Day care percutaneous renal surgery--is this viable?

Pros and cons of Percutaneous Nephrolithotripsy (PCNL) versus Extracorporeal Shockwave Lithotripsy (ESWL) have often been highlighted when one discusses on the management of renal stones. An oft quoted point is that PCNL entails a prolonged hospital stay whereas ESWL sessions are day surgical in nature. However, PCNL has superior stone clearance rate as compared to ESWL especially for lower pole stones. In addition, PCNL is more suitable for large bulk stones and when ancillary procedures are required e.g. endopyelotomy. The first 50 cases of successful tubeless PCNL were reported by Bellman et al in 1997. The remarkable recovery of patients in their series encouraged them to employ this technique as their technique of choice for the majority of their cases. A similar technique was employed on endopyelotomy by Liang et al and they concluded that this was a safe, less morbid and effective technique. We report our first case of tubeless PCNL.

The role of DRE in the diagnosis of prostate carcinoma.

DRE has been used as a diagnostic and screening tool for prostate cancer for decades. However these are based on Western data and its local applicability has yet to be verified. We held a Prostate Health Awareness Week in August 1998 and a total of 2086 men were screened. All men aged 50 years old and above were included for the study. The subjects were evaluated on DRE findings, PSA levels and if indicated a TRUS-guided biopsy results. We concluded that DRE per se might have limited role in the screening of prostate cancer in Malaysia. Screening using DRE and PSA combined are still recognized as the most cost-effective means. Neither DRE nor PSA alone has high enough specificity for diagnosis of prostate cancer cases. Combining DRE and PSA will definitely increase the specificity significantly.

Prevalence of symptomatic BPE among Malaysian men aged 50 and above attending screening during prostate health awareness campaign.

OBJECTIVE: To study the prevalence of symptomatic BPE among Malaysian men age 50 and above attending prostate health awareness campaign and to identify differences in prevalence between different ethnic groups residing within metropolitan Kuala Lumpur. MATERIALS AND METHODS: Demographic data and the completed International Prostate Symptom Score (IPSS), maximal uroflow rate (Qmax) and prostate size of volunteers, aged 50 and above, who attended the prostate health awareness campaign were analyzed. Subjects with known prostate diseases or prostate surgery, bladder disorders and neurological disorders were excluded. RESULTS: 2086 volunteers attended the campaign. 575 men fulfilled the inclusion criteria and their demographic data, IPSS; peak flow rate and prostate volume were analysed. Overall, 18.9% and 39.6% of the men were severely and moderately symptomatic, respectively. The prevalence of moderate to severe lower urinary tract symptoms (LUTS) in Malays, Chinese and Indians were 70%, 59% and 50% respectively (p = 0.004). The commonest bothersome symptoms were nocturia (56%), frequency (50.4%) and sense of incomplete voiding (43.5%). The mean peak flow rate of the subjects was 15.4 ml/s. 20.9% and 55.2% of the subjects had peak flow less than 10 ml/sec and 15 ml/sec respectively. The mean prostate size was 25.1 cc. There is no significant difference in term of maximal flow rate and prostate size among Malays, Chinese and Indians in Malaysia. A good correlation was found between the total symptom score and the single disease-specific quality of life question (r = 0.69, p < 0.001). The correlation between IPSS and peak flow rate (r = -0.22, p < 0.001) and prostate volume (r = 0.11, p = 0.009) was weak. There was no correlation between IPSS and age (r = 0.06, p = 0.17). The prevalence of symptomatic benign prostate enlargement (BPE) was 39.3%. The prevalence increased 8% per decade from 41.7% for men aged 50 to 59 to 65.4% for men aged 70 or more. There is no significant difference in prevalence of symptomatic BPE among the three ethnic groups. The Prevalence of BPO was 15.8%. CONCLUSION: The correlation between symptom score, maximal flow rate and prostate size was poor and one cannot predict the value of one parameter by knowing one or more of the other parameters. There is a high prevalence of LUTS suggestive of benign prostatic obstruction in the apparently healthy Malaysian aged 50 and above attending the prostate health awareness campaign.

Use of sedation in dentistry.

Fear and avoidance of dental treatment are major deterrents to oral health. Sedation can be used to control both the patient's fear and anxiety so that proper dental care can be provided for these patients. The purpose of this article is to discuss the use of sedation in dentistry and to provide a recommendation on the requirements and medico-legal aspects of sedation for the practitioner interested in incorporating sedation into their practice.

Oral rehabilitation using dental implants and guided bone regeneration.

The advent of osseointegrated dental implants focused initially on functional rehabilitation. Interest today centres on aesthetics and the philosophical ideal of replicating nature. Implants can be placed beyond resorbed anatomic limitations where the final prosthesis should be, rather than within the pre-existing resorbed bone. In order to achieve this, the following must be considered: implant positioning, adequate bone support and the overlying soft tissue envelope. Common techniques to modify the surgical environment include different methods of bone grafting and regeneration, ridge expansion and sinus augmentation. With the advent of growth factors like bone-morphogenetic proteins, restoration of bony contours will become more predictable. Soft tissue management techniques include tissue expansion and contouring, gingiva grafts and advancement or rotational flaps. Though some of these procedures can be done concurrently with implant placement, a secondary surgical procedure is often required. Ideal implant positioning involve establishing correct orientation in all dimensions. Due consideration should also be given to occlusion and harmony of the final restoration with the adjacent dentition.

Glutathion S-transferase activity and DDT-susceptibility of Malaysian mosquitos.

Comparative DDT-susceptibility status and glutathion s-transferase (GST) activity of Malaysian Anopheles maculatus, Culex quinquefasciatus and Aedes aegypti was investigated to ascertain the role of this enzyme in DDT resistance. The standardised WHO dose-mortality bioassay tests were used to determine DDT susceptibility in these mosquitos, whilst GST microassay (Brogdon and Barber, 1990) was conducted to measure the activity of this enzyme in mosquito homogenate. It appeared that DDT susceptibility status of Malaysian mosquitos was not correlated with GST activity.