Topical tenoxicam from pharyngeal pack reduces postoperative sore throat.

BACKGROUND: One puff of beclomethasone inhaler has been shown to reduce the incidence of sore throat following endotracheal intubation. The aim of this study was to determine the effect of a pharyngeal pack on the incidence of sore throat and whether tenoxicam-impregnated gauze pack significantly influenced the frequency of sore throat. METHODS: Eighty patients undergoing general anaesthesia for elective surgery of the nasal septum were evaluated. The anaesthetist sprayed the upper airway towards the trachea with one puff of beclomethasone inhaler (50 microg) before orotracheal intubation. Patients were randomly assigned to have either a 0.2% tenoxicam- or a 0.9% saline-impregnated gauze pack in the oropharynx during operation. They were evaluated for occurrence and severity of postoperative sore throat by direct questions 12-24 h after surgery. RESULTS: Four patients who experienced any symptoms in the tenoxicam group scored mild sore throat compared to 16 patients in the control group scoring mild, gradually developing moderate or severe sore throat (P<0.01). No drug-related side effects were observed. CONCLUSION: The intraoperative use of a tenoxicam-impregnated gauze pack is effective in reducing moderate or severe postoperative sore throat following the use of throat pack.

A policy in the management of urethral fistula.

Our experience with repair of urethral fistula in 33 patients over a 5-year period is reviewed. The ages ranged from 2 to 12 years with an average of 8 years. Meatal advancement and glanuloplasty (MAGPI) were performed in five patients; there was no recurrence. A layered repair was used in 26 patients; of these, 12 recurred. Twelve patients needed a second operation and, of these, one had urethral dilatation with spontaneous cure of the fistula and the remaining 11 had a layered repair with a recurrence in five. Five patients had a third repair with further recurrence in three. Suprapubic urinary division was used in 13 cases with a failure rate of 77% (10 cases), while transurethral drainage was used in 31 cases with a failure rate of 35% (11 cases). Three of the cases with a MAGPI procedure had no urinary division. It is concluded that the MAGPI principle should be used in the repair of coronal and some subcoronal urethral fistulae as it carries a good healing rate with a short hospital stay. Transurethral bladder drainage should be used more frequently.

Modification of the "Mustardé-Mathieu" and "Horton-Devine" urethroplasty in the management of hypospadias.

This paper reports on the method of repairing distal or mid-shaft hypospadias in 42 patients using a modification of the Mustardé-Mathieu and Horton-Devine techniques. A terminal meatus was achieved in all cases; there were two fistulae and one meatal stenosis.

Histochemical changes in intestinal atresia and its implications on surgical management: a preliminary report.

Histochemical studies of the intestine were performed on five neonates, three with intestinal atresia and two as normal controls. In this preliminary report, changes secondary to ischemia and obstruction were defined. It was shown that the ischemic changes were limited in extent both proximally and distally, and the obstructive changes were reversible. A conservative approach to resection in the management of intestinal atresia is suggested. Limited resection of the dilated proximal bowel together with the use of total parenteral nutrition will allow for a safe waiting period for the pathological changes to reverse themselves and effective peristalsis to return.

Anorectal myectomy in adult Hirschsprung's disease: a report of six cases.

The presentation and management of six adult patients with proven aganglionosis of the rectum are reported. Rectal mucosal biopsy combined with enzyme histochemistry was used to establish the diagnosis and it is recommended as the first investigative procedure. Conservative surgery either with anterior resection and anorectal myectomy or myectomy alone was found to be simple and relatively complication-free and to give very satisfactory results.

Experience with meatal advancement and glanuloplasty (MAGPI) hypospadias repair.

Our experience with the procedure of meatal advancement and glanuloplasty (MAGPI) is reviewed with a note on the technique. It was found that MAGPI can improve the position of the urethral meatus, correct meatal stenosis, release associated skin chordee and produce the aesthetic appearance of a normal penis. The fistual rate was zero and there were no other complications. It is recommended as the operative procedure of choice for glanular, coronal and selected cases of subcoronal hypospadias.

Congenital lobar emphysema: problems in diagnosis and management.

A retrospective study was made of 9 patients with congenital lobar emphysema who presented over the past 13 years. The ages of the patients at diagnosis ranged from 2 weeks to 10 years. The earlier the presentation, the more severe were the symptoms. Two patients were misdiagnosed initially at the referring hospitals with near disastrous results. Pitfalls in diagnosis are outlined and the various investigative procedures discussed. A flow chart for the diagnostic approach is presented. Treatment was usually by lobectomy but 2 older children presenting late with mild symptoms were managed conservatively with satisfactory results.

Percutaneous nephrostomy in pelviureteric junction obstruction in children.

Percutaneous nephrostomy using ultrasound guidance with the pigtail catheter is very useful in dealing with problems associated with pelvic hydronephrosis in children. It is safe, easy to perform and free of complications. Three cases are presented with a note on the technique. The role of percutaneous nephrostomy in pelviureteric junction obstruction in children is outlined.

A histochemical study of the mucosubstances of the colon in cases of Hirschsprung's disease with and without enterocolitis.

From the histochemical studies of the mucus factor in normal controls and 10 cases with Hirschsprung's disease including 5 with enterocolitis, using Alcian blue-PAS method, we concluded that ganglionosis had no effect on the secretion of mucus. The presence of qualitative changes in the type of mucopolysaccharides, demonstrated as an increase in the sulphated group especially in cases with enterocolitis, was secondary to the chronic obstruction. These nonspecific changes might diminish the protecting mechanism of the mucous membrane. Quantitative changes were seen to be related to the severity of the enterocolitis.