Assessment of incidence of recurrence and constipation in patients of rectal prolapse undergoing rectal mobilization only with division of lateral stalks

Background: Rectal prolapse is a pelvic floor disorder that can occur in men and women of all ages. It results in pain, bleeding per rectum, seepage, diarrhoea or constipation and a disabled quality of life. With the advent of twentieth century, perineal operative procedures have become more common. Perineal procedures though have lower morbidities but have higher recurrence rate and high incidence of post-operative constipation. Novel abdominal approaches to rectal prolapse repair also became common during the first half of this century. Numerous types of surgical procedures have been attempted. Most techniques developed till now have some advantages and some short comings. CT Speakman and Pollen et al have shown in their studies   that division of lateral ligaments caused new onset constipation and they attributed this effect to denervation of rectum. As the issue of recurrence and post-operative constipation remained unsettled.Methods: This was an observational study to assess the incidence of recurrence and post-operative constipation in patients of rectal prolapse. In well selected patients, we performed complete rectal mobilization with division   of lateral ligaments. We assessed the patients on the basis of Clevland clinical constipation scoring system.Results: Out of 25 patients, 4 patients developed constipation, 2 had mild and 2 had moderate constipation and 2 patients had recurrence. Patients were kept under six monthly follow-up till a period of eighteen months.Conclusions: Only rectal mobilization with division of lateral ligaments can be a good surgical option in patients of rectal prolapse not having severe constipation.

Anesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: A case series.

Peripartum cardiomyopathy is a rare cause of dilated cardiomyopathy in parturients, occurring in approximately one in 1000 deliveries, manifesting during the last few months or the first 5 months of the postpartum period. It can result in severe ventricular dysfunction during late puerperium. The major concern while managing these patients is to optimize fluid administration and avoid myocardial depression, while maintaining stable intraoperative hemodynamics. We present a case series of five parturients that were posted for elective cesarean section and managed successfully by the epidural volume extension technique.

Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine

Propofol has the disadvantage of causing pain or discomfort on injection. The aim of the study was to assess the efficacy of pretreatment with various drugs to alleviate the propofol injection pain. One hundred American Society of Anesthesiology [ASA] I and II adults, scheduled for various elective surgical procedures under general anesthesia [GA], were included in the study. They were randomly divided into four groups having 25 patients in each group. Group A received pretreatment with intravenous [i.v.] magnesium sulfate, group B received i.v. granisetron, group C received i.v. nitroglycerine and group D was the control group. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 seconds. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal response. A score of 0-3 which corresponds to no, mild, moderate and severe pain was recorded. All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was granisetron > nitroglycerine > magnesium sulfate > control. Granisetron was the most effective followed by nitroglycerine and magnesium sulfate in attenuating pain on propofol intravenous injection