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

Risk factors for hematoma development post reduction mammaplasty: novel associations and implications

The aim of this retrospective study was to analyze various preoperative and intraoperative factors that may contribute to the development of wound hematoma after reduction mammaplasty. This will help us to estimate a prospective patient's individualized risk based on selected identifiable factors, facilitating patient selection and preoperative counseling. Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty over a 10- year period [1999-2008] performed by a single surgeon were studied. The following factors were addressed: age, medical history, medications, smoking habits, Body Mass Index [BMI], phase of menstrual cycle, mass of resection, prophylactic heparin, operation time, intraoperative blood loss, preoperative and postoperative Hemoglobin [Hb] and Hematocrit [Hct] levels, various blood pressure measurements and hematoma formation. The operative time was divided into two periods and in our experience, hemostasis was achieved in the second period. In our series, six patients developed a postoperative wound hematoma; only two patients required operative evacuation [3%]. Body Mass Index [BMI], mass of resection and subcutaneous prophylactic heparin significantly affected the likelihood of wound hematoma [P values: 0.018, 0.002 and 0.031, respectively]. Smoking, age, medical illnesses and phase of menstrual cycle had no statistical significance on the development of wound hematoma. Logistic regression analysis showed that the peak systolic blood pressure during the period of hemostasis was significantly lower in patients who developed hematoma [P=0.019]. Our data indicate that there was a significant correlation between post-operative hematoma and Body Mass Index [BMI], mass of resection, prophylactic heparin and intraoperative hypotention during the period of hemostasis

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

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