Destructive Surgeries Research Articles

Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital

Objective:To determine the indications and rate of acceptance for destructive eye surgeries at the ophthalmology unit of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital.Methods:A retrospective consecutive case series in which the medical records of all patients consulting in this unit over a 9-year period (2002 to 2010) were reviewed. Records in which destructive surgery was recommended were retained. Information collected included demographic data, eye affected, clinical diagnosis, acceptance or refusal of surgery, and the outcome in those in whom surgery was performed.Results:A total of 48 patients had a recommendation for destructive eye surgery, of whom 30 (62.5%) were males and 18 (37.5%) were females. Mean age was 43.78 (SD = 28.11; range 1 month to 91 years). Children <10 years comprised 23.10%. The leading causes were endophthalmitis/panophthalmitis (47.9%), neoplasm (20.8%), and absolute glaucoma (14.6%). Surgery was done in 20 cases (41.7%). Evisceration was the most performed surgical procedure (50%), with endophthalmitis/panophthalmitis and neoplasm combined accounting for 65% of surgeries.Conclusion:The high rate of refusal is an indication of the psychological devastation undergone by patients or the families of children in whom eye removal is recommended. Awareness should be raised on preventive measures and the need to rapidly seek eye care.

Changing trend in the causes of destructive eye surgery at Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria

Background : With improvement in preventive medicine and advancement in the management of otherwise morbid eye conditions, the reasons for destructive eye surgeries have changed overtime. Objectives : This study aims at determining the current indications for destructive eye surgeries and compares these to the findings of a similar study done in the same unit two decades earlier. Materials and Methods : It is a retrospective study of 278 cases of destructive eye operations performed at the Guinness Ophthalmic Unit of Ahmadu Bello University Teaching Hospital Kaduna from January 1991 to December 2000. Results : They were 152 eviscerations, 67 enucleations, and 59 exenterations. Tumors were responsible for the majority of destructive eye operations in the unit (31%). This was followed closely by endophthalmitis/panophthalmitis (30%). Others were trauma (23%), corneal disease (8%) and painful blind eyes (7%). Conclusion : They were noticeable changes in the indications for destructive eye operations especially for some infective and nutritional causes which are largely preventable.

Exploration of the postponing mechanism that delays carcinoma onset

The average age at onset of malignancies arising from epithelial tissues is between 40 and 70 years old even in familial cancers. Although it is believed that the accumulation of multiple genetic alterations is needed for cancer onset, we hypothesize--based on the diversity of ages at onset for most types of epithelial cancer--that there is a postponing mechanism inside the human body that significantly delays the process of carcinogenesis. The key molecules controlling the cancer onset, here called "postponers", are hypothesized to be functioning in the individuals carrying susceptibility genes. As a consequence, cancers occur in middle age or even old age, with several decades of cancer-free lifetime for the patient. Genome-wide association studies and genomic expression profiling are suggested to identify candidate postponers. Hypothetic gene expression patterns for identifying candidate postponers are illustrated. Animal models will be helpful to test whether the absence or presence of the postponer molecules can alter the onset age of spontaneous tumors. If this hypothesis is true, by amplification of the postponing mechanism we might be able to significantly delay the onset of tumors, so that individuals carrying cancer susceptibility traits could gain an additional significant period of cancer-free life. Moreover, destructive prophylactic surgeries, e.g., for women who have BRCA1/2 gene mutations, might be avoided.

Indications for surgical removal of the eye in adults: a five-year review

To determine the indications and procedures used for removing the eye in adults in our environment. A retrospective study of destructive ocular surgeries carried out between January 1999 and December 2003. Theatre and case records of adult patients that underwent surgical removal of the eye over a five-year period were reviewed. Clinical and histological diagnoses were obtained as well as type of surgery and personal data. Results were analysed using simple percentages. The most common indication for removing the eye in adults was due to trauma in 47 (45.6%) cases while evisceration was the most common surgery performed in 91 (88.3%) cases. Males were three times more likely to lose an eye than females. In 74.8% of cases, the loss of an eye was in young persons less than 50 years. The economically productive age group are more likely to lose an eye. The reason for the loss of an eye in most cases is largely avoidable. Lack of education on ways to prevent ocular injuries and improved access to eye care services requires urgent attention.

Ophthalmic surgical practice In Ilorin, Nigeria in the 1990s

The treatment of ocular morbidity to restore vision often requires surgery. This study was done to determine the frequency of such surgical interventions and the various types of ophthalmic surgery done at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. A retrospective review of all ophthalmic surgical procedures done in UITH between January 1990 and December, 2000 was carried out. The records were obtained from the operating theatre's register. Data analysis was with SPSS version 10. Within the study period, 1398 ocular surgeries were performed. Cataract surgery was the commonest (54.5%) and mostly performed in the 50-69 years age group; repair of corneal laceration was next (6.9%). The third most common surgery was pterygium excision (6.7%), common in the 30-69 years age group. Trabeculectomy for glaucoma was in the fourth position (6.2%). Destructive surgery (evisceration, enucleation and exenteration) was performed more in the paediatric age group. Cataract blindness is curable by surgery; the progression of glaucoma could be arrested with surgery. Early surgical intervention in ocular trauma would not only restore anatomical integrity but functional ability of the eye. The cataract surgical output could be improved upon by organizing outreach program and peripheral eye clinics. Use of protective eye shields by susceptible individuals would minimize ocular morbidity from trauma. Prompt referral of children with potential blinding eye injury or treatable ocular tumour would reduce the incidence of destructive surgeries in children. Keywords: ophthalmic surgeries, practice, Ilorin, Nigeria The Tropical Journal of Health Sciences Vol. 13(2) 2006: 31-34

Acute Spontaneous Hematotrachelos Following Methotrexate Treatment of a Suspected Tubal Pregnancy

Hematotrachelos, engorgement of the uterine cervix with retained blood, may represent congenital or acquired conditions. Congenital hematotrachelos may be associated with obstruction distal to the cervix in cons ditions that include imperforate hymen, complete transverse vaginal septum, and, rarely, agenesis of the vagina with cervical atresia. 1-3 In contrast, acquired hematotrachelos is usually associated with cervical stenosis as a result of destructive cervical surgeries, including cone biopsy and loop electrosurgical excision procedures performed in the clinical management of cervical dysplasia. 4-8 We report an unusual case in which the development of acute spontaneous hematotrachelos was sonographically depicted in a multiparous patient during a 5-week period in proximation with intramuscular methotrexate treatment of a suspected tubal pregnancy.

Destructive eye surgeries in Sagamu

In a retrospective hospital-based study, case records of all patients who had their eyes removed at Olabisi Onabanjo University Teaching Hospital, Sagamu (OOUTH) from January 2000 to December 2003 wer retrieved and reviewed. The age, sex, indications for surgery and type of surgery done were recorded. Twenty-nine patients had destructive eye surgeries during the study period. The mean age of the patients was 29.69±16.93 years (range 1 - 85 years). Male: female ratio was 3.1:1. Evisceration was the most common destructive operation performed (62.07 percent n=18) while the most common indication for eye removal was trauma (48.28 percent n=14) followed by panophthalmitis (20.69 percent n=6) and malignant tumors (13.79 percent n=4). Less common indications were expulsive haemorrahage (3.45%n=1) and painful blind eye (3.45% n=1). Ocular trauma with badly traumatized eye, panophthalmitis and malignant tumors were the most common causes of destructive eye surgery. Keywords : retrospective study, eye removal Nigerian Medical Practitioner Vol. 48(2) 2005: 4749

Evaluation of the patient for surgical intervention of vertigo

Proper patient selection is critical for success in surgically treating patients with vertigo. The highest cure rates are seen in the treatment of Menière's disease. Patients must be aware that destructive surgeries will substitute some degree of ataxia for the intractable vertigo they are experiencing. The highest success occurs when there is unilateral vestibular disease, no contraindications to surgery (such as central dysfunction), and realistic expectation for surgical outcomes. In some circumstances, bilateral Menière's disease is amenable to nondestructive intervention. The preoperative work for surgical intervention consists of audiometry, electronystagmography (ENG), and may include supplementary tests, such as rotational or posture platform testing. The audiogram, ENG, and history are the most helpful tests, with supplementary tests added to evaluate cases of bilateral disease or further define central disease.

Primary ocular prosthesis in patients undergoing evisceration, enucleation and socket reconstruction in north central Nigeria: A multi-center study

Background: Facial disfigurement especially of the eye can cause a lot of psychological impact on one's life. After evisceration or enucleation, primary ocular prosthesis (POP) not only provides immediate cosmetic rehabilitation, but also helps the individual regain self-confidence to resume normal life. The aim of this study was to assess the surgical outcome of evisceration and enucleation with POP in patients with endophthalmitis/panophthalmitis and allied conditions. Materials and Methods: This was a multi-center prospective study by the authors at three centers in Makurdi of patients undergoing destructive and socket reconstructive eye surgeries who had ocular prosthesis (OP [artificial eye]) inserted as a primary procedure from January 2010 to June 2014. Results: Eighteen patients had OP fitted at the operating table. There were 13 males (72%) and 5 females, with male to female ratio of 2.6:1. The median age was 45.5 years. Half of the patients 9 (50%) were farmers. Indications for surgery were infection 10 (55.6%), corneal degeneration 4 (22.2%) and one each had trauma, tumor, anophthalmos and shallow socket. Fifteen (83.3%) patients had evisceration. There were no postoperative infections during the follow-up period. There was small degree of enophthalmos in 16 (88.9%) and slight color mismatch in17 (94.4%). The OP movement with the fellow eye was fair in all the patients. Conclusion: Insertion of POP did not cause progression of infection in patients undergoing evisceration or enucleation. Where resources are not available for an orbital implant before prosthesis, POP can be fitted without the fear of progress of infection.