Background: Post-haemorrhoidectomy wound pain is often the focus of concern for patients as well as their clinicians. Despite the recent enthusiasm brought about by stapled haemorrhoidectomy, conventional haemorrhoidectomy still remains the mainstay of surgical treatment for symptomatic third and fourth degree haemorrhoids in places where healthcare funding cannot afford these expensive devices. The present study aims at evaluating the effectiveness of pre-emptive analgesia and oral metronidazole in reducing wound pain and complications after open haemorrhoidectomy. Method: Patients with symptomatic third or fourth degree haemorrhoids undergoing open haemorrhoidectomy were randomized into four groups. Group 1 received pre-emptive analgesia (0.5% bupivacaine). Group 2 received oral metronidazole (400 mg three times daily for 1 week). Group 3 received both treatments while group 4 was the control group. Results: Number of patients recruited was 105. There was no significant difference among the four groups in terms of pain scores on the first three postoperative days, analgesic requirements, hospital stay and the time to return to normal daily activities. Patients who received oral metronidazole had significantly less pain at the time of the first bowel motion (P = 0.037). Conclusion: Oral metronidazole significantly reduces pain during the first bowel motion after open haemorrhoidectomy. Pre-emptive analgesia with 0.5% bupivacaine does not reduce postoperative pain.
To obtain the recent local epidemiological data and evaluate factors associated with outcomes of adult patients in non-traumatic non-shockable out-of-hospital-cardiac-arrest (OHCA) in Hong Kong. Methods: It was a cross-sectional study lasting for nine months (from July 2009 to March 2010) in two emergency departments (ED) which served a population of 1.1 million. All non-traumatic OHCA patients aged equal or greater than 18 years presented with non-shockable cardiac rhythms to ED without postmortem changes were included. The pre-hospital factors, managements and outcomes were recorded in a standardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the relationship between survival to admission (STA) and various prognostic factors. Results: A total of 348 patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients (17.5%) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival to hospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30-9.69), witnessed arrest (OR=8.00, 95% CI 3.38-18.96) and non-cardiac cause of arrest (OR=2.17, 95% CI 1.00-4.67). Conclusion: STA for adults presenting with non-traumatic non-shockable OHCA in our centre is 16.7%. Witnessed non-shockable OHCA patients presenting with initial PEA arrest rhythm and with a presumed non-cardiac in etiology are significantly associated with higher STA rate.
To report the epidemiology, outcomes and the predictors of survival in patients with out-of-hospital cardiac arrest (OHCA) with pre-hospital shockable cardiac rhythms in Hong Kong. Methods: It was a prospective study based on data from the cardiac arrest registry of emergency departments (ED) in two regional hospitals in Hong Kong from 1st August 2010 to 31st January 2012. All non-traumatic patients aged 18 years or above presented with OHCA with shockable pre-hospital cardiac rhythm and received pre-hospital defibrillation were included. The characteristics of patients, pre-hospital data, management and outcomes were recorded in a standardised form compatible with Utstein template at the time of patient consultation. Binominal logistic regression was applied to evaluate the relationship between survival to admission (STA) and patients' variables. Results: A total of 135 patients fulfilled the inclusion criteria. The mean age was 67.0 years old. The STA rate was 34.8% and the survival to discharge (STD) rate was 6.7%. Factors independently associated with better prognosis in terms of STA were presence of bystander cardiopulmonary resuscitation (CPR) (OR 5.76, 95% CI=1.08-30.5), restoration of spontaneous circulation (ROSC) before arrival to ED (OR 43.94, 95% CI= 4.19-460.43) and short time from calling emergency medical services (EMS) to first defibrillation (OR 0.82, 95% CI=0.70-0.96). Conclusion: STA rate for adults presenting with shockable OHCA in our study was 34.8%. Patients with shockable OHCA with bystander CPR, short call-to-shock time and achieved ROSC before arrival to ED are significantly associated with higher STA rate. (Hong Kong j.emerg.med. 2013;22:131-137) 目的:報告香港院前有可電擊除顫心律的心跳驟停(OHCA)患者的流行病學,結果和患者生存的預測 因子。方法:這是一項前瞻性研究,時間從 2010 年 8 月 1 日至 2012 年 1 月 31 日,數據的基礎來自香港兩 個區域醫院急診室(ED)的心臟驟停登記冊。所有年滿 18 歲或以上的非外傷 OHCA 患者,有可電擊心 律並獲院前除顫者都包括。患者的特性,院前的數據,治療和結果,以一個符合烏特斯坦模板的標準化形 式記錄。應用二項式 logistic 回歸,評估活著入院(STA)和病人的變量之間的關係。結果:共有 135 例 符合納入標準。平均年齡為 67.0 歲。 STA 率為 34.8% ,活著出院率(STD)為 6.7% 。與 STA 相關預後 較好的獨立因素,包括有旁觀者心肺復甦(CPR) (OR5.76 , 95 % CI=1.08-30.5),抵達 ED 前恢復自 主循環(ROSC) (OR43.94 , 95%CI=4.19-460.43)和從呼叫緊急醫療服務(EMS)到首次除顫的 時間短(OR0.82 , 95%CI=0.70-0.96)。結論:在我們的研究中,可電擊 OHCA 成年人的 STA 率為 34.8% 。 STA 率較高的顯著相關因素有:旁觀者 CPR ,呼叫到除顫的時間短,抵達 ED 前達到 ROSC 。
Background: Acute diarrhoea is a common presenting problem to the accident and emergency department. This study aimed to assess the efficacy of dioctahedral smectite (Smecta) in altering the duration and frequency of acute diarrhoea in the adult population in Hong Kong. Material and methods: This was a prospective, randomised controlled study carried out in the Accident and Emergency Department of Caritas Medical Centre from July 2005 to October 2005. One hundred and ninety eligible adult patients with acute diarrhoea lasting not more than 14 days were randomly assigned either (1) oral rehydration solution (ORS) one sachet three times daily and Smecta one sachet three times daily for two days; or (2) ORS one sachet three times daily for two days. The duration of diarrhoea, daily frequency of diarrhoea, presence of vomiting and fever following treatment were obtained by telephone interviews and mailed questionnaires. Results: For patients treated with or without Smecta, there was no statistically significant difference in the mean duration and daily frequency of diarrhoea in the first three days. Conclusion: The use of Smecta did not change the duration or frequency of acute diarrhoea in the adults in this study.
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