Thoracoscopic sympathectoirty for causalgia: local experience

The purpose of this study was to assess the efficacy of thoracoscopic cervicodorsal syrnpathectomy for the reduction of pain severity and disability associated with causalgia. From 2006 - 2009, 13 patients referred to Mansoura University Hospital with causalgia. All 13 patients share the following diagnostic criteria: 1] history of trauma and peripheral nerve injury, 2] burning pain, 3] sympathetic symptoms e.g. wet extremities, 4] pain aggravated by physical and/or emotional stimuli and 5] pain relieved by sympathetic block. All 13 patients underwent video-assisted thoracoscopic [lower third of stellate ganglia to T3] sympathectomy. The mechanisms of trauma include motor vehicle accidents in 3 patients, stab wound [3 patients], surgical procedure in 1 patient [carpal tunnel release], fracture [2 patients], wrong injection [1 patient], electrical injury [1 patient] and missile fragment injuries [2 patients]. The most common presenting symptoms were as follows: burning pain [100%], wet extremity [100%], cold extremity in 11 cases [92%], paraesthesia 10 cases [78%], and colour changes in the extremities in 5 cases [38%]. In all patients pain was relieved by sympathetic block. All patients had complete relief of symptoms in the immediate postoperative period and for follow-up from 1-4 years. Causalgia is a syndrome associated with burning pain, hyperaesthesia and symptoms of sympathetic over-activity. Sympathectomy is effective and the treatment of choice, particularly for patients who respond temporarily to sympathetic blocks

Three basic patterns of changes in serum thyroid hormone levels in graves' disease during the one-year period after radioiodine therapy

Was to clarify the characteristic patterns of the thyroid hormonal changes in Graves' disease during the one-year period after [131]I therapy considering that few serial hormonal data during this period are available in the literature. The levels of serum T[3], T[4] and FT[4] before and during one year were plotted as a function of time in 86 therapy courses of 70 patients without subsequent antithyroid or steroid therapy. 35 euthyroid, 6 hypothyroid and 29 hyperthyroid states were obtained during one year after therapy. Although individual patients had individual hormonal changing patterns, 3 common basic patterns were observed from baseline to one month [early] and thereafter [late], respectively. The early patterns were a decrease in 54 [77%], a minimum change in 8 [11.5%] and an increase in 8 [11.5%]. The late patterns were a stable state after an initial decrease with a bottom followed by an increase [valley pattern] in 47 [67%], a stable state after an initial increase with a peak followed by a decrease with a bottom and a subsequent re-increase [mountain pattern] in 12 [17%] and a late stable state after a gradual slow decrease without an obvious bottom near or till one year [downhill pattern] in 11 [16%]. The bottom level and the degree of hormonal recovery from the bottom determined the stable euthyroid, hypothyroid or hyperthyroid state in 49 [86%] of 59 with the valley or mountain pattern. Most of the bottom levels [81%] and transient abnormal changes including transient hypothyroidism [93%, 13/14], peak or hyperthyroidism [85%, 11/13] and euthyroidism [67%, 10/15] appeared within 6 months. The posttherapeutic stable euthyroid, hypothyroid or hyperthyroid state could be judged from the hormonal patterns in 57% [39/68] from 2.5 to 6 months, in 18% [12/68] from 6 to 9 months and in 25% [17/68] thereafter. Although the changes in thyroid hormones are not constant in Graves' disease during one year after [131]I therapy, there are three basic patterns; valley, mountain and downhill patterns from one month after therapy. The post-therapeutic stable state can be judged by the hormonal level recovered from the bottom in most patients

role of audit in a neurosurgical training programme in Saudi Arabia

The future of a speciality depends on among other factors, its training programme; this involves the education contract. Surgical audit provides a mechanism for educators to monitor in real-time the performance of residents and hospitals. Department of Neurosurgery, King Faisal University, Dammam, Saudi Arabia. A prospective audit was established. Magnitude of operations and intermediate equivalent [IE] were defined by the BUPA classification and assigned weighting. Audit on audit was also done for 1990-1992 inclusive. Total number of admissions was 1325. The commonest components of our case mix were trauma congenital anomalies especially hydrocephalus and prolapsed disc; rare cases were vascular anomalies and infections. On average 50% of admissions were emergencies and 41% were operated upon. The IEs were 398.2, 304 and 354.3 for the 3 years respectively. Senior residents share of the operative workload was 22% in 1990, 35% in 1991 and 39% in 1992; for trainee residents, the corresponding figures were 1%, 5% and 16%. First contrary to clinical impression, we found no evidence that the magnitude of operations had declined. Second, residents received a fair share of the available operative workload. Third, audit had played a useful role in the development of our neurosurgical training programme