Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Comparison between the effect of glycopyrrolate and atropine with and without cimetidine on gastric volume and pH in emergency cesarean section

The most common cause of maternal mortality is aspiration of gastric contents. So, many methods have been advocated to decrease or prevent this risk. This study was designed to compare the effects of intramuscular atropine or glycopyrrolate either alone or in combination with oral cimetidine on the pH and volume of gastric contents at the time of induction of general anesthesia in 50 obstetric patients undergoing emergency cesarean section. They were classified into five groups, 10 each. Each group received different combinations of atropine, glycopyrrolate and cimetidine. The fifth group was used as control. It was found that atropine alone elevated the pH to the alkaline side with no effect on gastric volume compared to the control group. Adding cimetidine raised the pH with no significant effect on gastric volume. Glycopyrrolate alone caused a significant reduction in the volume of gastric contents compared to the control group without affecting the gastric pH significantly. Cimetidine combined with glycopyrrolate resulted in significant elevation in the pH value and significant reduction in the gastric contents volume. So, this study confirmed the importance of premedication with drugs that raise the pH and reduce the gastric volume in susceptible obstetric females and the most effective combination in this respect was premedication with intramuscular glycopyrrolate and oral cimetidine