Intraperitoneal analgesic antiemetic effects of dexamethasone ropivacaine inpatients undergoing laparoscopic cholecystectomy

Sixty patients ASA I and II undergoing elective laparoscopic cholecystectomy under general anaesthesia were included in this study. At the end of surgery, 60 ml of the studied solution were injected intraperitoneally under both copulae of the diaphragm [20 ml at each copula] and 20 ml directly in the gallbladder bed guided by the surgical camera. The patients were randomized into three equal groups [n = 20 each]: The control group [C Group] received intraperitoneally normal saline 0.9%; ropivacaine group [R group] received 60 ropivacaine 2.5% intraperitoneally and ropivacaine dexamethasone group [DR group] received 16 mg dexamethasone added to 60 ml 0.25% ropivacaine. The patients were left in the Trendelenburg position for 20 minutes after IP injection. Postoperatively, the following parameters were evaluated in the study groups. Visual analogue pain score [VAS] was recorded at 30 min and at 1, 2, 4, 8, 12 and 24 hours after surgery. Shoulder tip pain was recorded on a five-point scale every hour for 24 hours postoperatively. The total dose of intramuscular meperidine was consumed in 24 hours by each patient. All episodes of nausea and vomiting [PONV] and rescue antiemetic drugs were used postoperatively for 24 hours. The study showed that the addition of dexamethasone to the intraperitoneal ropivacaine is effective in reducing the postoperative VAS, shoulder tip pain, decreasing postoperative nausea and vomiting as well as rescue antiemetic drugs and analgesic requirements in patients following laparoscopic cholecystectomy

Impotence, lead and oxidative stress: do they form a serious triangle? II: a histopathological ultrastructural study of cavernous tissue

This study was conducted to elucidate the histopathological and the ultrastructural changes induced by lead in the cavernous tissue of impotent subjects. For this purpose, the study included 49 male subjects who were categorized into two main groups. Group I [n=34] included impotent males who underwent surgery for penile implants. They were further subdivided according to the blood lead level into 2 subgroups: Subgroup 1 [n=18] with acceptable lead level and who suffered of diabetes mellitus and subgroup 2 [n=16] with high lead level. Group II [n=15] included potent males who underwent surgery for penile cancer. Two small samples of cavernous tissue were taken during the operation. One piece was preserved in absolute alcohol to stain lead by the Mallory-Parker stain. The other piece was fixed and stained for electron microscopic study

Is there a role for diagnostic laparoscopy in blunt abdominal trauma?

Patients with blunt abdominal trauma present a surgical dilemma. To operate or not is an important question, especially in those patients with equivocal abdominal signs. With the advent of new technology, many diagnostic tools have been utilized to increase the accuracy of management of these patients. In this prospective study, 40 patients with blunt abdominal trauma were included; all having equivocal abdominal signs. Patients were divided into two groups in a sequential manner to assess the role of diagnostic laparoscopy in comparison with diagnostic peritoneal lavage [DPL]. In this study, DPL had appositive predictive value [PPV] of 42.9% and a negative predictive value [NPV] of 83.3%, while diagnostic laparoscopy had a PPV of 93.3% and NPV of 80%. It was concluded that laparoscopy is a superior adjunct in diagnosis of these cases

Impotence, lead and oxidative sress: do they form a serious triangle? I: a Comparative toxicological biochemical study of cavernous tissue versus peripheral blood

This study was set out to assess the possible hazardous effects of lead on the endogenous antioxidant status of erectile tissues. The study included 49 male subjects categorized into two main groups. Group I [n=34] included impotent males, who underwent surgery for penile implants and further subdivided according to the blood lead into two subgroups; subgroup I [n=18] with acceptable lead level who suffered of diabetes mellitus and subgroup II [n=16] with high lead level. Group II [n=15] included potent males who underwent surgery for penile cancer. Blood and cavernous tissue samples were taken from each subject and in which lead concentration was estimated. In addition, nitric oxide [NO] and hydrogen peroxide [H2O2] were detected as representatives of free radicals, malondialdehyde [MDA] as a product of lipid peroxidation and superoxide dismutase [SOD], catalase, glutathione peroxidase [GPx], selenium, vitamin C and vitamin E as indicators of the endogenous antioxidant status

Carotid body tumours: surgical management and predictors of operative risk

In spite of a low but constant incidence of neurologic complications, resection of carotid body tumours of all sizes in appropriate surgical candidates has been advocated as the sole line of treatment of these rare lesions. This study summarizes our experience in the diagnosis and treatment of these lesions trying to identify the factors that predict the magnitude of operative risk.22 patients with 23 non-familial carotid body tumours presenting to the Cairo and Alexandria University Hospitals over a 4-year period were reviewed. There were 10 females and 12 males and the mean age was 42 years. A preoperative diagnosis, of being carotid body tumour, was not reached in 7 patients. In the remaining 16 tumours, duplex scanning, angiography, CT scanning and MRA clenched the diagnosis preoperatively, one tumour had FNAB and another open biopsy. 21 tumours were resected and the remaining 2 were irradiated. Internal carotid artery reconstruction employing great saphenous vein was required in 7 cases, end to end anastomosis in one case and lateral repair in another. A temporary shunt was used in 5 instances. Three patients suffered a transient hemiparesis while another 3 suffered a transient hypoglossal nerve palsy .It was concluded that surgical resection remains an effective form of treatment but is not without risk. The predictors of operative difficulty and hence increased risk include lack of preoperative diagnosis, mid and large sized tumours, Shamblin classes 2 and 3, use of FNAB as well as previous surgery