Recombinant factor VII [rFVII] can be useful for massive hemorrhage during radical nephrectomy

Radical nephrectomy for renal tumors can be associated with serious complications, e.g. massive bleeding or even table deaths. Various regimens like normovolemic hemodilution, autologous transfusion, hypotensive anesthesia, etc have been used in anticipation of hemorrhage in these operations. In our case there was not only massive hemorrhage but also a failure to clot and disseminated intravascular coagulation. All the routine regimens failed to stop bleeding and the generalized ooze. Recombinant Factor VII [rFVIIa] was used and it saved the day

Incidence of post dural puncture headache [PDPH] with different gauge spinal needles in relation to age

To asses the incidence of PDPH in different gauges of spinal needle in relation to age. 1500. Comparative Study Armed Forces Institute of Urology [RWP], Railway General Hospital [RWP] and Waseema Talat PVT LTD, Multan. 15[th] Aug, 2007 to 14[th] Aug, 2008. 1500 patients were studied in 9 different groups [A1, B1, C1, A2, B2, C2, A3, B3, C3] with group A, B and C for 23G, 25G and 27G respectively and 1, 2 and 3 for 26-40yrs, 41-55 yrs, and 56-70yrs respectively. Al included younger age group with 23G spinal needles and C3 included older age group with 27G spinal needle. ASA II/III grade patients were selected. All groups were preloaded with 10ml/kg body weight ringers lactate. Routine urine examination and blood complete picture were done. 24hrs strict post-operative bed rest observed. The frequency of PDPH in A1[6%], B1[3%], C1[2%], A2[3%], B2[1.33%], C2[0%], A3[0%], B3[0%], C3[0%]. The study clearly shows that incidence is much higher in younger age group even with the finest needle of 27 gauges