Cervical plexus block for thyroidectomy

Objective: Thyroidectomy is traditionally performed under general  anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our  environment. The aims of this study were to assess the feasibility, safety, effectiveness and patients= acceptability of bilateral superficial cervical plexus block for thyroidectomy in our hospital.Design: This is a prospective study of all consenting adult patients who presented with goiter and had thyroidectomy done in a Nigerian Teaching Hospital, between May 1998 and September 1999.Setting: The study was carried out at the University of Ilorin Teaching Hospital, which is a tertiary health institution.Subjects: The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective thyroidectomy done within the study period. Outcome Measures/Results: The 17 patients represented 65% of all those who underwent thyroidectomy in our hospital within the study period. There were 15 females and 2 males, giving a female to male ratio of 7.5:1. The median age of the patients was 44 (range 20-80) years. Types of goiter included 13 simple multinodular or nodular goiters, 3 diffuse toxic goiters and 1 malignant goiter. Sixteen (16) patients had subtotal  thyroidectomy, while one had total thyroidectomy. Varying degrees of pressure symptoms during mobilization of the gland, and postural aches were some of the intra-operative problems encountered. These problems were described by the patients as tolerable. Fifteen (88%) of the patients found the anaesthesia satisfactory and would not mind recommending or having the same anaesthetic technique for similar procedure. Two (12%) of the patients expressed dissatisfaction with the anaesthesia and would not want it for similar procedure. In one of the two, the surgery was  completed under general anaesthesia with endotracheal intubation when the block was found to be ineffective. The second patient became  extremely apprehensive during surgery, although she denied experiencing any significant pain and refused conversion to general anaesthesia. Conclusion: Bilateral superficial cervical plexus block is a useful   anaesthetic option for thyroidectomy in temperamentally suited patients. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform. It was acceptable to our patients.Key words: Cervical Plexus, Superficial, block, and thyroidectomy

Tracheal Configuration as a Radiographic Predictor of Difficult Tracheal Intubation in Goiters

Background: Goiters producing tracheal deviation or tracheal narrowing (TN) or both may cause difficult tracheal intubation (DTI). This study is to determine whether pre-operative assessment of trachea on neck radiograph can serve to predict DTI in goiters Methods: Pre- thyroidectomy radiographs of 160 patients were retrospectively studied for tracheal narrowing and deviation. Patients’ clinical and surgical data including Anaesthesiologists’ documented intubation experiences were also evaluated. Tracheal narrowing and relative sizes of the goiter were assessed on frontal and lateral neck radiographs. . Goodman Kruskal Tau cross tabulation analysis with SPSS 11.0 for windows was used to correlate TN to Anaesthetists operative reports of ease or difficulty of intubation. Results: Coronal and sagittal tracheal diameters ranged between 3mm to 27mm. It was less than 7mm in one or both planes in 21 (13.2%) of patients and all had DTI, P = 0.019. The length of TN did not show significant statistical correlation to DTI, P = 0.791. The only two patients having coronal or sagittal tracheal diameter less than 5mm, had failed intubation and surgery was done using bilateral superficial cervical plexus block. Conclusions: Goiters producing luminal TN of less than 7mm have potential for DTI and failed intubation when less than 5mm. Key words: Goiter, Difficult intubation, plain radiograph, thyroidectomy, Trache

Polystyrene-co-maleic acid/CdS nanocomposites: Preparation and properties

Composites of CdS nanoparticles confined in a polystyrene-co-maleic acid (PS-co-MAc) matrix have been prepared and characterized. It was shown that the acid groups of the co-polymer could be successfully used to control the aggregation of the nanoparticles, because they act as coordinate sites for Cd ions. UV-VIS measurements showed a blue shift of the absorption threshold, proving the presence of nanoparticles. An average size of the nanoparticles of about 4 nm is estimated from the change in band gap energy. Although the FTIR spectrum of the nanocomposite showed the presence of C-S bonds, a broad emission originating from surface recombination sites are noticed. DSC and TGA measurements revealed changes in thermal properties upon incorporation of nanoparticles. No thermal transition was observed in the nanocomposite, while the pure co-polymer exhibits a glass transition at 190 degrees C. In the presence of nanoparticles the onset of the thermal decomposition of the matrix is also shifted by 50 degrees C towards a higher temperature. (c) 2005 Elsevier Ltd. All rights reserved

Structure and properties of PbS-polyacrylamide nanocomposites

A synthetic procedure for the incorporation of PbS nanoparticles in a polyacrylamide (PAM) matrix is introduced. The method is based on the simultaneous polymerization of the monomer and thermal decomposition of the dithiooxamide-lead complex. X-ray diffraction analysis revealed that the PbS nanoparticles have a sphalerite crystal structure (galena). A transmission electron micrograph showed spherical particles, with an average diameter of about 3 nm, well dispersed in the polymer matrix. Although a sharp edge was not observed, the optical absorption of the PAM-PbS nanocomposite is shifted towards lower wavelengths compared to the bulk PbS. It was also found that, despite a low concentration of the inorganic phase, the nanoparticles significantly affect the thermal properties of the matrix

Single-route delaminated clay composites for efficient visible-light photo-mineralization of antibiotic-resistant bacteria and associated genes in water

Drinking water contaminated with antibiotic resistant bacteria could result in loss of antibiotic effectiveness in humans, increased healthcare cost and ultimately death. New delaminated photocatalytic composite (DPC) has been prepared. DPC doped with Cu/Zn kept multidrug resistant (MDR) E. coli and its sulphonamide resistance genes in contaminated water at log reduction >6 for 36 h in two disinfection steps under visible-light using fixed-bed mode (downward flow). In contrast, fluoroquinolone resistance genes persisted in treated water after the first disinfection step and were significantly reduced after the second disinfection step. Surface oxygen vacancies were mainly responsible for photoactivity of DPC. No bacteria re-growth was observed in treated water stored in light/dark for 7 days. A 95 % photo-mineralisation of MDR E. coli and its genes was achieved via the release of superoxide radical (in dark/light). Shelf-life study of DPC vs non-delaminated photocatalytic composite over 7 months suggests that the former remained far more efficient than the latter