Esmarch tourniquet in orthopaedic surgery

2007 ◽  
Vol 37 (3) ◽  
pp. 139-141 ◽  
Author(s):  
A L Akinyoola ◽  
L M Oginni ◽  
E A Orimolade ◽  
O J Ogundele

A bloodless field is important in many orthopaedic operations necessitating the use of a pneumatic tourniquet or Esmarch bandage. The outcome of the use of an Esmarch bandage for exsanguination and as a tourniquet in 112 consecutive patients who had elective orthopaedic operations on 131 limbs was evaluated. The setting was at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, from March 2003 to February 2005. The mean age of the patients was 25.7 + standard deviation years (range 1-70 years). The duration of tourniquet application ranged from 20 min to 2 h 35 min. Four limbs (3.1%) developed acute compartment syndrome; four (3.1%) had tourniquet paralysis with ulnar nerve involvement in three limbs. All limbs regained full neurological function following physiotherapy. There was wound infection in two limbs (1.5%). In spite of its drawbacks, the Esmarch bandage is still useful for exsanguination and as a tourniquet in orthopaedic surgery where there is no pneumatic tourniquet.

2013 ◽  
Vol 37 (6) ◽  
pp. 207-209
Author(s):  
Adam Moreton ◽  
Andrew Collier

Aims and methodTo determine the provision of teaching in psychiatry for foundation doctors up to the point of making specialty applications. Data for the cohort of foundation doctors entering training in 2010 were collected from teaching programmes across the Mersey Deanery and North Western Foundation Schools.ResultsIn the 17 hospitals that provided data, ‘protected teaching’ totalled 2354 h; 1.8% of time was dedicated to psychiatry, with 4 hospitals providing no teaching on mental health topics. The mean duration of psychiatry teaching was higher in university teaching hospitals (3 h 34 min) than district general hospitals (2 h 57 min); and almost a quarter of teaching sessions were titled only ‘psychiatry’.Clinical implicationsFor many foundation doctors their only experience of psychiatry will be through teaching sessions, and this is potentially the only time to change opinions and build interest in the specialty. Psychiatrists need to take a more active role in the provision of high-quality teaching for foundation doctors and become the visible role models which are currently lacking.


2020 ◽  
Vol 162 (10) ◽  
pp. 2303-2311
Author(s):  
Martin N. Stienen ◽  
◽  
Christian F. Freyschlag ◽  
Karl Schaller ◽  
Torstein Meling

Abstract Background In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443). Conclusion The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency.


2021 ◽  
Vol 21 (1) ◽  
pp. 437-44
Author(s):  
Bolajoko A Adewara ◽  
Sarat A Badmus ◽  
Olukemi T Olugbade ◽  
Edak Ezeanosike ◽  
Bernice O Adegbehingbe

Background: Phthisis bulbi is an irreversible cause of visual loss with insufficient evidence about its aetiology and status of patients’ fellow eyes. Objectives: To identify the distribution of patients with phthisis bulbi and determine the status of their fellow eyes at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Methods: We analysed data retrospectively retrieved from medical records of patients diagnosed with phthisis bulbi at in- itial clinic visit from January 2008 to December 2017. Information abstracted included biodata, laterality of phthisical eye, duration and aetiology of phthisis bulbi, visual acuity, and morbidities present in fellow eyes. Results: Seventy-nine patients presented with unilateral phthisis bulbi. The mean age was 51±21.2 years and forty (50.6%) were males. The commonest aetiologies of phthisis bulbi were trauma 37 (46.8%), infection 17 (21.5%) and uveitis/inflam- mation 11 (13.9%). Seventy (88.6%) patients had morbidities in their fellow eye such as glaucoma 26 (32.9%), refractive errors 23 (29.1%) and cataract 22 (27.9%). Forty (50.6%) patients were either visually impaired or blind in their fellow eye (p=0.001). Conclusion: The commonest cause of phthisis bulbi was trauma. Approximately nine out of ten patients had ocular mor- bidities in their fellow eye. A thorough follow-up of patients with phthisis bulbi is recommended. Keywords: Fellow eye; Nigeria; ocular trauma; distribution; phthisis bulbi.


2017 ◽  
Vol 38 (2) ◽  
pp. 189-193 ◽  
Author(s):  
Ibraheem Olayemi Awowole ◽  
Olusegun Olalekan Badejoko ◽  
Oluwafemi Kuti ◽  
Omotade Adebimpe Ijarotimi ◽  
Oluwaseun Oludotun Sowemimo ◽  
...  

Author(s):  
A. Oyaromade ◽  
B. A Muhammad ◽  
A. Omigbodun

Background: Although the frequency of twin pregnancies varies from one ethnic group to another, there has been a general trend toward an increase recently. Maternal and perinatal mortality are higher in twin than singleton pregnancies. Most studies on twinning had been done in university teaching hospitals where conditions are different from what is seen in secondary-care health institutions where this study was done Objectives: To determine the incidence, mode of delivery and maternal and perinatal outcomes of twin deliveries at a secondary-level hospital in North-Western Nigeria. Methodology: This was a descriptive study of 96 twin deliveries over a three-year period between May 2013 and April 2016 at a secondary-level hospital with access to specialist obstetricians and paediatricians. Result: There were 4,567 deliveries, with 101 twin deliveries, an incidence of 2.2% or 1 in 45 deliveries. The mean maternal age and parity were 26.4 years and 3.2 respectively. The mean gestational age at delivery was 35.9 weeks, with a mean birth weight of 2.18kg and 2.01kg for the first and second twins respectively. Male twins constituted 53.2% of twin births. The common presentations of the twins were cephalic–cephalic (64.6%), cephalic–breech (16.7%) and breech–breech (6.3%). Mode of deliveries were vertex vaginal (77.1%) and caesarean (14.6%). Breech presentation of the leading twin was the commonest indication for caesarean section (57.1%). Anaemia in pregnancy (16.7%) was the commonest maternal complication, while prematurity was the leading cause of perinatal mortality. Conclusion: Preterm delivery, malpresentation, operative delivery and maternal anaemia in pregnancy were commonly seen in association with twin pregnancy in this cohort of patients.


Author(s):  
Akaninyene Eseme Ubom ◽  

Nigerian women of southwest extraction have the highest rate of dizygotic twinning worldwide, with a reported incidence as high as 49 per 1000 deliveries. Among the risk factors for dizygotic twinning is advanced maternal age, which is also an independent risk factor for Down syndrome (trisomy 21). Down syndrome is the most common chromosomal disorder affecting live born neonates. It occurs very rarely in twins, seen in 14-15 per million non-identical twins. Down syndrome in one of non-identical twins was first reported in Nigeria by Otaigbe in Port Harcourt, in 2007. Herein, we report another case of suspected Down syndrome in one of non-identical twins born to a 41-year-old grand multiparous woman at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria. Keywords: Down Syndrome; dizygotic; fraternal; dichorionic; diamniotic.


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