Thyroidectomy under local anesthesia

Objective: to find effectiveness of thyroid surgeries under local anaesthesia when the patients had contraindication to general anesthesia

Study design: descriptive case series

Place and Duration of study: department of Surgery, Jinnah Hospital / Allama Iqbal Medical College Lahore, from January 2004 to March 2015

Methodology: a total of 100 patients were included. For infiltration anesthesia, lignocaine and bupivacaine were used. Two ampoules of lignocaine and two ampoules of bupivacaine [40 ml each] were taken and 160 ml normal saline was added in it. Total amount of infiltrate was 200 ml into which 0.5 ml of adrenaline 1/1000 was added. Total adrenaline concentration came to be 1/400000 in 200 ml. Before draping the patient, local anaesthesia was infiltrated starting from the incision, to all the area below from suprasternal notch to above the thyroid cartilage and laterally to anterior border of sternocleidomastoid. Patients were given tablet alprazolam [Xanax] 0.5 mg six hours prior to surgery. Just before the operation intramuscular injection diclofenac [Dicloran] 75 mg and intravenous antibiotics were also administered

Results: the study population included 81 females and 19 males with the mean age of 35+/-5 year. The mean procedure time was 105 minutes. Procedures included subtotal bilateral thyroidectomy [n=31], lobectomy [n=46] and total thyroidectomy [n=23]. Postoperative complications included bleeding [n=2]. Patients showed full self-dependency within 4 to 6 hours and remained under medical surveillance for 48 hours

Conclution: use of local anesthesia in thyroid surgery makes it cost effective with less postoperative pain. Early smooth recovery was also observed. Thyroid surgeries under local anesthesia may be considered a safe alternative where general anesthesia is not available or contraindicated for medical reasons

Comparison of rapid and conventional corneal collagen cross linking in patients having Keratoconus

To compare the effect of rapid and conventional methods of corneal collagen cross linking [CXL] on visual acuity [VA] and corneal parameters in Keratoconus. Randomized control trial. Armed Forces Institute of Ophthalmology, Feb 2012 to Apr 2013. Thirty patients, fifteen in each group, were randomized by non probability consecutive sampling to rapid or conventional CXL group. Pre and post operative [6 months] best corrected visual acuity [BCVA], anterior and posterior keratometric [K] values and pachymetry were recorded. Intra and inter group comparison of all these parameters were statistically analyzed. All thrty patients showed either stabilization or improvement in BCVA. Both groups showed comparable results in terms of improvement BCVA [p = 0.682], reduction in the corneal thickness at thinnest point [p = 0.062], anterior flat and steep K [p = 0.633, p = 0.443 respectively] and posterior flat and steep K values [p = 0.130, p = 0.068] at six months duration. Conventional and rapid methods of CXL are comparable in terms of their effect on VA and corneal parameters

Gastric carcinoma: location, morphological and histological profile

To know the common tumor location, morphological and histological types of gastric carcinoma. This cross sectional study was conducted in gastroenterology unit HMC from January to August 2010. One hundred and thirteen patients of more than 30 years of age and having endoscopic and biopsy proven gastric carcinoma were included in the study. All patients after necessary investigation were prepared for endoscopic examination, upper gastrointestinal endoscopy was done and findings were recorded. Biopsies of the lesions were taken for histopathological confirmation. Seventy five [66.4%] patients were male and 38 [33.6%] were female. The mean age was 56.02 +/- 12.11 years. Antrum was involved in 29[25.7%] cases alone, body alone was involved in 16[14.2%] cases, body and antrum in combination were involved in 15[13.3%] cases, cardia and fundus in 15[13.3%] cases, cardia alone in 13[11.5%] cases, fundus alone in 6[5.3%] cases, fundus, antrum and body in combination in 5[4.4%] cases, cardia, fundus and body in combination in 3[2.7%] cases and cardia and body in combination were involved in 2[1.8%] cases, while stomach was diffusely involved in 9[8.0%] cases. Tumor was polypoid/fungating in 51[45.1%] cases, ulcerated in 43[38.1%], infiltrating in 17[15.0%] and fungating and ulcerated in 2[1.8%] cases. Intestinal type gastric carcinoma was present in 39[34.5%] cases and diffuse type gastric carcinoma was present in 74[65.5%] cases. Gastric carcinoma is a male predominant neoplasm which commonly involves the antrum, usually as fungating or ulcerated lesion and majority of gastric carcinoma are diffused type gastric carcinomas

audit of the mortality due to severe head injuries in a neuro-surgical intensive care unit

To analyze the data of patients died in neurosurgical intensive care unit due to severe head injuries. This retrospective study was conducted in neurosurgical intensive care unit in Lady Reading Hospital, Peshawar from January to December 2007. The Clinical record of all the patients presenting with severe head injuries, who then expired in neurosurgical intensive care unit was collected. The record was analyzed accordingly for discussion and recommendations. Out of 112 patients, majority were young adults [n=64, 57.14%] followed by children [n=34, 30.35%] and elderly [n=10, 8.92%]. Road traffic accidents were the major cause of presentation [n=75, 66.96%] followed by history of fall [n=23, 20.53%] and fire arm injuries [n=13, 11.60%]. The correctable surgical causes were present only in 18 patients [16.07%] and the majority 94 [83.92%] were given conservative management. Among the non-surgical cases, both ventilatory therapy in 7 [6.25%] and tracheostomy in 39 [34.82%] patients failed to change the outcome. Road traffic accident was the major contributor in the mortality in patients presenting to neurosurgical intensive care unit. Most involved were young adults

effects of intravenous lignocaine on pain during injection of medium and long-chain triglyceride propofol emulsions

To determine if propofol-MCT/LCT premixed with lignocaine as well as given alone is effective in reducing pain on injection. Three hundred American Society of Anesthesiologists I-II patients listed for different elective procedures were randomized to three groups of 100 patients each. Group A received Diprivan a long-chain triglyceride preparation [LCT-propofol] premixed with lignocaine [i.e., 2 ml of 1% lignocaine in 20 ml of propofol]. Group B received Propofol-Lipuro [MCT/LCT-propofol] premixed with 2 ml normal saline, and group C received Propofol-Lipuro [MCT/LCT-propofol] premixed with lignocaine [2 ml of 1% lignocaine in 20 ml of propofol]. Anaesthesia was standardized in all the three groups. Undiluted Diprivan [LCT-propofol] and Propofol-Lipuro [MCT/LCT-propofol] were used for induction of anaesthesia and subjects were questioned about discomfort until contact was lost. Discomfort was recorded as none, mild, moderate or severe. Frequency of pain was 26% in group A [16% mild, 06% moderate and 04% severe pain,]. In group B frequency of pain was 28% [22% mild, 06% moderate and none severe pain], and in group C only 05% patients felt mild pain. None of them had moderate or severe pain. The p-value was 0.000007 in group C Vs A, 0.000027 in group C Vs B and 0.436782 in group B Vs A. The addition of lignocaine to MCT/LCT propofol significantly reduced the incidence of pain on injection compared to LCT-propofol with lignocaine p-value 0.000027 and MCT/LCT-propofol alone. Propofol MCT/LCT alone does not provide any advantage to reduce pain on injection in comparison to propofol MCT/LCT premixed with lignocaine

Cardiovascular responses to scalp infiltration, using adrenaline, with or without lignocaine, during craniotomy

To find out changes in the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after infiltrating scalp with adrenaline with or without Lignocaine in craniotomies. This comparative study was carried out at AIMS international hospital Hayatabad, Peshawar from January to June 2009. Cardiovascular response to scalp infiltration with adrenaline was noted in 100 unpremedicated patients undergoing craniotomy. They were divided into 2 groups of 50 patients each. Group A received lignocaine 2% with adrenaline 1:200, 000 and Group B received normal saline with adrenaline 1:200, 000. Episodes of tachycardia occurred more frequently in group B. Systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly increased in group B. Significant decrease in diastolic blood pressure and mean arterial pressure occurred in group A. In neurosurgical patients undergoing craniotomy, infiltration of the scalp with solution containing adrenaline alone causes significant hypertension. The addition of lignocaine attenuates the hypertensive response but causes decrease in blood pressure

Computed tomographic imaging of cerebral venous thrombosis

Cerebral venous thrombosis [CVT] is an entity which is not rare and can have devastating consequences if not diagnosed and treated in a timely manner. Although, the gold standard for diagnosing this entity is a catheter angiogram, magnetic resonance venography, by virtue of its non-invasiveness and detailed demonstration of the cerebral venous structures, has become the diagnostic modality of choice for this entity. However; in a resource-strapped country like Pakistan, CT scan remains the primary first [and sometimes the only] diagnostic modality used in patients with neurological problems. Therefore; it is important to recognize the signs of cerebral venous thrombosis on CT scan in order to initiate timely therapy. These CT findings of CVT are discussed in this paper. The CT findings of CVT have been divided into direct and indirect findings and the same have been described for noncontrast and postcontrast CT scans separately. A brief discussion of CT venography, which has come around as a promising tool for diagnosing CVT as a result of newer innovations in CT technology, is also included here

Incidence of pain on propofol injection and efficacy of addition of lignocaine or selecting big vein or both combined in reducing it a randomized control trial

To find out the frequency of pain due to propofol injection and to assess the efficacy of addition of lignocaine to propofol, selecting big vein in antecubital fossa or both combined in reducing pain. Incidence of injection pain with propofol was noted in 200 unpremedicated patients undergoing tonsillectomy. They were divided into 4 groups of 50 patients each. The patients were randomly allocated by card method to one of the four groups. Group A received plain propofol in a small vein on the dorsum of hand. Group B received 10 mg lignocaine added to propofol before administration into a vein on the dorsum of hand. Group C received propofol in a vein in the antecubital fossa and group D received lignocaine 10 mg added to propofol prior to administration in vein in the antecubital fossa. Incidence of pain was 58% with plain propofol injected in small vein, 10% when lignocaine was added prior to injection, 8% when injected in large vein and 6% when lignocaine was added before injecting propofol in large vein. Addition of lignocaine to propofol before injection into a small vein and administration of plain propofol into a large vein were equally and significantly effective [P value < 0.001] in reducing the incidence of pain. Addition of lignocaine to propofol into a large vein further reduced the incidence as compared to plain propofol but this was not statistically significant [P value >0.05]