Comparison of spinal anaesthesia induced hypotension in severely preeclamptic and normotensive parturients undergoing caesarean section

Introduction: Preeclampsia and eclampsia are one of the most common complications of pregnancy. These patients usually require caesarean section for the delivery of fetus. Spinal anaesthesia is commonly used in such patients and hypotension is the most common complication. In this study we compared the spinal anaesthesia induced hypotension in severe preeclamptic and normotensive parturients

Objectives: To compare the frequency of spinal anaesthesia induced hypotension in severely preeclamptic parturients with normotensive parturients undergoing caesarean section

Study Design: Cohort study

Setting: Department of Anaesthesiology, District Headquarter Teaching Hospital, Sargodha

Duration of Study: Six months [July 2013 to December 2013]

Subjects and Methods: Following informed consent, Total 200 patients were selected, 100 severely preeclamptic parturients Group A and 100 normotensive parturients Group B, undergoing caesarean section. Spinal anaesthesia was administered in the sitting position at level of L3-4 or L4-5 interspaces. Maternal systolic and diastolic blood pressure were recorded at 2-min intervals from the time of spinal injection for 20 min and then at 5-min intervals until the end of the surgery. Spinal hypotension was considered if there is 20% decrease of mean BP from the baseline or systolic pressure less than 100mm Hg at any time till the end of surgery

Results: The incidence of hypotension was significantly less [17.0%] in severely preeclamptic patients as compared with the normotensive parturients [42.0%]

Conclusions: Patients with severe preeclampsia have less chances of hypotension with spinal anaesthesia for elective caesarean delivery than healthy normotensive parturients

Comparison of ER, PR and HER-2/neu (C-erb B 2) reactivity pattern with histologic grade, tumor size and lymph node status in breast cancer.

INTRODUCTION: Carcinoma of the breast is the most common malignancy of women in Karachi. The current study was conducted with the objective of assessing estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu reactivity patterns of mammary cancers for correlation with histologic grade, tumor size and lymph node metastasis. MATERIALS AND METHODS: One hundred and fifty modified mastectomy specimens received at the section of histopathology, Aga Khan University Hospital, were selected using a non-probability sampling method. RESULTS: Mean age of the patients was 48.3 years (95%CI 46.5, 50.2). The left breast was more commonly involved (57%). Tumor size ranged from 0.3 to 15.0 cm; 12% were >2.0 and 35.3% were >5.0 cm in diameter. The predominant morphology was infiltrating ductal carcinoma (85.3%). The majority of the cases presented as grade II (55.3%) lesions with tumor necrosis (70%) and lymph node involvement (71.3%). ER and PR were positive in 32.7% and 25.3% cases respectively. HER-2/neu was positive (3+) in 24.7%. ER positivity increased and HER-2/neu positivity decreased with rising age. ER and PR expression was significantly lower in HER-2/neu positive as compared with HER-2/neu negative tumors (ER 83.8% vs 69.8%; PR 91.9% vs 77.8%). In the HER-2/neu positive tumors, ER and PR expression in high grade tumors was significantly decreased compared with intermediate grade tumors (ER 5.6% vs 10.5; PR 0% vs 5.3%). ER expression in the HER-2/neu positive, large sized tumors was also significantly decreased compared with smaller tumors (ER 6.3% vs 11.8). CONCLUSIONS: ER and PR expression in breast cancers in the current study was found to be comparable to published international data, but the frequency of HER-2/neu expression was higher, possibly reflecting a young age at diagnosis. Assessment of prognostic markers for the clinical management of breast cancer patients is strongly advocated to provide best therapeutic options.