Views of glaucoma patients on provision of follow-up care; an assessment of patient preferences by conjoint analysis.

AIMS: To determine patients' preferences for provision of glaucoma follow-up services examining preferences for location, access and personnel for delivery of this care. METHODS: 100 patient patients attending the glaucoma outpatient clinic for follow-up review underwent an interview-based assessment during which they completed the visual function questionnaire 25 and ranking of scenario options for provision of follow-up care for their glaucoma. Percentage preferences for aspects of care offered in the conjoint analysis scenario packages and generation of utility values for each of the factor levels included in the scenario design were calculated. RESULTS: Travel time and training of health professional were the most important factors for patients (accounting for over 60%) of their preference. Utility scores were generated for each factor, with shorter travel time and examination by a doctor being the most important features to the patients. Patients who lived furthest from the hospital and had severe visual disability considered the number of visits to complete an episode to be an important feature. CONCLUSION: Patients ideally would like to travel a short distance and be seen by a doctor when being followed up for their glaucoma.

Pedicled omental transfer for ischaemic limbs--a 5-year experience.

Chronic occlusive arterial diseases form a single largest entity amongst the peripheral vascular diseases. Current operative methods available for improving circulation often elicit poor results and the patient has to undergo an amputation. The technique of pedicled omental transfer has given hope of saving such unsalvageable limbs. Although symptomatic and clinical improvement has been reported by this method of "biological by-pass revascularisation", there are no simple, objective and easily reproducible tests to assess improvement in circulation. In this study pulse oximetry and stress testing have been used to assess revascularisation. This study comprised 56 patients (78 limbs) suffering from chronic occlusive arterial disease, spanning a period of 5 years. Patients were investigated and subjected to pedicled omental transplantation (omentopexy). Symptomatological assessment showed improvement in intermittent claudication in about 85% of patients, relief from rest pain in 86% and healing of chronic ulcers in 73% of patients. Objective tests of stress testing and pulse oximetry also showed improvement in circulation. Relief from ischaemia was more in cases of Buerger's disease (TAO) than in cases of atherosclerosis obliterans (ASO).

Civilian vascular trauma: an experience of 54 cases.

Fifty-four patients with civilian vascular injuries of the extremities caused by blunt trauma in 41 patients and by penetrating trauma in 13 patients were evaluated. Twenty-nine patients (53.7%) had associated fractures/dislocations and 19 sustained concomitant venous injuries. Twenty-nine patients (53.7%) came with a lagging period of more than 12 hours. Vascular injuries were diagnosed both clinically and by Doppler examination. In patients with equivocal findings, arteriography was performed. Arterial repair was done in 19 patients and saphenous vein interposition grafting was done in 2 patients. Fifteen patients required fasciotomy. Amputation was done in 13 patients (24.07%). It is concluded that the time lag, incorrect and incomplete assessment, and the reluctance to perform fasciotomy early and completely are some of the factors responsible for poor results.

Sigmoido-rectal intussusception.

Sigmoido-rectal intussusception is the least common type of intussusception seen in infants and children and is therefore usually misdiagnosed as rectal prolapse. Delay in diagnosis and treatment is due to lack of its awareness amongst surgeons, incomplete assessment of the prolapsed bowel at the anal orifice, and absence of classical traid of intussusception i.e. palpable abdominal mass, colicky abdominal pain, and bleeding per rectum.

Serum lipid peroxide and other enzyme levels of patients suffering from thermal injury.

The levels of the lipid peroxidation product malondialdehyde (MDA) and the activity of transaminases and alkaline phosphatases were estimated in the sera of 25 thermally injured patients at various time intervals after injury. The level of MDA was increased during the early postburn period, whereas the activities of transaminases and alkaline phosphatase became elevated later after injury. It is concluded that an increased concentration of lipid peroxidation product (MDA) in the early postburn period may affect the spleen, liver and kidney, resulting in the release of enzymes into blood stream. Such damage may be checked by the antioxidants superoxide dismutase or allopurinol.

Prevalence of hypocalcaemia and hypophosphataemia in the elderly males in Haryana.

Concentrations of serum calcium and inorganic phosphate and serum alkaline phosphatase activity have been determined in 75 males over the age of 60 years and 40 young adult controls. Serum calcium and inorganic phosphate levels were significantly lower in the elderly group. Serum calcium-inorganic phosphate product was below 30 in 36% of the aged individuals. Serum alkaline phosphatase activity was elevated in one subject only. These results indicate the existence of mild vitamin D deficiency in the elderly males in this region.