Traumatic rupture of the diaphragm

A retrospective study of 35 patients with traumatic rupture of the diaphragm admitted to Kasr El-Aini hospital during a period of 3 years: 26 cases with blunt trauma, 4 cases with penetrating injuries, 3 with no history of trauma and 2 had surgical trauma. Left sided ruptures predominated [27 cases]. Significant associated injuries were presented in 48.5% of cases. Precise preoperative diagnosis was difficult. X-ray was the most valuable diagnostic procedure and was positive in 14 patients. It could be concluded that in spite injuries of the diaphragm are not lethal by themselves but surgical repair is mandatory was the mortality in such group is high due to associated injuries

Interpleural bupivacaine administration for relief of post-thoracotomy pain

The purpose of this study is to evaluate the efficacy of interpleural bupivacaine in relieving post-operative pain after thoracotomy and to report any side effects for this technique. Thirty patients who have undergone thoracotomy for different causes were studied. All patients received 20 ml bupivacaine without adrenaline, once they reported pain after surgery. The local anesthetic was administered through the chest tube. Assessment of pain in the first 30 minutes. The analgesic time was 7.8 + 2.7 hours [mean + S.D.]. No significant changes in arterial blood pressure, heart rate and respiratory rate were observed after administration of interpleural bupivacaine. There was a significant improvement in the tidal volume, PaO2 and PaCO2 after interpleural administration of bupivacaine, no side effects were observed. It is concluded that interpleural local anesthetic is a safe, simple and effective method for relieving post-operative pain after thoracotomy

Haemodynamic changes following cardio pulmonary bypass in mitral and aortic valve replacement under fentanyl anaesthesia

30 patients scheduled for valve replacement were selected, 20 underwent mitral valve replacement and 10 underwent aortic valve replacement under fentanyl anaesthesia. If we consider the haemodynamic changes following the discontinuation of cardio-pulmonary bypass in the mitral group, we find a highly significant drop in pulmonary capillary wedge pressure [PCWP] from 27.1-+6.5 to 18.3-+6, mean pulmonary artery pressure [MPAP] from 37.5-+11.4 for to 27.7-+8.9 systemic vascular resistance [SVR] from 1753.7-+423.3 to 1249-+229.9, highly significant rise in cardiac output [CO] from 3.3-+ 068 to 4.37-+068 and cardiac index [CI] from 2.1-+043 to 2.8-+03.9. In the aortic group no significant changes in the haemodynamic were noted

Left ventricular outflow tract obstruction

We studied 35 cases with different form of left ventricular outflow tract obstruction operated upon in Cardio- Thoracic Unit at Kasr El Aini Hospital and As Salam International Hospital. Left ventricular outflow obstructions were divided into three major groups valvular aortic stenosis in 15 patients [42.86%], subvalvular aortic stenosis in 16 patient [45.7%] and supravalvular aortic stenosis [11.4%]. In the 1st group aortic stenosis group: Aortic valve replacement was done in all patients except one patient [6.67%] where aortic valvotomy was done. Pure subvalvular stenosis alone was present in 14 cases, while valvular aortic stenosis associated with subvalvular membrane was found in 2 cases [12.5%]. In the supra valvular aortic stenosis; patch enlargement alone was done in one case, patch enlargement and excision of an intimal ridge in 2 cases and patch enlargement, excision of an intimal ridge and aortic valve replacement in one case