ABSTRACT
Spinal Anesthesia [S.A] is currently becoming a more common and popular method for orthopedic surgeries. Unfortunately, Backache [BA] and Post Dural Puncture Headache [PDPH] are both frequent and troublesome. Several factors [including needle shape and size, frequency rates of puncture attempts, and age and gender] have been shown to affect the rates of such complications. To determine these factors and evaluate some modalities to prevent them. This is a prospective study on 200 patients- 15 to 65 years old with class type 1 and 2 A.S.A [American Society of Anesthesiology], who were candidates for orthopedic lower extremity surgeries. Anesthetic procedure was performed using a standard 24G needle L idocaine 5% plus Epinephrine. Symptom questionnaire was filled for the history of Headache and Backache and history of former S.A. postop puncture complications of 1[st] day, 1[st] week and 1[st] month were added to the forms. Statistical analysis was performed using SPSS version 16 and the results were considered significant at p<0.05. Rates of BA and PDPH were 12.5% and 17%, respectively. Post anesthetic BA for first day, week, and month were 16%, 9%, and 3.5%, respectively and PDPH were 6.5%, 3.5% and 1% respectively with no significant differences. History of former spinal anesthesia with BA and PDPH revealed notable differences [p<0.001]. The results of this study support the idea that history of previous spinal anesthesia could be a triggering factor for backache and headache in prior Spinal anesthetic procedures
ABSTRACT
Congenital unilateral absence of pectoralis muscles in combination with ipsilateral brachysyndactyly is the most acceptable definition of Poland syndrome. This very rare syndrome has been reported in association with various malignancies and deformities including cardiovascular anomalies. To our knowledge, pulmonary stenosis associated with Poland's syndrome has not been described previously in literature, and there are a few articles about atrial septal defect [ASD] in combination with this syndrome either. We present the first report of Poland syndrome associated with pulmonary valve stenosis and another case of Poland syndrome with ASD. We discuss common etiologic factors of this rare syndrome. Case one: The first patient is a 23 month old boy with Poland syndrome presentation such as absence of pectoralis major of right hemi-thorax, nipple and subcutaneous hypoplasia and ipsilateral brachysyndactyly. On physical examination, we found a systolic ejection sound in auscultation so that a complete cardiac evaluation was performed. Pulmonary stenosis with 7[mm] diameter was detected by Color-Doppler echocardiography. The second patient is a 5 year old girl presenting typical Poland syndrome clinical manifestation. She has congenital right pectoralis major agenesis, Right upper position of nipple and areola was compared to left hemi-thorax, and an ipsilateral hypoplastic hand with syndactyly and short fingers. The 2-dimentional echocardiogram revealed that she is suffering from an Ostium Secundum ASD. Although Poland syndrome is a rare congenital one, it is associated with numerous anomalies and malignancies in the reported articles. The two mentioned cases are the samples of cardiac anomalies associated with this very unique syndrome. According to critical situation of cardiovascular problems, performing a complete cardiovascular evaluation in addition to common medical-surgical treatments seems to be essential for patients with Poland syndrome