Surgical Glove Perforations During Surgical Operations: an Ever Existing Risk in the Theatre

Background:The use of surgical gloves as a protective barrier between the surgeon and the patient has been the accepted standard. The prevalence of intraoperative glove perforations is high and often not recognized. Perforations may increase the potential for wound sepsis and for accidental exposure of the surgeon and the patient to human immunodeficiency virus (HIV) and hepatitis B virus.Aim: To investigate the incidence of glove perforations during surgery and to evaluate the extent to which glove perforations remain undetected during surgery. Methods: A prospective study in which a total of 2541 gloves used to perform surgical operations on 210 patients within a period of 12 months (January - December; 2009) were analyzed for perforations. These gloves were worn by the surgeons and scrub nurse and were double gloves. Twenty five unused gloves were used as control. The operations were all for general surgical cases. All gloves were tested for perforations by a simple water inflation technique at the end of each procedure. Results: By this water inflation technique; 225 gloves (8.9) were observed to have had perforations. Twenty one gloves (9.3) were noticed to have perforated in course of the surgery while 204 (90.7) were unnoticed. None of the unused gloves showed any perforation. There was an obvious difference in the perforate rate between the inner and outer gloves. It was 13.7for inner gloves as against 88.3for outer gloves.Conclusion: The incidence of surgical glove perforations is unacceptably high. The risk of transmission of diseases between surgeon/patient remains present. Protective measures like double gloving; the use of blunt needles; needle puncture resistance surgical gloves; glove liners and finger guards should be introduced in hospitals

Primary Carcinoma of the Gall Bladder in University of Port Harcourt Teaching Hospital

Background: Carcinoma of the gall bladder [CaGB] is an uncommon but deadly cancer of the biliary tract Aim: To report experience in the management and the treatment outcome of patients managed for an uncommon tumour. Methods: Case notes of 215 patients who had gallbladder surgery between 1989 and 2009 in the Department of Surgery were retrieved. Demographic data; treatment and treatment outcome were retrieved from these case notes. Results: There were 18 cases of proven primary carcinoma of the gallbladder. There were 14 (77.8) females and 4 (22.2) males with a female/male ratio of 3.5:1. The patients aged between 52 and 70 years. The mean age at diagnosis was 61.3 years. The presenting symptoms were related to the associated gall stones and they are dyspepsia; anorexia; right hypochondrial pain; palpable gall bladder mass; weight loss; jaundice; pruritus; palpable liver and ascites. Five (27.8) cases were diagnosed correctly pre- operatively while 2 (11.1) cases with distended gall bladder were misdiagnosed as gastric outlet obstruction. Eleven (61.1) cases were diagnosed during surgery and were confirmed post operatively from the histopathological reports. Attempt at curative treatment was possible for only 8 (44.4) patients with early disease (stages I and II) .Fourteen cases (77.8) were well or moderately differentiated adenocarcinoma while 4 cases were undifferentiated adenocarcinoma and squamous cell carcinoma. Conclusion: From this report; we deduced that the treatment outcome of patients with gall bladder carcinoma is highly dependent on the stage of the tumour and the feasibility of a curative treatment

Obstructive uropathy in childhood : a Review

Background: Obstructive uropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which; if left untreated; will cause progressive renal damage.Aim: To present an update on obstructive uropathy in children with emphasis on the situation in Nigeria.Methods: Contemporary information on the management of obstructive uropathy was obtained by searching the Medline and adding information from the authors' experience.Results: Obstructive uropathy causes renal impairment in all age groups. The causes in children may be congenital or acquired. The congenital causes include pelvi-ureteric junction obstructions; posterior urethral valves (PUV); urethral atresia; phimosis and meatal stenosis. Associated anomalies include imperforate anus and ver tebral malformations. Acquired causes include calculi; post-traumatic and post-inflammatory strictures and meatal stenosis. Some specific manifestationsare prune-belly syndrome; hydronephrosis and renal failure. Diagnostic investigations include ultrasonog raphy; intravenous urog raphy; cystography and renography. Recent technological advances have impacted on the treatment of the different lesions. These include in utero vesico- amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Not all lesions require treatment. Criteria to select patients for treatment require definition. Occasionally treatment fails because of pretreatment irreversible renal damage. The resulting end-stage renal failure is an indication for renal transplantation.Conclusion: Obstructive uropathy is an important cause of renal impairment. Contemporary advances in the management are yet to become available in developing countries. Compromise treatment options therefore prevail. Adequate treatment is essential to prevent end-stage renal failure

Anaesthetic challenges in surgical excision of phaeochromocytoma

Background: Phaeochromocytoma is a rare tumour; which is benign but metabolically active; with a potential for malignancy. This tumour of adrenal or extra adrenal origin usually presents as hypertension; which can be sustained or paroxysmal and with lethal complications. Aim: To present an anaesthetic experience during the surgical resection of a phaeochromocytoma. Method: A 26-year old woman with phaeochromocytoma of the right adrenal gland is presented. The tumour was excised under general anaesthesia. The anaesthesia involved the use of continuous infusion of esmolol (an ultra short-acting intravenous cardioselective beta-antagonist) and propofol. The resected tumour was sent for histopathological examination. Results: The tumour was completely excised under general anaesthesia. The haemodynamic changes that occurred during tumour handling were controlled with fentany1;propofol/esmolol infusion. Histopathological findings confirmed phaeochromocytoma. Conclusion: Although; the anaesthetic and surgical management of a phaeochromocytoma could be an uphill task; it is possible in an environment with limit laboratory and intensive care facilities