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Objective: To evaluate fracture resistance and survival rate of IPS Empress CAD versus Polished Celtra Duo ceramic laminate veneers. Material and Methods:Thirty-six ceramic laminate veneers were fabricated for maxillary anterior teeth. The patients were divided into two groups according to the material Group 1(control group) fabricated from IPS Empress CAD laminate veneers and group 2 (intervention group) fabricated from Polished Celtra Duo laminate veneers. Standardized the same preparation with butt joint design and chamfer finish line located supra gingival were performed for all the teeth. The fabrication of the veneers was performed using Cad\Cam (Ceramill motion) machine, with software (Exocad). The veneers surfaces were treated and silanated according to the manufacture instruction of each ceramic and enamel surfaces were etched where total etch adhesive protocol was obeyed using BISCO. Follow up sessions were done every two months up to one year for each patient using dental probe and operator vision to evaluate the fracture, survival rate, marginal adaptation, sensitivity and caries. according to USPHS criteria (United States Public Health Service). This was performed by an experienced, blinded investigator. Results: Fracture resistance, marginal adaptation, retention, caries and sensitivity were evaluated according to the criteria of USPHS and we found there is no significant difference as both groups scaled zero score. Conclusion: Both IPS Empress Cad and Polished Celtra Duo laminate veneers revealed successful clinical performance in terms of fracture resistance, marginal adaptation, retention, and sensitivity after one year follow up period (AU)
Objetivo: Avaliar a resistência à fratura e a taxa de sobrevivência de laminados de cerâmica IPS Empress CAD versus Celtra Duo polidos. Material e Métodos: Trinta e seis facetas cerâmicas laminadas foram confeccionadas para dentes anteriores superiores. Os pacientes foram divididos em dois grupos de acordo com o material Grupo 1 (grupo controle) confeccionado com laminados IPS Empress CAD e grupo 2 (grupo intervenção) confeccionado com laminados Celtra Duo polidos. A mesma forma de preparo e acabamento de chanfro localizado supra-gengival padronizados foram realizados para todos os dentes. A confecção das facetas foi realizada em máquina Cad \ Cam (Ceramill motion), com software (Exocad). As superfícies laminadas foram tratadas e silanizadas de acordo com as instruções do fabricante de cada cerâmica e as superfícies de esmalte foram condicionadas seguindo o protocolo adesivo de condicionamento ácido total com BISCO. Sessões de acompanhamento foram realizadas a cada dois meses durante um ano para cada paciente usando sonda exploradora e visão do operador para avaliar a fratura, taxa de sobrevivência, adaptação marginal, sensibilidade e cárie; de acordo com os critérios USPHS (Serviço de Saúde Pública dos Estados Unidos). Isso foi realizado por um investigador experiente e cego. Resultados: a resistência à fratura, adaptação marginal, retenção, cárie e sensibilidade foram avaliadas de acordo com os critérios da USPHS e não encontramos diferença significativa, pois ambos os grupos escalonaram pontuação zero. Conclusão: As facetas laminadas IPS Empress Cad e Celtra Duo polido revelaram desempenho clínico bem-sucedido em termos de resistência à fratura, adaptação marginal, retenção e sensibilidade após um período de acompanhamento de um ano. (AU)
Subject(s)
Humans , Dental Marginal Adaptation , Dental Caries , Dental Veneers , Dentin Sensitivity , Flexural StrengthABSTRACT
Objective: To explore the efficacy of earthworm's coelomic fluid against gentamicin-induced hepatic and renal toxicity in rats. Methods: The animals were divided randomly into three groups (n = 6 per group): control, gentamicin, and Allolobophora caliginosa coelomic fluid-treated groups. Toxicity was established after injection of gentamicin daily for 8 days at a dose of 100 mg/kg. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total proteins, albumin, creatinine, urea, uric acid, malondialdehyde, glutathione, catalase and histopathology of tissues were investigated in the study. Results: Allolobophora caliginosa coelomic fluid significantly decreased urea, creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and malondialdehyde levels while significantly increasing levels of total proteins, albumin, glutathione and catalase. The histopathological investigation showed partial restoration of renal and hepatic architecture. Conclusions: This study shows the potency of Allolobophora caliginosa coelomic fluid in improving the biochemical and histopathological changes induced by gentamicin in the liver and kidney of the rats.
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Aim of the work: this study aimed to evaluate the coronary artery morphology and myocardial perfusion by single reproducible non-invasive contrast enhanced CT acquisition by using DECT scanners with high sensitivity and specificity as well as high diagnostic accuracy without the need to increase the contrast material or radiation dose
Patients and methods: this study was done during the period from October 2016 to December ,2017; age was ranged between 42 to 73 years old, were 35 patients with CAD diagnosed by cCTA underwent DECT for assessment of myocardial perfusion. The study included 35 patients referred for DECT myocardial perfusion examination in the Police Authority Hospitals, Radiodiagnosis Department in Cairo after diagnosing by cCTA. Each patient included in the study was subjected to full history taking, reviewing medical sheet, cCTA and CT myocardial perfusion examination. Technique was performed by using Aquilion one dynamic volume 320 detector rows CT, Toshiba Medical System, Tochigi-ken, Japan
Results: our study showed a significant correlation and good agreement between the findings of DECT myocardial perfusion defects and the findings of stenosis and its degree on cCTA on a segmental basis with 83% sensitivity, 87% specificity, 86% accuracy, 74% positive predictive value and 92% negative predictive value
Conclusion: DECT myocardial perfusion has high diagnostic as compared to cCTA as the gold reference standard
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Background: hepatocellular carcinoma [HCC] is the most common primary liver malignancy. Surgical resection and local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation cannot be offered
Aim of the work: this study aimed to evaluate the feasibility of DWI and the corresponding ADC values to detect tumor response after radiofrequency ablation for hepatocellular carcinoma
Patients and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and post gadolinium enhanced images as well as DW sequences were performed. ADC values of ablation zones and liver parenchyma were assessed. ADC values of ablation zones and adjacent signal alterations identified in DWI were analyzed
Results: residual or recurrent lesions were detected in 4 patients [20%]. The mean ADC value of ablated zones differed significantly from that of normal liver parenchyma. The corresponding ADC values were significantly lower in patients with residual lesion than in patients without residual lesion
Conclusion: it can be concluded that DWI is a feasible follow-up tool for post ablation liver contributing in detection of residual lesion
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Background: Veins have one-way valves which prevent blood from backing up into the legs when we stand or sit. When the valves become incompetent [or begin to have reflux], blood pools and causes an increase in pressure in the leg veins becoming enlarged and twisted
Objective: It was to evaluate the safety and efficacy of foam sclerotherapy in the treatment of primary varicose veins
Methodology: This study was carried out in Radiology Department of Ain Shams University Hospitals. 20 patients with sonographically proven primary varicose veins for which they had foam sclerotherapy injection
Result: The 20 patients enrolled in this study were ranging from 24 to 52 years with mean age of 36.4 years
Conclusion: Foam Slcerotherapy is effective and safe in treatment of primary varicose veins
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Background: Our study showed that ultrasound-guided, vacuum-assisted excision can play an efficient role in the diagnosis of benign breast lesions and is a safe and successful alternative treatment of fibroadenomas. Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up of these lesions is still debatable. We suggest that UGVAB, which has a well-documented role in the diagnosis of breast lesions, may provide an option for the definitive treatment of breast fibroadenomas
Objective: The objective of our work was to evaluate ultrasound-guided, vacuum-assisted excision [UGVAE] as an alternative approach in the diagnosis of radiologically benign breast lesions
Patients and Methods: We prospectively evaluated breast lesions excised using VAB between April -October 2017 at Ain-Shams University /interventionl radiology unit at radiology department, which had a proven diagnosis of fibroadenoma. An informed consent form was obtained from each patient of a total of 25 cases ultrasound-guided VABB using biopsy system. All patients have been subjected to breast ultrasound examination
Results: Thirteen patients developed hematomas during UGVAE but none needed surgical intervention, while twelve patients pass with no significant hematomas, with 100% cure rate. None of the patients experienced significant enough pain to require the cessation of the procedure, although 22 [88%] patients reported mild pain and moderate pain [12%] during procedure. At the two week control, 3[12%] patients reported taking paracetamol for mild pain. In ten of them [40%] the pain was strong enough to interfere with sleep
Conclusion: Vacuum assisted Ultrasound-guided biopsy allows real-time imaging, could be performed without breast compression, and is the preferred method if the lesion is detectable with ultrasound
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Background: Liver transplantation is currently accepted as a first line treatment for patients with end-stage acute or chronic liver diseases. Graft survival and overall patient survival have steadily improved since the first transplants were performed in the early 1960s, but a significant percentage of transplants develop complications related to vascular and biliary insufficiency. Graft ischemia after liver transplantation is associated with a high incidence of morbidity and mortality
Aim of the Work: to evaluate the sensitivity and specificity of Duplex ultrasound in detection most of vascular complication after liver transplantation in correlation with CTA
Patients and Methods: The study was done from Aug. 2017 until Aug. 2018, where 50-55 cases who underwent living donor liver transplantation with post-operative complications. The cases were done at Ain Shams University Hospital and other private hospitals. All cases where admitted to post transplanting intensive care unit in the postoperative period where a routine full laboratory and radiological assessment were done. The laboratory assessment included full liver function tests, kidney function tests, complete blood picture, and C-Reactive Protein. Immunosuppressant level and bilirubin level in drains had also done
Results: The patient age ranges from 36 to 53 years with the mean age of 45 years. Most cases have cases had hepatitis C related cirrhosis [90%]. One case had veno-occlusive disease related cirrhosis [Budd Chiari syndrome]. About 95% of cases were suffering from end stage liver disease. The results we have reached are that Doppler U/S sensitivity in diagnosis of these complications is 83.8% and CTA sensitivity is about 100%
Conclusion: It could be concluded that colour duplex is the investigations of choice in postoperative liver transplantation. They can be used as routine steps in the assessment of liver transplant graft postoperatively in recipient patient as early as possible within the first 3 days after operation and used as a late follow up, as they are noninvasive, safe, cheap, and accurate. Routine use of gray-scale US and color duplex showed to minimize the impact of postoperative complications and maximize both graft and recipient patient survival and if any complications suspected, it can be confirmed by CTA
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Background: the study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women
Objectives: Ovulation rate was taken as the gold standard for assessment of ovulation induction result
Patients and Methods: Analysis of the results provided the following information: A] Better sensitivity and specificity of colour Doppler indices in detection of ovulation. B] Better timing of human chorionic gonadotrophin administration and better ovulation rate when colour Doppler was used in cycle monitoring
Results: It can be concluded from the results of this study that combined use of transvaginal sonography and colour Doppler imaging is more reliable in assessment of ovulation and is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone
Conclusion: combined use of transvaginal sonography and colour Doppler imaging is more reliable in assessment of ovulation and is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause
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Background: mixed urinary incontinence [MUI] is defined as the complaint of involuntary loss of urine, associated with urgency and also with effort. Urodynamic studies [UDS] are widely considered the gold standard investigation for determining the type of incontinence
Aim of the Work: It evaluates the safety and efficacy of transobturator tape [TOT] procedure in treatment of women with mixed urinary incontinence
Patients and Methods: this study was carried out at Ain Shams Urology Department and National institute of urology and nephrology in the period from October 2017 to may 2018. This Study included 20 female patients with MUI who failed to respond to medical treatment and other forms of conservative methods. Post operative evaluation was carried out at 2 weeks, 3, and 6 months following operation
Results: Our study showed statistically significant cure rate for urge component 12 cases [60%], and also significant cure rate for stress component 17 cases [85%], no statistically significant difference in the cure rate depending on the age factor by dividing the patients into two groups group below forty [11 cases] and group above forty [9 cases]
Conclusion: our study showed statistically significant cure rate for urge component 12 cases [60%], and also significant cure rate for stress component 17 cases [85%]. The limitations in our study were small number of patients and short time of postoperative follow-up. We advocate that the TOT procedure should always be tried in the management of mixed urinary incontinence in female population as it is an effective and simple procedure
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Background: colorectal cancer is the second most common cause of cancer in women [9.2% of diagnoses] and the third most common in men [10.0%], it is the fourth most common cause of cancer death after lung, stomach, and liver cancer
Aim of the Work: the goal of this study was to elucidate the role of 18F-FDG PETCT in evaluation of colorectal cancer
Patients and Methods: twenty five patients with histopathologically proven colorectal primary malignancy were evaluated for suspected local recurrence and metastasis. No age predilection and both sexes were included, clinical history, image follow-up, tumor markers, and pathological reports were reviewed for gold standard
Results: the final diagnosis of distant metastasis and/or local recurrence in post-therapeutic cancer colon was evident in 70% of our patient population with PET/CT sensitivity of 95.6%, specificity of 91.4%, [NPV] of 88.9%, [PPV] of 96.7%, and diagnostic efficacy of 94.4% and CT sensitivity of 62.6%, specificity of 48.6, [NPV] of 33.3% [PPV] of 76.0%, and diagnostic efficacy of 58%
Conclusion: PET/CT is a better method to evaluate post-therapeutic colorectal cancer patients
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Background: The rising incidence of obesity coupled with its detrimental effects on fertility led to greater numbers of overweight and obese women utilizing assisted reproduction technologies [ART], such as in vitro fertilization [IVF] and intracytoplasmic sperm injection [ICSI]
Aim of the Work: To evaluate the impact of body mass index on embryo quality and clinical outcomes in couples underlying ICSI
Patients and methods: a retrospective observational comparative study was conducted on 400 Women at ART Unit, International Islamic Centre for Population Studies and Research [IICPSR], Al-Azhar University. Data were recruited from the patient`s files who did ICSI trial in IICPSR from December 2015 to December 2017, after exclusion of cycles in which the body mass index [BMI] was not recorded. After approval of the local ethics committee, all pregnant women were briefed about the nature of the study and informed consent was obtained from them before inclusion in the study
Results: The duration of infertility was progressively higher as BMI increased. Basal luteinizing hormone, follicle-stimulating hormone, and estradiol levels were higher in group 2 than in group 1. Higher total doses of gonadotropin were required in group 2 to obtain equivalent ovarian response than in group 1. No significant difference was observed on ovarian response and embryonic parameters. Serum estradiol level on ovulation triggering day was significantly higher in group 2. Ovarian hyperstimulation and cycle outcome were not significantly different between both groups
Conclusion: Overweight and obesity appear to have independent adverse effects on ovarian response to stimulation and outcomes in women undergoing ICSI
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Objectives: To evaluate the feasibility, operative time, efficacy and safety of the modified lateral position in percutaneous nephrolithotomy [PCNL] for renal calculi, comparing it with the standard prone position PCNL
Material and Method: The patient is placed with the thorax in the lateral position and the pelvis in an oblique position. Then the lower limbs are split and bent in the lowest position. Initial placement of a retrograde ureteral catheter, tract formation, stone fragmentation and retrieval, and optional extra procedures were accomplished with the patient in the same position
Results: The study comprised 82 patients; 29 in split-leg modified lateral position [SL-MLP] group and 53in conventional prone position [PP] group. Three patients [all in PP group] underwent sequential bilateral percutaneous nephrolithotomy [PNL] during the study period and each procedure was considered as an independent case. So, the studied cases, according to the number of PNL procedures, were 85; 29 in SL-MLP group and 56 in PP group
Conclusions: split-leg modified lateral position in percutaneous nephrolithotomy [SL-MLP PNL] has significantly lower operative time compared with conventional PP PNL. The stone free rate, need for ancillary procedures and complication rate were equal in both groups
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Background: chronic hip pain is a common problem in adults. In the absence of a known acute trauma, it can be a diagnostic problem as it can be attributed to many causes. The most common causes are avascular necrosis, inflammatory causes, transient osteoporosis or neoplastic lesions
Aim of the Work: the aim of this study is to evaluate the role of magnetic resonance imaging [MRI] in the evaluation and diagnosis of different causes of chronic hip pain in adults
Patients and Methods: the study was conducted on thirty patients who had chronic hip pain and they were referred to undergo MR imaging of hip joints in MRI Unit in Al-Hussain Teaching Hospital in Thi-Qar / Iraq and Ain Shams University Hospital in Cairo / Egypt
Conclusion: MRI is an essential imaging modality in musculoskeletal system in general and in hip region specifically
Recommendations: MRI should be done preferably with a limited number of sequences. If the diagnosis is still query or whenever inflammation or a neoplastic process is suspected, we should do other sequences in different imaging planes and go for contrast injection and post contrast studies [T1WI]
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Background: lung ultrasound is a part of the diagnostic armamentarium in Resuscitation and Recovery Units with an enormous potential due to its advantages capacity to diagnose more precisely than conventional radiology, earlier diagnosis, convenience due to being able to perform at the bedside, possibility of being performed by one person, absence of ionizing radiation and due to its dynamic character
Aim of the Work: this study aimed to assess the impact of chest ultrasonography in detecting, differentiation and management of the different pleural diseases
Patients and Methods: this prospective study included 50 patients who were presented with suspected clinical and/or radiological evidence of pleural disease in the Chest Department of Demerdash Hospital, during the period between November 2014 and June 2017. Patients with pleural diseases with lung involvement were excluded
Results: US were more statistically significantly sensitive and specific in the detection of pleural effusion compared to chest radiography. A sensitivity of 0.92 for US examination against 0.74 for chest radiography in detection of pleural thickening was noted. There were no statistically significant differences between the sensitivity and specificity of chest US and chest CT in detection of different pleural pathologies
Conclusion: US are an efficient and suitable method for the evaluation of different pleural diseases in critically ill patients in the RICU. US are mostly sensitive and specific in diagnosing pleural effusions. US-guided diagnostic and therapeutic pleural interventions are successful in achieving their goal with favorable outcomes and minimal complications
Recommendations: US accessibility was difficult for some patients because of tissue edema, subcutaneous emphysema and obesity. Thus further studies are needed in order to generalize these results
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Background: Various populations of regulatory T cells play a central role in the development of peripheral tolerance to allergens. Culturing of CD4+ T cells isolated from peripheral blood of allergic patients with vitamin D induces the generation of stable IL-10 producing CD4+CD25+ Treg cells suppressing the proliferation of T helper cells obtained from the same patients. The immune regulatory role of vitamin D in allergic patients has been controversial and obviously needs a more clarifying research work
Aim of the work: to determine the percentage of induced T regulatory cells producing interleukin 10 after stimulation of T regulatory cells with cow milk allergen in the presence of vitamin D in culture. This aims to further in-vitro study the immune regulatory role of vitamin D in cow milk allergic patients
Results: there is association between decreased level of vitamin D and milk-allergy, as serum level of 25[OH] D3 was insufficient in 16 [80 %] patients [10- 29.9 ng/ml] while 4 [20%] patients were sufficient [30-100 ng/ml]. Addition of vitamin D, in culture, induces the production of CD4+ CD25hi Foxp3+ IL10+. Treg cells within peripheral blood mononuclear cells [PMNCs] isolated from allergic children who had insufficient vitamin D, but not in allergic children who had normal level of vitamin D
Conclusion: this work provides further evidence for an important role of 1,25[OH]2D3 as an immune-modulatory molecule and suggests that supplementation of vitamin-D-deficient individuals, who are reported to have reduced numbers of circulating and Foxp3+ IL10+ Treg cells, may represent an attractive therapy for enhancing endogenous populations of Treg cells in allergy
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Pancreaticoduodenectomy is the primary means of treating cancer head of the pancreas. Associated mortality rates have dropped dramatically in the past decade, but morbidity rates remain high. Patients were divided randomly into two groups:- 1- The first group includes 49 patients have undergone pancreaticogastrostomy. 2- The second group includes 55 patients have undergone pancreaticojejunostomy. The patients were followed for the presence of complications especially pancreatic leak. The study included 104 patients divided randomizly into two groups the first group included 49 patients who had undergone pancreaticogastrostomy and the other group includes 55 patients who had undergone pancreaticojejunostomy. 70% were males, 30% were females, age 74 +/- 13 years. Comparing the complication observed after the two procedures, Multiple complications occurred in 30.6% in patients who undergone pancreaticogastrostomy and 38.18% in patients who undergone pancreaticojejunostomy. With no statistically significant difference between the 2 procedures. No reported mortality in the two groups had been observed. The most common complication observed in the pancreaticogastrostomy group was pancreatic fistula [14.28%] followed by intra-abdominal fluid [8.16%], biliary fistula, bleeding, reoperation [4.08%] each. For the pancreaticojejunostomy group the most common complication observed were pancreatic fistula [20%] followed by intra-abdominal fluid and reoperation [9.09%] each, biliary fistula [5.45%], no bleeding reported. pancreaticogastrostomy is associated with a lower frequency of multiple surgical complications which is not statistically significant and higher incidence of pancreatic fistula in the pancreaticojejunostomy arm
Subject(s)
Humans , Male , Female , Pancreaticoduodenectomy/adverse effects , Postoperative Complications , Pancreaticojejunostomy/adverse effects , Fistula , Anastomosis, SurgicalABSTRACT
Nosocomial infections [Nis] have become a matter of major concern in neonatal intensive care units [NICUs]. Nosocomial infections are the result of the interaction of several risk factors. To identify risk factors for nosocomial infections among neonates admitted to neonatal intensive care unit in Pediatric Assiut University Hospital [AUH]. Knowledge of modifiable risk factors could be used to guide the design of interventions to prevent the problem. Incidence [surveillance] study for identification of new nosocomial infections for one year and 9 days from [17 of April 2007 to 26 of April 2008]. The total population: All neonates attending NICU in pediatric AUH from the Obstetric Department of Maternal-Healthcare Assiut University Hospital. The target population is all neonates that developed nosocomial infections within 72 hrs of admission. The presence of risk factors was studied. A practical guide completed for each patient, which included: Demographic risk factors as age, birth weight, sex, single or multiple births, type of delivery, premature rupture of membranes, variables recorded daily as enteral feeding, parentral feeding, mechanical ventilation and indwelling catheter. Differences between patients with and without NI for discrete variables were estimated by the chi-square test. The association between risk factors and the presence of NIs were estimated by relative risk. From a total of 990 admitted neonates, the incidence rate and the incidence density rate were 16% and 24.45% infections per 1000 patient-days, respectively. Case fatality rate was 91.8%. The following risk factors were associated with Nis [P<0.05]: mechanical ventilation, umbilical catheter, prematurity, birth weight less than 1500 g, use of ryle, transport outside NICU, premature rupture of membrane and peripheral vascular catheter. The risk of NIs increases with increasing invasive devices, decreasing birth weight, and gestational age. There is an increased mortality rate associated with NI. Strategies to minimize the impact of risk factors must be identified
Subject(s)
Intensive Care Units, Neonatal/standards , Incidence , Risk Factors , Hospitals, University , Mortality/trends , Infection Control/methods , Fetal Membranes, Premature RuptureABSTRACT
This work aims to evaluate the role of renal biopsy in the diagnosis of patients presented with acute renal failure [ARE] with correlation between the clinical and pathological diagnosis and their impaction on the prognosis. The study was preformed on fifty patients presenting with the manifestation of ARE received in Pediatric Hospital Mansoura Eaculty of Medicine. Paraffin blocks were cut for hematoxyline and eosin and special stains as well. Analysis of pathological findings with clinical parameters related to outcome of patients. This study delineated that the childhood cause of ARF are acute glomerulonephritis [48%] followed by acute tubular necrosis [18%] then thrombotic microangiopathy [12%], then malignant lymphomatous infiltration [6%], then acute pyelonephritis [4%] lastly renal cortical necrosis [2%] and interstitial hemorrhage [2%]. The renal biopsy confirmed the clinical diagnosis in 58% of cases and altered .the clinical diagnosis in 12% of cases. Moreover in cases with uncertain clinical diagnosis the renal biopsy clarified the accurate diagnosis. More over the biopsy guided the treatment in some cases. The results of this study demonstrate that renal biopsy is essential in many cases of pediatric ARF not only to confirm the diagnosis but also to diagnose cases of unknown causes and changes the clinicat diagnosis in many cases as well
Subject(s)
Humans , Male , Female , Kidney/pathology , Biopsy , Histology , ChildABSTRACT
This study aims to determine advantages, disadvantages, and long-term results of rhomboid excision and Limberg flap procedure for sacrococygeal pilonidal sinus repair using either general or spinal anesthesia. A prospective randomized study involved 40 patients with sacrococygeal pilonidal sinus disease scheduled for elective pilonidal sinus excision using the Limberg rhomboid flap technique. The patients were asked about their complaints and choice of treatment. Physical examination was performed, and hospital records were reviewed. The 40 patients were randomized into two equal groups: group G, general anesthesia, with endotracheal intubation and group S, spinal anesthesia, who got 2.5 ml of 0.5% heavy marcaine with 25 micro g fentanyl subarachnoid injection, Total operating room time, time from entry into theatre till readiness for surgery, duration of surgery, time from end of surgery till shift to recovery room, recovery room time, onset of pain, analgesic use in recovery room, in the ward and at home, patients satisfaction, hospital stay and time taken to return to normal activity were compared. Perioperatfve side effects, wound healing and surgical complications were recorded. P <0.05 is considered statistically significant. All patients were satisfied with the final surgical results except 3 cases in group G who got seroma with negative bacterial culture and 2 cases in group S; 1 partial wound dehiscence and 1 purulent discharge. $o recurrent cases were recorded over the period of two years follow up. Time of hospital stay and time taken to return to normal activity were comparable in both groups; P > 0.05, Total operating room time and time from end of surgery till shift to recovery room were less in group S; P<0.05. However, time spent in recovery room was less in group G; P <0.05. Group S patients complained of pain after a longer period of time and required less analgesics in the first 24 postoperative hours; P<0.05. Patients were more satisfied with anesthesia in group S; P < 0.05. Anesthetic problems in group G included 2 laryngeal spasm, 3 nausea/vomiting, 1 respiratory depression, and 4 sore throat cases. On the other hand, group S problems included 1 pruritis and 1 urine retention cases. Rhomboid excision and Limberg flap procedure for managing sacrococcygeal pilonidal sinus has a low complication rate, short hospital stay, short time to return to normal activity and good long-term results. The procedure is proved to be safe whether done under general or spinal anesthesia. However, spinal anesthesia using 2.5 ml 0.5% heavy marcaine and 25 micro g fentanyl ensures less operating room time, better patient anesthesia satisfaction and prolonged postoperative analgesia. General and spinal anesthesia were proved to be safe in prone position if required precautions are followed
Subject(s)
Humans , Male , Female , Surgical Flaps , Anesthesia, General , Anesthesia, Spinal , Postoperative ComplicationsABSTRACT
This study looks at the anesthetic and surgical safety of fast-track day case laparoscopic cholecystectomy [LC] when bispectral index [BIS] guided desflurane, sevoflurane or propofol are combined with remifentanil. Times of recovery, return of early and late cognitive functions as well as complications for the first 7 postoperative days are compared. The study involved 75 patients who underwent elective laparoscopic cholecystectomy scheduled on day-case basis. The patients were divided into three groups [25 cases each]: desflurane/remifentanil [group D], sevoflurane/remifentanil [group S] and propofol/remifentanil [group P]. All patients received midazolam, dexamethazone and ondansetrone premedication. Anesthesia was induced with remifentanil, propofol and cis-atracurium. Infusions of cisatracurium and remifentanil were continued in all patients. Bispectral index [BIS] was kept between 40-50 to guide desflurane, sevoflurane or propofol. IV paracetamol [Perfalgan] register and pethidine and local bupivacaine were used for analgesia. The selection criteria were an American Society of Anesthesiologists [ASA] grade I, low risk of common bile duct stones, adult company at home, and residence within 10km of the hospital with easy transfer. Cases with history of allergy to the used anesthetic agents or psychiatric history, also cases with history of jaundice or history of biliary pancreatitis were excluded. The LC procedure was performed using a standard four-canula technique. Early and late recovery times, the incidence of postoperative nausea and vomiting, pain, shivering and additional use of antiemetic and anti-shivering were documented. Follow up of patients were done to record hospital admission, readmission, visit to accident and emergency department and surgical problems. The patients were between 35 and 50 years of age and the male to female ratio was 12:63. The mean length of the operation was 45 +/- 16 min. Early and late recovery times were faster in [group D] than [group P] and [group S]. Postoperative nausea, vomiting, shivering and pain did not differ significantly between the three groups. There was no hospital mortality and only one patient needed open cholecystectomy. 63 [84%] of the 75 patients went home on the same operative day, while 12 [16%] were admitted overnight. Causes of admission included social reasons [4 cases], surgeon preference [3 cases], pain and nausea [4 cases] with no significant differences between the three groups. One case was converted to open cholecystectomy in [group S] and was also admitted. For selected patients, fast track day-case LC using remifentanil with BIS guided desflurane, sevoflurane or propofol ensures safe operative and postoperative course. Recovery was earlier in desflurane in comparison to the other two groups