Risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage: retrospective study

ABSTRACT

Hong Kong Med J 2002;8:163-6 | Number 3, June 2002
ORIGINAL ARTICLE
Risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage: retrospective study
CM Lam, SF Wong
Department of Obstetrics and Gynaecology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Hong Kong
 
 
OBJECTIVE. To identify risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage.
 
DESIGN. Retrospective study.
 
SETTING. Regional obstetric unit, Hong Kong.
 
SUBJECTS AND METHODS. Women delivered at Princess Margaret Hospital between 1 January 1990 and 31 December 1997. Possible risk factors for preterm delivery among women with placenta praevia and antepartum haemorrhage including onset, pattern, and severity of vaginal bleeding; presence of uterine contractions on admission; and type of placenta were assessed.
 
RESULTS. Three risk factors for preterm delivery were identified from univariate analysis. These included second trimester vaginal bleeding (odds ratio=4.19; 95% confidence interval, 1.29-13.66), the presence of uterine contractions on admission (odds ratio=4.00; 95% confidence interval, 1.57-10.19), and a haemoglobin decrease of more than 20 g/L (odds ratio=3.00; 95% confidence interval, 1.00-9.04). Using the logistic regression model, second trimester vaginal bleeding and the presence of uterine contractions were found to be independent risk factors for delivery before 36 weeks.
 
CONCLUSION. Preterm delivery is increased in women with placenta praevia and antepartum haemorrhage who have second trimester vaginal bleeding or the presence of uterine contractions. This high-risk group may benefit from close in-patient monitoring and more aggressive management.
 
Key words: Labor, premature; Placenta praevia; Uterine hemorrhage
 
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Group A streptococcal infection in patients presenting with a sore throat at an accident and emergency department: prospective observational study

ABSTRACT

Hong Kong Med J 2002;8:92-8 | Number 2, April 2002
ORIGINAL ARTICLE
Group A streptococcal infection in patients presenting with a sore throat at an accident and emergency department: prospective observational study
MCK Wong, CH Chung
Accident and Emergency Department, North District Hospital, Po Kin Road, Sheung Shui, Hong Kong
 
 
OBJECTIVES. To determine the prevalence of group A streptococcal infection and to evaluate the predictive value of clinical findings and rapid streptococcal antigen detection testing in patients presenting with a sore throat or suspected clinically to have acute pharyngitis.
 
DESIGN. Prospective observational study.
 
SETTING. Accident and emergency department of a public hospital, Hong Kong.
 
PATIENTS. All patients presenting with a sore throat as the chief complaint, or suspected clinically to have acute pharyngitis, from April to September 2000.
 
MAIN OUTCOME MEASURES. Demographic data, clinical features, microbiological throat culture results, and rapid streptococcal antigen detection (Accustrip) test results.
 
RESULTS. Of 1449 patients recruited during the 6-month study period, only 44 (3.0%) had positive throat cultures for group A beta-haemolytic streptococcus. The majority of group A beta-haemolytic streptococci were isolated from patients between the age of 3 and 60 years. Clinical findings other than an absence of cough were found to be unhelpful in predicting group A beta-haemolytic streptococcal throat infection. The sensitivity of the rapid group A streptococcal antigen detection test was 52.6% and the specificity was 98.2%.
 
CONCLUSIONS. The prevalence of group A beta-haemolytic streptococcus in patients presenting with a sore throat, or suspected clinically of having acute pharyngitis, was low. If empirical antibiotics were given to all such patients, 97% of them would be unnecessarily treated. Age and absence of cough were the only clinical findings helpful in predicting the presence of group A beta-haemolytic streptococcal throat infection. The rapid group A streptococcal antigen detection test can provide a quick guide to clinicians on the necessity of antibiotic therapy. However, a confirmatory throat culture backup is recommended for patients with a negative test result.
 
Key words: Antigens/bacterial; Pharyngitis; Streptococcal infections; Streptococcus pyogenes
 
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Patient absconding behaviour in a public general hospital: retrospective study

ABSTRACT

Hong Kong Med J 2002;8:87-91 | Number 2, April 2002
ORIGINAL ARTICLE
Patient absconding behaviour in a public general hospital: retrospective study
ST Cheng, CH Chung, YH Leung, KK Lai
North District Hospital, Po Kin Road, Sheung Shui, Hong Kong: Accident and Emergency Department
 
 
OBJECTIVE. To identify characteristics of patients who abscond from general hospital wards, and to determine patient outcomes.
 
DESIGN. Retrospective study.
 
SETTING. In-patient wards of a public general hospital, Hong Kong.
 
SUBJECTS AND METHODS. Incident reports of 116 absconding episodes over a 20-month period from 1 November 1998 to 30 June 2000 were reviewed. Clinical characteristics, time and reason for absconding, destination of patient, outcomes, and adverse events were recorded.
 
RESULTS. The majority of patients who absconded were middle-aged males admitted through the Accident and Emergency Department to the specialty of Medicine. Most incidences occurred within 24 hours of admission while in the emergency admission wards. Twelve percent of incidents were due to repeat episodes of absconding. The most common clinical diagnoses given to this patient group were drug overdose, intoxication, and soft tissue injury. Known drug addicts (29.3%) formed a substantial proportion of the patient group. Forty-seven patients returned to the ward within a few hours, while a further nine (7.8%) re-attended the Accident and Emergency Department of the hospital within 4 days. Several adverse outcomes were recorded: one patient died following a fall from height and two patients committed criminal offences.
 
CONCLUSION. Patient absconding incidents are an important issue in hospital risk management. They can delay the delivery of appropriate medical treatment and may also lead to other adverse patient outcomes, in addition to potential medicolegal consequences.
 
Key words: Hospitals, general; Inpatients; Patient dropouts; Risk management
 
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Review of children with severe trauma or thermal injury requiring intensive care in a Hong Kong hospital: retrospective study

ABSTRACT

Hong Kong Med J 2002;8:82-6 | Number 2, April 2002
ORIGINAL ARTICLE
Review of children with severe trauma or thermal injury requiring intensive care in a Hong Kong hospital: retrospective study
DKK Ng, SWW Cherk, WL Yu, MY Lau, JCS Ho, CKW Chau
Department of Paediatrics, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
 
 
OBJECTIVE. To study the injury pattern of children admitted for management of severe trauma or thermal injury.
 
DESIGN. Retrospective review.
 
SETTING. Paediatric intensive care unit of a regional hospital, Hong Kong.
 
PATIENTS. Twenty-eight children were admitted under this category from July 1996 to December 1999.
 
MAIN OUTCOME MEASURES. Mechanisms, severity, and circumstances of injury.
 
RESULTS. Road traffic accident was the most common cause of admission, followed by thermal injury, accidental fall, and non-accidental injury. However, non-accidental injury children were admitted in a significantly more severe condition, as measured by the paediatric risk of mortality score, than those admitted for the other three reasons. Non-accidental injury was also associated with significantly higher morbidity and mortality than the other causes of admission.
 
CONCLUSIONS. During the 42-month study period, trauma and thermal injury accounted for 7% of all admissions to the paediatric intensive care unit. Road traffic accident was the most common reason, while non-accidental injury accounted for the most serious injury. Detailed analysis of all these cases identified certain preventable risk factors.
 
Key words: Child; Intensive care units, pediatric; Wounds and injuries
 
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Epidemiological study of Chinese multiple sclerosis in Hong Kong: questionnaire survey

ABSTRACT

Hong Kong Med J 2002;8:77-80 | Number 2, April 2002
ORIGINAL ARTICLE
Epidemiological study of Chinese multiple sclerosis in Hong Kong: questionnaire survey
KK Lau, LKS Wong, LSW Li, YW Chan, HL Li, V Wong
Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Hong Kong
 
 
OBJECTIVE. To study the epidemiology of Chinese multiple sclerosis in Hong Kong.
 
DESIGN. Cross-sectional questionnaire survey.
 
SETTING. All neurologists and some paediatric neurologists who looked after multiple sclerosis patients in Hong Kong from January through June 1999.
 
PARTICIPANTS. All confirmed multiple sclerosis patients.
 
MAIN OUTCOME MEASURES. Demographic data, investigation results, Kurtzke’s Expanded Disability Status Scale during the last follow-up visit, number of relapses between 1997 and 1998, and treatments used/currently in use.
 
RESULTS. Fifty-three Chinese multiple sclerosis patients were identified. The prevalence was therefore estimated to be 0.77 per 100 000 head of population. This low prevalence was also noted in other multiple sclerosis studies from South-East Asia (range, 0.8-4 per 100 000 head of population). The female to male ratio among the Chinese multiple sclerosis sufferers was 9.6:1, a figure somewhat higher than that reported in the other studies from South-East Asia (range, 3.2-6.6:1). The Chinese multiple sclerosis patients in this study also had a high spinal cord involvement (66%) and a low presence of cerebrospinal fluid oligoclonal banding (40%). These findings were different from those in Caucasian multiple sclerosis patients.
 
CONCLUSION. Chinese multiple sclerosis in Hong Kong has a low prevalence, a high female to male ratio, and a low cerebrospinal fluid oligoclonal banding presence.
 
Key words: Epidemiology; Hong Kong; Multiple sclerosis
 
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Picture archiving and communication system: prospective study

ABSTRACT

Hong Kong Med J 2002;8:21-5 | Number 1, February 2002
ORIGINAL ARTICLE
Picture archiving and communication system: prospective study
Y Hama, S Kusano
Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
 
 
OBJECTIVES. To evaluate the use of a picture archiving and communication system and user satisfaction in order to further improve its quality.
 
DESIGN. Prospective study.
 
SETTING. Medical college hospital, Japan.
 
MATERIALS AND METHODS. An automated computerised method was used to collect the data from March 1999 to February 2000.
 
MAIN OUTCOME MEASURES. Each workstation automatically recorded data on the rank of the user, purpose of use, use of postprocessing tools, and user satisfaction.
 
RESULTS. The number of resident users in the radiology reading room increased and those outside the reading room decreased, but the number of staff users changed little. The purpose of use and the use of postprocessing functions in the reading room were not significantly different from those outside it (P=0.179 and P=0.269, respectively). The average numbers of images accessed to per workstation monthly in the reading room, the general practice ward, and the gastroenterology ward were 1081, 970 and 741, respectively. Only 12 images in the orthopaedic surgery out-patient clinic and 70 images in the orthopaedic surgery ward, however, were accessed per month. The percentages of satisfied users decreased both inside and outside the reading room. The degree of satisfaction of users in the reading room was significantly different from that outside it (P=0.004). The most common reason for dissatisfaction was the length of time necessary to retrieve images.
 
CONCLUSIONS. It is necessary to shorten response times of picture archiving and communication system workstations. Repeated data collection and evaluation, however, are also important.
 
Key words: Diagnostic imaging; Information storage and retrieval; Radiology; Radiology information system
 
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Subcutaneous steroid injection as treatment for chalazion: prospective case series

ABSTRACT

Hong Kong Med J 2002;8:18-20 | Number 1, February 2002
ORIGINAL ARTICLE
Subcutaneous steroid injection as treatment for chalazion: prospective case series
SY Ho, JSM Lai
Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
 
 
OBJECTIVE. To study the efficacy of subcutaneous steroid injection in the treatment of chalazion.
 
DESIGN. Prospective consecutive case series.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. Patients with chalazion presenting to the out-patient clinic of the Department of Ophthalmology at the Prince of Wales Hospital from January to June 1998.
 
MAIN OUTCOME MEASURES. Size of the chalazion after steroid injection treatment.
 
RESULTS. Forty-eight consecutive patients with chalazion were treated with injection of triamcinolone into the subcutaneous tissue around the lesion. In 43 (89.6%) patients, the lesion subsided completely. Twenty-six (54.2%) patients had lesions that subsided with one injection. The size and duration of the chalazion at presentation did not significantly affect the outcome of the treatment. Two patients developed depigmentation of the skin at the site of injection. No other major complications were encountered.
 
CONCLUSION. Subcutaneous injection of the steroid triamcinolone acetonide appears to be a simple and effective treatment for chalazion. Further comparative clinical trials are indicated.
 
Key words: Chalazion; Eyelid diseases; Injections, intralesional; Triamcinolone acetonide
 
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Paediatric hepatoblastoma and hepatocellular carcinoma: retrospective study

ABSTRACT

Hong Kong Med J 2002;8:13-7 | Number 1, February 2002
ORIGINAL ARTICLE
Paediatric hepatoblastoma and hepatocellular carcinoma: retrospective study
KL Chan, ST Fan, PKH Tam, AKS Chiang, GCF Chan, SY Ha
Centre for the Study of Liver Disease, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
OBJECTIVES. To compare and contrast clinical characteristics and outcomes of hepatoblastoma or hepatocellular carcinoma in paediatric patients.
 
DESIGN. Retrospective study.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS AND METHODS. Medical records of 22 paediatric patients with hepatoblastoma (n=11) or hepatocellular carcinoma (n=11) admitted to Queen Mary Hospital between 1989 and 2000 were reviewed. Data gathered included demographic data, results of liver function tests, hepatitis A, B, and C titres, and alpha-foetoprotein levels, and imaging studies including chest X-ray, ultrasound study, computed tomography scan, and magnetic resonance imaging/hepatic angiogram for tumour staging and resectability.
 
RESULTS. The mean age of patients with hepatoblastoma was 18 months (range, 5 months to 3 years), while that of patients with hepatocellular carcinoma was 10.2 years (range, 2 to 16 years). Females predominated in the hepatoblastoma group (female:male, 8:3) and males in the hepatocellular carcinoma group (male:female, 10:1). None of the patients with hepatoblastoma were hepatitis B surface antigen positive, in contrast to 64% of the hepatocellular carcinoma group. Only 45% of the hepatocellular carcinomas were resectable at presentation and this figure remained unchanged following chemotherapy. A total of 91% of hepatoblastomas were resectable, four at presentation, and a further six after chemotherapy. Tumour rupture was more common in patients with hepatoblastoma than in those with hepatocellular carcinoma (36% versus 9% of cases, respectively). Mortality rates were considerably higher among the hepatocellular carcinoma group than the hepatoblastoma group in this series.
 
CONCLUSION. Childhood hepatoblastoma and hepatocellular carcinoma differ with respect to age and tumour stage at presentation, hepatatis B surface antigen status, tendency to rupture, chemosensitivity, and prognosis.
 
Key words: Leg; Pulmonary embolism; Ultrasonography, Doppler, duplex; Venous thrombosis
 
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Diagnosing deep vein thrombosis in the lower extremity: correlation of clinical and duplex scan findings

ABSTRACT

Hong Kong Med J 2002;8:9-11 | Number 1, February 2002
ORIGINAL ARTICLE
Diagnosing deep vein thrombosis in the lower extremity: correlation of clinical and duplex scan findings
YM Lee, ACW Ting, SWK Cheng
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
OBJECTIVE. To identify factors that predict a positive duplex scan examination result in patients with suspected deep vein thrombosis of the lower extremity.
 
DESIGN. Retrospective study.
 
SETTING. Vascular laboratory in a university teaching hospital.
 
SUBJECTS AND METHODS. The results of 345 lower extremity duplex venous scans performed between August 1994 and November 1998 were reviewed. All patients were in-patients referred from different specialties due to clinical suspicion of lower extremity deep vein thrombosis. Positive duplex scans were correlated with patients' demographic data (sex, age), medical history (history of malignancy, deep vein thrombosis, and pulmonary embolism) and clinical features (leg swelling, venous insufficiency, calf pain, and leg ulcer). Univariate analysis was performed using the Chi squared test.
 
RESULTS. A total of 345 scans were performed for 313 patients. The mean age was 55 years (range, 19-92 years). Sixty-three patients (49 male, 14 female) had a positive scan, giving a yield of 18.3%. Four factors had a significant association with a positive scan: male sex (P=0.0102), history of malignancy (P=0.0040), history of deep vein thrombosis (P=0.0001), and history of pulmonary embolism (P=0.0265).
 
CONCLUSIONS. Common presenting clinical features do not predict the result of ultrasonographic investigation for deep vein thrombosis. The chance of having a positive scan is significantly higher in male patients and those with a history of malignancy, deep vein thrombosis, or pulmonary embolism.
 
Key words: Leg; Pulmonary embolism; Ultrasonography, Doppler, duplex; Venous thrombosis
 
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Diabetic foot ulcers in the Hong Kong Chinese population: retrospective study

ABSTRACT

Hong Kong Med J 2001;7:350-5 | Number 4, December 2001
ORIGINAL ARTICLE
Diabetic foot ulcers in the Hong Kong Chinese population: retrospective study
HB Leung, YC Ho, J Carnett, PKW Lam, WC Wong
Department of Orthopaedic and Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
 
 
OBJECTIVE. To assess the predictive power of various parameters on the final outcome of ulcerated diabetic feet among the Hong Kong Chinese population.
 
DESIGN. Retrospective cohort study.
 
SETTING. Regional public hospital, Hong Kong. Patients: Medical records of 340 diabetic patients with foot ulcers (535) who were referred to the Diabetic Foot Clinic between July 1995 and June 2000 were reviewed.
 
MAIN OUTCOME MEASURES. Demographic and clinical data, including assessment of the foot and blood parameters.
 
RESULTS. Increasing age, wound depth, the presence of ischaemia, a low albumin level, and the lack of simultaneous ulceration were determined by stepwise logistic regression analysis to be the most significant independent predictors of an unfavourable outcome.
 
CONCLUSIONS. Major amputation is more likely to occur in elderly patients, with progressive wound depth, and in the presence of ischaemia. A low albumin level was also noted to be an independent predictor of major amputation in the population studied.
 
Key words: Amputation; Diabetes mellitus; Diabetic foot; Hong Kong; Prognosis
 
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