More than half of the known Helicobacter pylori strains are resistant to metronidazole, according to previous Hong Kong studies. The response rates to treatment regimens that comprise metronidazole as one of the antimicrobial agents have usually been disappointing in cases involving metronidazole-resistant strains. The objective of this open cohort evaluation was to assess the efficacy of an alternative regimen that combines omeprazole with amoxycillin and clarithromycin in Helicobacter pylori--positive ulcer and non-ulcer patients in Hong Kong. Furthermore, we aimed to investigate if 7 days were as good as 10 days of therapy. We studied 186 Helicobacter pylori--positive subjects; 149 subjects received 7 days of combination therapy and 37 subjects received 10 days. Our results showed that the overall Helicobacter pylori eradication efficiency was identical (94.6%) for both treatments. The incidences of adverse effects were also very similar (16.8% versus 16.2%) and both treatments were well tolerated. Thus, we propose that omeprazole in combination with amoxycillin and clarithromycin should be considered as one of the first-line therapies for patients with Helicobacter pylor infection in Hong Kong.

The Papanicolaou smear is a highly effective screening test for the detection of cervical neoplastic changes. The success of the test has resulted in unrealistic expectations of the accuracy of the test by both referring medical practitioners and the public. However, as with any pathological test, it has irreducible false negative and positive rates. This report is a comparison between interpretations based on cytological and histological tests and was undertaken to estimate the sensitivity of the Papanicolaou test as practised in Hong Kong. The overall absolute concordance rate for the study was 51.2%. The concordance rates within one diagnostic category were 63.9% and 74.6% for low- and high-grade squamous intraepithelial lesions respectively. The overall sensitivity of the test was 91.7% with a positive predictive value of 93.5%. Ten percent of the error rate was attributed to laboratory error; the remainder was attributed to sampling error and poor smear preparation. Forty-five percent of cases of atypical squamous cells of undetermined significance showed evidence of cervical intraepithelial neoplasia on subsequent biopsy. Follow-up biopsies of low-grade squamous intraepithelial lesions also showed as many lesions from cervical intraepithelial neoplasia grade I as from grades II and III. These findings suggest that colposcopies and biopsies should be performed as soon as possible rather than to repeat the smears in 3 to 6 months. The results of the study may provide guidelines for formulating follow-up recommendations.

Ageing of the Hong Kong population is associated with an increased prevalence of physical and mental disability. For persons with severe disability, infirmary care is needed. In the present study, the morbidity pattern of persons waiting for infirmary service in Hong Kong was studied. Two hundred and four consecutive Central Infirmary Waiting List persons were included in the study. Clinical assessment was based on history review and physical examination. The commonest diagnoses giving rise to severe disability in this population, 89.2% of whom were elderly (aged greater-than-or-equal65 years), in descending order of prevalence were stroke (40.2%), dementia (27.0%), proximal femoral fracture (7.4%), and parkinsonism (5.9%); 67.5% of subjects were dependent physically. For cognitive function, 87.3% had a subnormal Abbreviated Mental Test score of less-than-or-equal5. Approximately 80% had urinary incontinence and/or bowel incontinence. For the outcome of assessment, 93.6% needed infirmary care, while 6.4% did not. More adequate provision of infirmary beds, innovative medical, nursing, and social home-support programmes, and effective prevention and rehabilitation programmes for patients with these disabling diseases are urgently needed in Hong Kong.

Acute hepatitis patients admitted to a referral centre from January 1995 through December 1995 were studied to determine the seroprevalence of the hepatitis viruses and related risk factors. Of the 434 patients with acute viral hepatitis, the episodes due to hepatitis A, B, C, D, and non-A, non-B, non-C, (non-ABC) were 214 (49.3%), 163 (37.6%), 7 (1.6%), 0 (0%), and 50 (11.5%), respectively. Acute hepatitis A and non-ABC hepatitis commonly occur in late spring and early summer and are probably related to the intake of shellfish and travel to endemic areas. Approximately 60% of cases of symptomatic hepatitis B infection were acute exacerbations of chronic infection. Sexual exposure was the single most important risk factor for acute hepatitis B infection. The rarity of acute hepatitis C and D might be related to the low rate of intravenous drug use in our locality. Hepatitis E virus probably contributed significantly to the cases of non-ABC hepatitis. Further studies are needed to establish the importance of various causative agents of acute hepatitis in Hong Kong.

This prospective, randomised, double blind study examined the efficacy of intrathecal morphine for post-operative analgesia in Chinese patients undergoing surgery to repair fractured hips. There were a total of 40 American Society of Anesthesiologists physical status grade I to IV patients scheduled for surgery following a fractured neck of the femur. Patients were randomised to a control group in which they received subarachnoid plain 0.5% bupivacaine, 2.2 mL, and normal saline, 0.4 mL, giving a total volume of 2.6 mL, or to a study group in which they received plain 0.5% bupivacaine, 2.2 mL, and preservative-free morphine, 0.2 mg, diluted with normal saline to a total volume of 2.6 mL. Patients were monitored for up to 24 hours by staff blinded to group allocation. The level of pain was assessed by a visual analogue pain score and the time of first request for analgesia was noted. The results show the median pain-free period in the control group was nine hours (range, 2-24 hours), while it was 24 hours (range, 16-24 hours) in the morphine group, a significant difference (P<0.05). No major complications were reported. Intrathecal morphine is a useful technique for giving post-operative pain relief, especially in the elderly, in whom many other techniques cannot be safely used.