Post operative management of penetrating keratoplasty

Penetrating keratoplasty is a very delicate and precise procedure in ophthalmology. The preoperative, operative, and post operative care are all vitally important for the successful visual rehabilitation of the patient. This paper will only deal with the immediate post operative care with special attention to suture placement, epithelial defect, wound leakage, intraocular pressure and infections. The diagnosis and management of primary graft failure will also be discussed.(AU)

Hypospadias repair in Jamaica: a two year review of the Bustamante Hospital for Children (BHC) experience

Hypospadias is the most common urological anomaly presenting at the BHC. The aim of this study was to assess the various anatomical anomalies and the results of the treatment. Over a two year period 50 boys presented with hypospadias. Meatal position, type of repair, duration of hospital stay and complications were recorded. There were 19 proximal and 31 distal hypospadias cases. Most patients presented during the first year of life but most operations were done between ages three and four years. Choice of surgery depended on the meatal position, and approximately equal numbers of patients received inpatient and outpatient care. Urethral fistula was the most common complication. Hypospadias repair requires meticulous surgical skills and careful postoperative care. Surgical techniques and results vary, but efforts must be made to reduce the incidence of postoperative fistula formation.(AU)

Caudal clonidine added to local anaesthetics for post-operative analgesia after anal surgery in adults - abstract

Duration of postopertive analgesia with caudal local anesthetics is increased by the addition of clonidine in children. To assess its efficacy in adults, we undertook a prospective, randomized, double-blind study in adults undergoing elective haemorrhoidectomy. Fifty-eight patients were randomly allocated to one of two groups. Caudal anaesthesia was performed with 0.5 percent isobarbic bupivacaine 35 mg (7 ml) in 2 percent lidocaine 140 mg (7 ml) and epinephrine 1/200000. Clonidine 75 mg was added in Group C, and saline (1ml) in group S. Duration of analgesia, defined as the time from the caudal injection to the first request for supplemental analgesics, was recorded as well as the time for the first micturition, haemodynamic changes and sedation. No differences were found between groups for demographic data, sedation and the time to first micturition. The mean (ñSEM) duration of analgesia was longer in group C(729 ñ 120 min) than in group S (276 ñ 131 min) (p=0.01). Hypotension and sedation was not marked in our study. Bradycardia was more frequent in the clonidine group but had no haemodynamic repercussions. We conclude that the duration of postoperative analgesia with caudal local anaesthetics was significantly increased by the addition of 75 mg of clonidine without major side effects. (AU)

Perioperative nursing - the Jamaican perspective

Under constraints of a restricted economy Jamaica strives to deliver health care at the standard of developed countries. Nurses in Jamaica assume various roles as they provide perioperative nursing care;they work as a team and act as patient advocates. Bonds of caring and love are often established between patients, families, and the nursing staff. The quality of nursing care often determines the client's perioperative outcome, and Jamaican nurses strive to meet the challenges inherent in achieving positive outcomes.(AU)

Abdominal hysterectomies at area hospital, Point Fortin, Trinidad, West Indies

A retrospective analysis of abdominal hysterectomies (3.08 percent of major operations) at the Area Hospital (52 beds), over a 5-year period revealed that the majority of the patients were multiparous in the reproductive age group. Menstrual irregularity is the most frequent indication, however, hysterectomy in these cases is not justified. High febrile morbidity (38 percent), blood transfusions and prolonged hospitalization were observed. Peer review, prophlactic antibodies and survey of the Island hospitals are recomended to make hysterectomy approprite, safe and to explain any racial variation.(AU)

Temporary tube gastrostomy: a clinical evaluation

A prospective analysis of 150 temporary tube gastrostomies performed over two 12 month periods is presented. All were carried out at the time of another abdominal surgical procedure and were intended for post-operative gastric decompression. The results were analysed with reference to the site and nature of the primary surgical procedure and to any tube-related complications. Gastrostomy was found to be safe, comfortable and effective method of achieving prolonged gastric decompression, and its use is recommended in selected patients (AU)

The peri-operative management of the patient scheduled for open heart surgery

The perioperative management of 286 patients scheduled for open heart surgery has been described. Mortality associated with anaesthesia (0.4 percent), patient monitoring and measurement (0.4 percent) and cardio-pulmonary bypass (1.4 percent) has been low. Morbidity produced by these techniques has been reversed with supportive therapy. It is concluded that the techniques of anaesthesia, patient monitoring and measurement, and cardiopulmonary by-pass as reported herein are acceptable and safe for the patient undergoing open heart surgery. Operative mortality in the majority (114 patients) age group of 10-20 years has been relatively low (18 percent). However, cardiac failure is dominant as a major cause of early (operative) and late mortality. It is the authors' opinion that technical problems of intracardiac repair and cardio-pulmonary bypass in patients below 5 years, and errors in deciding operability have largely contributed to refractory cardiac failure. It is hoped that more critical selection of patients for operation and greater experience in operative techniques, would result in a decrease in operative deaths (AU)

The treatment of post-operative anaemia

The treatment of 35 patinets with ruptured tubal pregnancy who had undergone salpingectomy or salpingo-oophorectomy, with iron dextran infusion is described. The necessity for treatment was evidence of iron deficiency and a haemoglobin of between 8 and 10 g/100 ml. Dosage of iron dextran was calculated from a formula supplied by the makers of the preparation. The haemoglobin levels rose in all cases by from 2 to 4.1 g percent. Side effects were minimal. At follow-up no patient had a haemoglobin level below 11 g percent. It is suggested that unless blood replacement is an immediate necessity because of shock or severly low haemoglobin levels, infusion of iron dextran is a reliable procedure in the management of post-operative anaemia. (Summary)

The role and organisation of an intensive therapy unit in a modern hospital: part 1

Hospitals have earned their role in the community because they have shown that a person has a better chance of getting well if he attends a hospital rather than staying home in bed. Intensive therapy units have earned their role in the hospital because it has been shown that a greater number of lives may be saved by the use of intensive care and specialised equipment (Summary)

Pathology and treatment of urethral structure and its complications in Jamaica

The pathology and treatment of 66 severe or complicated strictures of the urethra are reviewed. There is little evidence from this series that lymphogranuloma venereum is an important cause of urethral stricture and its complications. The importance of avoiding the formation of false passages with bougies is emphasized. Fistulous tracks fall into definite patterns. A study of these in association with the urethrograms will allow pre-operative assessment of the extent of the lesions, and therefore of the extent of resection likely to be required. The suggestion is made that when unilateral hydronephrosis is present, obstruction at the lower end of the affected ureter is sometimes the result of infection which spread from the prostate gland or which was initiated by the passage of a bougie outside the urethra posterior to the base of the bladder. Patients with long-standing cystitis in association with stricture of the urethra may develop a carcinoma which is usually squamous celled and situated away from the base of the bladder. Impassable strictures and those complicated by fistula and abscess formation are best treated by excision and anastomosis in one stage when short and situated in the bulbo-membranous urethra, and by two-stage excision and reconstruction when long, multiple or in the penile urethra. (Summary)

Good amputation stumps in the lower limb

Amputations must be performed where possible to meet the requirements of the limb fitter. The essentials in the technique of the common lower limb amputation are described. A good amputation stump can be produced with a little extra effort on the part of the surgeon. It give him pleasure to see and the patient years of trouble free service. (AU)

Emergency tracheostomy

A series of 78 cases of emergency tracheostomy performed at the Kingston Public Hospital from 1944 to date is considered. The overall mortality rate was 50.2 per cent. Of 11 cases done by the ear, nose and throat unit within recent months, two died of causes unrelated to the operation. Possible causes of mortality and morbidity, and various details of operative and postoperative care are discussed. A routine for post operative care as followed in the Department of Otolaryngology of the Kingston Public Hospital is decsribed. It is recommended that all tracheostomies be performed by one specific unit and that the postoperative care be the responsibility of that unit. (AU)

Immediate bone grafting in treatment of adamantinoma

A case of extensive adamantinoma of the mandible is reported with a review of the literature on the treatment of malignant disease of the mandible. Mandibular resection with immediate autogenous bone graft is recommended as the ideal treatment. The post operative recovery period is short and the cosmetic and functional results are good. The operation is within the scope of the general surgeon. (AU)