Comparison between the induction of anesthesia using sevoflurane-nitrous oxide, propofol or combination of propofol and sevoflurane-nitrous oxide using laryngeal mask airway [LMA] in hypertensive patients

In a double-blinded trial, 90 patients with stable hypertension were enrolled in this study. Each group consisted of 30 patients. The induction in group S was by sevoflurane 4% + 50% oxygen +50% nitrous oxide by inhalation using the tidal volume technique. The induction in group P was by propofol 2mg/kg IV, and in group PS [combination group] was by propofol 1mg/kg followed by inhalation of 4% sevoflurane.The present study compared hemodynamic changes, laryngeal mask airway [LMA] insertion time and any complications occurred in the induction period between the three groups. LMA insertion time was significantly longer in the sevoflurane group than in the other two groups. Mean arterial blood pressure [MAP] was significantly lower within each group after induction in comparison to before induction. In all the groups, LMA was successfully inserted in all patients. According to patients induction was pleasant in 90% of patients in the propofol group and was 88% in the combination group and 40% in the sevoflurane group. This study concluded that in the combination group there is the advantage of patient satisfaction and rapid induction with no apnea which occurred with propofol and had the advantage of hemodynamic stability encountered with sevoflurane

Is there a role for postmastectomy radio therapy in early stage. Node positive breast cancer

The aim of this study was to evaluate whether the addition of radiotherapy to mastectomy and adjuvant systemic therapy influenced loco regional control, disease free and overall survival in early stage node positive patients with breast cancer. A total of 263 patients who underwent mastectomy for T1 or T2, node positive breast cancer were retrospectively studied. The systemic therapy consisted of six cycles of combination chemotherapy [FAC or CMF] or hormonal therapy [tamoxifen] for 5 years. One hundred and fifty-two patients received post mastectomy radiotherapy [PMRT], in addition to systemic therapy; while all patients were allocated to systemic therapy alone. Radiotherapy was given to the chest wall, supraclavicular and internal mammary nodes to a total dose of 50 Gy after the second cycle of chemotherapy. The frequency of loco regional recurrence was 5.9% among women who received radiotherapy plus systemic therapy and 41.1% among those who received systemic therapy alone. The 5-year relapse free survival was 85.5% in patients treated with combined modality and 50.5% in those treated with systemic therapy alone. The overall survival at 5 years was 89.5% among those given radiotherapy plus systemic therapy and 63.1% in those who received systemic therapy alone. Radiation toxicity was minimal, mainly skin pigmentation and dry desquamation

Prevention of sevoflurane induced agitation in children using caudal or IV clonidine

The aim of this work was to study the effects of clonidine on the incidence and severity of agitation in preschool children after sevoflurane anesthesia and to determine if caudal clonidine has an advantage over i.v. route. This placebo controlled double blind study included 75 children aged 2-7 years admitted to Menoufyia University Hospital for repair of congenital hernia or hydrocele. Sevoflurane was used for induction and maintenance of anesthesia. Caudal epidural block was performed in all the children using 0.175% bupivacaine 1 ml/Kg. Children were randomized into five groups; Group I: clonidine 1 micro g/Kg was added to caudal bupivacaine while normal saline was given i.v. as a placebo. Group II: received caudal bupivacaine while clonidine 1 micro g/Kg was given i.v. Group III: clonidine 2 micro g/Kg was added to caudal bupivacaine while normal saline was given i.v. Group IV: received caudal bupivacaine while clonidine 2 micro g/Kg was given i.v. Group V: received caudal bupivacaine and normal saline was given i.v. A 3-point agitation score was used to determine the incidence and severity of agitation. Midazolam bolus injection was used to treat severe agitation. Incidence of agitation was significantly less in patients who received clonidine 2 micro g/Kg [0% in Group III and 6.7% in Group IV] compared to control group [73.3%]. The difference was not significant when clonidine 1 micro g/Kg [Group I and II] was used. The difference was not significant when caudal and i.v. clonidine groups were compared [Group I vs. Group II and Group III vs. Group IV]. Midazolam bolus to stop agitation was not needed at all in Group III or Group IV. No bradycardia, hypotension or hypoxemia was noted. We concluded that clonidine 2 micro g/kg body weight, caudally or i.v., significantly decreases the incidence and severity of agitation in children after sevoflurane anesthesia without added side effects

CT findings of atypical meningiomas including aggressive and malignant forms

The study included 54 selected patients, 42 females and 12 males, ages ranging between 28 to 63 years examined by CT scan and plain X-ray for the skull. These cases showed CT findings of an intracranial neoplastic lesions not conforming with typical radiological findings of meningioma. Invasive meningiomas and meningosarcoma were part of this work. Operative and histological verification of the diagnosis of all these cases were obtained