Use of echocardiography and scintigraphy in assessment of coronary artery disease [comparative study]

The aim of the study was to perform a comparative study between dipyridamole Technetium Tc-99m sestamibi single photon emission computed tomographic scintigraphy [DMIBI] and dobutamine-atropine stress echocardiography [DASE] in assessment of coronary artery disease [CAD] in correlation to the coronary angiography. The study included 62 patients 43 males and 19 females [mean age: 60 +/- 11 years]. All patients underwent multistage DASE, DMIBI and coronary angiography over one month's time. These procedures were performed according to standard techniques and analysed in comparative issue for the sensitivity and their specificity in assessment of CAD. The study revealed 10 patients with three-vessel disease, 11 patients with 2 and 20 patients with single vessel disease. The other 21 patients had insignificant coronary disease for intervention. DASE and DMIBI were similarly sensitive [87% and 80% respectively] for the detection of CAD. However. DASE was more specific [91% vs. 73%, p<0.01]. Detection of Multiple wall motion abnormalities and perfusion defects were similar in both tests [72% vs. 66% respectively]. However, DASE was more specific than DMIBI [95% vs. 76% respectively p<0.01]. DASE and DMIBI were moderately concordant for the detection and extent of CAD [p<0.0001] but fairly concordant [p<0.001] in the detection of type abnormalities [normal, fixed, ischaemic or mixed]. DASE and DMIBI were comparable tests for the detection of CAD. Both were sensitive for the detection of CAD and moderately sensitive for the detection of the extent of the disease. However, DASE was more specific than DMIBI particularly in multi-vessels disease

Comparing the effect of topical eutectic mixture of local anesthesia and lidocaine infiltration on pain response and analgesia requirement during extra corporeal lithotripsy procedure [using the storz modulith SL20]

Fifty adult male patients [mean age 35 +/- 15 ys.] with renal pelvic stones were selected for this study, all patients required 3 ESWL sessions. First session was performed without any form of preoperative analgesia or anaesthesia. Second session, patients received 25mg of EMLA cream applied locally to cover a skin area overlying the treated kidney, 90 minuets before ESWL session. Third session was started 10 minuets after subcutaneous infiltration to the area overlying the treated kidney with 20 ml, 1% lidocaine. Using EMLA cream and lidocaine subcutaneous infiltration lead to decrease the pain score perception when compared to without anaesthesia session. During the first 500 shock waves of ESWL, pain score of 2 or more was reported by 6%, 10% and 35% of patients using EMLA cream, lidocaine infiltration and without anaesthesia respectively, and 38%, 32% and 70% during the following 2500 shock waves. This decrease in pain score lead to less need for I.V. alfentanil analgesia to 38% in case of using EMLA cream, 32% in case of using lidocaine infiltration, while it was 70% when nothing was used. Local anesthesia is an effective means to reduce the pain score and analgesia requirement during extra corporeal lithotripsy procedure. Both EMLA and local infiltration are effective. However EMLA cream is easy to apply and has no complications. It is only drawback is its price

Eight years experience in anaesthesia for total thymectomy as treatment for myasthenia gravis in Mansoura University Hospital

Twenty-five patients with myasthenia gravis underwent thymectomy at Mansoura University Hospital from 1985 to 1993. Preoperatively; there was one patient in Stage 1. 3 patients in Stage II patients in Stage III, 4 patients in Stage V and 3 patients in Stage VI. Atropine in a dose of 0.5mg was given l.V. as only premedication. All the patients were intubated under deep halothane anaesthesia and anaesthesia maintained by N20: 02 halothane [0.5-2%]. Ventilation was controlled without the use of muscle relaxant. Sixteen patients were extabuted immediately after the end of operation and after giving prostagmine equivalent to morning omitted dose. Six patients needed postoperative ventillatory support for period of few hours to one week. Three patients died in our series due to post-operative pulmonary complications and respiratory failure