If you are non-medical you may want to skip to the last few paragraphs.
Yesterday we removed a 16 kg (35 lb) ovarian tumor from a lady that was weak and short of breath. She had almost no room for her other abdominal organs. The omentum had grown over it and had veins the size of your fingers. We did not think we could remove it at first but we decided to try and so far post-op she is doing well. The tumor appeared benign but there were lots of adhesions all around it so it was somewhat difficult. She looks good today.
Today we did a “vesico-vaginal fistula” but actually it was a bladder reconstruction. Part of the urethra and much of the bladder was gone secondary to birth trauma a few yrs ago. One ureter was plainly visible as it squirted urine but we never could find the other ureter. The back side and bottom of the bladder was all we had to work with. We put in a ureteral stent in the ureter so that we would stay away from the ureter. Probably only one kidney functioning. We don’t have CT, or IVP or any kind of x-ray. We managed to free the edge of the remainder of the bladder and urethra and connected it all up. We have a foley and the ureteral stent through the urethra and hope everything holds. It took quite awhile just to figure out the anatomy and what to do. Danae and I do all such things as this together.
I did another SIGN nail last week but this time of a femur that had been fractured a few years ago but healed about 4 inches shorter. We had to remove the part that was healed together the old callous etc then put the ends of bone together and try to stretch out the muscles and tendons etc. We finally got the bone reamed out and the SIGN nail put in place but the leg is still a little shorter than the other but much better than before as now straight and solid. Previous sort of solid but crooked, so he is happy now.
Also last week we had a large (over 1 cm) ureteral stone that somehow made it down to the end of the ureter but would not go into the bladder. On ultrasound it was thought to be a simple bladder stone but when we got into the bladder we could feel the hard nodule posterior to the bladder. We threaded a ureteral stent and the stone moved back up toward the kidney but it floated back down finally. We dilated the ureteral opening much and finally was able to grasp it with forceps although it broke up in the process. He is doing well now.
We had two perforated gastric ulcers Fri and Sat night which we repaired and they are doing ok now. Today we had a large midline mass in a lady that had delivered a baby last month supposedly. We opened the mass after aspirating pus with a needle. There was a large amount of purulence that was greenish colored and not the usual e-coli smell but was inside the abdomen walled off. We drained and packed it.
Friday we did an AKA (above knee amputation) for gangrenous leg that supposedly began only two weeks ago as an infection in his foot and his blood sugar was normal. Even with the mid thigh amputation there was still some necrotic parts of muscle which we had to debride yesterday. We have not closed the amputation yet to be sure we have gotten rid of the infection and dead tissue.
Had a meningocele which we closed about 3 weeks ago and is now doing ok. It had a very large fluid filled sac that was irritated and about ready to rupture. The baby was about a month old.
We have had lots of hernias, hydroceles, and prostates and urethra strictures to do as many as 10 in a day. We have a fractured patella that we need to repair tomorrow.
I wish we had some more orthopedic equipment to work with. Need plates and screws. Need a intramedullary rasp so can place endoprosthesis for fracture neck of femur and need more variety of endoprosthesis to put in. They are not hard to do if one has the stuff to work with. Also need some sort of fixation devices for intertrochanteric fractures. Presently our main option is to put them in traction for prolonged time. Another advantage is you can put them in traction even without x-ray and still be correct. I had one with a shattered distal femur (we had an x-ray on her) that we placed in traction that is amazingly healing according to palpation and a xray in Moundou. She is moving her leg and wanting to walk and go home!
Today I saw one of my post-op mastectomy and axillary node dissection patients that was done in Sept and she feels good and I could not find any evidence of masses yet. She was happy and came from quite a few miles away.
We have a man with a unilateral III nerve oculomotor nerve palsy. He seems relatively good health otherwise. He was recently treated for malaria. Anyone with suggestions on that?
Scott and Bekki Gardner (Olen’s aunt and uncle) were here the past 3 weeks. He was trying to learn some OB-GYN from Danae. He is a general surgeon that is closing his practice and moving to Koza, Cameroon in a mission hospital there. They both got malaria while here but were feeling better when they left.
Dolores has malaria this week with a temp of 103.4 two days ago but seems a little better tonight. She also has had nausea, vomiting and diarrhea. So far I am in good health.
Hospital and housing construction has progressed a lot. Maybe when someone comes to visit we will have a place for them to stay. Our house is not finished yet but maybe will before we take our annual leave April 24. We plan to go through Thailand, Cambodia, Philippines, and Korea on the way home. Don’t have exact dates yet as only in the planning stage. Rachel, our granddaughter, is a student missionary in Thailand this year.
Our emails are drbland@sbcglobal.net and dfbland@gmail.net
Love, Rollin and Dolores.
Yesterday we removed a 16 kg (35 lb) ovarian tumor from a lady that was weak and short of breath. She had almost no room for her other abdominal organs. The omentum had grown over it and had veins the size of your fingers. We did not think we could remove it at first but we decided to try and so far post-op she is doing well. The tumor appeared benign but there were lots of adhesions all around it so it was somewhat difficult. She looks good today.
Today we did a “vesico-vaginal fistula” but actually it was a bladder reconstruction. Part of the urethra and much of the bladder was gone secondary to birth trauma a few yrs ago. One ureter was plainly visible as it squirted urine but we never could find the other ureter. The back side and bottom of the bladder was all we had to work with. We put in a ureteral stent in the ureter so that we would stay away from the ureter. Probably only one kidney functioning. We don’t have CT, or IVP or any kind of x-ray. We managed to free the edge of the remainder of the bladder and urethra and connected it all up. We have a foley and the ureteral stent through the urethra and hope everything holds. It took quite awhile just to figure out the anatomy and what to do. Danae and I do all such things as this together.
I did another SIGN nail last week but this time of a femur that had been fractured a few years ago but healed about 4 inches shorter. We had to remove the part that was healed together the old callous etc then put the ends of bone together and try to stretch out the muscles and tendons etc. We finally got the bone reamed out and the SIGN nail put in place but the leg is still a little shorter than the other but much better than before as now straight and solid. Previous sort of solid but crooked, so he is happy now.
Also last week we had a large (over 1 cm) ureteral stone that somehow made it down to the end of the ureter but would not go into the bladder. On ultrasound it was thought to be a simple bladder stone but when we got into the bladder we could feel the hard nodule posterior to the bladder. We threaded a ureteral stent and the stone moved back up toward the kidney but it floated back down finally. We dilated the ureteral opening much and finally was able to grasp it with forceps although it broke up in the process. He is doing well now.
We had two perforated gastric ulcers Fri and Sat night which we repaired and they are doing ok now. Today we had a large midline mass in a lady that had delivered a baby last month supposedly. We opened the mass after aspirating pus with a needle. There was a large amount of purulence that was greenish colored and not the usual e-coli smell but was inside the abdomen walled off. We drained and packed it.
Friday we did an AKA (above knee amputation) for gangrenous leg that supposedly began only two weeks ago as an infection in his foot and his blood sugar was normal. Even with the mid thigh amputation there was still some necrotic parts of muscle which we had to debride yesterday. We have not closed the amputation yet to be sure we have gotten rid of the infection and dead tissue.
Had a meningocele which we closed about 3 weeks ago and is now doing ok. It had a very large fluid filled sac that was irritated and about ready to rupture. The baby was about a month old.
We have had lots of hernias, hydroceles, and prostates and urethra strictures to do as many as 10 in a day. We have a fractured patella that we need to repair tomorrow.
I wish we had some more orthopedic equipment to work with. Need plates and screws. Need a intramedullary rasp so can place endoprosthesis for fracture neck of femur and need more variety of endoprosthesis to put in. They are not hard to do if one has the stuff to work with. Also need some sort of fixation devices for intertrochanteric fractures. Presently our main option is to put them in traction for prolonged time. Another advantage is you can put them in traction even without x-ray and still be correct. I had one with a shattered distal femur (we had an x-ray on her) that we placed in traction that is amazingly healing according to palpation and a xray in Moundou. She is moving her leg and wanting to walk and go home!
Today I saw one of my post-op mastectomy and axillary node dissection patients that was done in Sept and she feels good and I could not find any evidence of masses yet. She was happy and came from quite a few miles away.
We have a man with a unilateral III nerve oculomotor nerve palsy. He seems relatively good health otherwise. He was recently treated for malaria. Anyone with suggestions on that?
Scott and Bekki Gardner (Olen’s aunt and uncle) were here the past 3 weeks. He was trying to learn some OB-GYN from Danae. He is a general surgeon that is closing his practice and moving to Koza, Cameroon in a mission hospital there. They both got malaria while here but were feeling better when they left.
Dolores has malaria this week with a temp of 103.4 two days ago but seems a little better tonight. She also has had nausea, vomiting and diarrhea. So far I am in good health.
Hospital and housing construction has progressed a lot. Maybe when someone comes to visit we will have a place for them to stay. Our house is not finished yet but maybe will before we take our annual leave April 24. We plan to go through Thailand, Cambodia, Philippines, and Korea on the way home. Don’t have exact dates yet as only in the planning stage. Rachel, our granddaughter, is a student missionary in Thailand this year.
Our emails are drbland@sbcglobal.net and dfbland@gmail.net
Love, Rollin and Dolores.
Ureteral stent manufacturers is basically used in draining fluids or air from pleural spaces internally. At the end of the coil catheter looks like a loop and resembles a pig tail hence this Catheter is called Pigtail Catheter in the medical fraternity. The end of the coil helps to hold the Pigtail Catheter in proper and specific place and used to slow down the flow of fluids injected through the catheter so that they do not apply any pressure or burst out causing injury.
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