REVIEW OF ANAESTHESIA AND ANALGESIA IN THE FIELD WITH EMPHASIS ON AIRBORNE MILITARY OPERATIONS

The purpose of this article is to discuss various factors associated with successful handling of mass casualties in the field with special reference to the airborne military operations. Various limitations specific to airborne operations are highlighted. Stress is laid on the importance of variables as they effect medical support and planning. Various analgesics, both opiates and non opiates including role of subanaesthetic doses of ketamine are discussed. Adequate knowledge and experience in wide ranging field techniques including improvisations is stressed. The facts are placed in a specific, original context through which new insight can be derived. The feasibility of incorporating light weight modern equipments in field anaesthesia are also brought out.KEY WORDS: Analgesia, Field anaesthesia, Ketamine, Mass disaster     

Prevalence and characteristics of aquagenic pruritus in a young African population

Background

The internet is an increasingly important tool for physicians, but the extent to which it is used by dermatologists is unknown. We aimed to investigate the utilization of the internet by dermatologists in Saudi Arabia for medical purposes during their daily practice and to clarify the reasons for its use and non-use.

Methods

A self-administered questionnaire was distributed to all 160 dermatologists attending the National Dermatology conference in 2007.

Results

A total of 107 questionnaires were completed. Sixty-two percent of respondents had access to the internet in the workplace. The use of the internet to update medical knowledge was reported by 91%. Only 27% had internet access in consultation rooms. The majority of information retrieval occurred outside patient consultation hours (91%). Only 13% reported using the internet during patient consultation. Possible reasons included: lack of access (54%), time pressure (37%), possible interference with the physician-patient relationship (30%), and that use of the internet was too time-consuming (10%). The mean searching time used to solve a clinical problem was 34 ± 3 minutes. Fifty-eight percent used Pubmed; however, 77% of the dermatologists had no training at all in how to use this tool.

Conclusion

Professional medical use of the internet is widespread among dermatologists in Saudi Arabia. Providing access to the internet in the workplace and training of dermatologists to perform effective electronic searches are badly needed to improve the professional medical use of internet, which is expected to lead to better delivery of patient care.     

LATERAL APPROACH : A BETTER TECHNIQUE FOR SPINAL ANAESTHESIA IN THE MODERN ERA

The most commonly used technique in routine spinal anaesthesia practice is the midline approach, compared to the lateral or paramedian approach. With the better understanding of the technique and introduction of fine gauge spinal needles, this practice needs a rethinking. Lateral approach was used in 60 patients undergoing different surgical procedures below the umbilicus, using 24 or 25 gauge, Quincke spinal needle without an introducer. The result was gratifying. In 77% of the cases the subarachnoid space could be entered in the first attempt. There was no failure. No patient complained of postdural puncture headache or post operative backache. Only one patient reported paraesthesia during needle placement without any residual effect. Various other advantages of the technique are discussed. Thus with due practice, lateral approach is found to be superior in modern day spinal anaesthesia.KEY WORDS: Anaesthetic technique, Backache, Headache, Lateral approach, Spinal     

腹腔镜胆囊切除围手术期处理73113例

0 引言我院在1992-02/2004-12运用电视腹腔镜施行胆囊切除术(以下称LC)73113例,取得了满意效果,总结出一些规律,理论上有了新认识,实践工作中创出了独特的手术操作方法,形成了一整套围手术期的治疗规范.拓宽了适应证,并发症明显减少,现报告如下:     

Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage: an updated systemic review and meta-analysis

Introduction  

Previous meta-analyses of magnesium sulphate infusion in the treatment of aneurysmal subarachnoid hemorrhage (SAH) have become outdated due to recently published clinical trials. Our aim was thus to perform an up-to-date systemic review and meta-analysis of published data on the use of magnesium sulphate infusion in aneurysmal SAH patients.     

Asymptomatic bacteriuria in pregnancy in Port Harcourt

ObjectiveTo determine the prevalence of asymptomatic bacteriuria in pregnancy, to consider the antimicrobial sensitivity patterns of involved uropathogens, to elucidate the safety profiles of antibacterial agents, and to evaluate the role of urinalysis in screening for asymptomatic bacteriuria.MethodsAbout 760 apparently healthy pregnant subjects attending the Antenatal Clinic of the University of Port Harcourt Teaching Hospital were randomly selected for this study. Urinalysis and microscopy, culture, and sensitivity tests were carried out on clean-catch midstream urine samples obtained from subjects. Biochemical reagent strips were used for urinalysis while the standard wire loop and agar diffusion technique were respectively employed for culture and susceptibility testing.ResultsA total of 111 samples yielded moderate or severe growth on culture after 48 hours comprising 35, 31, 27, and 18 isolates of Staphylococcus spp., Proteus spp., Klebsiella spp., and Escherichia spp, respectivehy. Urinalysis results were positive for the presence of nitrate reductase and leucocyte esterase activity in 17 urine samples of these 111 samples. The isolates showed a general sensitivity to the fluorinated quinolones and to Nitrofurantoin.ConclusionsThe prevalence of asymptomatic bacteriuria is 14.6%, with the predominant organism being Staphylococcus spp. Drugs used for treatment should have excellent fetal safety profiles, and a rapid screening test with a high negative predictive value for asymptomatic bacteriuria would be ideal.     

Unusual loss of body hair in childhood: Trichotillomania or alopecia

Hair loss (alopecia) is a relatively common problem in childhood and the underlying pathophysiology and manifestations are diverse. We report four cases of hair loss with unusual distributions and discuss the outcome of their management.One child had alopecia with unilateral loss of hair over the eyebrow. He received topical corticosteroids and tacrolimus and his condition resolved. A girl had scalp alopecia which evolved to alopecia universalis. The mother and the child were non-compliant with treatment. A boy had alopecia totalis not responsive to Western or alternative treatment. The fourth child had trichotillomania and bizarre loss of scalp hair. Mother and child received psychological counselling and the child's hair loss improved. It is important to differentiate between alopecia and trichotillomania as the management is very different. Diagnosis and treatment are based on clinical assessment, evaluation of coexisting psychosocial factors and exclusion of autoimmune and other underlying disorders. In alopecia totalis or universalis, alternative therapy is often sought and tried for prolonged periods but efficacy has remained unproven. These cases serve to illustrate the principles of management of children with unusual patterns of hair loss.