Diagnostic value of beta-HCG, estradiol, and progesterone in ectopic pregnancy versus normal-intrauterine pregnancy

To evaluate the diagnostic value of rising level of serum beta subunit human chorionic genadotrophin, single measurement of progesterone, and estradiol in early diagnosis of ectopic pregnancy. A case control study was conducted on 40 women with ectopic pregnancy and 40 women with normal intrauterine pregnancy from Shatby University Maternity Hospital. Blood samples for the measurement of beta subunit human chorionic genadotrophin [beta-hCG], estradiol [E2], and progesterone were drawn in all the women upon admission. Extra blood sample was drawn for measurement of beta-hCG 24 hours after admission. The mean serum levels of beta-hCG, progesterone, and estradiol in patients with ectopic pregnancies [969.0 +/- 302.1, 7.9 +/- 2.83, 621.9 +/- 131.4 respectively] were significantly lower than these levels in normal intrauterine pregnancies [3186.8 +/- 649.2, 23.5 +/- 5.3, 1853.6 +/- 508.4 respectively]. The average rate of beta-hCG rising was [8%] for 24 hours in patients with ectopic pregnancy and [31%] in normal intrauterine pregnancies. Single measurement of serum progesterone level has the greatest sensitivity [97%] and specificity [90%] in the diagnosis of early ectopic pregnancy

Extra pleural versus epidural catheter techniques employing ropivacaine analgesia for post-thoracotomy pain relief

Objective: to assess the effectiveness of the long acting local anesthetic [0.25% ropivacaine] intermittently administered through an extra pleural paravertebral catheter versus a thoracic epidural catheter on post thoracotomy pain relief

Patients and Methods: forty patients undergoing elective posterolateral thoracotomy during the period between July 2001 and August 2002 were prospectively studied they were randomly allocated into two groups [A and B] of 20 patients each. Group A patients received an epidural type catheter inserted by the surgeon into an extra plural pocket extending far 2 to 3 intercostal spaces-both above and below the thoracotomy incision alongside the vertebral column by the conclusion of operation. A bolus dose of 15 ml of 0.25% ropivacaine analgesia was given during chest closure. Group B patients received a thoracic epidural catheter inserted by the anesthesiologist at T5-6 or T67 inters- before induction of anesthesia A bolus dose of 15ml of 0.25% ropivacaine analgesia was given after confirming the correct position of the epidural catheter. Postoperatively, patients both groups were intermittently administered 25 ml of 0.25% ropivacaine analgesia at 6 hourly intervals for 3 successive days. Pain scores [verbal rating scale], requirement of additional analgesia INSAID], pulmonary function test, shoulder range of motion as well as any complication encountered were assessed and compared in both groups

Results: excluding the immediate postoperative arousal period, the extra pleural analgesia provided better pain control than the thoracic epidural analgesia in the form of less mean values of the verbal rating scale [VRS]. Also, the extra pleural analgesia provided more rapid improvement of pulmonary functions, progressive increase of the shoulder range of motion [SROM] as well as less analgesic requirements in comparison to the thoracic epidural analgesia however these differences were statistically non-significant [P>0.05]. Side effects namely, hypotension, bradycardia and atelectasis were troublesome only in the thoracic epidural analgesia group. There was no mortality in either group

Conclusion: extra pleural paravertebral catheter technique is a valuable alternative to the thoracic epidural technique for post-thoracotomy pain relief it is easy to perform by the surgeon at the conclusion of operation without complications or side effects. It should be considered as the first choice alternative for post-thoracotomy pain control