Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

To compare and evaluate the effect of adding ketamine or nitroglycerin [NTG] as adjuncts to lidocaine for intravenous regional anesthesia [IVRA] on intraoperative and postoperative analgesia, sensorial and motor block onset times, and tourniquet pain. A prospective, randomized, double-blind study was carried out. Seventy-five patients undergoing hand surgery were divided into three groups as follows: control group receiving lidocaine 2%, LK group receiving lidocaine 2% with ketamine, and LN group administered lidocaine 2% with NTG. Sensory and motor blocks' onset and recovery times were recorded. Visual analog scale [VAS] for tourniquet pain was measured after tourniquet application and it was also used to measure postoperative pain. Analgesic consumption for tourniquet pain and postoperatively were recorded. Sensory block onset times were shorter in the LK [4.4 +/- 1.2 minutes] and LN [3.5 +/- 0.9 minutes] groups compared with the control group [6.5 +/- 1.1 minute] [P <0.0001] and motor block onset times were shorter in the LK [7.3 +/- 1.6 minutes] and LN [3.6 +/- 1.2 minutes] groups compared with the control group [10.2 +/- 1.5 minutes] [P<0.0001]. Sensory recovery time prolonged in the LK [6.7 +/- 1.3 minutes] and LN [6.9 +/- 1.1 minutes] groups compared with the control group [5.3 +/- 1.4 minutes] [P = 0.0006 and <0.0001, respectively]. Motor recovery time prolonged in the LK [8.4 +/- 1.4 minutes] and LN [7.9 +/- 1.1 minutes] groups compared with the control group [7.1 +/- 1.3 minutes] [P = 0.0014 and 0.023, respectively]. The sensory and motor block onset times were also shorter in LN group than in the LK group [3.5 +/- 0.9 versus 4.4 +/- 1.2 minutes, P=0.004; and 3.6 +/- 1.2 versus 7.3 +/- 1.6 minutes, P < 0.0001, respectively]. The amount of fentanyl required for tourniquet pain was less in adjuvant groups when compared with control group. It was 13.6 +/- 27.9 and 27.6 +/- 34.9 microg in LK group and LN groups, respectively, versus 54.8 +/- 28 microg in the control group. VAS scores of tourniquet pain were higher at 10, 20, 30, 40 minutes in the control group compared with the other study groups [P < 0.0001]. It was also higher in LN group compared with LK group at 30 and 40 minutes [P < 0.001]. Postoperative VAS scores were higher for the first 4 h in control group compared with the other study groups [P< 0.0001]. Conclusions: The adjuvant drugs [ketamine or NTG] when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance and improving the postoperative analgesia in comparison to the control group. Ketamine as an adjuvant produced better tolerance to tourniquet than the other groups. NTG as an adjuvant produced faster onset of sensory and motor blockades in comparison to other groups

Role of MRI in improving diagnosis of breast tumors

To assess the role that can be played by MRI to minimize the number of false positive cases of breast tumors that commonly occur with mammography. This study included 200 consecutive patients aged 40 years or more, who were referred to the Department of Radiology for suspicion of a breast lump. Mammography then magnetic resonance imaging [MRI] was performed for each patient. A patient with a positive finding in any of these two modalities underwent histopathological diagnosis. Sensitivity and specificity were calculated for each imaging modality and that for MRI of mammography positive patients. Most common benign lesion were fibroadenoma [11%] and radial scars [5.9%], while the most common malignant tumors were invasive ductal carcinoma [37.3%] and ductal carcinoma in situ [21.2%]. Prevalence of breast tumors among participants increased with their age. Prevalence of breast tumors among nulliparous participants was significantly higher than that among parous participants [88.6% Vs. 72.5%, respectively, p = 0.01]. The prevalence of breast tumors was significantly higher among those with positive family history of breast cancer [93.2%] than those with negative family history [70.6%], p = 0.003. Mammography provided a higher sensitivity than that provided by MRI [97.5% Vs. 90.7%, respectively], but a lower specificity [48.6% Vs. 94.3%, respectively], which has been fully improved by the application of MRI on cases who were positive by mammography [100%].The application of MRI for cases with positive mammographic findings can be a cost-effective procedure that greatly limits false positives, increases specificity and spares unnecessary invasive interventions. To conduct a community-based study to assess the role and cost-effectiveness of MRI in screening for breast cancer among females aged over 40 years, applying MRI on all those with mammographic findings

Value of magnetic resonance cholangiography in detection of extent of hilar cholangiocarcinoma

To determine the extent of hilar cholangiocarcinoma, using different magnetic resonance [MR] spin-echoes. A total of 87 patients, who presented with painless jaundice, comprised the subjects of the present study. All patients were prospectively examined with MR cholangiography after endoscopic retrograde cholangiography, percutaneous trans-hepatic cholangiography, ultrasound and CT. Only 18 patients [4 men and 14 women] had established the diagnosis of hilar cholangiocarcinoma. MR angiography was performed to provide a non-invasive angiographic picture for the hepatic artery and portal vein. MR cholangiography examinations allowed for visualization of the intrahepatic and extrahepatic bile ducts of all patients. It was able to delineate any hilar stricture, the proximal extent of the disease and the distal duct in all patients. The MR cholangiographic findings of 6 patients [33.3%] detected the tumor and its extension, similar to that of the direct cholangiograms. In the rest of patients with cholangiographic correlation [12 patients, 66.7%], MR cholangiography detected the mass and the exact extension in 8 patients [44.4%], while the mass was detected in 2 patients by CT and in one patient by ultrasound. As the proximal extent of tumor and stricture were clearly seen by MR cholangiographic findings, this resulted in change of the therapy plan in 8 patients [44.4%] regarding their resectability or interventional stenting. MR and MR cholangiography are rapid, reliable and non-invasive diagnostic modality in the diagnosis of hilar cholangiocarcinoma. Since MR cholangiography provides a wealth of relevant information, it should be used routinely for the diagnosis and staging of hilar cholangiocarcinoma

Assessment of four cephalometric measurements utilized in evaluation of the mandibular position

This study was conducted to assess and correlate four cephalometric measurements utilized in evaluating the mandibular position in the anteroposterior direction. The four measurements used were, the SNB angel, Downs facial angle, Bjork's facial angle, and modification of Koski's ratio. Lateral cephalometric radiographs of forty seven adults [20 males and 27 females] with age ranged from 18-20 years were selected for this purpose. All had accepted normal occlusions, normal skeletal relationship and balanced profiles. Statistical analyses were performed to assess these four measurements. The results revealed no significant difference between the norms of males and females in the four measurements. Downs and Bjork's facial angles presented more sysmmetrical normal distribution than SNB angle and Kosk's ratio. A low and non significant correlation was found between Downs and Bjork's facial angles. Therefore, their conjunctive use would be recommended. Finally, a high and significant correlation was found between Bjork's facial angle and SNB angle. Accordingly these two measurements could be interchangeable

Safety and efficacy of pentastarch 6% versus albumin 5% for acute normovolemic hemodilution in patients undergoing major abdominal surgeries

Acute normovolemic hemodilution [ANH] has been used to decrease allogenic blood transfusion. ANH has different systemic effects that may include hemodynamic, oxygen transport variables, renal, hematological and acid base status. The effect of pentastarch [6% hydroxyethyl starch, MW: 200 kDa] versus human serum albumin [5%, MW: 69 kDa] as volume replacement solution after induction of anesthesia for major abdominnal surgery was assessed in this study. Eighty patients were divided into two groups; HES group [no = 40] received pentasarch and ALB group [no = 40] received albumin. Fifteen m1/kg of blood was removed and replaced simultaneously with the tested solutions to keep central venous pressure between 12-15 mmHg. Blood was reinfused before the end of operations. Total blood loss at 1st postoperative day was significantly higher in HES group [1198.5 +/- 354.3 vs. 1044.2 +/- 288.3 m1 in ALB group]. Significantly Higher amounts of the tested colloid [2084.7 +/- 408.6 in HES group vs. 1766.6 +/- 574.3 ml in ALB groups, 4 hrs postoperatively], crystalloids [5748.8 +/- 1165.3 in HES group vs. 5116.8 +/- 1309.8 ml in ALB group at 1 st postoperative day], FFP [243.6 +/- 29.7 in HES group vs. 123.5 +/- 25.3 ml in ALB group, at the end of surgery] and packed RBC [988.8 +/- 47.8 in HES group vs. 645.9 +/- 44.8 ml in ALB group, at the end of surgery] were used in HES group. HES group showed significantly higher cardiac index [3.9 +/- 0.9 in HES group vs. 3.4 +/- 1.0 1/min.m 2 in ALB group, at the completion of ANH], better preservation of SVRI [2052.3 +/- 251.5 in 5HES2 group vs. 1729.6 +/- 159.4 dyne.sec/cm5. m 2 in ALB group, at the completion of ANH]. Renal functions were better preserved in ALB group. Serum creatinine was significantly higher HES group [1.41 +/- 0.35 vs. 0.98 +/- 0.31 mg% in ALB group, at 3rd postoperative day]. Urinary N-acetyl-beta-glucosaminidase [beta-NAG] was significantly higher in HES group [1.38 +/- 0.52] compared with ALB group [0.97 +/- 0.52] u/mmol creatinine] at the 3rd posstoperative day. alpha-1-microglobulin was significantly higher in HES group [19.7 +/- 9.3] compared with ALB group [15.2 +/- 9.3 mg/1] at the 3rd postoperative day. Activated PTT was significantly higher in HES group [44.8 +/- 4.4] compared with ALB group [40.5 +/- 4.7 sec] 4 hrs postoperatively. D-dimer was significantly higher in HES group [2.4 +/- 0.2] compared with ALB group [3.0 +/- 0.6 ng/1] at the 1st postoperative day. Thrombin/antithrombin III [TAT] was statistically higher in HES group [2.2 +/- 0.7] compared with ALB group [1.9 +/- 0.6 micro g/1] at the 1st postperative day. There was a state of metabolic acidosis in both groups with a significant difference in base-excess results [-3.2 +/- 1.5 in HES group vs. -4.1 +/- 1.3 mmo1/1 in ALB group] at the completion of ANH. We can conclude that both solution were safe and effective for performing ANH before major abdominal operations with the superiority of albumin over pentastarch

Shear bond strength of orthodontic brackets bonded with self-etching primer and conventional etchant and bond

The purpose of this study was to compare in-vitro the shear bond strength of stainless steel brackets bonded by phosphoric acid etching versus Reliance First Step self-etching primer. Forty human upper first bicuspids were used in this study. In Group I [control group], bicuspids were first etched with 37% phosphoric acid, rinsed with water and dried. The sealant was applied and Light- cure composite [Transbond XT] was used to bond the brackets. In Group II, a self-etching primer [First Step. Reliance Orthodontic Products, Inc.] was applied to the teeth according to manufacturer's instructions. Then, the brackets were bonded as in Group I. Each group was stored in water at 37°C for 1 week. Brackets were then subjected to a shear bond strength test using a computerized testing Lloyds machine. Descriptive statistics were calculated for each group and the Student t test was used to compare between the two groups. The results of this study revealed that the mean bond strength of self-etching primer group was significantly higher than PO4 acid etching group [26.0 N/mm[2] +/- 18.8 and 15.7 N/mm[2] +/- 5.6 respectively. p = 0.024481]

comparison between four methods for rebonding orthodontic brackets

The purpose of this study was to compare in-vitro the shear bond strength of stainless steel brackets bonded to previously bonded teeth via 4 different procedures. Eighty-four human upper first bicuspids were used in this study. They were all etched and bonded using Po4 acid and Transbond Light Cure composite. The brackets were debonded one week later with debonding pliers and the buccal surfaces cleaned with a finishing bur. Then, they were divided into four equal groups, 21 bicuspids each. They were rebonded with new brackets using 4 different protocols. In Group I, the teeth were re-etched with phosphoric acid and rebonded with Reliance Two-paste system. In Group II the teeth were also re-etched with Po4 acid and rebonded with Transbond Light Cure composite. In Group III. First-step etching primer was applied and Reliance phase II two-paste system was used to rebond the teeth, In Group IV. First-step etching primer was applied and Transbond Light Cure composite was used to rebond the teeth. The 4 groups were stored individually in water at 37°C for 1 week. Brackets were then subjected to a shear bond strength test using a computerized testing Lloyds machine. Descriptive statistics were calculated for each group and One-Way ANOVA was used to compare between the two groups, followed by multiple comparison of group means [LSD]. It was found that rebonding teeth by re-etching with phosphoric acid yielded higher bond strength than when using etching primer. Also, it was bound that rebonding using two-paste composite yielded higher bond strength than when using light-cure composite

Holmium: YAG laser prostatectomy; a comparative study with TURP

This prospective urodynamic-controlled study included 150 patients with bladder outlet obstruction due to benign prostatic hyperplasia [BPH]; 100 patients underwent holmium laser prostatectomy [HoLRP- HoLEP] and 50 patients were treated using transurethral resection of the prostate [TURP]. All patients had preoperative AUA symptom score, urinary flow rate, post-void residual urine, TRUS, filling cystometry, pressure flow studies, intraoperative course, postoperative outcome and postoperative retrieved prostate tissue; complications were detected and compared in both groups [with a follow up of six months]. The results of this study showed that holmium laser prostatectomy [HoLRP-HoLEP] is associated with a longer operation time, less blood loss, less perioperative morbidity, shorter postoperative catheterization time and shorter postoperative hospital stay in comparison with TURP. The follow up results [up to six months] showed that both groups were comparable with each other. However, a longer follow up is still required to assess the long-term results

Site of lesion in stroke and its relation to depression

A total of 174 patients [103 males and 71 females] suffering from acute stroke was recruited for this study. All patients were subjected to complete and thorough neurological history and examination on admission, mini-mental state examination [MMSE], CT scanning of the brain within 72 hours after the onset of stroke and Barthel daily living test to compare the physical disability before stroke with that at the time of neurological examination. Six months after the stroke, the patients underwent complete and thorough psychiatric evaluation according to DSM-IV, Barthel daily living test and Beck Depression Inventory. Sixty-two patients met the DSM-IV criteria for depressive disorder. Three significant correlates for post-stroke depression were identified; namely, female gender, severity of disability and volume of lesion. Left hemisphere lesions were significantly more associated with post-stroke depression than right hemisphere lesions. Within the left hemisphere, anterior lesions were significantly more associated with post-stroke depression than the posterior ones