Study on the characteristics and some risk factors of transurethral prostatectomy syndrome

Background: Benign hyperplasia prostate is a common disease in older men (over 60 years old). Transurethral resection of benign hyperplasia prostate is a method of improving symptoms with the best results, though with a high rate of complications, in which the most serious complication is transurethral prostatectomy syndrome (TURPS). Objective: The study aimed to describe clinical and para-clinical characteristics of TURPS and to define some risk factors of TURPS. Subject and methods: A descriptive, prospective study was conducted in 200 patients, who underwent TURPS, ASA I-II at the Anesthetic Emergency Department, Viet Duc Hospital from April 2007 to October 2007. To describe TURPS by observing clinical signs and serum sodium. The risks of TURPS were considered as prostate weight, operation time and amounts of used irritants. Results: The incidence of the TURPS was 7% of all resections. Clinical signs of the TURPS were nausea, vomiting, headaches, confusion and disorientation. TURPS was associated with hypotension (42.9%), bradycardia (35.7%), increased CVP (21.4%). The sodium concentration fell below normal in certain patients (64.3%). The amount of 3% Sorbitol (> 20 liters) was an independent risk factor of TURPS, but not the prostate weight or the operation time. Conclusions: The main signs of TURPS included central nervous symptoms (100%), circulatory and respiratory disorders (42.9%, 21.4%, respectively) and hyponatremia (64.3%). Sorbitol 3% > 20 liters was an independent risk factor of TURPS.

Evaluationg effects of protective ventilation for patients with Acute Lung Injury (ALI) or acute Respiratory Distress Syndrome (ARDS)

Background: Although there are many advances in the treatment of Acute Respiratory Distress Syndrome (ARDS), the mortality rate is still high (40%-60%). The new strategy \u2018protective ventilation\u2019 helped to lower the fatality rate and shortening the duration of mechanical ventilation in comparison with traditional modes. However, there is controversy about the effects of protective ventilation. Objectives: (1) To estimate the change of arterial blood gas and hemodynamic in the first 48hrs in the patients suffering from ALI or ARDS under protective ventilation. (2) To discover the disadvantages of this ventilation mode. Subjects: 30 ALI and ARDS patients (22 males and 8 females) treated at ICU, Viet Duc Hospital between April 2005 and October 2005. Method: Prospective and self-control study. Protective ventilation was applied for these patients. Artery blood gas, hemodynamic and disadvantages of protective ventilation were monitored during first 48hrs. Results: Protective ventilation significantly lowers airway pressure (p < 0.001). There was no change of PaCO2 (p > 0.05), and PaO2 was improved clearly after 12hrs of ventilation (p < 0.05). There were no significant changes of mean arterial pressure, heart rate and central venous pressure. 83.3% patients needed a high dose of sedation during protective ventilation. Conclusion: Protective ventilation lowered airway pressure, improved PaO2 and had no hemodynamic effect. However, patients required a high dose of sedation during this mode of ventilation.

The relationship of blood glucose to severity of injury in multiple trauma patients before operation

Background:Recent international researches in trauma patients have shown that hyperglycemia usually goes along with increased mortality, ventilator time and post-operative complications. The role of blood glucose in trauma prognosis and treatment is a current concern. Objective: To evaluate blood glucose change and the relationship of hyperglycemia to severity of injury in the clinical in multiple trauma patients before operation. Subjects and method: A prospective, descriptive study was conducted at the Emergency Surgery Unit and Post-anesthesia Care Unit, Department of Anesthesia and Recovery, Viet Duc hospital, from March to September/2006. The participants were over 15 years old, multiple trauma patients who were operated within 48 hours after the accident, but they had not been used inotrope, sedatives and operated in other clinical. Results: Hypoglycemia (under 3.5 mmol/l) was seen in 4/926 multiple trauma patients. Three of four were in shock due to severe blood loss, of which 2 patients had breath and cardiac arrest. Both patients died from multi-organ dysfunction immediately and one week after operation. The average blood glucose level of patients with ISS 25-40 and over 40 was significantly higher than those with ISS 16-24. Hyperglycemia had a closely positive association with ISS (r=0.48, p< 0.01). Conclusion: Most of multiple trauma patients have hyperglycemia before operation. Hyperglycemia has a relationship with severity of injury, especially with severity of anatomical injury. 4.1% patients have hypoglycemia which is mainly associative with prolonged shock.

Evaluating the effect of local and intraperitoneal bupivacain infiltrations on pain relief after laparoscopic cholecystectomy \r\n', u'\r\n', u'

Background: Laparoscopic surgery is as very safe as traditional open surgery. A laparoscopic cholecystectomy is a surgical procedure during which the doctor removes your gallbladde. Objectives: This study was to assess the effect of local and intraperitoneal bupivacain infiltration on pain relief after laparoscopic cholecystectomy and the side effects of this technique. Subjects and method: In study group (n = 37), 25 mg bupivacain 0.25 % and 75 mg were infiltrated at Trocat incisions and at intraperitoneal surgery site, respectively. In placebo group (n = 44): no infiltration was used. VAS was measured controlling patient's pain during at rest, following inspiratory effort and movement; IV perfalgan requirement and the side effects of the technique were observed. Results: VAS at rest, following inspiratory effort and movement as well as perfalgan requirement during postoperative 6 hours were lower in study group (p < 0.05). \r\n", u'A significant decrease of heart rate after 10 - 30 minute of intraperitoneal infiltration of bupivacain was noted. Conclusions: Local and intraperitoneal bupivacain infiltrations had an effectiveness on pain relief during 6 hours after laparoscopic cholecystectomy. Moderate bradycardia was a main side effect of this technique. \r\n', u' \r\n', u'

The effect of pre-incision nefopam on postoperative pain after major upper abdomonal surgery

Background: Nefopam a powerful painkiller has been put into clinical use since 1976, effects preemptive analgesia. Objectives: To assess the effect of presurgical IV Nefopam on postoperative pain after major upper abdomonal surgery. Subjects and method: A double-blind randomized controlled trial. 62 patients were divided into 2 groups: Nefopam (N, n = 31) and placebo group (PG, n = 31). Presurgical IV 20 mg Nefopam was used in N.PCA was used for both groups. Postoperative non-painful time (PNPT); VAS/48 hours at rest and on cough; IV Morphine rescue with PCA was measured during postsurgical 48 hour period.Results: PNPT was longer in N 42 \xb1 8,9 vs. 22 \xb1 4,8, p<0,01. Titration dose of morphine, Morphine consumption of first 24 hours, and of another 24 hours were lower in N 5,6 \xb1 1,7; 25,2 \xb1 4,9; 10,1 \xb1 3,6 mg vs. 7,1 \xb1 1,5; 30,1 \xb1 4,5; 13,3 \xb1 2,1, p<0,05 and < 0,01, respectively. VASs under tested conditions during first 16 hours were significant lower in N. Conclusion: Presurgical Nefopam had the effect of pre-emptive analgesia as evidence by a significant VAS decrease during the first 16 hours with lower Morphine consumption of 48 hours .

Postoperative patient \ufffd?controlled epidural analgesia with bupivacaine \ufffd?fentanyl after gastrectomy

Background: Gastric cancer surgery is major surgery and often encountered in surgical. Objectives: To assess the efficacy and the side effect of postoperative patient \ufffd?controlled epidural analgesia (PCEA) with bupivacaine \ufffd?fentanyl after gastrectomy. Subjects and method:A prospective trial was conducted on 30 patients with gastrectomy because of cancer. Epidural catheter was inserted at level of D7-D9. Postoperative pain relief using PCEA with bupivacaine 0,125% - fentanyl 2\u03bcg/ml: 2ml bolus every 10 min, with basal infusion 2ml/h. VAS during normal tidal ventilation and following cough, the side effects were monitored during 48 hour period. Results: VAS decreased from 6,4 \xb1 1,4 to 2,6 \xb1 0,7, p<0,01 after 15 min. 90% patients had VAS under 2,5 after 1 hour and 100% reached VAS under 2,5 after 8 hours during normal tidal ventilation and following cough as well. Incidence of urinary retention, nausea and pruritus were 13,3; 3,3; and 3,3% respectively. Conclusion: PCEA provided a effective pain control after gastrectomy during normal tidal ventilation and following cough. The side effects remained unusual and minor.

Surgical treatment of subacute hematogenous osteomyelitis in children

Background: Subacute hematogenous osteomyelitis is a rare disease and difficult to diagnose. Hematogenous osteomyelitis is an infection caused by bacterial seeding from the blood. Acute hematogenous osteomyelitis is characterized by an acute infection of the bone caused by the seeding of the bacteria within the bone from a remote source.\r\n', u"Objectives: The study had two purposes: (1) Remark of Clinical and Xray syndrome of Subacute hematogenous osteomyelitis, and (2) Evaluation of the surgical results. Subjects and method:We operated on 42 patients with Subacute hematogenous osteomyelitis during 18 years period ( from 1984, October to 2005 December). Included 11 female, 31 male at the age from 4 to 12 years old. A rontgenographic classification was described by Gledhill & Roberts. The surgical debridement and irrigated with the antibiotic. Results: The patient's temperature is mildly elevated or normal, the pain isn't remarked. The WBC is normal. The cultures obtained by biopsy are positive in 8/42 patients. The lesions of type 1 in (88.1 % and type 2 in 11.9%. The follow - up: Good in 61.7%,Fair in 32.4%, Poor in 5.9%. Conclusions: The diagnosis and treatment are usually delayed, sometimes must be established by an open biopsy and cultures. Treatment with curettage of the lesion and administration irrigated with the solution antibiotics.\r\n", u'

Intubation condition and side effects of different doses of succinylcholine

Background: Succinylcholine is drug muscle relaxant the only depolarizing current can also be used in clinical. Objectives: The current study assessed the intubation condition and side effects of different doses of succinylcholine. Subjects and method: In a randomized, double blind trial, 90 patients were divided into 3 groups. 1, 1.5 or 2 mg/kg succinylcholine was added with Fentanyl and Thiopental for induction in group I, II and III, respectively. A rapid induction and postoperative myalgia were evaluated. Results: Fasciculation time as well as myalgia increased significantly by the doses. Intubation conditions were better in group II and III. Increase of kalemia was seen in all groups, but most significantly in group III (3,7 \xb1 0,3 vs 3,3 \xb1 0,2, p<0,05). Conclusion: 1, 1.5 or 2 mg/kg succinylcholine equally provided acceptable intubation condition. Succinylcholine 2 mg/kg induced more fasciculation, myalgia and increase of kalemia.