One solution to the arsenic problem: a return to surface (improved dug) wells.

Arsenic contamination in drinking-water in Bangladesh is a major catastrophe, the consequences of which exceed most other man-made disasters. The national policy encourages the use of surface water as much as possible without encountering the problems of sanitation that led to the use of groundwater in the first place. This paper describes the success of the Dhaka Community Hospital (DCH) team and the procedure in implementing sanitary, arsenic-free, dugwells. The capital cost for running water is US$ 5-6 per person. Sixty-six sanitary dugwells were installed in phases between 2000 and 2004 in Pabna district of Bangladesh where there was a great need of safe water because, in some villages, 90% of tubewells were highly contaminated with arsenic. In total, 1,549 families now have access to safe arsenic-free dugwell water. Some of them have a water-pipe up to their kitchen. All of these were implemented with active participation of community members. They also pay for water-use and are themselves responsible for the maintenance and water quality. The DCH helped the community with installation and maintenance protocol and also with monitoring water quality. The bacteria levels are low but not always zero, and studies are in progress to reduce bacteria by chlorination.

Free conjunctival grafts in the repair of leaking filtering blebs

PURPOSE: To evaluate the effectiveness of free conjunctival grafting for leaking conjunctival blebs following trabeculectomy. METHODS: Retrospective study of seven patients with leaking conjunctival blebs that were repaired by free conjunctival grafting. The effectiveness of this procedure in stopping the bleb leak, maintaining satisfactory intraocular pressure (IOP), maintaining satisfactory anterior chamber depth, and preserving vision was evaluated. RESULTS: Free conjunctival grafting appeared to have stopped the bleb leak in 6 patients (85.7 percent), maintained satisfactory IOP in 5 patients (71.4 percent), maintained satisfactory anterior chamber depth in all patients, and preserved pretreatment vision in 3 patients. CONCLUSIONS: Free conjunctival grafting appears to be an effective method to treat leaking blebs, without loss of IOP control.

O uso intraoperatório de mitomicina C em glaucomas refratários / Topical intraoperative mitomycin C in refractory glaucomas

Foram revistos os prontuários de 42 pacientes portadores de glaucoma refratário submetidos a trabeculectomia associada ao uso intra-operatório de mitomicina C (0.4 mg/ml) entre outubro de 1991 e maio de 1992 no Serviço de Glaucoma do Wills Eye Hospital (Philadelphia, EUA). Dos 42 olhos, 34 puderam ser seguidos por pelo menos 6 meses. Dentre estes 34, 29 (83,5 por cento) apresentaram controle pressórico adequado ao final de um período de seguimento médio de 7,2 +ou- 1,4 meses. As principais complicaçöes pós-operatórias, entre as quais, descolamento da coróide (16,6 por cento), câmara anterior rasa (9,5 por cento) e maculopatia por hipotonia (4,8 por cento) estäo relacionadas ao excesso de filtraçäo observado no pós-operatório. Este estudo sugere que a mitomicina C é um potente inibidor do processo de cicatrizaçäo, altamente eficaz em prevenir a falência da cirurgia filtrante em olhos com glaucomas refratários. A reduçäo da dosagem e do tempo de exposiçäo à mitomicina C podem resultar em um menor número de complicaçöes secundárias ao excesso de filtraçäo. Estudos prospectivos e randomizados estäo sendo realizados para investigar esta possibilidade