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Twelve elderly patients were studied whilst undergoing major surgery and anaesthesia. Plasma cortisol levels increased significantly in all patients whilst 9 of the 12 excreted increased quantities of urinary 17-OHCS. Intra-abdominal surgery provoked a greater response than major surgery outside the abdominal cavity. It was concluded that the adrenocortical response to major surgery and anaesthesia was well preserved in these patients.

Changes in temperature and body heat were measured in 30 patients. Despite the warming of most fluids given intravenously, all the patients ventilated with dry anaesthetic gases became cooler, with an average heat loss of 12.4 kilocalories per hour. In a group to whom the gases were delivered saturated at body temperature, the average hourly loss was 1.5 kilocalories. This difference is in agreement with the effects calculated from respiratory heat exchange, and indicates that heated humidification can help to limit or prevent the development of hypothermia in anaesthetized adults.

Introduction: This small study relates our early experiences with the Limbal Relaxing Incision (LRI) for management of astigmatism in patients undergoing cataract surgery. Aims: To evaluate the efficacy of LRI in the management of primary astigmatism when combined with phacoemulsification. Subjects and methods: Limbal relaxing incisions were performed to correct primary astigmatism in 12 eyes of 12 cataract patients who underwent phacoemulsification as the primary procedure. The length and number of incisions were determined using the AMO LRI calculator software programme using Donnenfield and NAPA nomograms. Keratometric astigmatism was measured preoperatively and postoperatively on day 1 and after 3 weeks or more. Surgically-induced astigmatism (SIA) and the intended angle of error were evaluated by the vector analysis method. Preoperative and postoperative uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity (BSCVA) were evaluated in each visit. Results: The mean age of patients was 52.92 ±10.91 years. There were 75 % male and 25 % female patients. The mean keratometric preoperative astigmatism was 2.08 ±1.05 diopter. The mean 1st postoperative day keratometric astigmatism was 1.74 ±1.32 diopter and the mean final keratometric astigmatism at 3 weeks postoperatively was 1.05± 0.68 diopter. The mean SIA on the 1st postoperative day was 2.97 ±1.72 diopter at 103.25±56.57 degree with intended angle of error 6.53±9.61 degree. The mean SIA on the 3rd postoperative week was 2.26±0.87 Diopter at 107.08±49.96 degrees with intended angle of error 2.90±7.87 degrees. Conclusion: Limbal relaxing incisions are effective method to reduce postoperative astigmatism with good predictability of intended angle. Keywords: limbal relaxing incision (LRI); uncorrected visual acuity (UCVA); surgically induced astigmatism (SIA); angle of error; target astigmatic treatment (TAT) DOI: 10.3126/nepjoph.v1i2.3681 Nep J Oph 2009;1(2):90-94

Background: Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. Objectives : 1) To assess the utility of intraoperative smear cytology and correlate with the final histopathological diagnosis. 2) To describe the cytomorphological features of common brain tumours in smear preparation. Materials and methods : The material for this study was obtained from 100 consecutive biopsies of central nervous system neoplasms sent for intraoperative consultation. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing. The smears were stained by the rapid Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with paraffin section findings. Results : Of the total 100 cases, 86 showed accuracy when compared with histopathological diagnosis. This was comparable with other studies. Of the remaining, two cases were frank errors, 12 cases showed partial correlation, with five cases showed incomplete typing of the cell type and seven, discrepancy in grading of tumours. The error percentage was 14%. Correlation with clinical details and radiological findings were helpful in improving the accuracy rate. Conclusions : Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible and cost effective tool to diagnose brain tumours. Smear cytology is of great value in intraoperative consultation of central nervous system pathology. Key words: Intraoperative consultation, smear cytology, central nervous system neoplasms doi: 10.3126/kumj.v6i4.1734 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 453-457

During relatively minor surgical procedures under halothane anaesthesia, an increase in plasma protein-bound iodine concentration was observed. In patients previously given thyroxine labelled with radio-iodine, plasma radioactivity concentrations also increased. There was a concomitant decrease in radioactivity in the liver. The results suggest that anaesthesia leads to a progressive discharge of protein-bound thyroxine from the liver into the plasma. The effect is believed to be reversible.

In 10 Nigerian patients undergoing upper abdominal surgery the plasma cortisol concentration was slightly decreased after premedication with pethidine and atropine, and during anaesthesia without surgery. There was a small increase during surgery. None of these changes was statistically significant. There was a significant increase in the postoperative period however. Premedication caused a slight increase in blood sugar which remained steady during anaesthesia. There was a significant increase after 30 and 60 min of surgery, with a peak value at 60 min after operation. There were no significant changes in the mean values of plasma insulin concentration throughout the period of study.

Airway temperatures and humidities were examined during adult anaesthesia before and after use of a heat-and-moisture exchanger (HME). The unmodified anaesthetic circuits delivered gases at room temperature, with three levels of relative humidity. End-phase temperatures and absolute humidities were higher with the HME in circuit, most noticeably when the inspired gases were saturated. Use of the HME with a dry non-rebreathing system gave minimal improvement in the end-inspired humidity of gases entering the trachea, and the respiratory heat loss remained high.

The intraocular pressure in relation to different inspired halothane concentrations was investigated in ten patients under general anaesthesia utilizing a muscle relaxant (pancuronium bromide) and nitrous oxide. Pulmonary ventilation was controlled in such a way that the end-tidal carbon dioxide concentration remained constant and within physiological limits. In every patient the intraocular pressure decreased a halothane was administered and then returned to the initial level when the adminstration of halothane ceased.

Arterial blood was sampled from 10 anaesthetized, spontaneously breathing patients before, during and after pelvic laparoscopy using N2O as the insufflating gas. There was little change in Paco2 during the procedure. With an inspired oxygen concentration of approximately 37%, the mean Pao2 decreased during laparoscopy from 163 mm Hg (±24 mm Hg) to 146 mm Hg (±28 mm Hg). In the postoperative period, with the patients breathing room air, the mean Pao2 was 78 mm Hg (± 10 mm Hg). In 2 other patients, who were heavy smokers, arterial Pao2 decreased to less than 100 mm Hg during laparoscopy and the mean Pao2 in the postoperative period with the patients breathing room air was 49 mm Hg (±0.07 mm Hg). One of these patients had significant airflow obstruction and impaired gas transfer. It is concluded that spontaneous ventilation during pelvic laparoscopy may be unsuitable for patients with lung disease, and that arterial hypoxaemia may occur in patients with apparently normal lung function.

Cardiovascular anomalies associated with tetralogy of Fallot in 161 patients are reported. Eighty-four associated anomalies were identified in 61 patients. The difficulty of clinical recognition of many of the 20 different defects is stressed. Patent foramen ovale and patent ductus arteriosus occurred frequently, especially during infancy. The common anomalies of the systemic veins and arteries included persistent left superior vena cava, aberrant left subclavian artery and congenital abnormalities of the coronary arteries. Pulmonary valvular and arterial abnormalities were common, including absence of the pulmonic valve, pulmonary artery branch stenosis and absence or hypoplasia of the left pulmonary artery. Secundum atrial septal defects were identified in 5 patients. The surgical implications of these anomalies are discussed.

Eight patients developing coronary ostial stenosis following Starr-Edwards aortic valve placement are reviewed. Coronary perfusion with a balloon tip perfusion catheter was performed during the intraoperative period on all patients and was considered technically satisfactory. Angina pectoris developed within six months of surgery in seven of eight patients and left main coronary artery occlusive disease was demonstrated in each of these cases. One patient who did not develop angina pectoris had right coronary artery narrowing without intraoperative perfusion of this vessel. All patients were reoperated, five survived, two are free of symptoms. Coronary ostial stenosis is a clinically recognizable complication of aortic valve replacement with potential for surgical correction.