etiology of acute scrotal swelling on surgical exploration among children and adolescents in Jahra

To describe the clinical presentation as well as the outcome of surgically explored acute scrotal swellings among children and adolescents recorded at the Al-Jahra Hospital, Kuwait during the period 1985-1995. Hospital records of 120 cases were reviewed. Seventeen% of the cases were found to be testicular torsions [TT] and 40% torsions of testicular appendages [TAT]. Other etiologies included traumatic swelling [15%], idiopathic edema [13%], epididymo-orchitis [10%], hydroele [4%] and others [2%]. Ages of patients ranged from 6 months to 18 years, averaging 9.3 years [SD = 2.9] for TAT cases and 10.1 years [SD = 6.4] for TT cases. Swelling and pain were located on the left side for 65% of the torsion cases. Direct trauma was reported in 22% of the torsion cases. In 90% of TT cases, orchidopexy was performed with success. Subsequent testicular atrophy occurred in only 1 patient who had symptoms for more than 48 h prior to surgery. Orchidectomy was directly performed on necrosed testes in a patient with signs lasting more than 48 h, and another patient with signs lasting 4 days. Conclusions: Primary health care physicians in Jahra district should continue to educate parents and adolescents to recognize the gravity of scrotal pain, and the importance of early response as a way of avoiding testicular necrosis

General anesthesia reduces basal tear production

To measure the effect of general anaesthesia on basal tear production in order to determine the need for the prophylactic use of ophthalmic preparations. Design and Setting: 150 patients [300 eyes] undergoing general anaesthesia for more than 90 minutes for non-ophthalmic surgical procedures were divided randomly into 3 groups [C, T and O]. Eyes in group C were left as such, in group T hypoallergen tape was applied and in group O chloromycetin applicap ointment was used. In all the eyes basal tear production was assessed by Schirmer 1 and 2 tests both pre and postoperatively. All the patients were subjected to conventional general anaesthesia technique. General anaesthesia reduced basal tear production irrespective of the method of eye protection used [P < 0.0001]. It is suggested that prophylactic eye care during general anaesthesia should include both replacement of tears and prevention of mechanical exposure of the cornea

Topical timolol prevents interoculer pressure response to succinylcholine and tracheal intubation

The effect of topical timolol on intraocular pressure response to succinylcholine and tracheal intubation was studied in 40 adult patients, divided randomly into two groups of 20 each. These groups received normal saline [one drop] and timolol [one drop, 0.5%] as pretreatment in a double blind manner, thirty minutes before anaesthetic induction with thiopentone and succinylcholine 1.5 mg/kg. Topical timolol caused a significant decrease in intraocular pressure. Succinylcholine and tracheal intubation caused a significant increase in intraocular pressure in the control group [normal saline] whereas intraocular pressure remained below basal levels throughout the period of study in the trial group [timolol]. In conclusion, topical timolol pretreatment administered 30 minutes prior to induction of anaesthesia offers protection against succinylcholine and tracheal intubation initiated increases in intraocular pressure without causing any significant cardiovascular effects

Haemodynamic effects of anaethesia in a patient chronically treated with angiotensin converting enzyme inhibitors

A 55 year old controlled hypertensive patient, on treatment with captopril, was subjected to general anaesthesia using conventional anaesthetics. The patient had two episodes of severe hypotension and bradycardia intraoperatively which responded to intravenous crystalloids and atropine. Possible mechanism of action for such haemodynamic instability during general anaesthesia and relevant literature has been reviewed