DERMOID CYSTS

DERMOID CYSTS

These  are  cysts  situated  deep to the skin  and  there  is  no

punctum,thus the skin moves over the cysts.

 - They are either along lines of embryonic union (congenital) in

   the mid line and external angular dermoids

 - They can  also  occur on the palms of hands and  back  due  to

   puncture wounds and result  from  deep  implantation  of  skin

   elements (Implantation dermoid). 

Both varieties are filled with Sebum.

 

TREATMENT

Most dermoids cam be excised under local anaesthesia.The external

angular  dermoids  should  be preceded by  X-ray  to  exclude  an

intraceranial extension.

 

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KELOIDS AND SUBACEOU CYSTS

3.4 KELOID
Following an  injury or surgical incisions,sites of repair show enlarging overgrowth of vascular collagen in the healing wound
leading to ugly scars.

There is a constitutional factor responsible in affected individuals  

The hyperplastic scar as opposed to keloid usually stops  growing,and does not itch.

 

TREATMENT

Lesions  may  be  helped  by small dose  of  radiotherapy  or  local cortisone application.
Surgical excision in combination with other methods may
provide comparable results

 

3. CYSTS

3.1 Subaceous Cysts

This is a cyst in the skin usually in a hair bearing area and  is

believed to originate from a subaceous gland in a hair  follicle,

it is in fact a retnetion cyst due to obstruction of the mouth of

subaceous  gland.  The cyst is found on the scalp and  is  filled

with putty like subaceous material

The  punctum is visible on its summit and is the site  of  block. 

The cyst is attached to the skin on clinical examination.

 

TREATMENT

The uninfected cyst can be excised under local anaesthesia.  

If infected they require antibiotics and drainage

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SKIN CONDITIONS

2.1 Callosity

 

This  is  an acquired localised thickening of the  skin.   It  is

usually  seen in the hands of manual workers. 

 

The thickening  is as  a  result  of use of the hands in  response  to  the  persons

occupation  it  is  protective in nature  and  thus  requires  no

treatment.

 

2.2 Corns

 

These  are  also  callosities on the foot and  are  localised  to

points where the skin is over a joint and receives pressure  from

the joint within and the ill fitting footwear from outside.  They

can also be seen on the sole of the foot.  They can sometimes get

painfull .

 

A change to open foot wear can provide relief.  This can also  be

treated  with  painting with 10% Salicylic acid in  collodian  or

acetone.  The corn peels off.

 

2.3 WARTS

These  are  localised  areas of skin hyperplasia  and  look  like

papillomas and are caused by infection by filterable virus.  They

can  be multiple through cross infection and occur often  on  the

hands and face .

 

TREATMENT

Warts  may be removed by curettage, diathermy or  excision  under

local or general anaesthesia if multiple.

They also respond to treatment with 10% formalin, podophyllin  or

salicylic acid plaster (50%)

 

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SKIN & APPENDAGES

SKIN AND APPENDAGES

 

1. ANATOMY

The skin is the outer envelop of the body and has a large surface

area (1-1.8 sq. meters).

   *  The thickness varies, being thin on the the eyelids, glans

      penis and thick on the soles of the feet, palms of the

      hands and back

   *  There are two components of skin the outer (superficial)

      epidermis with the function of producing keratin.

      The cells show characteristics of differentiation

      proceeding on to degeneration with the keratin placed most

      superficially.

   *  The deeper layer,the dermis consists of collagen, elastic

      fibres and fat cells(

   *  This deep layer supports the nerves, blood vessels and the

      skin appendages (hair follicles, sweat glands).

   *  The skin also contains melanocytes that prduce melanin.

   *  This material provides colour to the skin and protects the

      germinal layers and the melanocyte from the effects of

      ultraviolet light.

 

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RESPIRATORY SUPPORT

10. RESPIRATORY SUPPORT

   1.  In cases of loss of consciousness.  This may be because of

       a)  Head injury

       b)  Poisoning

       c)  Diabetic coma

       d)  Fainting because of fright

       e)  Stroke

       f)  Heart-attack

       g)  Drunkeness

 

       In these cases, check the airway is clear, pull the head

       back,jaw and tongue forwards, clear the throat.

 

   2.  If not breathing, give mouth to mouth breathing as shown

       in  or  ventilation of self inflating bag if

       available

   3.  Some may require long term support on a ventilator

 

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ANESTHESIA RECOVERY ROOM

9. RECOVERY ROOM

-  On  the  completion of a surgical  procedure  the  patient  is

   allowed  to recover from the effect of the anaesthetic  agents

   and  the relaxants by giving appropriate medication  till  the

   point   that  the  patient  is  respiring  spontaneously   and

   adequately.

-  He is disconnected from the anaesthetic machine and the  endo-

   trachael  tube  can  now be removed after  ensuring  that  the

   patient has a clear air-way by sucking out all secretions.

-  He  is  then  wheeled in the recovery room  where  he  can  be

   observed   frequently till complete recovery from the  effects

   of the pre-medication and the anaesthetic agents.

The points to be observed are:

   *  Continuous free airway

   *  Adequate perfusion is observed by skin colour, temperature,

      pulse, blood pressure records

   *  Prevention of aspiration

   *  Medication for pain

 

Patients  that are severely ill because of extensive surgery  are

kept  in an intensive care unit. Monitoring to  gain  information

on;

   -  Cardiac function (ECG)

   -  Blood biochemistry, pH, PCO2

   -  Pulse, Blood pressure and central venous pressure records

   -  Adequate ventilation

 

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ANESTHESIA RELAXANTS

8. RELAXANTS

Muscle relaxants given intravenously can cause profound muscular

relaxation without increasing the depth of anaesthesia.

* It is to be noted that these patients will have inability

to maintain ventilation because of relaxation of

respiratory muscles.

* This can be compensated for by artificial ventilation to

maintain normal arterial oxygenation and normal carbon-

dioxide excretion.

* There are two varieties of muscle relaxants.

- Curare which interferes with transmission of impulse

at the myo-nural junction by competing with

acetylcholine at the motor-end plate(Non-depolarizing).

They are longer acting.

- Succinylcholine: These interfere with myo-neural

transmission by producing depolarization of the end-

plate.These agents are shorter acting.

 

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