Suicidal burn in Hong Kong

The aim of our study is to review our experience in the management of patients who sustained burns associated with suicidal attempts over a 10-year period. In particular, we look into the outcome and incidence of self-harm/suicide after discharge among the survivors. Thirty-one patients with median age 36 years, ranging from 10 to 74, were included. Twenty-three (74%) were males and eight (26%) were females. Nearly three quarters (74%) of our patients had a known history of psychiatric illness: 11 had known history of substance abuse; 3 of them had drug-induced psychosis; 6 had schizophrenia; 5 had depression; 4 had personality disorders; 1 had pathological gambling and another one had adjustment disorder. Relationship problems and work/financial difficulties were the commonest reason for the suicidal attempts. Self-inflicted flame burn was the most frequent (39%; 12 patients) method of burning. Six patients (19%) died. The remaining 25 patients healed and were discharged. Seventeen patients required ICU care. The median length of stay in ICU was 7 days. The overall median length of stay was 35 days. The median follow up time for those survived is 63 months. Only 4 of these patients had further suicidal/parasuicidal attempts. Despite the high mortality, once these patients survived the initial injury, they are unlikely to commit suicide again. Thus, we believe that aggressive resuscitation should therefore be advocated for all suicidal burn patients.     

Emergency contraception in Hong Kong

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Trauma system in Hong Kong

The presence of a regionalized trauma system has been shown to improve outcome in trauma. Trauma care has undergone significant changes in Hong Kong in recent years. In 2003, five public hospitals were designated as trauma centres. Since then, there has been a progressive improvement in trauma patient outcome in Hong Kong. Trauma centre designation by itself, however, does not constitute a trauma system. The latter is an integration of prehospital care, interhospital transfer, trauma centres, rehabilitation, prevention, education and research. Under the primary trauma diversion policy, trauma patients in Hong Kong are no longer sent to the nearest hospitals, but transferred directly to trauma centres where definitive care can be implemented earlier. The present article describes some of these changes and addresses issues pertinent to the future development of trauma service in Hong Kong.     

Women surgeons in Hong Kong

Objective: To survey Hong Kong women surgeon's current situation: their ability to balance career, personal and family life, and to look into some gender-specific issues. Methods: A 28-item questionnaire online survey was emailed to 142 female and 761 male surgeons with questions asking about four areas: demographic data, job satisfaction, work life balance and work opportunity. Results: Fifty-eight female and 114 male surgeons completed the questionnaire. The mean age of female surgeon respondents was significantly younger than male surgeon respondents (33 vs 43 years, P < 0.001). Both female and male surgeons worked long hours (70% female and 64% male worked >= 60 hours per week, P = 0.402); however, both felt satisfied or very satisfied with their current job situation (74% female and 76% male, P = 0.536) and were happy or very happy with other aspects of their lives (84% female and 82% male). More male respondents were married (83% male vs 35 % female, P < 0.001) and more married men had biological children at the time of the survey (83% male vs 62% female, P = 0.034). Both married males and females had family commitments affecting training, career advancement and overseas training. The majority of male and female surgeons did not experience discrimination during training or career advancement; however, more females felt discriminated against during selection and training processes (25% female vs 12% male, P = 0.001) and during career advancement (18% female vs 10% male, P = 0.013). Conclusion: Our survey results showed that both female and male surgeons are able to combine productive careers with satisfactory personal and family lives. However, both female and male surgeons faced many difficulties in their working lives; women may have more difficulties regarding family issues, as our survey showed that more women surgeons remained single and more married women surgeons had no children. Policies that facilitate a work life balance are important to attract and retain the best and talented physicians, regardless of sex. In view of the increasing number of women surgeons, frequent surveys are needed to determine whether women surgeons experience a working environment that ensures a level playing field.     

Primary glomerulonephritis in Hong Kong

The clinical presentation and natural history of 428 patients with biopsyproven primary glomerulonephritis were reviewed. Minimal change glomerulonephritis presented with the nephrotic syndrome and followed a benign course. Membranous glomerulonephritis took a slow downhill course. HBs antigenaemia was present in 30% of patients with membranous glomerulonephritis. Mesangiocapillary glomerulonephritis often presented with mixed nephritic-nephrotic syndrome and had a bad prognosis. No type II variant was detected. Mesangial IgA glomerulonephritis commonly presented with abnormal urinary sediments although 2.5% of adults presenting with the nephrotic syndrome without glomerular insufficiency had mesangial IgA disease. Mesangial IgA glomerulonephritis was an important cause of end-stage renal failure in Hong Kong.     

Intrahepatic cholangiocarcinoma in Hong Kong

We retrospectively analyzed the results of hepatic resection for patients with intrahepatic cholangiocarcinoma managed between December 1966 and January 1998 at the University of Hong Kong Medical Center, Queen Mary Hospital. There were 61 men and 40 women (mean age, 61.8 years). The clinical records of these patients were reviewed. A survival analysis was performed on the group of patients who had undergone hepatic resection. Twenty-one patients were treated conservatively. Non-resective (palliative) operations were performed in 32 patients. The median survivals after conservative management and palliative operation were 2.5 and 3.3 months, respectively. The remaining 48 patients underwent hepatic resection. The overall operative morbidity and mortality rates after hepatic resection were 41.7% and 16.7%, respectively. The median survival after hepatic resection was 16.4 months. The overall 1-, 3-, and 5-year survival rates after hepatic resection were 60.3%, 29.4% and 22.0%, respectively. Lymphatic permeation (P = 0.007) and hilar nodal metastases (P = 0.009) were found to be significantly associated with poor survival after hepatic resection. Hepatic resection is the treatment of choice for intrahepatic cholangiocarcinoma when it is resectable. Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998     

Suicidal burns in Hong Kong Chinese

There were 1063 acute burn patients admitted to the Burns Unit of Prince of Wales Hospital, Hong Kong, between March 1993 and February 1999. Eleven patients (1%) were burned due to attempted suicide. Seven were males and four were females, with a male:female ratio of 1.75:1. The median age was 38 years (range: 20-49 years) and the median extent of the burns was 55% total body surface area (range: 1-95%). Ten patients (90.9%) were self-incinerated and one patient attempted suicide by jumping into a hot bath. Seven patients (63.6%) suffered from severe smoke inhalation injury that required immediate intubation for ventilatory support. The average number of operations for the survivors was 3.7 (range: 0-8) and their median hospital stay was 42 days (range: 2-92 days). Four patients (36.4%) died from their injuries. Suicidal burns were more common among unemployed males with a history of psychiatric illness and substance abuse. Town gas (naphtha: a mixture of 49% hydrogen, 28.5% methane, 19.5% carbon dioxide and 3.0% carbon monoxide) was the most frequently used agent for self-immolation because it is probably the most convenient source of a fire accelerant in Hong Kong. Compared to the general burn population, this suicide group had a larger extent of burns, higher incidence of inhalation injury, required more operative treatment and longer hospital stay with a higher mortality rate.     

Father of neurosurgery in Hong Kong

Neurosurgery in Hong Kong had its origins as a division of General Surgery and became a subspecialty only 46 years ago with the arrival of Hsiang-Lai Wen. For well over a decade, Wen would be the only neurosurgeon in the colony. His contributions to neurosurgery included the ventriculosuperior sagittal sinus shunt and the application of acupuncture in anesthesia, pain ablation, and drug detoxification. A pilot with the China National Aviation Corporation during World War II, he played an active part in the Allied war effort. As a diplomate of the American Board of Neurological Surgery, Wen sought to improve the standard of neurosurgery in Hong Kong and southern China with the establishment of the Hong Kong Neurosurgical Society in 1981 and the Research Institute of Neurosciences in Guangzhou in 1988. Wen was acknowledged as Hong Kong's "father of neurosurgery," and his work paved the way for the development of modern neurosurgery in the region.     

Laparoscopic urology development in Hong Kong

Objectives: The application of laparoscopy in urology is increasing in Hong Kong. In the present paper the development of laparoscopic urology in Hong Kong is portrayed. The variety of laparoscopic urological operation that have been developed is defined, as well as interesting features associated with its development. Methods: A search on presentation/publications on laparoscopic urological topics by local authors were carried out on the electronic database supplemented by a manual hand search from January 1991 to November 2002. Results: A total of 68 presentations were identified covering a variety of urological topics including some of the most complex reconstructive procedures. The first report was in 1994. The three most presented topics were on paediatric urology, adrenalectomy and nephrectomy. Up to 45% of the reports were contributed by or collaborated with another specialty. Conclusions: Laparoscopic urology had a good foundation and able to keep pace with the world development. Cross specialty collaboration and interaction is an important feature in its development.      

香港地区骨科发展历程

Hodgson教授在1951年抵港，开始了骨科发展史的首页，骨痨的清创及前路脊柱融合术令香港世界知名。随后，骨科迅速发展，先后在13家大医院开设骨科部门；资深医生改为私人执业，建立了强大的私人市场。目前全港有约380名骨科专家或在职受训医生，超过2450张急诊骨科床及多张复康床。香港骨科医学会是一群紧密联系的医生及治疗师的组织。香港骨科医学院则负责国际认可的专业考试，举办训练，持续进修。如此能确保香港骨科的迅速发展在未来将会继续。     

Colorectal carcinoma in Hong Kong.

The clinical and pathological features of colorectal carcinoma occurring in 470 Chinese patients in Hong Kong are reported. There was a preponderance of advanced stages of the disease in spite of the presence of a large number of well-differentiated lesions. Polyposis coli was the predisposing cause in 1% of our patients, and none of them had ulcerative colitis. The clinical features of our patients on presentation were generally similar to those exhibited by Caucasians. An abdominal mass was palpable in about half of patients with colonic lesions, and virtually all rectal cancers could be felt by rectal examination. Almost a quarter of our patients presented with complications. In 2% of our patients the initial diagnosis was acute appendictis. A high resection rate was achieved, but many radical resections turned out to be only palliative. Our operative mortality was 8.3%, although for social reasons, the "in-hospital" mortality was 19.2%. The corrected five-year survival rate was 42.7% when curative resection was attempted.     

Acute pancreatitis in Hong Kong.

A series of 311 Chinese patients with acute pancreatitis admitted to Queen Mary Hospital, Hong Kong, over a 10-year period is reviewed. Biliary tract disease was associated with pancreatitis in 52.4 per cent of patients and 77.9 per cent of them had stones, mud or parasites in the common bile duct. Fever and jaundice were present in 55 per cent and 41.2 per cent of patients respectively. Because of the prevalence of recurrent pyogenic cholangitis among the indigenous population, emergency operation, with the aim of common duct decompression, was conducted in 54.3 per cent of patients during the acute episode, with a mortality rate of 14.8 per cent. Five of 142 patients (3.5 per cent) died whilst on conservative treatment and all 5 had haemorrhagic pancreatitis. The overall mortality rate was 9.6 per cent. Exploration of the common bile duct, which was carried out in 57.4 per cent of patients in the acute phase, was not associated with a higher mortality than when laparotomy alone was performed, and 19 patients had sphincteroplasty without any death. Subtotal pancreatectomy was performed in 2 patients with haemorrhagic pancreatitis with 1 death.