Background: Upper extremity surgeries are commonly performed under regional anaesthesia. Regional anaesthesia of the upper extremity has several advantages over general anaesthesia such as improved postoperative pain management, decreased postoperative narcotic consumption, and reduced recovery time. Objectives: The aim of the study was to compare between dexamethasone and magnesium sulphate as adjuvants in supraclavicular brachial plexus block as regards the onset and duration of sensory and motor block as well as side effects. Patients and Methods: This prospective double-blinded comparative study was carried out in Faculty of Medicine, Ain-Shams University Hospital on 120 adult patients between 21-50 years of both sexes with ASA classification 1&2 who were scheduled for elective upper limb orthopaedic surgeries. A written informed consent was obtained from all patients. Every patient received an explanation about the purpose of the study. Procedures had been approved by the institutional and the regional ethical committee. Total 120 patients are enrolled in the study and divided into 3 groups A and B and C (40 for each one). Results From aspect of increasing the duration of sensory &motor block magnesium sulphate group (group A) showed higher prolongation of sensory & motor block with recovery of pin prick sensation in median time 313 mins ± when compared with group B &C even with longer time taken for patient to request rescue analgesia after 5 hours. In group (B) by adding dexamethasone with bupivacaine the blood pressure rate are increased after 20 min of injection and return normal after 240 min, heart rate are normal, but in case of sensory and motor block about 77.5% of study patient in this group have full motor and sensory block, in case of increasing time of motor and sensory block the dexamethasone success increasing time for motor and sensory block to reach 278 min sensory and 314 min in motor block, first call of Analgesic are after 4 hr. Conclusion: Group A (Magnesium sulphate with bupivacaine) were more effective and increasing affected time in motor and sensory block than Group B (Dexamethasone with Bupivacaine) and Group C (Control).
Background Acute lung injury and ARDS are major causes of morbidity and mortality all over the world. Major steps of understanding the pathophysiology, causes, diagnosis and treatment of this syndrome were taken in last twenty year. Diagnosis of this condition remains underestimated by physicians particularly mild form of this syndrome specially in developing world in which presence of investigations and well trained physicians is not adequate. Objective To compare between the outcomes of fluid administration strategies in the form of restricted or conventional fluid administration that affect oxygenation, weaning of mechanical ventilation and free days of icu admission in acute lung injury patients and its severe form ARDS. To detect the optimal strategy of fluid administration which decrease morbidity and mortality. Patients and Methods Type of Study: Prospective study. Study Setting: The study will be conducted in the ICU units at Ain-Shams University Hospitals and Ahmed Maher Teaching Hospital. Study Period: Four months from date of approval of the protocol. 90 adult patients- divided into three groups each group include 30 patients- (fulfilling inclusion criteria) admitted in the ICU units at Ain Shams University Hospitals and Ahmed Maher Teaching Hospital were included. Results Based on more than one point of view; underlying cause of ARDS palys major role in predicting these unpredictable results of this study in haemodynamically unstable patients. There are many factors, rather than hypoxemia, that affect organ outcomes (including respiratory system itself) in haemodynamically unstable patients which may caused by septic shock and other types of shock. Conclusion This small trial evoked new questions more than answering traditional ones about fluid management of acute lung injury and ARDS. Firstly; the accurate method to assess and guide fluid therapy in ARDS should be on top of searching priorities. Although using central venous pressure to guide fluid therapy could theoretically results in outcome improvement, but according to its many limitations and poor relation to volume status, its using in that issue is questionable. Secondly; establishing one fluid management strategy to all patients with ARDS seems to be not accurate. Unpredictable results on outcomes in ARDS patients receiving fluids particularly in those were haemodynamically unstable drive us to seek for new classification of ARDS patients based on underlying cause, haemodynamic stability and other elements that responsible for organ failure rather than volume status. However; this small trial suggests conservative fluid strategy in acute lung injury patients which are haemodynamically stable. And using of both conservative and liberal fluid administration strategies wisely in those patients which are haemodynamically unstable to reach the optimal intravascular volume– pressure with the best risk–benefit ratio.
Background Pathology in the sellar and suprasellar regions accounts for several disabling and distinctive neurological syndromes characterized by visual failure and upper cranial neuropathies. These features have a major impact on functional outcome more than the commonly associated endocrine morbidity. Objective this study aimed to present the incidence of various lesions in the sellar and suprasellar area and evaluate the different protocols for management of these lesions. Methods The study will include 40 cases of sellar& suprasellar lesions that will be admitted and treated in the neurosurgical departments in Ain Shams University Hospital as well as El-Galaa armed forces hospitals and 57375 Children Cancer Hospital between 12/2015-9/2018 Results: Pituitary adenoma was the most frequent(42.5%), followed by craniopharyngioma(30%), then Meningioma(12.5%) with other low frequent diagnoses , Headache was the most common complaint followed by blurring of vision, diplopia and nausea & vomiting. MRI sella was the most valuable investigation. 3 approaches were used and trans-sphenoidal approach was the most common used approach. Postoperative radiotherapy was significantly most frequent in Craniopharyngioma followed by pituitary adenoma and least frequent in meningioma. Conclusion we have reached to conclusion from this study, that transsphenoidal approach was suitable for most pituitary adenomas and Its main indication was mainly midline sellar and suprasellar tumors with limited lateral or posterior extension. The pterional approach was suitable for meningiomas and craniopharyngiomas and Its indication was a supra-or parasellar lesions with both lateral and posterior extension specially those reaching the clivus. Total excision was most frequent in pituitary adenoma followed by meningioma and least frequent in craniopharyngioma. Postoperative radiotherapy was significantly most frequent in Craniopharyngioma followed by Pituitary Adenoma and least frequent in meningioma.
Background Traumatic brain injury (TBI) is among the most important public health problems associated with high healthcare and social burden and significant mortality and morbidity. Overall low income countries have the highest TBI associated mortality and morbidity. Aim of the Work Some studies have demonstrated that intracranial pressure (ICP) monitoring reduces the mortality of traumatic brain injury (TBI). But other studies have shown that ICP monitoring is associated with increased mortality. Patients and Methods Systematic review of Published English literature from 2000 to 2017. Using appropriate combinations of MeSH terms and key words, including intracranial pressure, intracranial hypertension, ICP monitor, intracranial pressure monitoring, TBI traumatic brain injury, and craniocerebral trauma. Brain Trauma Foundation guidelines, mortality. We performed this relatively wide search to include the maximum number of relevant patients. Results In total, 2552 studies were identified and screened for retrieval using the strategy described above. After careening the title and abstract, 1968 studies were excluded and 554 were retrieved and subjected to detailed evaluations. Based on the inclusion and exclusion criteria, 527 of those studies were excluded, and thus 27 studies were included in the systematic review. All included studies were published, peer-previewed papers. Conclusion ICP monitoring may play a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, there was no significant effect for reducing the risk of hospital mortality, lowering occurrence rate of pulmonary infection, use of mechanical ventilation and duration of hospital stays. RCTs with larger sample size are necessary to further support the current results.
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