Cost analysis of cataract surgery with intraocular lens implantation: a single blind randomised clinical trial comparing extracapsular cataract extraction and phacoemulsification

A randomised single blinded clinical trial to compare the cost of cataract surgery between extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM) between March and December 2000. A total of 60 patients were included in this study. The cost of a cataract surgery incurred by hospital, patients and households up to two months after discharge were included. The costs of training, loss of patients' income after discharge and intangible costs were excluded. Results showed that the average cost for one ECCE operation is RM1,664.46 (RM1,233.04-RM2,377.64) and for PEA is RM1,978.00 (RM1,557.87-RM3,334.50). During this short period of follow up, it can be concluded that ECCE is significantly cheaper than PEA by an average difference of RM 313.54 per patient (p < 0.001). Cost of equipment and low frequency of PEA technique done in HUKM were the two main reasons for the high unit cost of PEA as compared to ECCE.     

Study of the Impact of Deltamethrin Impregnated Mosquito Nets on Malaria Incidence at a Military Station

Deltamethrin impregnated mosquito nets have been successfully used all over the world to combat malaria. To study the efficacy of these mosquito nets in the service conditions of Armed Forces, a field trial of Deltamethrin impregnated mosquito nets was carried out at Military Stations ‘A’ (trial station) and B (control station) between July 96 to June 99. July 96-June 97 was the pretrial year during which base line data was collected for malaria incidence. Three rounds of Deltamethrin impregnation of the mosquito nets were done in the trial station for the actual trial duration (July 97-June 99) in lieu of residual spraying. Antimalaria measures including residual spray were continued as usual in the control station. The intervention led to a significant decline in slide positivity rate and malaria incidence in the trial station. Malaria cases declined by 87% in the trial station whereas the control station noticed an increase by 75% at the end of the trial.Key Words: Deltamethrin impregnated mosquito nets, Malaria control     

Distension technique to improve computed tomographic evaluation of oral cavity lesions

BACKGROUND: The apposing mucosa of the oral cavity makes the computed tomographic identification of a clinically obvious mass difficult. Contrast distension techniques have been used in radiology to evaluate for presence of a "hidden" mass. OBJECTIVE: To illustrate the utility of distending the oral cavity with air, water, or contrast to display otherwise obscure oral cavity lesions. PATIENTS AND METHODS: In 3 normal subjects and 5 patients with biopsy-proved oral cavity lesions, serial contiguous 3-mm axial and coronal computed tomographic scans were obtained before and after distension of the oral cavity using intraoral air or water. Air distension was achieved by having the subjects perform a modified Valsalva maneuver during the scan acquisitions. Fluid distension was obtained using approximately 40 mL of water. RESULTS: In each case, the contrast successfully distended the oral cavity, separating the mucosal surfaces. Gingivobuccal lesions that were obscured by apposition of the lips and cheeks to the gums and teeth, or by apposition of the tongue to the inner margins of the gums and teeth, were clearly demonstrated. Lesions involving or extending into the retromolar trigone were also well demonstrated using this distension technique. CONCLUSIONS: Computed tomographic display of the anatomy and pathology of the oral cavity can be improved simply by distending the oral cavity using air or water as a contrast medium. This technique successfully shows lesions that are obscured by the apposing surfaces of the vestibule and the oral cavity proper, improving computed tomographic diagnosis.     

Endoscopic removal of a dental prosthesis in the hepatic flexure of the colon

The diagnosis of impacted foreign body in the colon is usually delayed until the complications such as perforation or abscess formation occur. Here we describe a patient who presented with diffuse abdominal pain due to the impaction of a dental prosthesis in the hepatic flexure of the colon. The dental prosthesis, which was inadvertently swallowed, was successfully removed under colonoscopy. Unexplained abdominal pain should alert the clinician to the possibility of foreign body ingestion and further therapeutic colonoscopy may replace or lessen the need for surgical procedures to extract foreign bodies from the colon.     

The forced response test and myringoplasty results

Pre-operative assessment of the Eustachian tube function using a Passive Eustachian tube function test ’The Forced response test‘ and the results of tympanoplasty in safe Ch. SOM. Adhesive Otitis Media and Posterosuperior inpouching cases have been mentioned in this study     

Hemangiomas of the salivary glands

Five salivary gland hemangiomas in adults are reported. The feasibility of preoperative diagnosis on clinical and radiologic grounds is emphasized. Adult hemangiomas are of the cavernous type and can be differentiated from infantile capillary hemangiomas clinically as well as histologically. Cavernous hemangiomas in the adult should be treated by surgical excision.     

Common anxieties of patients undergoing oesophago-gastro-duodenoscopy, colonoscopy and endoscopic retrograde cholangio-pancreatography

AIMS & METHODS: To investigate the anxieties of patients undergoing oesophago-gastro-duodenoscopy (OGD), colonoscopy and endoscopic retrograde cholangio-pancreatography (ERCP) in relation to their demographic features, their knowledge and understanding of the procedure, its indication, and their doctors' explanation. A standard questionnaire was filled in consecutively for 280 OGD patients, 64 colonoscopy patients and 50 ERCP patients. RESULTS & CONCLUSIONS: Majority of the anxious patients were afraid of pain. There was no difference between the "fearless" and "fearful" groups in terms of source of referral and inpatient/outpatient status. However for all 3 procedures, anxious patients were significantly younger by a mean of 10 years. Females, better educated and OGD patients undergoing the procedure for the first time were more anxious but this difference was not seen with the more complex colonoscopy and ERCP. The more sophisticated ERCP seemed to instill greater anxiety amongst Malay patients. Doctors were significantly more likely to explain the indication for OGD and colonoscopy than how it would be done. This discrepancy was not seen with ERCP where the endoscopists tend to adopt a more personal approach. Most patients prefer to be sedated.     

Recurrent infiltrating lipoma of the head and neck. Case report and literature review

Lipomatous tumors with intramuscular infiltration are uncommon in the head and neck. Oral lipomas have been recorded in the literature; however, infiltration and recurrence have rarely been documented. We describe a case of an oral lipoma that did not have microscopic characteristics of malignancy, lipoblastomatosis, or atypia, but which showed intramuscular invasion and recurred twice after surgery. Although certain characteristics distinguish our case from congenital lipomatosis, the clinical picture is quite similar. Lipomas with intramuscular invasion uniformly tend to recur when they are not widely resected, whether in the trunk and extremities or in the head and neck. These lesions can rapidly enlarge and infiltrate local tissues, and they require wide resection with an attempt at preservation of important structures. Preoperatively, computed tomographic analysis allows a lipoma to be diagnosed by its low attenuation, and a grossly infiltrating tumor can be distinguished from the ordinary well-encapsulated lesion.