BACKGROUND: Hydrocephalus is a common neurosurgical problem in Port Moresby General Hospital (PMGH) contributing to 27 (24%) of the 114 neurosurgical operations done in 2003 and 2004. During the same period it was responsible for 25% of the cases seen in the neurosurgery clinic. AIM: To prospectively audit and follow up hydrocephalus cases in PMGH over 2 years from January 2003 to December 2004 and ascertain the causes and the outcome of treatment. METHOD: All cases of hydrocephalus seen in 2003 and 2004 were categorized according to cause. The associated findings on ultrasound scan or CT (computed tomography) scan when available were noted. The subsequent progress was documented with and without treatment for at least 6 months. RESULTS: 61 cases of hydrocephalus were seen for surgical opinion. The age ranged from 4 weeks to 56 years. The commonest age group affected was in the first year of life (61% of cases). There were 34 cases (56%) of congenital hydrocephalus followed by 19 (31%) post meningitis and 8 (13%) due to tumour. There was only one case of myelomeningocele with concomitant hydrocephalus. Ventriculoperitoneal (VP) shunts were inserted in 24 cases. 3 shunts were bypasses from the posterior horn to the cisterna magna, making a total of 27 shunt operations. 9 shunts were performed for post-meningitic hydrocephalus, 15 for congenital stenosis and 3 for a posterior fossa tumour. 24 out of the 27 shunt operations were in children aged <9 months. Post-VP-shunt infection of 2 cases reported within 6 weeks of operation gave an infection rate of 7%. There was cerebrospinal fluid (CSF) leak in 2 cases with Pundez-type shunts. There were 2 shunt blocks needing revision. CONCLUSION: Shunt operations can be done in PMGH with good outcomes. The decision-making about surgery can be made on the basis of the enlarging head and the ultrasound findings.
Hydrocephalus ; Creation of shunt ; seconds ; Surgical aspects ; Mores

BACKGROUND: Skull trepanation is an ancient art and has been recognized in many, if not most, primitive societies. Papua New Guinea came into contact with Europeans in the late 1800s and therefore it was possible for the art to be documented at a time when cranial surgery in Europe was still in its infancy. METHODS: A reviewof published articles and accounts of those who observed skull trepanation or spoke to those who had. Review of a video of trepanation as practised today in Lihir. FINDINGS: Richard Parkinson was a trader turned amateur anthropologist who was able to observe the surgical procedure being practised in Blanche Bay (New Britain). Trepanation was also witnessed by Rev. J.A. Crump in the Duke of Yorks. In New Britain the operation was performed for trauma but in New Ireland it was also employed on conscious patients for epilepsy or severe headache, particularly in the first five years of life. There was, however, a tendency to operate on frontal depressed and open fractures, rather than temporoparietal ones. Once the decision to operate was made the wound was irrigated in coconut juice and this was also used to wash the hands of the surgeon. Anaesthesia was not required as the traumatized patient was unconscious. The procedure is described and the tools included local materials such as obsidian, shark's tooth, a sharpened shell, rattan, coconut shell and bamboo. Of particular interest is the observation of brain pulsations and their relationship to a successful outcome. ASSESSMENT: The outcomes were good, in that 70% of patients were thought to survive, contrasting with a 75% mortality for cranial surgery in London in the 1870s. There is supporting evidence in that many trepanned skulls show evidence of healing and life long after the procedure was completed. Other societies have reported similar survival rates. The good outcomes may have been due to wise case selection as well as a high level of surgical skill following sound principles of wound debridement without necessarily being able to drain a haematoma.
Skull ; New ; Procedures ; Injury wounds ; Surgical aspects

Hiroshima General Hospital dates back to 1947. Initially it was known as the Saiki Hospital affiliated with the Agricultural Association of Hiroshima Prefecture. It had 60 sickbeds and four departments-internal medicine, surgery, otolaryngology and dentistry. In those days, there were a large number of atomic bomb survivors in this medically underserved province of Saiki, so that the hospital was extremely busy treating these hibakushas. With the increase in the number of patients, the hospital kept expanding. It was not until 1979 when the number of beds increased to 270 that the hospital was reorganized and assumed the present name. Since then, it has continued to expand and its medical facilities improved. Having been accredited with the type B general hospital by Japan Council for Quality Health Care, it has now become the nucleus of the health care system in the western part of Hiroshima Prefecture, with 570 beds.By way of illustrating how our hospital has been involved in community health care, we will take a look at the trend of the number of emergency cases admitted at night or on holidays. Up until 1998, the annual number of such cases had stood at somewhere around 4,000 but in 2003 the figure exceeded 10,000. For routine physical checkups, electrocardiograms are used. In 1975, 1,800 patients underwent ECG tests and in 2000 the number leapt to 27,000. This author has taken it upon himself to interpret all these ECG records.The Department of Cardiology in our hospital had made it a rule to conduct noninvasive testing in diagnosis. In 1984, the x-ray examination system to make a diagnosis of circulatory troubles was introduced. In 1988 when the Department of Cardiovascular Surgery was set up, it started employing percutancous transluminal coronary angioplasty (PTCA) procedures and other interventional techniques. At first, coronary artery imaging was preformed on not more than 40 cases annually, but now the number of such cases surpasses 500. Interventional treatment is given to well over 130 cases, 85% of which have stents implanted. The initial success rate of intervention is 90.3% and the rate of restenosis was 35.8%. The cases of A-C bypass grafting performed at the department of cardiovascular surgery are increasing in number. Now the use of skeletonized artery bypass graft surgery with extracorporeal circulation at normal temperature has become standard procedure. By the use of the multi-detector row helical CT (MDCT), we are now studying coronary bypass patency and imaging quality. Except for some cases, it has become possible to obtain three-dimensional reconstruction images comparable to angiocardiographic images in terms of quality. We expect that MDCT will replace catheterization and become a standard noninvasive diagnostic procedure in the foreseeable future.We will adopt new thechniques and new therapeutic methods positively but not blindly placing too much confidence in state-of-the-art technology. Based on the fundamental principles of our hospital, we will devote ourselves to medical care, putting the needs of patients before everything else.
Hospitals ; Hospitals, General ; seconds ; Surgical aspects ; Electrocardiogram

The city of Itoigawa is a remote place, with a population of as few as 50,000, where people aged 65 and older occupy 30% of its population. Most people with neurological disorders here have been treated at the Neurosurgical Department of the Itoigawa General Hospital. However, the number of surgical operations has decreased year after year. In search of the factors in the decreasing tendency, we analized the annual statistics about the hospitalized patients and this city's population in the past 11 years beginning on Nov. 1 1995. The diminution of the operation cases was correlated most positively with a decrease in the population of this city (+0.844), and most negatively with an increase in the ratio of persons aged 65 or older (-0.822). The number of operation cases was probably linked to the change in population make-up of the region. The number of operations on older patients had a tendency to decline presumably because of functionally poor prognosis. Conclusively, this study revealed that it is hard for neurosurgeons working in remote localities like this city to keep up the number of operative cases.
Cities ; Relations ; Small ; seconds ; Surgical aspects

Hand-washing before operations is an important and fundamental precaution against infection. However, it should be noted that washing hands many times and brushing excessively damage the skin and cause wound infection during operations. Inthis paper, we examined the disinfection effect of the scrub method using Chlorohexidine gluconate and an ultrasonic cleaner. The scrub method was very effective, whereas the rate of disinfection tended to fall when the utltrasonic method was used.
Hand ; Washing ; Surgical aspects ; Disinfection ; g <3>

Objective: The object of this study was to assess the outcomes of surgical treatment of stage pT1a and pT1b1 cervical cancer.Method: The medical records of 59 patients at our institution with pT1a and pT1b1 cervical cancer who underwent an operation as their primary treatment between January 1996 and September 2006 were analyzed retrospectively.Results: Ten patients underwent an operation which was less aggressive than the current operative modality at our institution. Three patients had recurrence. No patients had recurrence resulting from insufficient operations. No patients had any histologic subtype of adnexal metastasis in the resected specimens. Two of the five patients with squamous cell carcinoma and lymph node metastases at the initial operation had recurrence. Only one patient had a histologic subtype of adenosquamous carcinoma. The patient with adenosquamous carcinoma had recurrence.Conclusion: The results suggest that the surgical procedure did not affect prognosis in the cases we analyzed by surgical modalities. The current evidence suggests that a patient in an early stage can undergo less aggressive surgery than the current operative modality requires.
Surgical aspects ; Recurrence ; Cervical Cancer ; Patients ; Stage of Surgical Procedure

Although a laparotomy itself may be successful, various complaints, whose organic causes are not definite, occasionally arise afterwards. We report two cases of complaints after abdominal operations successfully treated with kososanryo. The chief complaints were anorexia in Case 1, and anxiety in Case 2. We treated the pathological states in these cases as qi stagnation, or qi obstruction in Japanese-oriental medicine sense. The symptoms in these cases improved soon after administration of kososanryo, which is traditionally used for qi stagnation. On closer investigation, we first report that kososanryo is useful for complaints after abdominal operations. Complaints after various operations lower quality of life and, what is even worse, may cause unreliability of medical treatment. The present cases suggest that Japanese-oriental medicine has therapeutic utility in the therapy of complaints after various operations.
seconds ; Complaint, NOS ; Surgical aspects ; Cases ; GENERAL OPERATIVE PROCEDURES

To evaluate the efficacy of hochuekkito on genital prolapse, 37 patients with genital prolapse or descending organs were studied. Hochuekkito (7.5g/day) was administered to all patients without confirming their Sho. Change of subjective symptoms, consequence of disease, relation between efficacy and grade of prolapse, and adverse effects were evaluated. The mean age of patients was 68.7 years. The mean number of parities was 2.5. No patient was nulliparious, or had over 5 parities. Total efficacy rate for subjective symptoms was 48.9%. The treatment was also effective for those who had suffered from vaginal prolapse after total hysterectomy. At endpoint, six of 37 patients continued taking hochuekkito. Six of 37 patients stopped taking Kampo after all their symptoms had disappeared. Ten of 37 patients received surgery. Nine of 37 patients were set with ring pessaries. Five of 37 patients discontinued their drugs beyond endpoint of their own accord. Adverse events were observed in only one patient. Hochuekkito was considered a useful Kampo drug for those who are suffering from genital prolapse, and do not want to be set with ring pessaries or receive surgery.
Ptosis ; symptoms <1> ; Medicine, Kampo ; Genital ; Surgical aspects

Acute appendicitis has been known as a disease entity for well over a century but a confident diagnosis before surgery in all patients suspected of the condition is still not possible. Timely diagnosis is essential to minimise morbidity due to possible perforation of the inflamed organ in the event treatment is delayed; so much so that surgeons often preferred to operate at the slightest suspicion of the diagnosis in the past. This resulted in the removal of many normal appendixes. When the diagnosis of appendicitis is clear from the history and clinical examination, then no further investigation is necessary and prompt surgical treatment is appropriate. Where there is doubt about the diagnosis however it is advisable to resort to imaging studies such as abdominal ultrasound or computed tomography to clear such suspicions before subjecting the patient to an appendicectomy. These studies would also help avoid delays in surgery in deserving patients.
Diagnostic ; Appendicitis ; Acute ; Surgical aspects ; GENERAL OPERATIVE PROCEDURES

Traumatic brain injury (TBI) is one of 3 leading causes of deaths in the Surgery Department of Port Moresby General Hospital in the last 30 years despite being responsible for only 5% of admissions. It maims and kills the young. Most of these injuries and deaths can be prevented by addressing public health issues such as modifying people's lifestyles to avoid drink driving, wearing seat belts in vehicles and peaceful conflict resolution. Severe disabilities can be minimized by prompt and adequate management that prevents secondary brain injury. This is achieved by aggressive maintenance of normal cerebral oxygenation and blood pressure (BP) and optimization of intracranial pressure (ICP). These outcomes are achieved by ensuring that the airways are patent, with respiration assisted where necessary, and by the use of fluids or inotropes to maintain a normal BP. Prompt appreciation of mass lesions and their removal will optimize ICP, improve cerebral perfusion pressure (CPP) and oxygenation. Management of severe TBI involves appropriate use of ventilation and pharmacological agents to ensure ICP and CPP are optimized either in situations where surgery is not indicated or after decompressive surgery. The high morbidity and mortality posed by TBI can be reduced by addressing these issues in Papua New Guinea.
seconds ; Cell Respiration ; Surgical aspects ; Papua New Guinea ; Physical trauma