1,540 research outputs found

    Sub-tenon Anaesthesia versus Intracameral Anaesthesia in Patients Undergoing Cataract Extraction: A Comparative Study of the Level of Pain, Visual Perception and Anxiety

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    Background: Phacoemulsification is a modern method of cataract extraction. Sub-tenon anaesthesia used to be the preferred anaesthetic technique for this procedure before intracameral anaesthesia gained its popularity in recent years. Nevertheless, many surgeons still believe that sub-tenon anaesthesia is better than topical anaesthesia. This study aimed to evaluate and compare the experiences of patients who were treated for cataract by phacoemulsification surgery using either sub-tenon or intracameral anaesthesia. Methods: Cross-sectional study conducted at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. Participants were asked to complete a questionnaire within 1-2 hours following surgery. The questionnaires were designed to gather information on the patient’s level of anxiety, visual perception and amount of pain experienced during cataract surgery. Results: A total of 62 patients were included in the study. Thirty-one patients received anaesthesia by sub-tenon injection, whereas another 31 patients received anaesthesia by intracameral injection. There were no significant differences in the level of pain experienced by the two groups of patients during instillation of anaesthesia and during surgery (p=0.205 and p=0.592, respectively). There were also no significant differences in terms of visual perception and anxiety levels during surgery between the two groups (p=0.178 and p=0.731, respectively). Conclusion: Intracameral anaesthesia obviates the need for an injection during cataract surgery and is as comfortable for patients as sub-tenon anaesthesia in terms of visual perception, level of pain, and anxiety

    Recent Developments In Surgery:Cryosurgery

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    Cryosurgery means freezing of living tissues for sufficient time to cause necrosis as a treatment of surgical diseases. Improvement in cryogenics have made it possible to obtain tissue temperatures as low as - 190°C. The mechanism of cellular death involves intracellular crystallization with uniform death of all cells within the frozen solid area - a sort of 'thermal shock’ due to physical changes in cell wall and intracellular biochemical changes. It is associated with thrombosis of microcirculation and hence the term ’bloodless knife’. Since intense cooling numbs the sensations, it obviates the need of anaesthesia totally. &nbsp

    Laparoscopic Retrieval Of Perforated Intrauterine Device

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    We present a case of successful laparoscopic retrieval of a perforated intrauterine device (Lippes loop). The Lippes loop was inserted after manual intrauterine adhesiolysis as a treatment of uterine synaechia presenting as secondary amenorrhoea of 20 months duration. The uterine perforation in this patient did not occur at the time of insertion but possibly during the attempt at transcervical removal of the missing IUD by manipulation with the retrieval hook. Double puncture laparoscopic technique under ketamine general anaesthesia was performed to remove the IUDwithout complication and patientwenthome the same day. Keywords: Laparoscopy, Missing Intrauterine Device (IUD), Lippes Loop, Uterine Perforation Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 394-39

    Haemodynamics during Percutaneous Nephrolithotomy in Spinal Anaesthesia with Two Doses of Hyperbaric Bupivacaine (0.75%)

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    To compare variation in haemodynamics during percutaneous nephrolithotomy in spinal anaesthesia with two doses of hyperbaric bupivacaine (0.75%). Methods: In this randomized comparative study 60 patients, undergoing percutaneous nephrolithotomy, were included. It was done to compare the variation in haemodynamic parameters after spinal anaesthesia using two different doses of local anaesthetic before and after keeping patients in prone position. Patients were divided into two groups: Group A(n=30) (22.5 mg hyperbaric Bupivacaine 0.75%) and Group B (n=30)(30 mg hyperbaric Bupivacaine 0.75%). Spinal block was performed in sitting position. Hemodynamic measurements were carried out at different time points while patients were in supine and prone position.Results: Decrease in heart rate was significant in Group B than in Group A after 10 minutes of spinal block while in supine position (p<0.001) and the drop in heart rate was significant statistically in Group B when patients were turned to prone position (p<0.001).Systolic and diastolic blood pressures decreased in Group B at 5 and 10 minutes in supine position which further decreased following prone positioning and the decrease was highly significant statistically(p=<0.001).Conclusion: 22.5 mg of injection hyperbaric Bupivacaine is haemodynamically safer as compared to 30 mg of the same drug during spinal anaesthesia in percutaneous nephrolithotomy

    Basal narcosis: with special reference to the use of tri-bromethanol (Avertin)

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    CONCLUSIONS: (1) Every patient about to undergo a surgical operation should have the benefit of basal narcosis in some shape or form. (2) At the present time Avertin is the most satisfactory and generally applicable basal narcotic available. (3) Avertin is invariably safe if a dosage of 1 gram per kilogram of bodyweight be not exceeded. (4) Morphia should not be used as a premedicament as it is unnecessary and adds to the risk. (5) Avertin is essentially a basal narcotic and not a general anaesthetic. (6) The supplementary anaesthetic is of great importance in obtaining successful after -results and a simple technique for its administration is detailed. Emphasis is laid on the use of CO₂ and oxygen after operation. (7) Avertin may be used with advantage in obstetrics but it is probably inferior to nembutal and chloral as a routine anaesthetic, especially where working single-handed. (8) Practically every surgical condition can be dealt with under avertín. The contra-indications to its use are according to the condition of the patient rather than to the procedure to be adopted, with the exception of operations on the anus and rectum, and tonsillectomy. (9) Tonsillectomy should not be performed under avertin unless a special technique is adopted. (10) Certain conditions of the patient are better treated by avertie than by other means. These are cases of thyroid disease, diabetes, heart cases and all patients of a particularly nervous temperaument. (11) There is a definite .field for the use of avertie in ophthalmology. (12) In the foregoing series of cases the results of Avertin narcosis were uniformly satisfactory (with the exception of the two tonsil cases mentioned above) and post -operative complications were conspicuous by their absence.Though the series is small it covers many different varieties of surgical procedure and the results obtained have been so successful as to warrant the continued use of the drug

    Management Of Bilateral Temporomandibular Joint Ankylosis In Children: Case Report

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    Long standing temporomandibular joint (TMJ) ankylosis may cause severe facial deformity and growth retardation as well as psychological problems when it occurs in children. Different kinds of opinion have been advanced as regards its management. This article discusses the aetiology and management of bilateral TMJ ankylosis in form of a case report in a patient with severe facial deformity, malocclusion and retarded growth following bilateral TMJ ankylosis secondary to trauma. The patient was successfully managed by placement of costochondral grafts and interpositionalarthroplasty with partial temporal myofascial flaps. Good mouth opening was achieved and subsequent follow-ups showed improved mandibular and general body growth as well as psychosocial performance. The aim of this paper is to discuss the management challenges posed by bilateral TMJ ankylosis

    Outcomes and costs analysis of Externalized PyeloUreteral versus internal Double-J ureteral stents after paediatric laparoscopic Anderson-Hynes pyeloplasty

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    BACKGROUND: The gold standard treatment for Uretero-Pelvic Junction Obstruction (UPJO) is laparoscopic dismembered pyeloplasty according to the Anderson-Hynes technique. The internal Double-J ureteral (DJ) and the Externalized PyeloUreteral (EPU) stents are usually the drainage of choice. Only a few articles have compared the clinical impact of the different drainage techniques on the perioperative morbidity and none presented a cost analysis of the incurred hospital stay. OBJECTIVE: To present the clinical outcome and financial analysis of a cohort of children who underwent a laparoscopic pyeloplasty comparing the use of the DJ versus EPU stent. STUDY DESIGN: Retrospective study of consecutives children who underwent laparoscopic Anderson-Hynes pyeloplasty in a single tertiary paediatric referral centre from January 2017 to March 2020. Patients were grouped according to the type of stent used: DJ stent vs EPU stent. RESULTS: Fifty-three laparoscopic pyeloplasties were performed on 51 patients: 27 (50.9%) had an EPU stent and 26 (49.1%) a DJ stent. There was no statistically significant difference between the two patient groups with regards to surgical time, hospital stay, stent-related complications or the need for re-do surgery. All the EPU stents were removed with an outpatient admission 8.1 days ± 3.1 after surgery while the DJ stents were removed with a cystoscopy 61.6 days ± 30.2 after surgery (p value < 0.001). On a financial analysis (Figure), the hospital costs for stent removal were significantly lower for the EPU stent group (£ 686.7 ± 263.4 vs £ 1425 ± 299.5, p value < 0.01). DISCUSSION: Both drainage methods have some disadvantages. Possible complications associated with DJ stents include migration and artificial vesicoureteral reflux which may lead to higher incidence of Urinary Tract Infections. Possible disadvantages of the EPU stent insertion are related to the damage of the renal parenchyma and to the risk of developing skin site infections and urinary leaks. However, in our series the EPU stent has not been associated with a higher incidence of bleeding, leakage or discomfort. In addition to clinical considerations, there is a financial implication to be considered. With this regard, the EPU stent was associated with a significant reduction in the incurred hospital costs. CONCLUSIONS: The use of DJ and EPU stents is equivalent in regards of overall complications and success rates. DJ and EPU stents provided comparable success and complication rates, however the latter avoids the need of an additional general anaesthesia and reduces the overall incurred hospital costs

    Indications for forceps delivery

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    The Scope and Challenges of Rural Surgical Practice in Nigeria

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    Background: Rural surgical practice is the practice of Surgery under conditions of limited resources which brings surgical services to the doorsteps of the rural Populace, majority of whom are poor.Aims: The aim of this paper is to highlight rural surgical practice in Nigeria.Materials and Methods: A review of personal experiences in rural surgery and interaction with other practitioners in the field as well information gathered at Rural Surgery conferences in Nigeria and abroad.Results: Scope of surgery performed is commonly usually limited by infrastructure, manpower and funding. Procedures include fields as Obstetrics and Gynaecology, Urology, Orthopaedics, Ear Nose and throat, Anaesthesia as well as General Surgery. A high proportion is contributed by emergencies especially Caesarian Sections, removal of foreign bodies from the ear, nose and throat, initial management of simple fractures, Hip-pinning, appendectomies, relief of intestinal obstruction, suprapubiccystostomies, catheterization and management of ruptured ectopic tubal pregnancies. The procedures are carried out by General Duty doctors with only a few surgeons in established self-owned practices. Challenges include poor living conditions, poor accessibility, lack of infrastructure and equipment, lack of suitably trained assistants, inadequate schools for their children, lack of suitable jobs for spouses. In spite of difficulties Rural Surgery in Nigeria has come to stay and is growing especially with formation of Rural Surgical Practitioners in Nigeria.Conclusion: Rural surgical practice is feasible in Nigeria and should be encouraged by the Government as it forms an important arm of Healthcare delivery in Nigeria.Key Words: Rural, Surgery, Scope, Challenges, Limited resources, Povert
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