Informed consent from uninformed patients: a dilemma

To assess the amount of information provided pre-operatively by the doctors/nurses to the patients undergoing surgery and to relate understanding of this information with the educational status of the patient and their anxiety levels. Descriptive study. Surgical Units of Jinnah Postgraduate Medical Centre, Karachi, From November 2012 to April 2013. A set of standardized questions were asked relating to patient's knowledge about the informed consent process, their education level and its impact on the understanding of informed consent as well as the impact of language of the consent form on the patient's interpretation of the information provided. Out of 291 patients, 168[58.1%] patients signed the consent form themselves. Two hundred eight two [96.9%] patients were aware of the type of surgery they had to undergo. Two hundred and nine [71%] patients knew that it was their legal right to have their consent taken by the doctor before any surgery. Fifty six patients understood the consent form completely. Out of 56 patients who understood the consent form, 39 individuals had an education level of at or above matriculation. Thirty three consents were taken by operating surgeon or residents that significantly decreased the anxiety level. Most of the patients were aware of the importance of consent process as their legal right. High education level improved the understanding of the process

Xeroderma pigmentosum

To describe the features of Xeroderma pigmentosum observed in the stage 3 of the disease. Case series. Mayo Hospital Lahore, from December 2001 to September 2008. All patients diagnosed with Xeroderma pigmentosum stage 3 in the outpatient department of the study centre, were included. The age at first presentation, tumour sites, histology, recurrence rate, new tumour formation rate and the number of biopsies taken in a single session were recorded. The follow-up time was seven years. There were 25 patients including 15 males and 10 females. The mean age at initial presentation with the tumour was 20.4 years. The maximum number of biopsies taken from one patient during the same operation was 15 [mean=4]. Complete tumour clearance was achieved in 15 patients and 3 patients were inoperable. Altogether, 70% tumours were basal cell carcinomas [BCC]. The average interval for the development of a new tumour was 6 months. Twenty [80%] of the tumours were on the face, one was on the back and 3 on the forearms. Thirteen patients had ocular complications. Fifteen had a first degree relative afflicted. All wounds were closed primarily or with split grafts. There was a family history. The tumours were mostly BCCs. The rate of new tumour formation and recurrence was exceptionally high

Comparison of traditional two injections dorsal digital block with volar block

To compare the traditional two injections dorsal digital block with volar block in terms of effectiveness of anaesthesia and pain of initial pinprick. Study Design: Quasi-experimental. Place and Duration of Study: AVH and casualty operation theatres, Mayo Hospital, KEMU, Lahore, from January to June 2007. Thirty patients requiring surgical procedure distal to proximal phalanx crease on two fingers of same or one finger of both hands were included. Cases with allergy to lignocaine, previous vascular insufficiency, previous digital replantation or peripheral neuropathy were excluded. One finger of every patient received two injection dorsal block whereas the other finger received single subcutaneous injection in the midline of the phalanx with lignocaine and epinephrine [volar block]. Patient looked away during the performance of block and wrote the severity of initial pinprick on a visual analogue scale. Effectiveness of anaesthesia was made measurable by the absence of pain during the surgical procedure. Total duration of the anaesthesia and any undesirable numbness of adjacent finger were noted. The t-test was used to compare the means and p-value less than 0.05 was considered significant. The mean pain scale score were 4.27+0.87 and 5.27+1.05 for volar and dorsal techniques respectively [p < 0.05]. Volar blocks were 100% effective whereas in dorsal blocks success rate was 80% [p < 0.05]. Single subcutaneous injection in the midline of phalanx with lignocaine and epinephrine [volar block] was significantly less painful to administer, is effective and safe technique to achieve digital anaesthesia, compared to the dorsal technique