Anatomical study of the arterial supply of human extra ocular recti muscles

Extraocular muscles are highly specialized striated muscles exhibiting generous innervation and more variation in fiber size and type than other skeletal muscles. The arterial supply of the extraocular recti muscles [EORMs] is liable to be severely damaged during medial and lateral approaches to the orbit to treat various disorders. Was to study the arterial blood supply of the EORMs to help the surgeons to adopt procedures in which these arteries can be saved. Also to study the difference in the vascularity between the global and orbital layers of the muscles. Twenty human orbits were dissected after arterial injection of the internal carotid artery with red latex. The different arterial pedicles for each muscle were studied regarding their number, origin and points of entry. Morphometric study was done to count the number of the blood vessels in the orbital and global layers. The luminal cross sectional area of these blood vessels were studied, measured and statistically analyzed. The arterial supply to the extra ocular recti muscles came from the ophthalmic artery, the lacrimal artery and the inferior muscular artery. The superior rectus muscle was supplied by 1-2 arterial pedicles from the ophthalmic artery, while the medial rectus muscle was supplied by 2-6 pedicles from the ophthalmic and inferior muscular arteries. The inferior rectus muscle was principally supplied by 2-5 branches from the inferior muscular artery but the lateral rectus muscle was supplied by 2- 5 pedicles coming from the lacrimal artery and muscular branches from the ophthalmic artery. Through morphometric study, there were abundant blood vessels in the orbital layer and larger luminal cross sectional area of the blood vessels at midorbital portion in the global layer. The arterial blood supply to the EORMs was variable but always substantial and the pedicles were numerous, their number was 1-5 arterial pedicles for each muscle. Since 70-80% of the blood supply of the anterior segment of the eye ball arise from the forward extension of the muscular arteries[5]. So, in cases of transposition procedures during strabismus or retinal reattachment surgery, surgeons must take care of these muscular arteries in order to keep the blood flow within the corresponding anterior ciliary arteries.Also It could be concluded that the orbital layer of the EORMs has increased vascularity and increased content of mitochodria and oxidative enzymes than the global layer

New concepts in treatment of post-dural puncture headache: Tetracosactide vs. tetrazepam

We investigated the effect of tetracosactide hexa-acetate vs tetrazepam as therapeutic agent for treatment of post-dural puncture headache [PDPH]. Thirty patients with PDPH were randomly allocated to receive either tetracosactide 1 mg IM [group A, n=15] or oral tetrazepam 1.2 mg/kg [group B, n=15]. Severity of headache [VAS scale], neck rigidity, nausea and vomiting were recorded before treatment and at intervals after treatment. The need for supplementary management as hydration, analgesics or epidural blood patch was also recorded. Our results suggest that tetrazepam has a superior effect compared to tetracosactide in controlling PDPH. It also alleviates neck rigidity and vomiting in a statistically significant way. The drug is also cheap, easy to use and has minimal side effects

Immunohistochemical study of male albino rat prostate in different age groups after castration

In this study we examined the lobe-specific and age-dependent expression of Bcl-2 and Bax proteins, 80 male albino rats were used in this study, 20 rats were control 10 aged 4 month, and 10 aged 24 months, the rest of animals were divided into 3 equal groups each 20 animals half of them 4 months age and the rest 24 months age. The experimental groups were castrated, and were killed at 1, 10, 30 days after castration. Bcl-2 expression in the ventral lobe were lower compared with expression in the dorsal and lateral lobes respectively. Bax expression in the ventral lobe was higher than that in the lateral and dorsal lobes, respectively. In all three lobes, Bcl-2 was detected in epithelial cells, but not in stromal cells, where as Bax. protein was localized in both cell types. After castration, Bcl-2 expression in the ventral lobe decreased significantly from the control level shortly after castration, but increased significantly by 30 days. By contrast, Bax expression increased significantly, gradually decreased by time, and was nearly undetectable by 30 days post-castration. In the dorsal and lateral lobes, neither Bcl-2 nor Bax expression was significantly altered after castration. In the ventral lobe of old rats after castration, Bcl-2 followed a pattern of expression similar to that observed in young rats. However, Bax were lower in old rats compared with those in young rats after castration. Therefore, cell death follows the down-regulation of Bcl-2 expression in the ventral lobe of young and old rats. Moreover, the higher Bcl-2 expression in the dorsal and lateral lobes of controls and in the ventral lobe by 30 days after castration serve to protect cells from apoptosis. The conclusion of the study was that; the rat prostate lobes offer a model to study the molecular mechanisms of cell death and survival that are related to the androgen dependence of prostate epithelial ceils in normal and diseased conditions. The relative abundance of Bcl-2 and Bax proteins is critical in directing cells toward or away from apoptosis. The relative abundance of Bcl-2 protein correlates with the survival of prostatic epithelial cells. The age dependent decrease in cell death correlates with a reduced stimulation of Bax protein

Comparison of caudal bupivacaine plus ketamine and caudal bupivacine plus I.V. ketamine for post operative analgesia in children

The aim of this study was to compare the effect of single dose caudal bupivacaine, caudal bupivacaine plus ketamine and caudal bupivacaine plus I. V. ketamine in children for post operative pain management. Following ethics committee approval and informed parental consent 96 ASA I or II children between 1 and 10 years of age scheduled for elective inguinal hernia repair with general anaesthesia were recruited. After induction of anaesthesia and placement of a laryngeal mark air way [LMA], the patients were randomly divided into three groups to receive either caudal bupivacaine alone 0.25% 1ml.kg[-1] or caudal Bupivacaine 0.25% 1ml. kg[-1] plus ketamine 0.5mg/kg[-1] or caudal bupivacaine 0.25% ml.kg[-1] plus I.V Ketamine 0.5mg. Kg[-1]. Pain was evaluated by children's hospital of Eastern Ontario pain scale and sedation with a five point sedation test. No difference was found regarding age, weight, and duration of operation between the groups [p>0.05]. Duration of analgesia was longer in caudal ketamine group [1380.2+208.8min] than the other two groups. Pain scale was similar between groups in the first 2h-postoperative but lower in caudal ketamine group [4.6 +/- 1.1] than I.V ketamine group or bupivacaine group at 3h. The number of patients requiring supplementary doses of analgesia was significantly lower in caudal ketamine group 3 children compared with the IV ketamine group or bupivacaine group. Bupivacaine [0.25%] plus ketamine 0.5mg.Kg[-1] given caudally prolong postoperative analgesia and significantly reduce the need for subsequent post operative analgesia compared with caudal bupivacaine alone or I.V ketamine plus caudal bupivacaine

comparison of fentanyl, meperidine and lidocaine in preventing the withdrawal response associated with rocuronium injection

We compared the efficacy of IV fentanyl, IV meperidine and IV lidocaine as pretreatment for the prevention of withdrawal response after rocuronium injection. For this prospective, randomized, placebo-controlled, double-blinded study we recruited 120 patients aged between 18 and 65 years, ASA physical status I or II, who had undergone elective surgery requiring general anesthesia and positive pressure ventilation. Patients were randomly allocated to 1 of 4 groups; group F received 2ml IV fentanyl 50micro g/ml [100 micro g], group M received 0.5ml IV meperidine [25mg], group L received 2ml of preservative-free lidocaine 2% [40mg] and group P [placebo] received 2 ml of normal saline. The incidence of withdrawal response after rocuronium was 56%, 16%, 15% and 7% in the placebo, lidocaine, meperidine and fentanyl groups respectively. We found a significant reduction in incidence of withdrawal response in the fentanyl, meperidine and lidocaine groups when compared with the placebo group [p<0.05], with the fentanyl group being most effective [p<0.05]. In conclusion, it was found that fentanyl, meperidine and lidocaine are effective clinical treatments to alleviate the withdrawal response associated with rocuronium injection, with the fentanyl being the most effective of the three used drugs

Selective spinal anaesthesia with hyperbaric bupivacaine as compared to general anesthesia with sevoflurane for ambulant surgical procedures

Forty adult ambulatory knee arthroscopy patients received either selective spinal anesthesia with 5mg of hyperbaric bupivacaine or general anesthesia with sevoflurane in a randomized and controlled study. The study was done to determine whether spinal anesthesia with small dose bupivacaine provides equal fast-tracking possibilities a shorter stay in the postanesthesia care unit [PCU], and earlier discharge for home compared with general anesthesia with sevoflurane. No difference was seen in the fast tracking possibilities or time in the postanesthesia care unit [PACU] between the two groups. Home readiness was achieved after 95.25 [45-210] and 115 [44-260] minutes [NS] in the selective spinal anesthesia and general anesthesia groups respectively. In the hospital, the pain scores were significantly [p=0.028] higher in the general anesthesia group compared with the spinal anesthesia group and the need for postoperative opioids was significantly larger [p<0.0132] after general anesthesia. The incidence of postoperative nausea and vomiting was 0% versus 25% in the selective spinal anesthesia and the general anesthesia groups respectively [p<0.0168]. We conclude that for outpatients undergoing knee arthroscopy, selective spinal anesthesia with hyperbaric bupivacaine provides equal recovery times with less frequent side effects compared with general anesthesia with sevoflurane

Hemodynamic and neuroendocrinal stress response in relation to intrathecal opioids and isobaric bupivacaine as pre-emptive analgesics in laparoscopic-assisted vaginal hysterectomy

Certain complications of major surgery [e.g. myocardial infarction, pulmonary and thromboembolic complications, stress ulcers and post operative fatigue] can be attributed to the general metabolic response to surgery. Perioperative and postoperative regional anesthesia have been associated with decreased postoperative morbidity by lowering the incidence of such complications. As compared with local anesthetics, spinal opioids have selective segmental analgesia without sensory, motor blockade or autonomic block. Also, spinal opioids analgesia is not associated with central nervous system or cardiac excitability, toxicity or tachyphylaxis. The aim of the current study is to compare the hemodynamic and neuroendocrinal stress response of low dose intrathecal sufentanil in combination with low dose isobaric bupivacaine in patients undergoing laparoscopic-assisted vaginal hysterectomy under general anaesthesia with that of intrathecal morphine and bupivacaine injection. Patients were randomly allocated into one of two equal groups [each 10 patients]. Group [A]: Patients of this group received 10 micro gm intrathecal sufentanil in 1ml saline and 1ml isobaric bupivacaine 0.5%. Group [B]: Patients of this group received 100 micro gm intrathecal morphine in 1ml saline and 1ml isobaric bupivacaine 0.5%. Sufentanil group [A] tend to have overall low mean arterial blood pressure and heart rate than the morphine [B] group. There was no statistical difference between respiratory criteria [arterial oxygen saturation and breathing rate] between the two groups. Neuroendocrinal patterns [cortisol and glucose levels] were generally higher in the sufentanil group [A] than in the morphine group [B]. Both morphine in a dose of 100 micro gm and sufentanil in a dose of 10 micro gm are safe adjuncts to isobaric bupivacaine as intrathecal analgesia. They are both safe and are not associated with major hemodynamic or neuroendocrinal side-effects within the limits of such doses. Morphine in such dose has a slightly better hemodynamic and neuroendocrinal profile than sufentanil

Low dose Intrathecal sufentanil versus mrophine and Isobaric bupivacaine in laparoscopic surgery: Effect on postoperative pain relief

This study was designed to evaluate the perioperative analgesic effect of intrathecal anaesthesia with a low dose intrathecal sufentanil combined with low dose isobaric bupivacaine and to compare it with a low dose intrathecal morphine combined with low dose isobaric bupivacaine in laparoscopic surgery. 45 female patients of ASA I and II were scheduled for laparoscopic adhesolysis for infertility as diagnosed by hysterosalpingiography with or without diagnostic laparoscopy. Patients were randomly allocated into one of three equal groups: Group [I]: Patients in this group received 20 micro gm intrathecal sufentanil in 1ml saline and 1ml isobaric bupivacaine 0.5%; Group [II]: Patients of this group received 10 micro gm intrathecal sufentanil in 1ml saline and 1ml isobaric bupivacaine 0.5%; and Group [III]: Patients of this group received 100 micro gm intrathecal morphine in 1ml saline and 1ml isobaric bupivacaine 0.5%. The main finding of this study was that 100 micro gm of intrathecal morphine prolonged postoperative pain relief as measured with VAS [9 +/- 1.813] where intrathecal sufentanil was less effective for prolonged analgesic effect [3.47 +/- 0.51 for 20 micro gm group and 3.40 +/- 0.52 for 10 micro gm group], with p value 0.000 which is extremely significant. This dose resulted in excellent pain relief and a low dem and for systemic analgesics postoperatively. On the other h and, intrathecal sufentanil in dose of 20 micro gm has the same duration of action of 10 micro gm with denser block but with higher incidence of side effects. We conclude that intrathecal morphine 0.1 mg provided good analgesic effect in laparoscopic adhesolysis that lasted for longer duration [mean 9 hours] than intrathecal sufentanil with fewer side effects

Tactile TOF count as a predictive factor for the efficacy of neostigmine reversal of rocuronium-Induced blockade during propofol or sevoflurane anesthesia

This study was done to determine whether train-of-four [TOF] count is a good predictor to the efficacy of neostigmine administration for reversal of rocuronium-induced blockade during propofol or sevoflurane anaesthesia, and to follow subsequent recovery until the TOF reached 0.9. One-hundred-twenty patients, divided into eight equal groups, were randomly allocated to maintenance of anaesthesia with propofol or sevoflurane. The tactile response of the adductor pollicis to TOF stimulation was evaluated on one arm, and the mecha-nomyographic response was recorded on the other Neuromuscular block was induced with rocuronium 0.6 mg.kg[-1] and maintained with rocuronium to 15% of the control first twitch in TOF, neostigmine 0.07mg.Kg[-1] was administered on reappearance of the first [Group I], second [Group II], third [Group III], or fourth [Group IV] tactile TOF-response in each anaesthesia. The times from administration of neostigmine until the ratio recovered to 0.7, 0.8 and 0.9 were recorded. The times [[median [range]] to TOF ratio - 0.9 were 8.2 [4.5-17.3], 7.8 [3.6-11.9], 5.6 [1.8-9.1], and 4.4 [1.1-7.6] min in Groups I-IV during propofol anaesthesia, respectively, and 24.6 [8.1-66.3], 22.8 [7.6-51.1], 15.4 [7.1-39.7], and 9.1 [4.9-22.3] minutes in corresponding groups during sevoflurane anaesthesia, respectively, [p<0.05]. We recommend more than 2 TOF responses with propofol anaesthesia and 4 TOF responses with sevoflurane anaesthesia for adequate reversal within 10 and 15 minutes, respectively. The more tactile TOF responses present at the time of reversal achieved greater adequate recovery

Effect of desferoxamine and urine alkalinization on myoglobin-induced kidney injury in albino rats

Myoglobinuric acute renal failure is a known complication of several clinical sittings involving muscle damage. Renal damage has been partially attributed to iron released from myoglobin, which then catalyzes the generation of reactive oxygen species and oxidant tissue injury. To define whether desferrioxamine [iron chelator] and urine alkalinization would confer direct and additive protective effects on myoglobin-induced renal failure, glycerol model of myoglobinuric acute renal failure in albino rats was used. Rhabdomyolysis was induced by injecting hypertonic glycerol solution in saline [50%], at a dose of 8 ml/kg body weight, in the muscles of the hind limbs of rats. Forty adult male rats were randomized into five groups, eight rats/group. The 1st group was injected with glycerol solution, the 2nd with glycerol and intra-peritoneal desferrioxamine at a dose level of 50 mg/kg body weight twice daily, the 3rd with glycerol and given 0.28 molar sodium bicarbonate drinking solution, the 4th with glycerol and desferrioxamine and was given the alkali drinking solution, and the 5th [control group] with normal saline and desferrioxamine and given the alkali drinking solution. The results showed that desferrioxamine and urine alkalinization reduce oxidative stress in renal tissue and protect against functional and structural myoglobinuric renal damage, and both treatment regimens provide additive protective effects

Chemicopathologic findings in bilharzial portal gastropathy, correlation between serum gastrin, gastric acid output, histopathologic findings and antral agyrophil cells

This study attempted to correlate the changes in serum gastrin, basal gastric acid output, histopathologic findings in the antral gastric mucosa and its G cells in patients with bilharzial portal gastropathy. Forty patients with hepatosplenic schistosomiasis recovered from ruptured esophageal varices were selected in addition to ten healthy control persons of matched age and sex. All patients and controls were subjected to thorough clinical examination, endoscopy with antral punch biopsy for histopathologic examination and histochemical staining of antral G cells. There was a significant positive correlation between serum gastrin and the number of G cells and a significant negative correlation between basal gastric acid output and the number of G cells. However, a nonsignificant correlation was found between serum gastrin, histopathologic changes, portal vein diameter and degree of liver damage denoting that hypergastrinemia was due to the overproduction and impaired feedback inhibition by gastric acid output