Original Article

FH Loh, RC Koa
Correspondence: Dr F H Loh, fh_loh@pacific.net.sg

ABSTRACT
Objective To compare the clinical and functional outcomes of patients undergoing laparoscopic versus open hysterectomy for benign gynaecological pathology.
Setting Gynaecological unit in a university hospital.
Methodology Forty consecutive cases of laparoscopic hysterectomy performed by the first author between June 1994 and December 1998 were reviewed. Their post-operative clinical and functional outcomes were compared with that of 40 patients with similar uterine size who had abdominal hysterectomy through a Pfannenstiel incision performed by consultant gynaecologists over the same time period.
Findings Thirty-seven (92.5%) of the 40 patients had successful completion of laparoscopic hysterectomy. Of the patients who had successful laparoscopic hysterectomy, the duration of surgery was longer (mean duration: 159 vs 98 minutes), but they had a lower risk of complications (8.1% vs 20%), reduced analgesic requirement (mean pethidine dose: 93 vs 199 mg), and stayed for a shorter time in hospital (mean post-operation stay: 3.1 vs 4.9 days) when compared with patients who had abdominal hysterectomy. They were also able to return to full domestic function and sexual activity earlier. More patients in the laparoscopic hysterectomy group were happy with the appearance with the surgical scar, and the overall satisfaction with the surgery was also more positive than those who had abdominal hysterectomy.
Conclusion Laparoscopic hysterectomy is associated with improved clinical and functional outcomes when compared with open hysterectomy.

Keywords: laparoscopic hysterectomy, abdominal hysterectomy
Singapore Med J 2002; 43(8): 403-407

PM Kong, CC Chan, P Lee, YT Wang
Correspondence: Dr Kong Po-Marn, po_marn_kong@ttsh.com.sg

ABSTRACT
Exhaled carbon monoxide is a useful marker of airway inflammation in untreated asthma. Whether exhaled CO is clinically useful in steroid treated patients in a hospital setting is uncertain. We therefore studied exhaled CO as a marker of asthma severity in clinical practice. Non-smoking "acute" asthmatics (hospitalised; n=33), "stable" asthmatics (n=35), and healthy controls (n=22) were recruited. Exhaled CO, peak expiratory flow (PEF) and FEV1 were measured daily (hospitalised cases) or once only (stable outpatients). Inpatients were managed without knowledge of the results. Exhaled CO levels in acute asthmatics (initial levels), stable asthmatics and controls were similar (median=2.0 ppm, h=5.05, p=0.08). In acute asthmatics, initial exhaled CO did not correlate with duration of hospitalisation, doses of intravenous corticosteroids, doses of nebulised salbutamol, PEF (% predicted) or FEV1 (% predicted). In stable asthmatics, exhaled CO did not correlate with corticosteroid dosage, PEF (% predicted) or FEV1 (% predicted). In the setting of acute hospitalised asthma patients, exhaled CO may not add any further to clinical management. This may in part be due to prior treatment with corticosteroids.

Keywords: carbon monoxide, asthma, clinical practice
Singapore Med J 2002; 43(8): 399-402

KF Quek, CS Loh, WY Low, AH Razack, CB Chua
Correspondence: A/Prof Dr Low Wah Yun, lowwy@ummc.edu.my

ABSTRACT
Objectives This study examined the effects of treatment of lower urinary tract symptoms (LUTS) on the health-related quality of life (physical/functional, mental, social and global aspect), pain and prostatic symptoms.
Patients and Methods The study consisted of 123 LUTS patients on medical treatment (alpha blockers) and 52 who underwent surgical treatment (TURP). The patients were assessed one week before and three months after medical and surgical treatment by using the Health-Related Quality of Life (HRQOL-20), the Visual Analogue Scale of Pain (VAS), the Present Pain Intensity (PPI) and the International Prostate Symptom Score (I-PSS) inventories and questionnaires.
Results Prior to treatment, the surgically treated patients were found to suffer more pain, severe prostatic symptoms, bothersomeness and deterioration in health-related quality of life than the medically treated patients. Postoperatively, the surgical group showed a significant reduction and improvement in all aspects of pain, prostatic symptoms, bothersomeness and overall health-related quality of life, as compared with the medication group. The mean ages of the surgical and medical treated groups were 69.56 years (SD=7.94 years) and 64.62 years (SD=7.94 years) respectively.
Conclusion The result showed that operative procedure had significantly improved the overall health-related quality of life of LUTS patients compared to those on medical treatment.

Keywords: lower urinary tract symptoms, Health-Related Quality of Life, Present Pain Intensity, Visual Analogue Scale, International Prostate Symptom Score
Singapore Med J 2002; 43(8): 391-398

KK Ng, HCP Lim, FC Ng, MK Li, D Consigliere, SJ Chia
Correspondence: Dr Ng Kok Kit, kokkitng@yahoo.com

ABSTRACT
Erectile dysfunction (ED) seriously impairs the quality of life. Patients with diabetes mellitus (DM) are prone to ED due to various factors, including vasculopathy, neuropathy and sex hormone abnormalities. This is a retrospective study involving 1,511 patients taking sildenafil. Patients with DM have significantly more comorbidities like hypertension and ischaemic heart disease. They are also more likely to be on medications which may affect erectile function, including various antihypertensive drugs. 77.9% of patients with DM reported success with sildenafil, as compared to 86.5% of patients without DM. A significant number of patients with DM require a higher dose of sildenafil as compared to those without DM.

Keywords: Sildenafil, Viagra, diabetes, erectile dysfunction, impotence
Singapore Med J 2002; 43(8): 387-390

JT Quek, SC Li
Correspondence: Dr Li Shu Chuen, phalisc@nus.edu.sg

ABSTRACT
Aim of Study This study aims to evaluate the effectiveness of existing AIDS health education interventions in Singapore amongst the adolescent population of Singapore. By identifying specific target groups that lack knowledge and information regarding HIV, it is hoped that suggestions may be provided towards increasing the effectiveness of these interventions.
Method A cross-sectional survey using a self-administered questionnaire of randomly selected adolescents between the ages of 13 and 19 years was performed to assess their knowledge of HIV and their opinions and awareness of HIV education in Singapore.
Results A total of 400 adolescents of various backgrounds were surveyed. In general, the subjects surveyed possessed reasonably good knowledge about HIV/AIDS, with an average score of 77.4% (SD = 15.8%). However, the results also showed areas of knowledge deficiency and misconception prevalent among those surveyed. Subgroup analysis showed that adolescents from low-income families, relatively less academically successful schools and those of younger ages knew significantly less than other adolescents. In terms of the awareness of HIV/AIDS education and information, the percentage of the subjects who could recognise any of the three commonly issued pamphlets or poster or who knew of any telephone numbers to call to receive information on HIV and AIDS was low. Less than 40% of those surveyed felt that enough awareness was being created within the public regarding AIDS.
Conclusion It can be concluded that most adolescents surveyed felt that they are inadequately educated regarding HIV and AIDS. The results would certain target groups using the appropriate media in future educational intervention.

Keywords: HIV, AIDS, adolescents, health education, Singapore
Singapore Med J 2002; 43(7): 359-364

V Gopalakrishnan, WY Sekhar, EH Soo, RA Vinsent, S Devi
Correspondence: A/Prof Shamala Devi, shamala@ummc.edu.my

ABSTRACT
The aim of this study was to compare two commercial kits, the Typhidot and the PanBio ELISA with the present Widal test. Demographic data for all serodiagnosed cases for the years 1991-1998 were collected. From this data, 144 were selected as samples for comparative evaluation of the commercial kits. Fifty sera were culture positive for Salmonella typhi, 50 were culture negative but clinically diagnosed as typhoid fever and Widal positive and 44 were serodiagnosed as enteric of which 21 were culture positive for other Salmonella species, 20 were serodiagnosed for other febrile illnesses and three sera culture positive for other species of enterobacteriaceae. The specificity, sensitivity and efficiency of the tests were calculated with the positive culture for S. typhi as the gold standard. Sensitivity, specificity and efficiency of test for Typhidot and Typhidot M kits were 98%, 76.6% and 84.0% and PanBio ELISA were 78%, 80% and 79.9%. The two commercial kits evaluated were found to be less time consuming and easier to perform than Widal. The Typhidot M seems to be a practical alternative in the field and in small hospitals with lesser facilities.

Keywords: Salmonella typhi, ELISA, immunodot blot, Widal
Singapore Med J 2002; 43(7): 354-358

Chutima Sirikulchayanonta, Kiatsuda Boonmee, Paradee Temcharoen, Suwat Srisorrachata
Correspondence: Chutima Sirikulchayanonta, ravsr@mahidol.ac.th

ABSTRACT
Background For decades, birth weight doubling time (BWDT) has been used as an indicator for the assessment of physical growth of infants. However, the relevant data in the literature were obtained mainly from western subjects and no similar studies have been carried out for South EastAsian or other Asian countries.
Objective To determine BWDT and related variables for Thai infants.
Methods A study was conducted from January to August 1999 at the well baby clinic of Bamrasnaradura Hospital. Apparently normal infants (335) with birth weight between 2,500 and 4,000 grams were recruited and followed up until they had doubled their birth weights. Data on infant birth weight, sex, mother education, occupation, income and feeding practices were collected.
Results The mean BWDT was 114 days which was slightly less than that given in previous reports. Male infants doubled their birth weights in less time (104 days) than females (123 days) and the difference was statistically significant (p < 0.001). Infants with lower birth weights doubled their birth weights earlier than those with higher birth weights (p < 0.001). Infants who were not given complementary food had shorter BWDT than those who were (p < 0.001), but we could not demonstrate any significant association between BWDT and type of food, mother's education or family income (p > 0.05). Factors that did affect BWDT were birth weight, sex, daily weight gain and use of complementary food. However, by multivariate analysis only birth weight and daily weight gain showed significant association with BWDT (p < 0.001).
Conclusion Both prenatal and postnatal factors may affect BWDT significantly.

Keywords: birth weight doubling time, Thai infant
Singapore Med J 2002; 43(7): 350-353

K Kumar, KK Tang, J Thomas, C Chumpon
Correspondence: Dr J Thomas, gnsjoh@sgh.com.sg

ABSTRACT
Aim To prospectively establish the incidence of deep vein thrombosis (DVT) after cranial procedures in patients with brain tumour in Singapore.
Methodology Over a period of one year from June 1995 to May 1996, 106 consecutive patients were recruited into the study. All patients undergoing surgery within the period of study were included. Each patient underwent a preoperative and postoperative (on postoperative Day 5 to Day 7) ultrasound examination of the lower limbs to establish the presence of DVT. Prophylaxis was limited to the peri-operative use of elastic stockings on hemiparetic limbs. There were 56 males and 50 females aged between 22 to 86 years (median 45 years). Ethnicity was Chinese, 92% Indian, 6% and other 2%. Ninety percent of the patients were ambulant pre- and post-operatively. No patient had a prior history of DVT. The distribution by pathologic diagnosis was brain metastases, 26% meningioma, 26% glioma, 19% pituitary adenoma, 14% acoustic neuroma, 6% and 9% miscellaneous tumours.
Results DVT was identified in 5/106 patients (4.7%), all of whom had either meningioma or glioma. All five cases occurred in supratentorial tumours. The tumour specific incidence was 7.1% for meningioma and 15% for glioma. 4/5 patients (80%) had pre-existing hemiparesis of the affected limb. No patient developed clinical pulmonary embolism.
Conclusion The overall incidence of postoperative DVT in our population, using minimal prophylaxis, was not significantly different from the best results of prospective studies on North American or European patients employing a full regime of prophylaxis. The high-risk groups were similar. Prophylaxis using subcutaneous heparin should be used cautiously in high-risk patients.

Keywords: prospective, incidence, prophylaxis
Singapore Med J 2002; 43(7): 345-349

E Quah, KC Tan, SLC Saw, JS Yong
Correspondence: A/Prof Euston Quah, ecsquahe@nus.edu.sg

ABSTRACT
This study provides estimates for the cost of smoking in Singapore in 1997.A first attempt for Singapore, the paper reports on two different methods used, namely, the human capital approach and the demographic approach. These two measures are similar in that they compare the economic cost of smoking in the actual situation with the hypothetical alternative where there had been no smoking. The direct cost of smoking includes the amount spent on hospital care for five main diseases related to smoking whilst the indirect cost includes the value of lost income. The mortality cost of smoking is derived from the aetiological fractions of these diseases. The results from the human capital approach show that the social cost of smoking in 1997 ranged from S$673 million to S$839 million. Assuming there has been no smoking since 1990, calculations from the demographic approach indicate that national output would have increased by S$614 million in 1998. Nonetheless, the results from both approaches show that most of the cost of smoking is incurred by males.

Keywords: smoking, social cost, mortality, demography, human capital
Singapore Med J 2002; 43(7): 340-344

CM Toh, SK Chew, CC Tan
Correspondence: Dr C M Toh, TOH_Cheong_Mui@moh.gov.sg

ABSTRACT
The epidemiological transition in Singapore from infectious to chronic, non-communicable diseases created different challenges for our public health system. The population-based strategy is adopted in primary prevention, through the promotion of a healthy lifestyle--smoking cessation, physical activity, eating right and managing stress. Complementing this are measures to detect chronic conditions early through screening and optimal treatment of the disease. While improvements were seen in the common risk factors of smoking and physical inactivity, prevalence of measurable risk factors like hypertension increased between 1992 and 1998. In 2000, the Ministry of Health initiated a series of national disease management plans for major disease conditions affecting Singaporeans. This approach uses a comprehensive and systematic approach to integrate the various components, with identification of responsible parties to ensure successful implementation of initiatives. Chronic diseases will remain prevalent as our society rapidly ages. Close monitoring of our initiatives in disease management will provide information on the long-term efficacy of such strategies.

Keywords: chronic diseases, health promotion, disease management, Singapore, public health
Singapore Med J 2002; 43(7): 333-339