ADENOTONSILLECTOMY: CARE GIVERS' RECALL OF INFORMATION ON RISKS PROVIDED DURING INFORMED CONSENT PROCESS.

BACKGROUND: "Informed consent" for surgery has been widely researched; however, there is no local data on surgical risk recall by care givers' (usually a parent) of children undergoing adenotonsillectomy (Ts &A). AIM AND OBJECTIVE: This study evaluated care givers' recall of the surgical risks for Ts&A after verbal explanation compared to combined verbal and written explanation in the informed consent process. DESIGN OF THE STUDY: This was a prospective randomized comparative study of fifty parents/guardians of patients undergoing tonsillectomy and adenoidectomy for obstructive sleep disorders. SETTING: The E.N. T. Unit, Korle Bu Teaching Hospital, Accra, Ghana. MATERIALS AND METHODS: Parents/guardians of children were randomized to only verbal explanation or combined verbal and written explanations prior to signing informed consent a day before their wards' operation. Recall of surgical risks explained in the informed consent procedure was evaluated two days postoperatively. The rates of surgical risk recall for the two groups were analysed and compared. RESULTS: There were no significant differences in the demographic characteristics of the parents/guardians. The overall recall rate for surgical risks for the whole group was 46.0%. The surgical risk recall rate for the verbal explanation group, 44.4% was not significantly different from that for the combined verbal and written explanation group, 47.2% (p=0.624). There was a weak but significant positive correlation between risk recall scores and parental level of education (Spearman rs=0.306; p = 0.015). CONCLUSION: Among parents/guardians whose children were undergoing adenotonsillectomy, combining written explanation with verbal explanation in the informed consent process did not significantly improve postoperative surgical risks recall rate when compared with only verbal explanation. The overall risk recall rate was 46.0%. A study with larger sample sizes is recommended to confirm these findings.

Characteristics and products of the reductive degradation of 3-nitro-1,2,4-triazol-5-one (NTO) and 2,4-dinitroanisole (DNAN) in a Fe-Cu bimetal system.

It has been shown previously that, under acidic conditions, 3-nitro-1,2,4-triazol-5-one (NTO) and 2,4-dinitroanisole (DNAN) degrade in the presence of iron/copper bimetal particles; the reactions can be modeled by pseudo-first-order kinetics. This study investigates the reaction mechanisms of the degradation processes under different conditions. Batch studies were conducted using laboratory-prepared solutions and an industrial insensitive munition-laden (IMX) wastewater. The influence of parameters such as initial pH of the solution, copper/iron (Fe-Cu) contact, and solid/liquid ratio were systematically investigated to assess their impact on the reaction kinetics. These parameters were subsequently incorporated into pseudo-first-order decomposition models for NTO and DNAN. The activation energies for the degradation reactions were 27.40 and 30.57 kJ mol-1, respectively. Degradation intermediates and products were identified. A nitro-to-amino pathway, which ultimately may lead to partial mineralization, is postulated. The amino intermediate, aminonitroanisole, was detected during DNAN degradation, but for NTO, aminotiazolone is suggested. Additionally, urea was identified as a degradation product of NTO.

Quality of life outcomes of adenotonsillectomy for obstructive sleep disorders: our experience in a Tertiary Care Centre in Ghana.

BACKGROUND AND OBJECTIVES: Obstructive Sleep Disorders (OSDs) impacts negatively on the quality of life of children. However the long term outcomes of adenoton-sillectomy remain unknown. The aims and objectives of this study was to assess the long term quality of life of Ghanaian children with OSDs undergoing adenotonsillectomy. METHODS: The subjects for this study were cohort of children who were part of a study named Study1 carried out at E.N.T. Unit, Korle Bu Teaching Hospital, Accra. These children had adenotonsillectomy for OSDs and their quality of life were evaluated preoperatively and again four to six weeks post operatively using Obstructive Sleep Apnoea 18 (OSA 18 ) questionnaire; a quality of life assessment tool. Thirty five children who were at least nine months post adenotonsillectomy were invited to a follow up E.N.T.clinic for the current study named Study 2 and their quality of life were again evaluated using OSA 18 questionnaire. RESULTS: Thirty-one children with a mean age of 5.08 ± 0.95 years were seen. The mean OSA-18 preoperative score for Study1 was 4.27 ± 0.27; the mean OSA 18 post operative scores for Study1 and Study 2 were 1.93 ± 0.25 and 1.78 ±0.31 respectively. There was a significant reduction in the mean post operative OSA 18 score for both studies compared to the corresponding preoperative mean score (p-value = 0.001). The mean postoperative overall quality of life scoresfor Study 1 and Study2 were 8.52 ± 0.53 and 7.68 ± 1.06 respectively. CONCLUSION: There was significant improvement in long term quality of life outcomes following adenotonsillectomy for OSDs.

Foreign Body Inhalation: A Review of Patients at the Korle Bu Teaching Hospital; Accra; Ghana

BACKGROUND: Foreign body inhalation; a surgical emergency requiring prompt management to avoid morbidity and mortality ; poses a diagnostic and management challenge to otolaryngologists. OBJECTIVE: To assess the pattern of foreign body inhalation at the ENT Unit Korle Bu Teaching Hospital Accra; Ghana. METHODS: The theatre records of patients managed for foreign body inhalation from Ist January 2003-31st December 2006 at the ENT Unit of the Korle Bu Teaching Hospital Accra; Ghana were studied with respect to age; sex; clinical presentation; types of foreign bodies removed; location of foreign bodies; and outcomes of the laryngoscopy or bronchoscopy procedures.RESULTS: There were forty patients with an age range of seven months to 15 years with a mean age of 4.78 years and a peak age incidence at zero-four year age group. The commonest inhaled foreign bodies included groundnuts in five (12.5) patients; fish bones in six (15) patients; plastic materials in five (12.5) patients; metal material in five (12.5) patients and seeds in five (12.5) patients. The common clinical presentations included respiratory difficulty; irritating cough; choking; painful swallowing and whistling sound during breathing. Foreign bodies were localized in the right main bronchus in 27 (67.5) patients; and in the left main bronchus in ten (25) patients and in the larynx in three (7.5) patients. One patient died during bronchoscopy and another patient had bronchotomy for failed bronchoscopy. CONCLUSION: The peak age of occurrence of forein body inhalation is in the zero-four year age group. The commonest inhaled foreign bodies are groundnuts; fish bones; plastic materials; metal materials and seeds. Majority of inhaled foreign bodies tend to localise in the right main bronchus

Foreign body inhalation: a review of patients at the Korle Bu Teaching Hospital, Accra, Ghana.

BACKGROUND: Foreign body inhalation, a surgical emergency requiring prompt management to avoid morbidity and mortality , poses a diagnostic and management challenge to otolaryngologists. OBJECTIVE: To assess the pattern of foreign body inhalation at the ENT Unit Korle Bu Teaching Hospital Accra, Ghana. METHODS: The theatre records of patients managed for foreign body inhalation from Ist January 2003 to 31st December 2006 at the ENT Unit of the Korle Bu Teaching Hospital Accra, Ghana were studied with respect to age, sex, clinical presentation, types of foreign bodies removed, location of foreign bodies, and outcomes of the laryngoscopy or bronchoscopy procedures. RESULTS: There were forty patients with an age range of seven months to 15 years with a mean age of 4.78 years and a peak age incidence at zero to four year age group. The commonest inhaled foreign bodies included groundnuts in five (12.5%) patients, fish bones in six (15%) patients, plastic materials in five (12.5%) patients, metal material in five (12.5%) patients and seeds in five (12.5%) patients. The common clinical presentations included respiratory difficulty, irritating cough, choking, painful swallowing and whistling sound during breathing. Foreign bodies were localized in the right main bronchus in 27 (67.5 %) patients, and in the left main bronchus in ten (25%) patients and in the larynx in three (7.5%) patients. One patient died during bronchoscopy and another patient had bronchotomy for failed bronchoscopy. CONCLUSION: The peak age of occurrence of forein body inhalation is in the zero to four year age group. The commonest inhaled foreign bodies are groundnuts, fish bones, plastic materials, metal materials and seeds. Majority of inhaled foreign bodies tend to localise in the right main bronchus.

Treatment outcome of locally advanced nasopharyngeal cancer with concurrent chemoradiotherapy.

BACKGROUND: Treatment options for locally advanced Nasopharyngeal lancer include radiation alone or cisplatin based concurrent chemoradiotherapy. Concurrent chemoradiotherapy is associated with higher morbidity but has been shown to yield better survival. OBJECTIVE: This study was aimed at determining the outcome of treatment of Nasopharyngeal Cancer with concurrent chemoradiotherapy in our setup. METHODS: Twenty-six patients with biopsy proven disease who had undergone staging procedures were studied according to age, sex, WHO histological type and stage of disease. Treatment consisted of 70 Gy to the primary site and 60 Gy to the neck with disease. Chemotherapy was given as follows: three cycles of three weekly cisplatin at 80 mg/m2 during radiation followed by three cycles of three weekly cisplatin at 60 mg/m2 on day 1 and 5-fluorouracil at 1000 mg/m2 on days 1 to 5 in the adjuvant setting. Side effects of treatment, pattern of failure and survival were determined. RESULTS: The male to female ratio was 2:1, age range was 10-68 years. WHO type 3 was predominant at 50%. Stage IVB disease was present in 73.1% of patients. Average number of chemotherapy cycles received was three. Median follow up period was 30 months (8-56 months), 42.3% survived beyond 24 months. Twelve patients developed recurrence of disease, of which eight had local regional recurrence only. CONCLUSION: Concurrent chemoradiotherapy is possible in our setting with acceptable morbidity at the prescribed doses. Survival beyond two years is possible in our environment with this regime. Local failure is the predominant cause of death.

Nasal septal surgery: evaluation of symptomatic and general health outcomes.

Although septoplasty and submucous resections are common procedures, there have been very few studies on the outcome of nasal septal surgery. This prospective study of two hundred patients undergoing septal surgery used the Fairley nasal symptom score, the Nottingham health profile, a general health questionnaire and clinical examination of nasal cavities to assess the outcome. A wide range of baseline severity scores was observed. Almost 40% of patients failed to attend for review. Analysis of the outcomes in the remaining 121 patients revealed significant improvement in (a) nasal obstruction in 74%, (b) facial pain in 72%, and (c) catarrh in 64% of patients. There was a lack of correlation between observed postoperative reduction in the number of nasal septal areas deviated and improvement in nasal obstruction. The Nottingham health profile and general health questionnaire scores remained unchanged in a large majority of patients. Postoperative improvement in nasal obstruction was independent of grade of surgeon or concomitant lateral nasal wall surgery. The principal benefits of septal surgery relate to improvement in nasal symptoms. The generic quality-of-life measures such as the Nottingham health profile and general health questionnaire did not show significant improvement in quality of life. Our results support the use of disease-specific instruments to evaluate the outcome of septal surgery.

Informed consent: British otolaryngologists surveyed.

A repeat postal questionnaire of British otolaryngologists has been carried out to assess changes in their practice of obtaining informed consent. The previously reported high level of good practice is maintained. Currently informed consent is more often obtained in outpatients or the preadmission clinic than it was in 1991. Consultants and specialist registrars are more involved in this process. Although there is little evidence given to support a persistent increase in a defensive approach towards gaining informed consent, there is some change in the reporting of surgical complications that may reflect an increased awareness of the concept of 'material risk'.