RESUMO
TRUS guided biopsies is painfull and uncomfortable procedure; which could cause many complications up-to vasovagal attacks. Some patients can not sustain the procedure to complete his required biopsies either due to presence of anal disorders [fissures, piles. stenosis .. ] or untolerable pain during biopsy. The objective of this study was to evaluate the use of peri-anal and peri-prostatiic local infilterating aneasthesia prior to TRUS biopsy in patients with or without painful anal conditions. Five hundred patients who are subjected for TRUS biopsy were included in this study of them 150 patients were found to have painful anal problems [fissure, piles. tight anal canal]. Peri-anal infilterating aneasthesi were used only in [n=150] patients who complaining of anal problems while. periprostatic aneasthesia were performed in all included patients [n=500] of this study. DRE was routinly performed prior to TRUS 10 assess the presence of anal disorders and to evaluate the prostate. Local injection of xylocain 0.5% in perianal rectal muscle before the introduction or TRUS probe followed by peri-prostatic injection of the same anesthetic material which were injected in sagital axis started from the seminal vesicle base of each side or the prostate till the prostatic apex. Then TRUS evaluation of the prostate and its measures, presence of focal lesion and capsular integrity were done to give the proper time for aneasthia. Biopises were taken according to TRUS finding using the standard sixtant or the extended biopsy technique+/- lesion directed. Most of the patients [90%] were comfortable using this procedure without significant pain during TRUS guided biopsies. Only 3% of the patient feel mild pain during mid-zonal biopsy because of repeat biopsy. Patients with painful anal problems were comfortable without prior treatment or delay in the procedure. Some of this painful anal problems improved after the procedure [anal dilatation]
On conclusion: Peri-anal local infilterating aneasthesia solve the problem of TRUS biobsy in patients with painful anal problems without delay or the procedure. Peri-prostatic local infiltrating aneasthesia was safe and effective prior to TRUS guided biopsies for all patients
RESUMO
The Goal of any surgeon treating L.C.P.D. is to improve upon the natural history of the disease. Containment whether surgical or non-surgical has evolved as an effective line of treatment in achieving such goal. Salter's innominate osteotomy improves containment by redirecting the acetabulum such that the soft plastic femoral head is protected within the solid confines of the acetabulum in the weight bearing position. Eventually when healing is over, a round non-deformed head is the likely result. This is a report on the short-term results of salter's innominate osteotomy [done in conjunction with full adductor myotomy and iliopsoas recession] performed at the new children hopital of Cairo University. The material of this study included 25 patients with L.C.P.D. [21 males 4 females] who were treated at an average age of 7.6 years [range 6.5 y-12y]. All patients had total involvement of the femoral head with or without head at risk signs. The period of follow-up averaged 30 months [range 24-54 months]. Assessment both clinically and radiologically [using Stulberg classification] was done at the final follow-up there were 19 satisfactory hips [Stulberg class 1 and 2]. We conclude that Salter's innominate osteotomy is an effective procedure in achieving containment in L.C.P.D. and hence bettering the natural history of the disease provided some pitfalls are avoided