Sleep on lateral position as a treatment of obstructive sleep apnea syndrome

Sleep on lateral position was supposed to be the most conservative method for treatment of patients with obstructive sleep apnea syndrome [OSAS]. This study was performed to objectively evaluate the effect of sleep position on one hundred-eight cases suffering from OSAS with mean age 46.7+12.4 years and mean body mass index [BMI] 26.6+3.7 Kg/m[2]. Polysomnographic recording was done for each patient after insertion of a soft silicon catheter with 4 barosensors. The terminal sensor was adjusted at the lower half of the esophagus to be confirmed by roentogenography. The study was conducted during the afternoon period; one hour on supine position and one hour on lateral position. Analysis of the pressure recording indicated that the negative intrae-sophageal pressure decreased from 54. 7+24.2 cm H[2]O on supine position to 33.9+25.7 cm H[2]O on lateral position [38%, P<0.001, n= 108]. Sixty-three patients [58.3%] indicated a remarkable response during sleep on lateral position [Le. 75-100% decrease of either intraesophgeal pressure or apnea/ hypopnea index]. We concluded that prescription of lateral position as a treatment of OSAS can be useful for some patients without surgery and can be adjuvant for others after performing sleep apnea surgery. This should be based on upper airway pressure recording to exclude patients who indicate no improvement and those who become worse

Intraperitoneal lidocaine for pain ralief during and after tubal sterilization

We conducted a randomized, blinded, placebo-controlled study to evaluate the effectiveness of intraperitoneal lidocaine, IM meperidine, or both drugs together for pain relief [intraoperative and postoperative] in postpartum tubal ligation. Sixty postpartum patients scheduled to have tubal ligation were randomly divided into four groups to receive IM isotonic sodium chloride solution [2 mL] and intraperitoneal instillation of 40 mL of isotonic sodium chloride solution [Group I]; IM meperidine [100 mg in 2 mL] and intraperitoneal instillation of 40 mL of isotonic sodium chloride solution [Group II]; IM injection of isotonic sodium chloride solution and intraperitoneal instillation of 1% lidocaine in 40 mL [Group III] and both imeperidine and intraperitoneal lidocaine instillation [Group IV]. The rninilaparotomy was performed after local infiltration with 20 ml of lidocaine. A numerical rating score was used to rate pain on a 0 - 10 scale during and after the surgical procedures. During the surgical procedures, the mean pain scores were 1.8 in group III and 0.7 in group IV. These pain scores were significantly lower than those in groups I and II, which were 6.4 and 6.0, respectively [p < 0.001]. Postoperative mean pain scores at 24 h rest were 2.1 in group III and 0.8 in group IV. These pain scores were significantly lower than those in groups I and II, which were 6.5 and 6.4, respectively [p < 0.001]. Postoperative mean pain scores at 24 h movement were 2.9 in group III and 1.6 in group IV. These pain scores were significantly lower than those in groups I and II, which were 7.5 and 7.3 respectively [p < 0.001]. The plasma lidocaine concentrations reached a maximum in groups III and IV 30 min after instillation begun. The highest mean plasma lidocaine level was 2.6 ug/ml [range 1.2 - 3.6]. In conclusions pain relief was inadequate in patients undergoing post-partum tubal ligation under local anesthesia, even after the administration of IM meperidine. Intraperitoneal lidocaine, however, effectively, decreased intraoperative and postoperative pain in these patients

Medulloblastoma in adults a clinico-pathological review and prognostic factor study of 19 cases

Out of 19 Patients diagnosed as medulloblastoma in adults, 12 were males and 7 were females. The mean age was 24 years with a range between 15 and 42 years. The main predominant features were increased intracranial pressure, headache, vomiting and papilledema. The classical histological type was encountered in 11 cases [58%] while the desmoplastic type was present in 5 cases [26%] and the pleomorphic type in 3 cases [16%]. Shunting, tumour resection partially or totally, biopsy, radiotherapy and chemotherapy were the line of treatment given to the patients. The 5 years survival for all the cases was 52.6% [50% for males and 57% for females]. Patients in older age groups tolerated the after radiation effect better and had better survival rates. Patients with a tumour with classical histological pattern had better survival as well as those in whom the tumour was totally resected, Recurrence rate was 57.9% and mainly in the posterior fossa and syinal cord metastases was found in 18.2% of the recurrent cases. Maximal tumour resection is recommended within the limits of acceptable morbidity. Post operative craniospinal irradiation is the most important step of treatment of medulloblastoma as the tumour is highly radiosensitive

Cerebello-pontine angle tumours- Clinicopathological study and surgical outcome

24 patients having CPA tumors were operated upon in the last 2 years; 11 acoustic schwannoma, 6 meningioma, 3 epidermoids, 2 arachnoid cysts, one astrocytoma and one case of sarcoidosis. CT scan and audiological investigations were done for all cases. Total removal of the tumor was achieved in 36% of acoustic schwannoma and 33% of meningioma cases. The overall mortality was 16%