Effect of narcotics on C.B.D. pressure

Many reports have studied the effect of narcotics on the terminal bile ducts and oddi's Sphincter, which demonstrate that narcotics mainly morphine produce slow and prolonged increase in common bile duct pressure. The aim of our study was to compare between the effects on the common bite duct: pressure of either intravenous bolus or intermittent injection of equianalgesic doses of commonly used narcotics mainly Fentanyl, Meperidine and Nalbuphine during cholecystectomy operations. Sixty patients scheduled for elective cholecystectomy were participated to the study the effect of equianalgesic doses of Fentanyl, Mepredin and Nubain either in the form of bolus or intermittent way. Premedication with 10 mg valium only. After anaesthesia and exploration, the cystic duct cannulated and measurement of the interacholiedochal pressure by modified caroli apparatus. Comparing the predrug value and postdrug. value indicate that there is significant increase in the common bile duct pressure in both Fentanyl and Meperidine when the drugs given in bolus way, while if given through intermittent method only the meperidin raise the pressure while the fentanyl did not increase the Pressure. Nubain did not cause any increase in the common bile duct pressure either if it is given on bolus or intermittent method

role of ultrasonography in the diagnosis of suspected acute appendicitis

180 patients with suspected clinical diagnosis of acute appendicitis during 20 months period were examined by graded compression ultrasonography 56 patients were true positive. Appendicitis was proved at surgery in 64 patients; criteria for ultrasonographic diagnosis was the visualization of the non compressible appendix with diameter > 6 mm., hypoechogenic layer > 2 mm. and the presence of periappendiceal fluid or the presence of appendicolith. Non visulaization is considered a negative sign. True positive ultrasonographic diagnosis was observed in 56 out of 64 surgically proven appendicitis [87.5%]. 18 patients were negative at laparotomy 4 of them were seen by ultrasonography with a diameter < 6 mm. and 14 were not visualized. The remaining 98 patients improved on conservative measures, 9 of them were visualized by ultrasonography with diameter > 6 mm. but on repetition of ultrasonography during follow up the diameter decreased to reach < 6 mm. in 4 cases and appendix was not seen in 3 cases while in the rest [2 cases] the diameter was still > 6 mm but with hypoechogenic layer < 2 mm and clinically all the 9 cases improved. In the rest of patients [89 patients] the appendix could not be visualized. The sensitivity of ultrasonography in this work was 56 /64 [87.5%], specificity was 107/116 [92.2%]. The positive predictive value was 56/56+9 [86%] and the negative predictive value was 107/107+8 [93%]. For this ultrasonography is a valuable tool in the diagnosis of acute appendicitis in patients with equivocal clinical findings