Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation. Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A [n = 30] received intrathecal injection of ropivacaine 2 ml [0.75%] and Group B [n = 30] ropivacaine 1.8 ml [0.75%] with fentanyl 10 micro g. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test [for parametric data] and Mann-Whitney U test [for non-parametric data] were used for statistical analyses. There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B [P = 0.001]. Duration of motor block was longer in group B being 210.51 +/- 61.25 min than in group A being 286.25 +/- 55.65 min [P < 0.001]. The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects

Coronary artery bypass surgery in patients with end stage renal disease: overall outcome in single centre experience

Coronary artery bypass surgery and its entire perioperative management is demanding in patients with end stage renal disease [ESRD]. We included data from all patients on hemodialysis who underwent coronary artery bypass grafting [CABG] between November 1st, 2003 and November 1st, 2006 at Sheikh Zayed hospital and Federal postgraduate medical institute, Lahore, Pakistan. During the study period 41 patients with end stage renal disease underwent coronary artery bypass grafting at the Sheikh Zayed hospital and Federal postgraduate medical institute, Lahore. Among these patients, we recorded a perioperative mortality of 19.51%. Six months survival rate was 75.60% among study group patients. The incidence of peripheral artery disease is reported significantly higher in the dialysis dependent patients. Uremic patients showed significantly lower hemoglobin serum levels [4], fresh frozen plasmas [FFP's] when needed. Our preliminary study indicates that coronary artery bypass surgery can be performed with acceptable midterm results when the specific requirements of this patient group are taken into account

Peculiarity of surgical tactics for management of ischemic heart disease in patients with left main coronary artery stenosis

The left main coronary artery disease has poor natural history. Sudden death, massive myocardial infarction, angina and poor quality of life indicate the ominous nature of the disease. Coronary artery bypass grafting remains the ultimate choice of its management. A relatively high mortality and morbidity of its surgical treatment described in literature leads to the actuality of this disease. This work is a part of our continuous effort for refinements in anesthetic and surgical techniques to reduce mortality and morbidity in such patients and is in the clinical practice at our institute for the last few years. During the period from February 1998 to October 2005, 74 patients underwent coronary artery bypass surgery for left main coronary artery stenoses, at Federal Postgraduate Medical Institute, Shaikh Zayed Hospital, Lahore. All patients presented with angina, unstable in 62.2%. An old myocardial Infarction was present in 52 [70.3%] patients. An emergent surgery was needed in 5[6.8%], urgent operation was performed in 45[60.8%] patients and elective procedure was done in 24[32.4%]. Average stay in the hospital was 9.0+2.7 days. There were 2 hospital deaths and one late non cardiac death. The post operative recovery was eventless in majority of the patients. The return of patients to their jobs improved significantly [P < 0.005] three months after operation. Our current surgical results are certainly improved than many previous studies on coronary artery bypass grafting for left main stem stenoses

Should we do hepatitis B and C screening on each patient before surgery: analysis of 142 cases

To see the prevalence of hepatitis B and C in surgical cases undergoing elective surgery. A prospective observational study. Surgical Unit-I Fauji Foundation Hospital, Rawalpindi from January 2003 to June 2003. A total of 142 patients above the age of 20 years undergoing elective surgery were screened for hepatitis B and C. majority of them were females [63.74%] and among them 11.26% were found Hepatitis C and 2.11% Hepatitis B positive. It is concluded that every case under going surgery should be screened for Hepatitis B and C. Awareness regarding Hepatitis B and C should be created among doctors and paramedical staff

Restless leg syndrome

Restless leg syndrome [RLS] is a very common medical condition that is under recognized and often misdiagnosed and maltreated in general practice in Pakistan. It is a very distressing condition for patients and often attributed to nutritional deficiencies or labeled as simple cramps. Its cure is rarely possible. In this article the authors intend to discuss the diagnosis and management of this condition

Pattern of upper gastrointestinal bleeding at Rahim Yar Khan

It is a Prospective Observational case series. The study was conducted at Sheikh Zayed Hospital/Hamza Medicare Rahim Yar Khan, between January 1997 and December 2004. Patients and Methods; Consecutive 892 patients presenting with significant gastrointestinal bleeding, between January 1997 and December 2004 were recruited in this study. Source of active bleeding was defined by endoscopy. Esophageal variceal bleed was the main finding 580, followed by gastric erosions 133 patients, Esophageal Ulcer 65, duodenal ulcer 61, bleeding gastric ulcer [26], Mallory Weiss Tear 21 and Osler Weber Rendu Syndrome/AV malformation 06 only. Esophageal varices are-real problem within our area but the scope has changed in the western world. Variations in disease pattern from time to time require the periodic studies to be aware of the current underlying mechanism of the ailments in the area of work. Total reliance on literature may consume local resources

Is it necessary to invaginate the stump after appendectomy?

To compare the technique of simple ligation of the appendix with ligation and burial of the stump during appendicectomy for acute appendicitis. Design: A comparative study of 677 appendicectomies. Place and duration of study: Department of General Surgery, Fauji Foundation Hospital Rawalpindi from June 1999 to June 2003. Patients and methods: All patients who underwent appendicectomy for uncomplicated acute appendicitis were divided into two groups. In Group-I simple ligation and in Group-II ligation with invagina-tion of appendix stump was carried out. Patients were followed up for nine months to check the development of complications. Both groups were similar with respect to age and sex. Simple ligation of the stump was done in 382 patients, while in 295 cases invagination of the stump after ligation was done. The incidence of postoperative wound infection [6.44%] and paralytic ileus [4.40%] was higher in Group-II as compared to Group-I. Simple ligation of appendix stump is better and safe procedure during appendicectomy

Urdu pain words

This study presents the Urdu version of the McGill Pain questionnaire [MPQ] developed by partially adapted methodology originally employed by Melzack and Torgerson. Four groups of subjects participated. Each groups [n=35] presented a preliminary translation of the MPQ and asked to assign an intensity rating out of the 5 - points intensity scale to each 106 adjectives. Finally the adjectives whose translation and rating were more closer were selected

Two dose glucose tolerance test

A non-conventional method for the diagnosis of diabetes mellitus, namely two dose glucose tolerance test has been evaluated to assess its significance and diagnostic value, particularly in detection of potential diabetics. Besides indicating age and sex distribution of cases studied, this article also discussed criteria of differentiation between diabetic, abnormal and normal subjects. The results reveal that there are more female diabetics than males. Likewise, the percentage of females showing abnormal glucose tolerance response [potential diabetics] is than that of males. The data relating the age factor to prevalence of diabetes indicate that more and more persons develop diabetes as age advances, upto the age group of 40-59 years. Potential diabetics [abnormal groups] also follows the same pattern of age distribution. The results also furnish the pattern of glucose tolerance curves for different groups of individuals, which evidently means that the two dose GTT is useful in sorting out potential diabetics from apparently normal individuals