ABSTRACT
Technological advances are leading to the possibility of remotely controlled or veven completely autonomous delivery of anesthesia. Advances in other specialties, as well as the paradigm shift towards functional medicine, are promising improvement in overall state of health, and reducing the numbers and types of surgical procedures, thereby reducing the required numbers of the relevant workforce, including anesthetists, in future. The specialty of anesthesia needs to transform into a more over-arching role of perioperative medicine in order to stay relevant
ABSTRACT
Objective: To compare medical versus surgical treatment of nasal polyps in terms of frequency of success and recurrence. Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted at the department of ear nose throat [ENT], Combined Military Hospital [CMH] Peshawar over 2 years' period, from Jan 2000 to Dec 2002
Material and Methods: During this period, 80 patients were diagnosed of nasal polyps. These patients were randomly divided into two treatment groups. Patients in group-A received medical treatment in the form of intra-nasal steroids while patients in group-B received surgical treatment depending upon the extent of disease. Outcome variables were frequency of successful resolution of nasal polyps after 1 month of treatment and frequency of recurrence upon 1 year follow-up
Results: The age of the patients ranged from 15 years to 40 years with a mean of 26.13 +/- 2.5 years. There were 49 [61.25%] male and 31 [38.75%] female patients in the study group giving a male to female ratio of 1.6:1. There was no significant difference between the two study groups in terms of gender [p=0.818] distribution. Bilateral intranasal polypectomy was the most frequently performed procedure [70.0%] followed by intranasal ethmoidectomy [12.5%], external ethmoidectomy [10.0%] and functional endoscopic sinus surgery [7.5%]. The frequency of successful treatment was significantly higher with surgery [100% vs. 52.50%; p<0.001] as compared to intra-nasal steroids at 1 month follow-up. However, over the long-term follow-up, the frequency of recurrence was significantly lower with intra-nasal steroids [4.8% vs. 30.0%; p=0.022] as compared to surgery. There was no complication in the patients treated with intra-nasal steroids. While crusting [15.0%] followed by infection [10.0%] were among the few complications observed in the surgical group-B
Conclusion: Though associated with significantly lower frequency of successful treatment, intranasal steroids were associated with significantly lower frequency of recurrence as compared to surgery. Moreover, their use was not associated with any complication as experienced with surgery. Due to these benefits and non-invasiveness, intra-nasal steroids become first line treatment of choice. It can be advocated on the basis of the present study, that patients with nasal polyps should receive a course of intra-nasal steroids and surgery should only be reserved for refractory cases
ABSTRACT
To compare the efficacy of Epley manoeuvre and Semont manoeuvre in the management of benign paroxysmal positional vertigo. Randomized controlled trials. ENT Department Combined Military Hospital [CMH] Kharian and Gilgit from March 2005 to February 2010. Hundred cases of benign paroxysmal positional vertigo [BPPV] were selected on Dix-Hallpike test by non probability convenient sampling technique and randomly divided into two groups of 50 cases each. Patients in group-1 were treated by Epley manoeuvre and patients in group-2 were treated by Semont manoeuvre. The patients were examined on first day, 3[rd]30 day, 7[th] day and after 01 month and clinical results were observed. In group-l, 68% cases showed immediate resolution of symptoms, 74% cases on 3[rd] day, 80% cases on 7[th] day and total 82% cases recovered completely after one month. In group-2, 62% cases showed immediate resolution of symptoms, 68% cases on 3[rd] day, 74% cases on 7[th] day and total 78% cases showed complete recovery after 1 month. There was insignificant difference between the two groups regarding recovery at different follow ups. It was concluded that Epley and Semont manoeuvres are equally effective in the management of BPPV
Subject(s)
Humans , Male , Female , Disease ManagementABSTRACT
Percutaneous tracheostomy is a common procedure in intensive care unit. The different diameters of loading dilators in the standard Blue Rhino percutaneous tracheostomy kit and available tracheostomy tubes means that difficulties may be encountered during the procedure due to formation of a 'step' between the tube and the loading dilator. This increases the potential for complications and might add to the cost. In order to find out the best combination of tracheostomy tubes and loading dilators, this study compared the various tracheostomy tubes. Size 8 of all tracheostomy tubes had the best fit when used with specific loading dilators in the standard Blue Rhino Kit. It is recommended that a size 8-tracheostomy tube be chosen with the standard Blue Rhino technique for percutaneous tracheostomy. If a smaller tube is deemed necessary, a size 7 will provide a good fit
ABSTRACT
We report a caesarean section [CS] that was safely performed under spinal anaesthesia in a patient on aspirin and ginkgo biloba [herbal medicine] therapy. Both of these medicines have anti-platelet activities with effects on the coagulation profile and their concurrent administration with aspirin has been said to be associated with increased risk of bleeding. Our patient was offered the choice of either general or regional anaesthesia and she opted for the later. An emphasis is laid on full documentation of all communication to the patient or attendants
ABSTRACT
We present a case report of elective Caesarian section of a morbidly obese parturient under combined spinal epidural [CSE] technique, which, somehow, lasted for more than five hours. The patient remained awake of her own desire and she refused conversion to general anesthesia. The course of anesthesia required careful titration of the local analgesic solutions, well beyond the usual admissible total doses, and maintenance of her hemodynamic parameters
ABSTRACT
18 cases of external laryngeal trauma are being analyzed retrospectively. Main etiological factors were road traffic accidents 11 cases [61.11%] accidental strangulation 3 cases [16.66%], blunt trauma due to fall 1 case [5.5%] during fight 2 cases [11.11%] and suiccidal attempt 1 case [5.55%]. Most of the patients presented with hoarseness or aphonia 8 cases [44.44%], pain and tenderness of neck 6 cases [33.33%], odynophagia 6 cases [33.33%] and swelling of the neck one case [5.55%]. After careful history, meticulous examination and detailed investigations patients were grouped according to clinical findings. Group one had 4 patients having supraglottic swelling, edema, ore stenosis occurs as a squalal of lalpferl trauma ad occurs after sometime, not immediatily after trauma hamatoma [22.22%], group two had six patients having supraglottic stenosis [33.33%] group three had subglottic stenosis. Number of patients was again 6 [33.33%]. Group four had two patients having subglottic stenosis and tracheal stenosis [11.11%]. Treatment was varied depending upon the severity of the injuries. Fourpatients [22.22%] were managed by tracheostomy and conservative measures i.e., voice rest, humidification and bed rest. Fourpatients [22.22%] underwent laryngotracheal reconstruction with hyoid descent, three patients [16.66%] had suprahyoid release, resection and reanastomosis of stenotic segment. Two patients [11.11%] had laser ablation, two patients [11.11%] had laser ablation and serial dilations and one patient [5.55%] had laryngotracheal reconstruction with hyoid descent and augmentation with septal cartilage. Three patients [16.66%] underwent more than one operation. Fifteen patients out of eighteen [83.33%] recovered un-eventfully having stable air way, voice capable of verbal communication, decannulation and swallowing without aspiration, two patients [11.11%] are still not decannulated and are declared unsuccessful, one patient [5.55%] has got left vocal cord paralysis. A delay in early detection of external laryngeal trauma may precipitate life threatening airway compromise later on, therefore prompt and accurate diagnosis should immediately be followed by skillful air way management