A Comparative Study on the Close Reduction of Arytenoid Dislocation under Indirect and Direct Laryngoscope

To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation,indirect laryngoscope (IL) and direct laryngoscope (DL) were utilized for the closed reduction of the displaced arytenoid under local anesthesia.23 patients who underwent the reduction for dislocated arytenoid under IL or DL from January 1991 to June 2001 were reviewed.The data were collected on the duration of the laryngeal injury,times of receiving reduction,side-effects after the treatment and the period for voice to returen to normal.The relationship between the duration of the laryngeal lesion and the period of the voice rehabilitation was examined.13 patients received the reduction under IL and 10 patients under DL,Except the times of the reduction,which showed significant difference,no differences were found between IL group and DL group in the course and the period of voice rehabilitation,as well as sore throat after the manipulation.The patients‘ voice recovery was positively related to their course of disease in both IL and DL group.It is coucluded that the recovery of normal voice is obviously affected by the duration of arytenoid dislocation.The reduction under Il is as effective as under DL in the treatment of arytenoid dislocation.Reduction by DL is better suit the patients with long time course of disease.     

Urine as an alternative to urethral swabs for the diagnosis of Chlamydia trachomatis in infertile males

Swabbing the urethrae of men has been the traditional approach for collecting specimens for detection of Chlamydia trachomatis . Recently, however, urine testing using enzyme immunoassay has yielded promising results. A total of 105 patients attending the Andrology Clinic at Ga Rankuwa Hospital, Medunsa were included in the study. These patients were asymptomatic and had no urethral discharge. Three endo-urethral swabs and first-catch urine were collected fiom each patient. The urethral swabs were used for enzyme immunoassay (EIA) (IDEIA 111), tissue culture and direct immonufluorescent antibody (DFA) test (IMAGEN) to detect C. trachomatis . In addition about 15–30 ml of first-catch urine, or urine collected at least 2h after the previous micturition, was collected for each patient for EIA testing. Fifteen (14.3%) of 105 patients were positive on urethral swab EIA, in comparison with the DFA test in which 14 (13.3%) were positive. Eight (7.8%) were positive in tissue culture. Urine EIA was positive in 17 (16.2%) patients, of whom five (4.8%) were positive in urine EIA only. All EIA positive urines were confirmed by DFA. We recommend that first-catch urine or urine collected at least 2h after the previous micturition in infertile males may be considered a suitable alternative to urethral swab for chlamydial diagnosis because it is noninvasive and nontraumatic.     

Treatment time analysis for extensive amalgam restorations

The treatment times for the fabrication of Extensive Amalgam Restorations (EAR) as recorded in a longitudinal clinical trial at the Dental School in Nijmegen were analyzed. 269 EAR's with different retention methods were made on molars by three operators. A mean total treatment time of 60 min was found. The factor operator had a significant influence on all treatment phases resulting in a 26% difference in total treatment time between operators. Also significant influences were found in some treatment phases for the factor retention, side location of the tooth and extension of the restoration. The results of this study with regard to treatment times must be considered from the perspective of the quality of the care provided.     

睫状体缝合复位术的临床观察及护理

目的:探讨适合睫状体缝合复位术病人的护理方法。方法:对34例(34只眼)因外伤致睫状体分离和脱离导致低眼压,随后行睫状体缝合复位术的病人进行观察和护理。结果:32只眼术后1周至6个月眼压恢复正常,其中5只眼术后2～5个月内分别进行第二次手术或氩离子激光光凝而痊愈。视力改善者21例,无变化者13例。结论:睫状体缝合复位术是治疗外伤性睫状体分离和脱离的有效方法。术前行超声生物显微镜(UBM)检查、术后密切观察眼压变化并给予正确处理、做好心理护理和出院指导是确保手术成功的重要措施。     

MEASUREMENT OF SURGICAL COSTS: A CLINICAL ANALYSIS

Because of reduced health care funding it is becoming necessary for surgeons to take a greater interest in the costs of individual operations. This study reports costs directly measurable to the patient, and also the indirect costs of hospital overheads, an operating suite and teaching, which were 37, 10 and 15%, respectively (62%), of hospital budget. A scheme has been developed which could give surgeons a standard to report direct costs. Pre-admission, ward, operating room, recovery, intensive care and post-admission are defined as cost periods and the modalities of staff, equipment (capital, maintenance and replacement), imaging, laboratory and consumables apply to each. This strategy was applied to assess open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) as an example. The direct costs for OC were $3706 and LC $2868, a difference of $838; the indirect and direct costs were OC $6004 and LC $4646, a difference of $1358. Thus indirect cost magnified the difference between the operations. Bed stay, density of nursing and use of disposable instruments were the major influences on direct costs. The individual cost advantage of a shorter bed stay may be countervailed by an increased hospital activity. The main patient benefit of new operations may be improved quality of life and more rapid return to work with prevention of salary losses. A method has been developed to define costs of a particular surgical operation with the purpose of stimulating surgeons' interest in this topic and developing a common style of reporting. This method should help clinicians dealing with hospital finances and waiting lists. Indirect costs are a hidden substantial cost of surgery. Considerably more attention needs to be paid to indirect costs in controlling surgical budgets.     

The costs of atopy and asthma in children: Assessment of direct costs and their determinants in a birth cohort

The aim of this study was to estimate costs accrued by the health care of children with asthma in comparison to children with atopic eczema and seasonal rhinitis and to investigate cost determinants. From the multicenter cohort study (MAS-90), we selected children with an asthma, atopic eczema and/or seasonal rhinitis diagnosis during the first 8 years of life, and overall 8-year health care utilization was estimated retrospectively by reviewing medical records. Asthma treatment (n = 76) incurs an average cost of US$ 627 per year, 44% due to hospital stays. Atopic eczema treatment (n = 91) cost on average US$ 219 and seasonal rhinitis (n = 69) US$ 57 per year. In asthma and atopic eczema, costs increase significantly with disease severity. Allergy diagnostics use accounts for only 1% of total costs. Costs for asthma and atopic eczema treatment are highest in those years when topical steroids are used for the first time, but decrease with every further year of steroid use. A remarkable 25% of asthmatic children with severe symptoms were not treated according to national guidelines, so that most steroid treatment was initiated during the first hospital stay. In the case of asthma, total direct costs increased until the 3rd year of the disease, and then decreased with further years of diagnosis, while steroid use continued to increase. These results indicate a 'learning effect' in the treatment of asthma and atopic eczema for each patient as well as considerable cost-saving potential by preventing severe asthma. Moreover, the importance of considering cost-driving factors and using cohort or longitudinal designs in cost-of-illness approaches is emphasized.     

Food and health at work–a review. The costs and benefits of a policy approach

The workplace is an important setting for health promotion and provides an ideal opportunity for shaping healthy eating patterns in occupational groups for whom inequalities have been identified (DHSS, 1980). Workplace food/health policies provide an intermediate and pragmatic step towards achieving the dietary targets set out in the Government's white paper Health of the Nation and the most recent COMA report (DoH, 1991,1992). Food/health policies have been widely adopted in the NHS (Gibson & Kallevik, 1990) and preliminary research suggests that they are an effective means of intervention (Wallis & Poulter, 1988; Frost et al., 1991). Industry has been slower to link food and health promotion to a policy making process. Surveys imply that action on healthy eating in companies often originates in the occupational health department and is based on individualistic approaches with little energy being put into preventive activities which would originate in the canteen (Mclnerney & Cooper, 1989; Poulter, 1990). Policies provide a means of balancing the environmental and educational paradigms of health promotion. If food/health policies are to grow in the private sector then industry has to be convinced that the benefits Justify the costs. Some philanthropic employers are motivated by interests other than financial gain, but others are commercially led. There is little hard evidence to demonstrate that any type of employer-sponsored healthy eating initiative provides a favourable return for investment. It has been ‘guesstimates’ and extrapolation from other situations which have provided the justification for UK companies to allocate any resources towards addressing food/health issues. In April 1990 the National Grid Company adopted a comprehensive food/health policy. This paper draws on the experiences in developing and implementing the policy document to discuss the issues around evaluative activity in a commercial setting. Views are expressed on the feasibility of measurement and the value of the informaton collected. One aim of the future should be to research this under-examined area to establish a solid body of information. This would raise the level of debate from one which is currently based on anecdotal evidence to a sounder scientific footing and, therefore, ensure the future growth of such policies in the corporate sector.     

Point mutation in the band 4.2 gene associated with autosomal recessively inherited erythrocyte band 4.2 deficiency

Abstract: A patient who represented acute hemolytic crisis was studied. Analysis of the erythrocyte membrane proteins by SDS-PAGE revealed a deficiency of band 4.2. In the family, the sister of the patient who had been clinically normal was also shown to be deficient in band 4.2. Binding studies showed that the propositus' membranes were able to bind normal band 4.2 protein as much as control. It was suggested that the binding sites for the protein were prepared on the membrane. We analyzed the band 4.2 cDNA of the propositus and detected a mutation that changes a codon for alanine to one for threonine at residue 142. Band 4.2 exon III of genomic DNA which included the mutation site was amplified and sequenced directly in the family members, and it was revealed that only the homozygotes of the mutation allele manifested band 4.2 deficiency and the parents, who were heterozygotes, showed normal amounts of band 4.2. Recently, the same mutation was reported as Protein 4.2^NIPPON in another 4 cases (Bouhassira et al. Blood 1992: 79: 1846–1854). This study supports the hypothesis that this mutation is the pathogenetic cause of band 4.2 deficiency and not a polymorphism.