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.

A retrospective review was performed of all women who had undergone operation for a tubal pregnancy at the Prince of Wales Hospital, Hong Kong, from November 1992 to March 1994. One hundred and five patients were included-611 were managed by laparoscopy and 44 by laparotomy. There were no differences in age, parity, gestational age, frequency of previous ectopic pregnancy, or laparotomy between the two groups. Sixty per cent of patients in the laparotomy group had a diagnostic laparoscopy prior to the laparotomy. The laparoscopy group had a lower incidence of haemoperitoneum (45.9% vs 75.0%, P<0.05). There was no difference in the mean operating time. The laparoscopic approach was associated with a significant reduction in: intra-operative blood loss (46.7 76.8 mL vs 213.4 149.3 mL. P<0.001), post-operative analgesia requirement (odds ratio 0.08, 95% CI, 0.02-0.32), post-operative morbidity (odds ratio 0.27, 95% CI, 0.12-0.58), length of hospital stay (2.9 2.2 days vs 5.1 1.2days, P<0.001) and recuperation period (11.0 9.3days vs 21.7 8.5 days, P<0.001). Operative laparoscopy has the advantage of combining diagnostic and therapeutic procedures in a single operation, and is a better approach than laparotomy in the management of tubal pregnancy.

Adult inpatients with injuries to the hand admitted to the Department of Orthopaedics and Traumatology of the Prince of Wales Hospital, Hong Kong, from June 1992 to May 1993 were surveyed (n=533). The causes of injury, mechanisms involved, and the nature of injuries were recorded. The injuries were further graded according to four different scales. It was found that 65% of the injuries were sustained at work, 15% in domestic environments, 7.6% during sports or recreational activities, and 6.5% in traffic accidents. Injuries caused by heavy machinery amounted to 26.7% and the electric saw was the second most common cause of injury accounting for 9.4% of injuries. Crush injuries occurred in 37.8%. The incidence of hand injury is estimated to be 600 per 100,000 population annually. The pattern of hand injuries bears some similarities and differences to published series. A comparison with data obtained in Hong Kong in the 1970s shows that major changes have occurred. We need continual surveillance of hand injury patterns.