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PubMed2006

Cancer of the ovary at the University of Benin Teaching Hospital: a 10-year review, 1992-2001.

Forty-nine patients managed for primary ovarian cancer between January 1992 and December 2001 were analyzed, to appraise the incidence, clinical presentation and management. Data of relevance to the socio- demographic profile, clinical presentation, histopathological types, treatment modality and outcome of management were extracted from patients' case notes. A total of 412 patients with gynaecological malignancies, including 49 (11.9%) ovarian cancer were admitted in the gynaecological wards in the study period. The peak age of incidence was between 51- 60. mean 58 years. Social classes I and II were in the majority, 21.7% and 32.6% respectively. Late presentation, with stage III (76.2% of the patients) is the modal stage at presentation. The majority (73.8%) of the tumours were of epithelial origin. Gastrointestinal symptoms (86.9%) were the most common clinical features at presentation. The majority of patients (91.3%) had surgery (cytoreductive) as first line treatment, while 36/42 patients had adjuvant chemotherapy. Intraoperative haemorrhage (11.9%) was the most common complication. 2.4% of the patients died intraoperatively Primary ovarian carcinomas in Benin are predominantly epithelial in origin. It is the second most frequent gynaecological malignancy. Patients present late. mortality is high and unsatisfactory despite multimodal therapy. Public enlightenment to increase awareness and introduction of screening program for early detection is advocated.

Adolescent↗
PubMed1998

Anomalous duplicated cystic duct as a surgical hazard: report of a case.

Anomalies of the biliary ductal system are not uncommon, and their clinical significance is variable. We present herein the case of a 70-year-old Japanese woman found to have an anomalous duplicated cystic duct, which is an extremely rare congenital anomaly. Intraoperative delineation of the anomaly by real-time cholangiograms assisted us in being able to subsequently perform a safe cholecystectomy. This case serves to demonstrate the importance of being aware of the possibility of potential biliary variations in order to avoid ductal injuries during biliary surgery.

Aged↗
PubMed1995

Aortic regurgitation in coronary artery bypass grafting: implications for cardioplegia administration.

BACKGROUND: Echocardiography can detect aortic regurgitation (AR) that may interfere with the adequate delivery of cardioplegia solution to the myocardium during cardiac operation. When aware of this lesion, the surgeon can modify the operative technique accordingly. We sought to evaluate the ability of intraoperative transesophageal echocardiography to detect AR and to correlate the severity of the lesion with the need for retrograde cardioplegia administration. METHODS: Eighty-four consecutive patients undergoing coronary artery bypass grafting were evaluated. When AR was noted by intraoperative transesophageal echocardiography, a cannula was placed in the coronary sinus for possible retrograde cardioplegia administration. The surgeon was unaware of the severity of AR. After operation, the severity of AR was quantitated using the ratio of the regurgitation jet width to the left ventricular outflow tract diameter. RESULTS: The AR patients who required retrograde cardioplegia had a significantly higher ratio of regurgitation jet width to left ventricular outflow tract diameter than those AR patients who did not (0.36 +/- 0.06 versus 0.19 +/- 0.06, p < 0.005). CONCLUSIONS: Transesophageal echocardiography can provide accurate information regarding the presence and severity of AR. The calculated severity of AR on transesophageal echocardiography is associated with the need for retrograde cardioplegia administration.

Aged↗
PubMedDate not supplied

Recovery following outpatient anesthesia: use of enflurane versus propofol.

STUDY OBJECTIVE: To compare the intraoperative conditions and postoperative recovery of patients following the use of either propofol-nitrous oxide (N2O) or enflurane-N2O for maintenance of outpatient anesthesia. DESIGN: Randomized, single-blind study. SETTING: University hospital outpatient surgery center. PATIENTS: 61 ASA physical status I and II, healthy female outpatients undergoing laparoscopic surgery. INTERVENTIONS: Patients were randomly assigned to one of three anesthetic regimens. Group 1 (control) received thiopental sodium 4 mg/kg intravenously (i.v.), followed by 0.5% to 1.5% enflurane and 67% N2O in oxygen (O2). Group 2 received propofol 2 mg/kg i.v., followed by 0.5% to 1.5% enflurane and 67% N2O in O2. Group 3 received propofol 2 mg/kg i.v., followed by propofol 50 to 160 micrograms/kg/min i.v. and 67% N2O in O2. All patients received succinylcholine 1 mg/kg i.v. to facilitate tracheal intubation and atracurium 10 to 20 mg i.v. to provide adequate relaxation during the maintenance period. MEASUREMENTS AND MAIN RESULTS: Recovery from anesthesia was assessed by a research nurse who was unaware of the anesthetic technique used. The mean +/- SD time to eye opening was significantly longer in the thiopental-enflurane-N2O group (Group 1) than in the propofol-propofol-N2O group (Group 3) (6.1 +/- 2.5 minutes vs. 3.5 +/- 2.8 minutes, respectively). In addition, the mean time to respond to verbal commands was significantly shorter in the propofol induction groups compared with the thiopental induction group. However, the use of enflurane versus propofol for maintenance of anesthesia did not significantly prolong the time from arrival in the recovery room to sitting, tolerating oral fluids, walking, or being judged "fit for discharge." There were no differences among the three groups with respect to postoperative pain or analgesic requirements. Finally, patients who received enflurane for maintenance of anesthesia had a significantly higher frequency of nausea and vomiting than the propofol maintenance group. CONCLUSION: Induction of anesthesia with propofol is associated with a more rapid emergence from anesthesia than induction with thiopental. Maintenance of anesthesia with enflurane did not prolong recovery compared with maintenance with propofol, but enflurane was associated with increased frequency of postoperative nausea and vomiting.

Adult↗
PubMed2002

Intraoperative and on-site cytopathology consultation: utilization, limitations, and value.

The intraoperative and on-site cytopathology can be successfully performed with a number of smear preparations. Specimen concentration technique is the preferred method. The Romanowsky stain such as Diff Quik used in our laboratory is economical, convenient, reproducible, and quick. This can be at times combined with Ultrafast pap or other rapid stains, which provide good nuclear details. Such evaluations are most valuable in the staging of epithelial tumors and primary diagnosis of a number of central nervous system lesions. On-site and intraoperative diagnoses help triage the specimens for additional studies. This reduces the turn around time and makes the procedure cost-effective and beneficial to the patient. An awareness of the "normal" adjacent structures and familiarity with the cytomorphology of the specimens in comparison to the exfoliative specimens is critical in developing a cytopathology service with high degree of sensitivity and specificity.

Cytodiagnosis↗
PubMed2004

["Relaxant" awake but still relaxed].

We report on a 23-year-old female patient who underwent removal of the implants after maxillary surgery. At the end of surgery the administration of anaesthetic agents was discontinued. During the following 30 min several attempts were made to wake the patient, but she did not respond to verbal or pain stimuli. No changes in heart rate, blood pressure vegetative reactions such as sweating, lacrimation, or mydriasis were noted. Protective reflexes like coughing could not be elicited. After 30 min neuromuscular monitoring was applied and indicated residual muscle paralysis after the use of mivacurium. The patient was again sedated and transferred to the ICU, where she was mechanically ventilated for an additional 9 h. An atypical cholinesterase was determined as the underlying reason for the prolonged action of mivacurium. Retrospectively, the patient remembered the attempted wake-up period in detail. However, she reported no feelings of fear or helplessness because she had faith in the anaesthesiologist, a close friend of the patient's family for many years, who kept her calm and comfortable by talking to her during the entire period. Several months after the incident, the patient reported having neither increased fear of surgery nor any negative psychological effects on her life following this incident of awareness.

Adult↗
PubMed1991

Intraoperative anaphylactic reaction due to latex hypersensitivity.

Severe anaphylactic reaction secondary to latex allergy has lately been recognized and reported especially in individuals with spina bifida. We report a case of severe intraoperative anaphylactic reaction due to latex allergy. Preoperative testing for latex allergy may be helpful in determining latex allergy. We suggest a preoperative management protocol for patients who are thought to have latex allergy. An increased awareness to latex allergy will help avoid this potentially catastrophic event.

Adolescent↗
PubMed2003

Dural cavernous angioma: a preoperative diagnostic challenge.

BACKGROUND: Dural cavernous angiomas are uncommon benign vascular malformations which may present intraoperative difficulties in hemostasis when the diagnosis is not suspected preoperatively. Preoperative diagnosis can be difficult when angiomas show atypical features and share imaging characteristics with other entities. METHODS: A patient presented with a radiographically aggressive lesion, subsequently identified as a dural cavernous angioma. The lesion is reviewed and its clinical, radiographic, and pathological features are compared with other vascular malformations. CASE REPORT: A 40-year-old man presented with new onset seizures and an enhancing lesion infiltrating the floor of the right middle cranial fossa. Due to its aggressive radiographic appearance, initial considerations included chondrosarcoma, meningioma or metastasis. Pathological examination, however, revealed the lesion to be a cavernous angioma of dura. CONCLUSION: This uncommon lesion may present a diagnostic challenge with significant intraoperative implications. T2 sequence hyperintensity in a relevant lesion should raise suspicion of an hemangioma. It is important to be aware of this entity and its potential to mimic other entities on radiographic grounds.

Adult↗
PubMed1982

Arteriovenous malformations.

Cerebral AVM's consist of an abnormally large connection between the arterial and the venous systems resulting in a wide variety of configurations, which are grossly subdivided into five types. Emphasis is given to the basic surgical principles of first understanding the nature of the lesion; second, having a thorough preoperative awareness of the vascular architecture from stereo angiography; and third, using standard, common sense, surgical maneuvers followed most importantly by intraoperative assurance of the complete removal by repeat serial angiography.

Capillaries↗
PubMed1985

Maternal and neonatal responses related to the volatile agent used to maintain anaesthesia at caesarean section.

A standardized technique of general anaesthesia, with one randomly selected variable, was provided for 237 patients undergoing elective and 540 undergoing emergency Caesarean section. The variable was the volatile agent used to maintain anaesthesia, the choice resting between trichloroethylene (0.2 or 0.3 vol.%) and halothane (0.2, 0.3, 0.4 or 0.5 vol.%). No association was found between the type of agent and the duration of anaesthesia, or the duration of either the I-D or the U-D interval. A smaller total dose of suxamethonium was administered in conjunction with the higher concentrations of volatile agent. A statistically significant but clinically unimportant increase in the time elapsing from the cessation of anaesthesia to maternal achievement of a "safe level of consciousness" was found with the higher concentrations. The incidence of maternal awareness plus unpleasant dreams was unacceptably high when the lower concentrations were used, and it is recommended that either trichloroethylene 0.3 vol.% or halothane 0.4 or 0.5 vol.% be used. Neither agent, at these concentrations, was associated with neonatal depression in group A elective sections in which the fetus presented by the vertex, and although there was a possible tendency for their use in cases of fetal compromise to be associated with an increase in the incidence of neonatal respiratory depression, the degree of depression was of little consequence to neonatal well-being. It was confirmed that breech presentation and prolongation of the U-D interval are important determinants of depression and birth asphyxia among infants delivered by Caesarean section under general anaesthesia.

Anesthesia, General↗
PubMed2003

Detection of awareness in surgical patients with EEG-based indices--bispectral index and patient state index.

BACKGROUND: Patient state index (PSI) and bispectral index (BIS) are values derived from the EEG, which can measure the hypnotic component of anaesthesia. We measured the ability of PSI and BIS to distinguish consciousness from unconsciousness during induction and emergence from anaesthesia and a period of awareness in surgical patients. METHODS: Forty unpremedicated patients were randomized to receive: (1) sevoflurane/remifentanil (< or =0.1 microg kg(-1) min(-1)), (2) sevoflurane/remifentanil (> or = 0.2 microg kg(-1) min(-1)), (3) propofol/remifentanil (< or =0.1 microg kg(-1) min(-1)), (4) propofol/remifentanil (> or = 0.2 microg kg(-1) min(-1)). Every 30 s after the start of the remifentanil, patients were asked to squeeze the investigator's hand. Sevoflurane or propofol were given until loss of consciousness (LOC1). Tunstall's isolated forearm technique was used during neuromuscular block with succinylcholine. After tracheal intubation, propofol or sevoflurane were stopped until return of consciousness (ROC1). Propofol or sevoflurane were re-started to induce LOC2. After surgery, drugs were discontinued and recovery (ROC2) was observed. PSI and BIS at LOC (LOC1 and LOC2) were compared with those at ROC (ROC1 and ROC2) (t-test). Prediction probability (P(k)) was calculated from values at the last command before and at LOC and ROC. Values are mean (SD). RESULTS: At non-responsiveness, BIS (66 (17)) and PSI (55 (23)) were significantly less than at responsiveness (BIS, 79 (14); PSI, 77 (18); P<0.05). The wide variation with both BIS and PSI measurements of the 80 'awareness' values led to an erroneous classification as unconscious in some cases (BIS, six patients; PSI, nine patients). P(k) was 0.68 (0.03) (BIS) and 0.69 (0.03) (PSI). CONCLUSIONS: Despite significant differences between mean values at responsiveness and non-responsiveness for BIS and PSI, neither measure may be sufficient to detect awareness in an individual patient, reflected by a P(k) less than below 70%.

Adult↗
PubMed1997

Patients' memories of events during general anaesthesia.

Awareness remains a serious complication of general anaesthesia with potential adverse psychological sequelae. Even during seemingly adequate general anaesthesia, implicit memory may be retained along with the ability to subconsciously process auditory stimuli. As a result behaviour may be modified and postoperative progress influenced. We shall discuss the structure of memory and the effects of increasing doses of general anaesthesia on cognitive processes. In addition methods of assessing the depth of anaesthesia will be reviewed.

Anesthesia, General↗
PubMed2005

Dreaming during anaesthesia in children: incidence, nature and associations.

In previous studies, the incidence of dreaming during anaesthesia in children was reported to be between 9.7% and 19%. These limited studies were performed over 15 years ago using outmoded anaesthetic techniques. No recent studies have examined the nature of dreaming or its impact on children. In this prospective cohort study of 864 children, we determined the incidence, nature, predictors and behavioural consequences of children who reported dreaming during anaesthesia. Children aged 5-12 years who had undergone general anaesthesia were interviewed for dreaming on three occasions. Dreaming was reported by 10.4% of children. The content of the dreams was mostly pleasant and unrelated to their hospital experiences. Dreaming was more common in younger children and in children who had also experienced awareness during anaesthesia. No association was found between dreaming and the anaesthetic drugs used. Dreaming was not associated with an increased risk of behavioural disturbances postoperatively. Anaesthetists should be reassured that dreaming is a common occurrence that does not appear to distress children.

Age Factors↗
PubMed2004

Comfortably numb?

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Anesthesia, General↗