Pulmonary effects of thoracic epidural analgesia for cardiac valve replacement surgery

The study was performed on forty patients [ASA physical status II: III] with symptomatic mitral valve disease underwent mitral valve replacement surgery. The patients where criteria were randomly allocated into two equal groups [20 patients each] 1- General anesthesia group [GA] ['control group]. 2- General anesthesia with thoracic epidural analgesia group [TEA group]. Anesthetic technique and management of cardiopulmonary bypass were standardized for all patients. Spirometric data: [FVC, FEV1, FEV1/FVC% and PEFR,], and respiratory rate were measured at the night before surgery, after extubation by 1h, 12h, 24h, 48h, 72h and [6th postoperative day Arterial Blood Gases: PaO2, PaCO2 and pH were measured after induction of GA by 15 min., after extubation by 48h, 72h and 6th postoperative day. Visual analogue scale [VAS] score for assessment of pain was measured after extubation by 1h, 6h, 12h, 18h, 24h, 48h, 72h and 6th postoperative day. Total dose of fentanyl analgesia was calculated in each group. There were some improvement in respiratory function [FVC, FEV 1 and PEFR.] started at the 3rd to the 6th post operative days.There were insignificant changes in FEV1/FVC all over the study period RR decreased significantly in the epidural group than control group in all readings. There was a significant decrease in VAS in TEA group than the control group throughout the study period. PaO 2 was significantly decreased in both groups at all readings. 1. Intensive Care Unit [ICU] stay: There was insignificant difference between the two groups. 2. Time to first awake /hour was significantly decreased in thoracic epidural group than general anesthesia group [1.3 +/- 0.3 vercus 2.5 +/- 0.6]. 3. Time to extubation /hour was significantly decreased in thoracic epidural group than general anesthesia group [3.5 + 0.2 versus 7.3 +/- 0.3]. 4. Total postoperative fentanyl consumption in 1st 24h was a significant decrease in TEA than GA group [p<0. 00] [677.9 +/- 26 in TEA group versus 1203.4 +/- 44 in general anesthesia group] perioperative epidural infusion of 0.125% bupivacaine and fentanyl, started before induction of anesthesia in valve replacement surgery reduces the total requirements of intraoperative narcotics, without cm appreciable delay in extubation. There was slight improvement in pulmonary function, but not to expected values and far less than control reading indicating multifactorial bases of pulmonary dysfunction in cardiac surgery using CBP

results of arthroscopyic repair of complete thickness rotator cuff tear in chronic impingement of the shoulder joint using the giant needle technique

This work evaluated the results of arthroscopic end to end repair of small and medium sized complete thickness tears of the rotator cuff [<2.5 cm] in hooked type of acromion. Arthroscopic subacromial decompression preceded the rotator cuff repair, where the Fleega giant-needle technique was used. Twelve patients [nine males and three females] were included in this study. The minimum follow up period was one year. University of California and Los Angeles [UCLA] scale for the pre and postoperative evaluations concerning the improvement of pain and function was used. It was concluded that the giant needle technique for the repair of rotator cuff tear, with subacromial decompression, is an excellent method for the treatment of full thickness cuff tear of small and medium size

Enhancement of fracture healing in crossbred dogs using subcutaneous injection of salmon calcitonin

The impaired fracture healing results in pseudoarthrosis or skeletal deformity that causes functional disability bone is composed of cells and organic matrix [30%], and minerals [70%]. Fracture healing consists of three interrelated phases: inflammatory, repair, and remodeling, to return to original tissue structure. To asses the effect of salmon calcitonin on fracture healing during the mineralization process. Twenty crossbred dogs were used in this study. After a fracture was created at the midshaft of the radius and ulna of the animals and stabilized with an external splint. Ten dogs of them were injected subcutaneously with salmon calcitonin. Blood samples were taken from the cephalic or recurrent tarsal vein before the operation and at 2,4, and 6 weeks after the operation. For histological assessment bone biopsy was taken from the fractured sites at 2,4,6 weeks post-operative from both groups. The radiographic analysis revealed complete union at 6 weeks post fracture fixation in the salmon calcitonin treated group [2]. In the other group the fracture remained unhealed till the 10[th] week post-operative. The serum biochemical analysis showed highly significant increase in alkaline phosphatase in group [2] and non significant decrease in calcium level in the group [1]. The histopathological examination. Declared that the periostium was activated, the osteoblasts appeared early and the formation of osteoid callus was noticed at the 4[th] week. At the 6[th] week complete ossification and formation of the boney specules were observed in the group [2]. While in the group [1] all these observations were delayed 4-6 weeks. Salmon calcitonin accelerates fracture healing and therefore proposes that it is a potent bone anabolic agent for clinical use. It also gives us simple and easier interferences by using of external fixation rather than using of the most massive, complex, and expensive internal fixations for treating the simple, single long bone fractures in dogs. Fracture healing, salmon calcitonin, dogs

combination of dual bicortical onlay bone grafting and compression plating for atrophic humeral nonunion

This study was performed to evaluate the functional and radiological results of treatment of the established atrophic nonunited diaphyseal humerus fractures by the combination of compression plating and autogenous dual bicortical bone grafting, to determine whether a standardized treatment of aseptic humeral shaft nonunions results in union after one operation without substantial complications. Eleven adult patients [nine females and two males] who had been diagnosed as atrophic nonunion of humeral diaphyseal fractures were included in this study. All patients were treated by the same technique using compression plating and autogenous fixed dual bicortical bone grafting. The follow up period ranged from 12 to 18 months [average 15 months]. The functional outcome of the operative intervention was evaluated using the Stewart and Hundley [27] rating scale. Union of the fracture occurred in every case. The mean healing time was 18.6 [16-22] weeds. The range of motion of the shoulder and elbow was excellent in 8 patients, that of the shoulder moderate in 3, and, that of the elbow moderate in 2 and poor in 1. the overall functional results were excellent in 7 patients, good in 3 and fair in one case. When attempting to heal persistent nonunited fractures, multiple methods used simultaneously should be considered to increase the chance of success. Given the good functional results in this series, the combination of compression plating and dual onlay bicortical bone grafting appeared to be a good method for treating humeral shaft atrophic nonunions

Functional results of Keller's arthroplasty and its modifications in the treatment of Hallux Rigidus in adults

This study was performed to evaluate the functional results of operative treatment of hallux rigidus in adults by Keller's arthroplasty and modified Keller's arthroplasty. Twenty adult patients, fourteen-females [one of them had bilateral hallux rigidus] and five males were presented to the outpatient clinic in the Suez Canal university hospital was included in the study and they had hallux rigidus of the metatarsophalangeal joint of the big toe grade two [thirteen patients] and grade three [seven patients] patients were divided into two groups, group A operated by Keller's arthroplasty and group B by modified Keller's arthoplasty. Follow up with clinical and radiological assessment was done at six and twelve months for both groups. The functional outcome for both groups was evaluated according to Michael et al., Seven patients in group B [70%] and two patients in group A [20%] had excellent results at one year follow up according to the system proposed by Michael et al., also two patients [20%] of group A have poor results. Limited range of motion and poor foot function as a result of recurrence of osteophyte formation and narrowing of the joint space were the causes of poor outcome. Postoperative complications were only superficial infection in two patients in the first group. Keller's arthroplsty is an easier technique but the modified procedure has a better functional result and it is more stable than Keller's arthroplasty

Functional assessment of arthroscopic anterior cruciate ligament reconstruction using bone- patellar tendon-bone autograft

This study aims at analyzing the results of arthroscopic anterior cruriate ligament reconstruction using bone patellar tendon bone auto graft with accelerated postoperative rehabilitation program. Thirty knees in thirty patients, 29 males and one female, were included in this study after clinical, functional, radiological, and arthroscopic assessment and diagnosis of rupture of the anterior cruciate ligament. Lysholm score was utilized to evaluate the patient's symptoms and signs and clinical assessment both pre and postoperatively. The preoperative Lysholm score ranged between 46 and 76 points with an average of 60.6 six months after the operation, the score ranged between 77 and 91 points with an average of 84.8 after one year, the average was 88.6 while at the end of the follow up the average was 92.8 points. All patients showed significant improvement from the preoperative scores. At the end of the follow up, 24 patients [80%] scored excellent [< 90 points] and 6 patients [20%] scored good [77-90 points]. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone auto graft with accelerated postoperative rehabilitation program in young adults, lead to reasonable stability and good overall function of the knee joint