1/8. hypnosis instead of general anaesthesia in paediatric radiotherapy: report of three cases.PURPOSE: This report proposes hypnosis as a valid alternative to general anaesthesia for immobilisation and set-up in certain cases in paediatric radiotherapy. methods: We report three cases of children who underwent radiotherapy in 1994 and were treated using hypnosis for set-up during irradiation. The first and the second were two cases of macroscopic resection of cerebellar medulloblastoma in which craniospinal irradiation was necessary, while the third patient suffered of an endorbitary relapse of retinoblastoma previously treated with bilateral enucleation, radiotherapy and chemotherapy; in this last situation the child needed radiation as palliative therapy. hypnosis was used during treatment to obtain the indispensable immobility. Hypnotic conditioning was obtained by our expert psychotherapist while the induction during every single treatment was made by the clinician, whose voice was presented to the children during the conditioning. RESULTS: Every single fraction of the radiation therapy was delivered in hypnosis and without the need for narcosis. CONCLUSIONS: hypnosis may be useful in particular situations to prepare paediatric cancer patients during irradiation, when lack of child collaboration might necessitate the use of general anaesthesia and when anaesthesia itself is not possible.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/8. Management of the pelvic recurrence of rectal cancer with radiofrequency thermoablation: a case report and review of the literature.INTRODUCTION: The results of rectal cancer surgery are limited by the development of local recurrence (LR) that represents a great challenge to the surgeon. In the presence of unfavourable conditions for performing a curative operation, various forms of palliative treatment are indicated to control the patient's symptoms and the disease's complications. Recently, radiofrequency thermoablation (RFTA) has become a complimentary alternative therapy for malignant inoperable liver tumours. The present paper reports the use of RFTA in the management of pelvic recurrence of rectal adenocarcinoma. CASE REPORT: Fourteen months after abdominoperineal resection, a 32-year-old woman began to complain of progressive pelvic and lumbar pain. A large pelvic mass was found and serum CEA was elevated (66.4 ng/ml) at that time. Due to the dimensions of the presacral tumour (8 x 5 x 4 cm3) and the associated refractory pain, the patient underwent RFTA of the recurrent disease. Under epidural anaesthesia, a computed tomography-guided percutaneous needle electrode was introduced into the tumour. Although the procedure provided immediate pain control, the patient developed an intestinal obstruction 3 months later. This complication required surgical treatment to release adherences from the necrosed tumour. CONCLUSION: Apart from this complication, RFTA allowed prolonged relief of the pelvic pain and improved quality of life. Faced with an unresectable pelvic recurrence, RFTA proved to be a viable option for controlling pain, although a relatively high cost and eventual complications may limit its use.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
3/8. Gastric rupture after awake fibreoptic intubation in a patient with laryngeal carcinoma.An 86-yr-old man with recurrent laryngeal carcinoma developed gastric rupture after awake fibreoptic intubation before induction of general anaesthesia. Early clinical signs included a distended, tense and tympanic abdomen with pain and massive pneumoperitoneum (chest radiograph). laparotomy revealed a 4-cm longitudinal perforation along the lesser curvature of the stomach. This case represents a rare but severe complication that may occur during fibreoptic intubation in the awake patient.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
4/8. Endoscopic management of craniopharyngiomas: a review of 3 cases.The authors describe the endoscopic management of cystic craniopharyngiomas in 3 cases. This method has been attempted in cystic craniopharyngiomas using a rigid endoscope. The instrument has been described earlier (7-9). All these operations were done under general anaesthesia. Criteria for endoscopic extirpation and removal included type D, E, F classification according to Yasargil (17). All 3 cases fitted in the F category. There were one female and two male patients. In the female patient an aspiration of cyst contents was performed as a first attempt to relieve her hydrocephalus. Two months later recurrent symptomology necessitated a larger intervention. All cysts were opened using the laser, drained by a Fogarthy balloon-catheter, and the capsule removed by forceps. This technique is safe and provides a reasonable alternative to open microsurgery, radioactive isotope instillation, or radiotherapy. In our series we achieved total removal in one case after the second intervention and partial removal in two cases. There was no mortality directly associated with this procedure and the female patient developed severe electrolyte disturbances after macroscopic total removal. Our results suggest that endoscopic of management of cystic craniopharyngiomas is a safe and effective procedure which could be considered as the initial management for cystic craniopharyngiomas of the intraventricular type.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
5/8. Thermoradiotherapy with combined interstitial and external hyperthermia in advanced tumours in the head and neck with depth > or = 3 cm.Advanced tumours in the head and neck 3-6 cm depth are too deep to be completely heated by external 915 MHz microwaves. A preliminary study was performed using interstitial plus external hyperthermia combined with external beam radiation therapy to heat tumours to depths > or = 3 cm. Nine advanced metastatic lesions of squamous cell carcinoma located in the head and neck were treated between 1987 and 1990 with the combined hyperthermia technique and radiation doses of 38-60 Gy (mean of 49 /- 3 Gy). The mean tumour volume was 58 /- 9 (SE) cm3 (range 24-94 cm3) with a mean tumour depth of 3.9 /- 0.3 cm (range 3-5.5 cm). The deeper aspects of the tumour were heated by interstitial 915 MHz microwave antennas and the superficial aspects heated by external 915 MHz applicators. A single plane of polyurethane closed-end catheters, 16 Ga, were inserted under local anaesthesia approximately 1.5-2 cm apart in parallel arrays at the base of a lesion behind the sternomastoid muscle, or an equivalent site in a dissected neck, extending forward and angled deeply no more than 15 degrees. Hyperthermia was administered twice weekly immediately after radiation therapy in a mean of 5.3 /- 0.7 external heat sessions (range 3-7) and a mean of 3.5 /- 0.6 interstitial heat sessions (range of 1-6). Interstitial hyperthermia was usually administered in alternating sessions with external hyperthermia, but in some patients all of the sessions of one modality were administered followed by all of the sessions of the other modality. In no case were both interstitial and external heatings performed on the same day. Surface thermometers were used to monitor skin temperature during external hyperthermia sessions. Results showed that by 8 weeks after completion of treatment, six lesions exhibited a complete response (67%) and three a partial response (33%). One of the partial responses continued to regress and became a complete response (78% complete response). The recurrence rate in complete responders was 14% (1/7) with time to recurrence of 7.7 months. Six lesions were recurrence-free at last follow-up of 21.3 /- 8.8 months. Skin reactions were absent in four fields (44%), erythema was noted in five (56%) and thermal blistering in one (11%). Ulceration occurred only in association with tumour breakdown when the skin was infiltrated by tumour (three patients, 33%).(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
6/8. Technical note: interstitial laser photocoagulation for the treatment of prostatic cancer.Interstitial laser photocoagulation (ILP) is a new percutaneous technique for local ablation of deep-seated tumours. We have applied this to treat a focal abnormality in a patient with prostatic carcinoma, under local anaesthesia and sedation. Transrectal ultrasound and computed tomography (CT) were used to guide three 18G needles, inserted transperineally, into the abnormal area. A thin (0.8 mm outer diameter) optical fibre was passed down each needle, so that the tip of the fibre lay within the tumour. The other end of the fibre was connected to a portable diode laser, which was activated at 2 W for 500 s. Real-time monitoring with ultrasound showed a gradually enlarging echogenic zone around the fibre-tip and a marked increase in colour Doppler signal; the echogenicity and Doppler signal decreased within a few minutes of completing treatment. Dynamic CT treatment 10 days later showed the treated area as a non-enhancing, avascular zone. Biopsies from this region confirmed the presence of necrosis. There were no complications. ILP appears to be a safe and effective way of ablating areas of focal abnormality in the prostate.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
7/8. Endoresection of choroidal melanoma.AIMS: The results of 52 endoresections for choroidal melanoma are reported. methods: The current technique involves vitrectomy, retinal incision over or peripheral to the tumour, haemostasis by raising intraocular pressure and by moderate hypotensive anaesthesia, choroidal incision around tumour, endoresection with vitrector, endodiathermy to bleeding points and residual tumour, fluid-air exchange to reattach retina, endolaser to achieve retinal adhesion around the coloboma and destroy residual tumour in the sclera, silicone oil injection with removal after 12 weeks, cryotherapy to the sclerotomies, and adjunctive ruthenium plaque radiotherapy in selected cases. RESULTS: patients receiving primary endoresection had a mean age of 53 years, a mean largest basal tumour diameter of 8.2 mm, and a mean tumour thickness of 3.9 mm. 40 tumours extended to within 2 disc diameters of the optic disc, with 17 involving disc. Follow up ranged from 40 days to 7 years (median 20 months). At the last visit, 90% of eyes were retained, with vision of 6/6-6/12 (two), 6/18-6/36 (three), 6/60 to counting fingers (18), hand movements (nine), and light perception (four). The main complications were retinal detachment in 16 and cataract in 25. Secondary endoresection (11) was performed after plaque radiotherapy (four), photocoagulation (four), trans-scleral local resection (two), and proton beam radiotherapy (one), with retention of the eye in nine cases. By the close of the study, no patients developed definite local tumour recurrence but one died of metastatic disease 41 months postoperatively. CONCLUSION: Depending on tumour location, endoresection may conserve central vision or temporal field when radiotherapy would be expected to cause optic neuropathy. Longer follow up is necessary to establish the efficacy of tumour control.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
8/8. Multiple papilloma of the larynx in an adult--a case report.Multiple papilloma of the larynx commonly affects the juvenile subjects. Only a few adult cases have been reported. Such a rare case in bangladesh, is reported here. Twenty five years old one male patient was admitted into Sir Salimullah Medical College & Mitford Hospital with the complaints of hoarseness of voice & dysponea. He was diagnosed as papilloma clinically and histopathologically, and treated with tracheostomy & microlaryngoscopic excision of the masses. The patient was readmitted after 3 months with recurrence of papilloma at the same site and the growth was excised under anaesthesia. The past history of his illness revealed that he underwent to more surgeries for the same condition. The patient was lost to follow up.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |