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PubMed2002

The Myles Gibson military lecture: surgery in the Napoleonic Wars.

Throughout the twenty-two year period of the Napoleonic Wars, campaigns under extremes of climate cost the Allies much in terms of mortality and morbidity. Although Bonaparte brought about many sound political and national improvements, when France had been brought to its knees by the bloody Revolution, his ambitions became excessive and his military forays difficult to support. Following early successes in the field, he underestimated the determination, persistence and the ability of some opposing commanders. The French medical services profited greatly from the innovations of the post-revolutionary period, and the efforts of men such as Larrey and Percy. The British Army medical support was scanty, and, initially lacked experience. To some extent, this latter defect was corrected by Sir James McGrigor during the Peninsular War. Each campaign brought it's own perils and most men died of deprivation, disease and effects of climate, rather than battle injury. There were technically able surgeons who were inevitably hampered by lack of antiseptic technique, anaesthesia and the lack of understanding of the fundamental aspects of hygiene, adequate diet and good nursing care.

Europe↗
PubMed2002

6th Yahya Cohen Lecture: visual experience during cataract surgery.

INTRODUCTION: The visual sensations many patients experience during cataract surgery under local anaesthesia have received little attention until recently. This paper reviews the recent studies on this phenomenon, discusses its clinical significance and suggests novel approaches to reduce its negative impact on the surgery. METHODS: Literature review. RESULTS: Many patients who have cataract surgery under retrobulbar, peribulbar or topical anaesthesia experience a variety of visual sensations in their operated eye during surgery. These visual sensations include perception of light, movements, flashes, one or more colours, surgical instruments, the surgeon's hand/fingers, the surgeon and changes in light brightness. Some patients experience transient no light perception, even if the operation is performed under topical anaesthesia. The clinical significance of this phenomenon lies in the fact that approximately 7.1% to 15.4% of patients find their visual experience frightening. This fear and anxiety may cause some patients to become uncooperative during surgery and trigger a sympathetic surge, causing such undesirable effects as hypertension, tachycardia, ischaemic strain on the heart, hyperventilation and acute panic attack. Several approaches to reduce the negative impact of patients' visual experience are suggested, including appropriate preoperative counselling and reducing the ability of patients to see during surgery. CONCLUSIONS: The findings that some patients find their intraoperative visual experience distressing have a major impact on the way ophthalmologists manage their cataract patients. To reduce its negative impact, surgeons should consider incorporating appropriate preoperative counselling on potential intraoperative visual experience when obtaining informed consent for surgery.

Anesthesia, Local↗
PubMed2002

James IV Lecture. Epilepsy surgery, hypothalamic hamartomas and the quest for a cure.

This presentation reviews the epidemiology of epilepsy, the evolution of epilepsy surgery, the selection of cases for surgery, the range and results of epilepsy surgery, and the future development of this burgeoning field. Hypothalamic hamartoma (HH) is a rare developmental lesion which causes intractable gelastic epilepsy which is refractory to medical therapy. Hypothalamic hamartoma presents a formidable surgical challenge. The application of a midline transcallosal interforniceal approach to resect the HH from within the third ventricle, in a series of 28 patients, is presented. This has produced excellent results with minimal morbidity. This surgery is placed within the context of epilepsy surgery in general.

Epilepsy↗