1/2. An unusual complication of minitracheostomy.A 72-year-old woman had a minitracheostomy inserted for sputum retention. This was undertaken by a relatively junior resident who opted to use an early model minitracheostomy kit Minitrach II. The following day the patients condition deteriorated and intubation was warranted, at which time it was apparent to senior staff that the minitracheostomy had been malpositioned. Ten days later, formal tracheostomy was performed under general anaesthesia. After incision, an abscess in the thyroid gland was found. histology subsequently revealed a Hurthle cell tumour of the thyroid. Thyroid abscess is exceedingly rare. It typically occurs in abnormal thyroid tissue and with a focus on infection. The combination of Hurthle cell adenoma and a foreign body (the minitracheostomy) was evidently causative in this instance. This complication of minitracheostomy insertion has not to our knowledge, previously been reported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. The use of bank sclera to correct lid retraction.Twenty-two scleral grafts were inserted in patients with retracted lids, the youngest patient was two years old at time of surgery. Two patients were operated on under local anaesthesia and the remainder under general anaesthesia. In the patients with thyroid disease larger grafts were required, the temporal side of the graft being 3 mm greater vertically than the nasal. Our first cases were undercorrected, so we used grafts of a size at least twice that required to lower the lid. Other complications were rare. For ptosis overcorrections, and congenital lid retraction, the graft should be 2 mm bigger horizontally and vertically than the amount required to lower the lid.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |