Pain relief after hemorrhoidectomy value of continuous perfusion of the anal canal with bupivacaine and modified closed technique

In this research, we studied the effect of continuous perfusion of the anal canal with the long acting local anesthetic bupivacaine as well as a modified technique of closed hemorrhoidectomy, on post-operative pain. The modification used here is closure of the wounds in a circumferential direction rather than the classic radial manner. This work included 112 patients with 2nd., 3rd and 4th degrees hemorrhoids. They were divided randomly into 4 equal groups; [A1] open hemorrhoidectomy with continuous perfusion of anal canal with 500cc. Normal saline for 8-10 hours, [control group] [A2] like [A1] with the addition of 20cc. Bupivacine 0.5% to the saline. [B1] modified closed technique + perfusion with 500cc saline, [B2] like [B1] with the addition of bupivacaine to the saline. Post-operative pain was evaluated according to the demand for analgesia during the first postoperative day and also the first week. Continuous bupivacaine perfusion reduced significantly the need for analgesia during the first day; as shown in group A1 vs. A2 and also B1 vs. B2 [P<0.01]. Urine retention which is caused mainly by post-operative pain, was lower in the groups with bupivacaine perfusion [A2] and B2] but the difference was significant only between [B2] and [A1] [P<0.05]. During the first post-opeative week, patients managed by closed techniaue [B1] and B2] experienced lesser pain than the open group [A1 and A2] [P<0.001]. Comparing also the closed versus the open hemorrhoidectomy regarding wound healing and anal stenosis revealed, better results, with the former procedure through the first post-operative month [P<0.05]. From this study we recommend the use of continuous perfusion of the anal canal with bupivacaine and the use of closed technique for hemorrhoidectomy as this will decrease the post-operative pain and urine retention, and also the wounds will heal faster with lower tendency for anal stenosis

Fetal assessment using umbilical artery doppler indices and nonstress testing in high risk pregnancy

Doppler velocimetry of the umbilical artery and nonstress testing [NST] were done for 60 patients with high risk pregnancies. These included severe pre-eclampsia [N= 18], severe hypertension [N=11], diabetes [N=10], postdate [N=7], suspected IUGR [N=14]. Both tests were done on the same day on weekly basis or more frequently whenever necessary to evaluate fetal condition, predict any adverse outcome, and to avoid unexpected fetal demise. Neonatal outcome was determined by 1 and 5 minute Apgar score, admission to neonatal intensive care unit [NICU], and perinatal morbidity and mortality. Adverse fetal outcome was encountered in 80% and 88% of fetuses with abnormal doppler and abnormal NST respectively. On the other hand adverse outcome was found in 30% and 40% of fetuses with normal Doppler and NST respectively. When both tests were abnormal. 95% of fetuses showed adverse outcome. Sensitivity, specificity, positive predictive value, and negative predictive value were nearly the same for both tests with no superiority of one test over the other. It is concluded that Doppler velocimetry of the umbilical artery and NST are useful in predicting fetal outcome. The two tests are complementary to one another with the doppler measuring umbilical blood flow and NST measuring CNS function

Primary and secondary lymphoma of the brain CT features

CT findings in 21 patients with brain lymphoma were reviewed. Four patients had primary lymphoma and the other 17 patients had secondary type. The secondary type had propensity to involve the extracerebral spaces either alone or combined with intracerebral involvement. The CT features of lymphomatous masses within the brain, whether primary or secondary, have essential similar CT features which included deep location in the deep white matter, basal ganglia, thalami and corpus callosum. Multilicity was a common feature together with lack of edema and mass effect. It can be concluded that awareness of such features increase the diagnostic yield of CT