Evaluation ultrasonographic changes of the uterus in puerperium

To describe the ultrasonographic features of the uterus and uterine cavity within the first 24 hours following vaginal delivery, and to correlate it with postnatal maternal morbidities, if any. this was a prospective, descriptive, observational study. Postpartum women were scanned by transabdominal ultrasound within 24 hours after vaginal delivery. The women were divided into 2 groups according to the presence of predefined risk factor[s]. Uterine length, AP, uterine width, volume, endometrial stripe thickness and endometrial contents were evaluated. They were interviewed by telephone after 2 weeks. Results expressed as range and mean with standard deviations [SD] and compared using independent-samples were t-test. Categorical data were presented as numbers and percentages and compared by Chi-square test. Statistical significance was considered at a p<0.05. The postpartum uterus normally appears enlarged, has an angulated form and lies in a retroverted position. The myometrium is found to have a heterogeneous echo appearance. A mixed echo pattern with fluid and solid components was seen in the cervical area. In the majority of cases the upper uterine segment is empty. The mean uterine length was 18.8cm for both low-risk and high-risk groups. Similarly, the mean AP, width, volume and endometrial thickness did not differ significantly between the two groups. All uterine dimensions were significantly larger in multiparous women. Neither endometrial stripe thickness nor the sonographic presence of echogenic material in the uterine cavity can be used to predict clinically significant postpartum complications; and the presence of risk factors were found to increase the probability of puerperal uterine complications. The uterine body and position, as well as the cavity, are easy to examine by ultrasound. Accumulation of fluid and debris in the cervical area in the early puerperium is a common and insignificant finding of the uterus. The presence of risk factor [s] were found to increase the probability oj puerperal uterine complications

Anesthetic and akinetic effects of 1% ropivacaine given in two different peribulbar block; single medial canthus or double in jection technique

Owing to the advanced age of. patients scheduled for cataract and IOL insertion, and the high concentrations of local anesthetic used in peribulbar blockade, the use of ropivacaine produces an effective motor blockade with minimal risks for neuro and cardiotoxicity. Concerning globe injury due to multiple injections the new single injection medial canthus is theoretically preferred to decrease the frequency of globe injury. In this study we used ropivacaine evaluating its effectiveness in single and double injection peribulbar technique aiming to get the benefit of the drug and the best method of administration in peribulbar blockade. This single blind study was done on 60 patients ASA 1-111 underwent cataract and IOL insertion surgery. Patients were taken peribulbar block using 8 ml. 1% ropivacaine with 30 lU/ml hyalurinidase. Patients were classified into two equal groups; groupl [n.30] is the single injection group group 2[n.30] is the double injection group. Eye globe and lid akinesia and anesthesia, the need for supplementary injection and the incidence of complications like ecchemosis/high intra ocular pressure nausea, vomiting and pain were recorded. This study, concluded that,26 patients [86.6%] of single injection group VS 28 patients [93.3%] in double injection group were having complete anesthesia and akinesia after giving block, only 4 patients in group 1 [13.3%] needed supplementation of block VS 3 patients [10%] in group 2 with almost no difference in absence of intra and post operative complications. 1% Ropivacaine is a suitable agent for single injection peribulbar anesthesia for cataract surgery

Effect of combined intrathecal morphine and clonidine on stress response, extubation time and postoperative analgesia after cardiac surgery

Pain is a major complication after cardiac surgery if poorly controlled it leads to more complication as respiratory depression, myocardial ischemia, delayed extubation, and more ICU stay, with the more analgesic consumption and patients suffering. Intrathecal morphine produces intense and prolonged analgesia. Thus this method of administration can be useful adjunct for controlling postoperative pain and facilitating early extubation after cardiac surgery. The addition of intrathecal clonidine to morphine allows the dose of intrathecal morphine to be reduced and reduces the risk of respiratory depression while maintaining good analgesia and allows early extubation. The aim of this study was to evaluate the effects of combined intrathecal morphine and clonidine on stress response, time of extubation, and postoperative analgesia after cardiac surgery. this study was carried out on 40 patients undergoing open cardiac surgery and divided into two groups; group [1]: is the control group n. 20 and group [11]: the morphine clonidine group n.20 patients were received intrathecal morphine 4 meg/kg and clonidine Imic/kg. There was no statistical significant changes in cvp, sao2, pao2and lactate level in both groups but there was a decrease in H R after induction and before bypass in the intrathecal morphine clonidine group compared with the control one also there was a significant reduction in MAP after induction, before bypass and after bypass in morphine clonidine group Vs control group. Cortisol level was decreased after sternotomy, after ICU admission and after extubation in the morphine group Vs control group. Time to extubation, vas, and morphine consumption in 24 h were all decreased in the morphine group compared with the control one, with no significant differences in post operative complication in both studied groups. The combination of intrathecal morphine and clonidine allow the dose of morphine to be reduced, reduces the risk of respiratory depression, gives effective control of postoperative pain in cardiac patients and reduce the duration of controlled ventilation. In patients with well-preserved ventricular and respiratory function scheduled for fast-track cardiac surgery, the use of combined intrathecal morphine and clonidine provides superior postoperative analgesia and early extubation

Effect of acid amides on porcine pepsin

The activity of porcine pepsin toward a synthetic peptide was examined kinetically in presence and absence of some acid amides which are mainly urea analogues The peptide Ac-ILe-Glu phe[No2] -Argamide [assigned peptide VIR] was synthesized to fit the subsites S2 and S3 of porcine pepsin. This peptide was purfied before its use in the assays However, it was found that urea has no effect on k[cat] value of the enzyme while acetamide effect showed its elevation. On the other hand, thiourea acted as a reversible inhibitor which was a noncompetitive type. Also, N.N-diphenyl thiourea showed a reversible inhibition. These data suggested that hydrogen binding and hydrophobic interactions affect the subsites and both thiourea and N,N-diphenyl thiourea may modify one of the subsites through C= S group