Types of Cataract Surgeries

1. Phacoemulsification
   
2. Extracapsular Cataract Extraction (ECCE)
   
3. Intra-capsular extraction
   

Glaucoma

Definition:

A disease of the eye characterized by high (or normal) intraocular pressure within the eyeball, damaged optic disk, atrophy of the optic nerve, hardening of the eyeball, and partial defect in the field of vision or complete loss of vision.

Classification:

4 basic types.

1. Primary glaucoma

1. Primary Open Angle Glaucoma
2. Normotensive glaucoma
3. Primary Angle Closure Glaucoma
4. Other variants (ex. Pigmentary glaucoma, pseudoexfoliation glaucoma)

2. Developmental glaucoma

1. Primary congenital glaucoma
2. Infantile glaucoma
3. Glaucoma associated with hereditary of familial diseases.

3. Secondary glaucoma

1. Inflammatory glaucoma
   
2. Phacogenic glaucoma
   
3. Glaucoma secondary to intraocular hemorrhage
   
4. Traumatic glaucoma
   
5. Neovascular glaucoma
   
6. Drug-induced glaucoma
   
7. Glaucoma of miscellaneous origin
   

4. Absolute glaucoma

Stages of Labour

Usually 3 stages are described

Stage 1

It starts with the onset of labour pains and ends with the full dilatation of the cervix.

This stage lasts for 12 hrs in primigravidae and 6 hours in multiparae.

Stage 2

It is furhter divided into 2 phases.

1. Propulsive phase - starts from cervix dilatation upto the descent of the presenting part into the pelvic floor.
2. Expulsive phase - It ends with the delivery of the baby.

This stage lasts for 2 hrs in primigravidae and 30 mins in multiparae.

Stage 3

This involves the expulsion of the placenta and all the membranes.

This stage lasts for about 15 mins.

Stage 4

This stage of observation  lasts for about 1 hour after stage 3. During this stage, the general condition of the patient and the behaviour of the uterus are to be carefully watched.

Atrophic Rhinitis

Definition:

It is a chronic inflammation of nose characterized by atrophy of the nasal mucosa.

Typically seen in females nearing puberty.

Aetiology:

1. Hereditary
2. Racial (more in whites)
3. Endocrinal disturbances (oestrogen)
4. Nutritional deficiency.
5. Infections
6. Auto-immune

Pathology:

Squamous metaplasia in the mucosa, atrophy of seromucinous glands, venous blood sinusoids and neve elements, obliterative endarteritis. Turbinates undergo resorption. Paranasal sinuses are small due to arrested development.

Clinical features:

1. Anosmia
2. Degenerative changes
3. Nasal obstruction
4. Epistaxis
5. Greenish/greyish black dry crusts
6. Typically, the posterior wall of the nasopharynx can be visualised.
7. Nose may show saddle deformity

Treatment:

No definitive treatment is available for this condition. The following measures are tried to provide releif to the patient.

Medical

1. Nasal irrigation and removal of crusts (alkaline solution)
2. 25% glucose in glycerine
3. Local antibiotics
4. Oestradiol spray
5. Placental extract
6. Potassium iodide (oral)

Surgical

1. Young's / Modified Young's operation - it involves the complete or partial closure of both the nostrils, to be opened after 6 months. This allows the turbinates and the mucosa to grow.
2. Narrowing the nasal cavities - this is done by injection of teflon paste or insertion of fat/cartilage/bone/teflon strips under the mucoperiostium.

Chronic Simple Rhinitis

Aetiology and Risk factors:

1. Persistant rhinitis (due to tonsillitis, adenoids or sinusitis)
2. Chronic exposure to irritants (smoke, dust etc.)
3. Nasal obstruction
4. Vasomotor rhinitis
5. Endocrinal/metabolic factors (Hypothyroidism etc.)

Pathology:

This disease is considered an early stage of hypertrophic rhinitis.

Clinical features:

1. Nasal obstruction
2. Post nasal discharge
3. Headache
4. Oedema of turbinates

Treatment:

Medical

1. Treat cause
2. Nasal irrigation with alkaline solution
3. Nasal decongestants
4. Antibiotics

Deviated Nasal Septum (DNS)

Etiology:

1. Trauma : usually in childhood, may even be during delivery.
   
2. Developmental
3. Hereditary
4. Racial predisposition

Types:

1. Anterior dislocation.
2. C-shaped
3. S-shaped
4. Spur
5. Septal thickening.

Clinical Features:

1. Nasal obstruction (more if high deviation)
2. Headache
3. Sinusitis
4. Epistaxis
5. Anosmia (partial of complete)
6. External deformity.
7. Middle ear infection.

Treatment:

Surgical treatment is adviced if nasal obstruction is complete, total anosmia is present and in  cosmetic indications.

2 types

1. SMR (Sub-mucosal Resection) operation: Not done anymore because of the numerous complications involved and now with the availability of better options.
2. Septoplasty: (treatment of choice) The mucoperichondrial flap of one side is elevated after giving a modified Killian's incision. The defect in the cartilage &/or bone is removed. This surgery can be combined with a rhinoplasy if necessary.

Advantages of Septoplasty:

1. Conservative operation.
2. Can be done in children.
3. Can be combined with rhinoplasty.
4. Revision possible in case of recurrance/unsatisfactory results.
5. Less complications.
   

Umbilical Hernia

Types:

1. Complete or incomplete (depending on whether sac extends through defect or not.)
   
2. Irreducible (incarcerated)
   
3. Sliding (wall of hernia sac not completely formed by peritoneum)
   
4. Richter's hernia (1 side of bowel wall trapped)
   

Causes:

1. Definite familial incidence.
   
2. Prematurity
   
3. Incomplete development of: lateral umbilical ligaments (obliterated umbilical arteries), urachus, round ligament (umbilical vein), subumbilical extension of transversalis fascia (Richet umbilical fascia).
   
4. Increased intra-abdominal pressure.
   

This condition is rarely symptomatic.

Treatment:

Surgery is the treatment of choice.

Indications:

1. Incarceration
2. Symptoms clearly referable to hernia.
3. Large sac

2 types of surgeries may be performed

1. Simple transverse repair of fascial defect.
   
2. Mesh or plug repair.
   

Diffuse Malignant Mesothelioma

Pathogenesis:
The disease spreads over surfaces of viscera and body cavities.
Clinical Features:

• Chest pain
• Dypsnea
• Occasionally abdominal pain, nausea, vomiting and weight loss.

Prognosis is very bad, mostly fatal and shows poor response to treatment.

This disease can only be prevented by avoiding exposure to asbestos.