.

RESULTS. Of 286 major burn patients treated in this 7-year period, 25 patients died from their injuries, yielding a mortality rate of 8.7%. Stepwise logistic regression was applied to develop a predictive model for mortality. We found that inhalation injury, age, and total body surface area involvement were independent significant predictors of death. Accuracy of this predictive model reached 93%. Similarly, stepwise linear regression was used to develop a predictive model for length of hospital stay. Sex, inhalation injury, total body surface area of burn, and total body surface area2 of burn were significant predictors of length of hospital stay (R2=0.2). Only three patients’ duration of hospital stay was more than three standard deviations from the predicted length of hospital stay.

CONCLUSION. A predictive model for mortality and length of hospital stay has been developed for major burn patients in Hong Kong. This model may help clinicians to counsel patients and relatives at an early stage of care, to provide a basis from which new treatment plans can be compared, and to facilitate efficient allocation of valuable resources.

Key words: Burns; Length of stay; Mortality

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