Histologic profiles of reduction mammaplasty specimens among jordanian females

Reduction mammaplasty is a common surgical procedure that yields a variable amount of tissue for pathologic examination. The purpose of this study was to evaluate the histological diagnoses of the reduction mammaplasty specimens and to determine the incidence of breast lesions in otherwise asymptomatic and healthy Jordanian females. All reduction mammaplasty specimens of 73 patients over a 10-year period [September 1999-September 2009] at Jordan University Hospital were retrospectively examined. The average number of blocks submitted per breast was 4 [range 3-5]. Variables such as age and preoperative mammograms were examined. A total of 143 specimens were evaluated. Normal mammary tissue was present in 36 patients [49%]. The most common benign lesion was fibrocystic disease [21%] Precancerous breast lesions were identified in 7 patients [9.6%]. No case of carcinoma in situ or invasive carcinoma was encountered in our study. Most of the histopathological lesions were found in patients younger than 35 years of age. Preoperative mammograms were done for 26 patients and all were normal. This study demonstrates the importance of systemic analysis of breast reduction specimens to help identify and guide the management of patients with increased risk of breast cancer following reduction mammaplasty. Consequently, thorough sampling and handling of breast reduction specimens should be emphasized

Thromboprophylaxis in neurosurgical patients at Jordan university hospital: a prospective comparative study

Venous Thromboembolism [VTE] is potentially a life threatening complication in patients undergoing major neurosurgical procedures. There has been a general reluctance over the years to use anticoagulant prophylaxis for patients with head injury or in patients who need intracranial surgery. Intermittent Pneumatic Compression [IPC] and elastic stocking are widely used as prophylaxis against venous thrombo-embolism in these patients. The aim of the study is to assess and compare the value of VTE prophylaxis using a control group with Low dose Unfractionated Heparin [LDUH] every eight hours alone with a study group using Intermittent Pneumatic compression [IPC] and elastic stocking along with Single dose Unfractionated Heparin [SDUH] at the time of anaesthesia in induction on patients undergoing brain and spinal surgery. A prospective case-control study was conducted at Jordan University Hospital, over 15 months during the period 2005-2006. A total of 223 patients were included. In the study group, 113 patients using single dose of unfractionated heparin at the time of anaesthesia induction along with Intermittent Pneumatic Compression [IPC] intraoperatively and compression Elastic Stocking [ES] post operatively were used until full ambulation. In the control group, there were 110 patients in whom unfractionated heparin at a dose of 5000 units every 8 hours was used until full ambulation or for 7 days. All patients underwent either brain surgery or spinal surgery. The characteristics of the two groups were fully comparable except for the duration of surgery which was statistically longer in the study group [P= <0.001]. Deep Vein Thrombosis [DVT] occurred in 3 patients in the study group, compared to 6 patients in the control group, of these 6 patients, 4 patients developed PE in addition to DVT and one of the four patients expired. The observed differences among these rates are statistically not significant [P=0.288]. When pooled together, patients who developed VTE in both groups were older than those who did not have VTE. This difference was statistically significant [P=0.07]. The combination of elastic stocking, intermittent pneumatic compression along with single dose unfractionated heparin at the time of anaesthesia induction is comparable in effectiveness of reducing the incidence of VTE as the low dose unfractionated heparin alone in patients undergoing neurosurgical procedures of the brain or spine, despite the trend towards better results of the combined method

Intravenous dexmedetomidine or propofol adjuvant to spinal anesthesia in total knee replacement surgery

The purpose of this study was to compare the effect of intravenous dexmedetomidine with the intravenous propofol adjuvant to spinal intrathecal anesthesia on the duration of spinal anesthesia and hemodynamic parameters during total knee replacement surgery. Seventy five patients were enrolled into this randomized study from the 1[st] of April 2008 till the 30[th] of August 2009 for total knee replacement surgery under spinal anesthesia. They were randomly assigned into three groups, group D, group P and group C. Following intrathecal injection with bupivacaine 12.5 mg in all patients in the three groups, patients in group D received intravenous loading dose of microg/kg/hr dexmedetomidine over 10 minutes and a maintenance dose of 0.2 to 0.5 p,g/kg/hr. Patients in group P received intravenous propofol 4 mg/Kg/hr over 10 min and a maintenance dose of 0.5-2 mg/Kg/hr. Patients in group C [control group] received nothing extra to the regular IV fluid. The regression times to reach SI sensory level and Bromage 0 motor scale, the hemodynamic parameters, the Bispectral Index level of Sedation [BIS], and arterial CO[2] level were recorded. The regression time to reach SI dermatome was 149.4 +/- 14.6 min in group C, 152.8 +/- 16.6 min in group P and 209.6 +/- 25.9 min in group D. The regression to Bromage 0 was!84.6 +/- 22.8 min in group C, 190.0 +/- 21.0 min in group P, and 255.8 +/- 36.7 min in group D. Statistical analysis of regression of sensory and motor block was significant among groups [C vs. D, P vs. D, P < 0.05]. The heart rate was significantly decreased in group D in comparison to groups C and P. Sedation levels were within accepted ranges in groups D and P and not affected in the control group. Minimal respiratory depression occurred in group P and D, clinically it was not significant. Supplementation of spinal anesthesia with intravenous dexmedetomidine or propofol produces good sedation levels without significant clinical hemodynamic changes. Adding dexmedetomidine produces significantly longer sensory and motor block than propofol

impact of long-lasting preemptive epidural analgesia before total hip replacement on the hormonal stress response. a prospective, randomized, double-blind study

Recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. One physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h[-1] ropivacaine 0.2% [study group, n=21] or 5 ml*h[-1] saline [control group, n=21]. Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia [PCEA] with ropivacaine 0.2%. The main outcome measure was the concentration of authentic beta-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol. Both groups were comparable concerning preoperative parameters and pain scores. Epidural blocks were sufficient in all patients for operative analgesia. Preemptive analgesia was performed for 11-20 hours in both groups and led to significantly decreased pain scores before surgery. Preemptive analgesia with epidural ropivacaine did not lead to decreased concentrations of beta-endorphin [1-31] before the start of surgery or in the postoperative period. Furthermore, no differences could be detected in the time course of beta-endorphin and adrenocorticotrope hormone after surgery. However, cortisol concentrations differed significantly between groups before the operation, but showed a comparable rise after surgery. Differences in postoperative pain after preemptive analgesia do not seem to be due to an altered endogenous opioid response

Horner's syndrome after lumbar epidural analgesia during labor

Horner's syndrome is rarely reported after epidural analgesia during labor. The use of Top-Up local anesthetic for controlling labor pain in the first stage of labor, or to dense the block in caesarean deliveries can result in this complication. We reported a cases of Horner's syndrome during epidural analgesia in labor in spite of not giving any Top-Up dose. The case was clinically evident and was successfully managed by stopping the epidural infusion, and reassuring the parturient as well as the family; until the disappearance of the signs and symptoms. The infusion was then restarted, delivery was uneventful and no consequent neurological or psychological problems were noticed after a one-month follow-up

balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery

To evaluate the effect of adding dexmedetomidine to a balanced anesthetic technique on postoperative nausea and vomiting after laparoscopic gynecological surgeries. A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between December 2008 and February 2009. Eighty-one female patients in their child-bearing age [17-48 years]; American Society of Anesthesiologists [ASA] clinical status I, who were scheduled for elective diagnostic laparoscopic surgeries under general anesthesia were divided into 2 groups. Group D [n=42] received dexmedetomidine infusion, while group P [n=39] received 0.9% sodium chloride infusion along with the balanced anesthesia. The incidence of early [up to 24 hours] postoperative nausea, vomiting, nausea and vomiting, and the need for postoperative rescue anti-emetic medications were recorded. The total incidence of postoperative nausea and vomiting decreased significantly in group D; 13 out of 42 patients [31%], compared to group P; 23 out of 39 patients [59%], vomiting alone did not significantly change, the incidence of postoperative nausea, and the use of rescue anti-emetic medications were significantly different. A significant drop in overall consumption of fentanyl and sevoflurane was also noted in group D. Combining dexmedetomidine to other anesthetic agents, results in more balanced anesthesia and a significant drop in the incidence of postoperative nausea and vomiting after laparoscopic gynecological surgeries

Effect of dexmedetomidine added to spinal bupivacaine for urological procedures

To determine the effect of adding dexmedetomidine to bupivacaine for neuraxial anesthesia. Sixty-six patients were studied between April and May 2008 in the University of Jordan, Amman Jordan. They were randomly assigned into 3 groups, each receiving spinal bupivacaine 12.5mg combined with normal saline [group N] Dexmedetomidine 5ug [group D5], or dexmedetomidine 10ug [group D10]. The onset times to reach T10 sensory and Bromage 3 motor block, and the regression times to reach S1 sensory level and Bromage 0 motor scale, were recorded. The mean time of sensory block to reach the T10 dermatome was 4.7 +/- 2.0 minutes in D10 group, 6.3 +/- 2.7 minutes in D5, and 9.5 +/- 3.0 minutes in group N. The mean time to reach Bromage 3 scale was 10.4 +/- 3.4 minutes in group D10, 13.0 +/- 3.4 minutes in D5, and 18.0 +/- 3.3 minutes in group N. The regression time to reach S1 dermatome was 338.9 +/- 44.8 minutes in group D10, 277.1 +/- 23.2 minutes in D5, and 165.5 +/- 32.9 minutes in group N. The regression to Bromage 0 was 302.9 +/- 36.7 minutes in D10, 246.4 +/- 25.7 minutes in D5, and 140.1 +/- 32.3 minutes in group N. Onset and regression of sensory and motor block were highly significant [N vesus D5, N versus D10, and D5 versus D10, p<0.001]. Dexmedetomidine has a dose dependant effect on the onset and regression of sensory and motor block when used as an adjuvant to bupivacaine in spinal anesthesia

Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia

The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new ?2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. 48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C [the control group] received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group [261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05]. The duration of motor block was longer in dexmedetomidine group than control group [199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05]. Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability