Influence of anaesthesia on blood loss during prostatic resection

The volume of blood loss during prostatic resection [TURP] is determined by a number of factors. The aim of the present study was to ascertain the independent effect of a general or a spinal anaesthetic on the amount of intraoperative blood loss. A total of 110 patients treated by TURP, were entered in to a prospective study. The mean age of the patients was 71 years [range 45-91]. Sixty-six patients [60%] received a spinal and 44 [40%] had a general anaesthetic; 80% of resections were benign and 20% for malignant disease. The mean resected weight was 29.7grams [range 3-100] and the mean resection time was 28.9 minutes [range 5 - 60]. The volume of blood loss was calculated by a well described method and the mean loss was 319mls [range 6 - 1587]. The mean weight of the resected prostate tissue and the volume of blood loss was significantly high in patients who had received a spinal anaesthetic [p=0.001 and p=0.005 respectively]. However, when the independent i nfluence of the type of anaesthesia and the resected weight on blood loss was analysed, it was found that the former had no significant effect [p=0.28] whereas the later influenced very significantly [p<0.001]. Blood transfusion requirement was similar in both groups and no hypotensive episodes were recorded. Although previous studies have suggested that spinal anaesthesia reduces blood loss during prostatic resection, however, the present study fails to confirm this association

Diagnosis and eradication of helicobacter pylori in patients with duodenal ulceration in the community

To determine the value of Helicobacter pylori [Hp] serology in diagnosis of active Hp infection in patients with documented duodenal ulcer [DU] and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. Prospective, single-blinded, randomised trial. One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test [UBT]. Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs [OCM] or tinidazole 500 mgs [OCT]. Eradication was confirmed by a repeat UBT. Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT [100%] had a significantly better eradication rate than OCM [87.8%], p = 0.023. There was no difference in side effects. [1] Positive Hp serology in patients with DU does not always mean active infection and [2] for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp

Impact of helicobacter pylori eradication on dyspeptic symptoms in the community

Eradication of Helicobacter pylori [Hp] will cure most Hp positive duodenal ulcers [DU]. However, after such treatment, patients often continue to get dyspeptic symptoms. The effects of Hp eradication in patients with proven DU on gastro-oesophageal reflux disease [GORD] symptoms are controversial. Aims: To study any changes in patient's symptoms following eradication of Hp in the setting of chronic DU and its effects on the need for continuing treatment for acid suppression. Eighty out of 85 patients [94%] from general practice with documented successfully eradicated Hp with a week long triple therapy regimen. Their symptoms and requirement for acid suppression treatment were studied at enrolment and after successful eradication of Hp for a median of 17 months. Eighty one% patients had improvement in ulcer-type symptoms. 21% developed new GORD symptoms. 68% discontinued long-term acid-suppression treatment. 79% requiring continued acid suppression therapy had new or continued GORD symptoms. Patients in the community with Hp positive DU disease after eradication, 81% patients got symptomatic improvement, two third discontinued their acid suppressing therapy but 21% developed new GORD symptoms. Among those who required continued acid suppression, 79% had GORD symptoms