Transperitoneal exclusion: a simple third world solution for abdominal aortic aneurysm

We present an operation never described before for dealing with abdominal aortic aneurysms by exclusion via a midline trans-abdominal approach. This breakthrough holds many advantages over conventional aneurysmorrahphy and requires further clinical trials (AU)

Caesarean myomectomy: a safe procedure - abstract

The cases of 16 women who had Caesarean myomectomy between 1993 and 1996 were reviewed and compared with 16 women who had Caesarean section without this procedure during the same period. At Ceasarean secton fibroids were removed after delivery of the baby and placenta and after administration of oxytocin. Haemostasis was achieved by continuous interlocking sutures of the defects from fibroid removal. The parameters examined included pre and post operative haemoglobin levels, measured blood loss, need for transfusion, post operative febrile morbidity and length of stay in hospital. Caesarean mycomectomy resulted in mean blood loss of 494ml (range 200-1000ml) compared with 355 ml (range 150-900 ml) in the controls. The haemoglobin fall was 1.7 g/dl compared with 1.4 g/dl in the controls. There were no significant differences in the other paremeters examined. In conclusion we believe this procedure is safe but a larger study is required to determine this conclusively. (AU)

A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy

OBJECTIVE: To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy. METHODS:between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre-and postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay. RESULTS: Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] verus 512.7 mL [SD 400] for tourniquet [P = .036]. Six of 26 patients in the tourniquet lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (P = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusion given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications. CONCLUSION: Vasopressin prevents blood loss better than using the tourniquet durIng myomectomy.(AU)

The management of benign prostatic hypertrophy(BHP): a Caribbean perspective

Benign prostatic hypertropy (BPH), which causes urinary obstruction, is a prostatic response to 5-hydroxy testosterone produced from testosterone by 5 O reductase. Blockade of 5 O reductase activity by Finasteride prevents BPH. Finasteride, now available, is expensive but, if affordable, is a real option for the patient with early BPH. We do about 100 transurethral resections of prostate (TURP) annually (TUIP/BNI are excluded). Eighty percent (80 percent) of these men present in acute retention of urine with an indwelling Foley catheter. These patients need urgent removal of an obstructive prostate. We offer most of these men a TURP. Two years ago we presented our early results, at CCMRC, of IPVP before TURP. We showed then that transrectal IPVP halved blood loss during TURP in the small prostate (<50 g). We continued the study and reported the use of IPVP in the large prostate of o 50 g. This group was studied without controls. Our justification was that the first part of our study with the small prostate group (done with controls) clearly demonstrated that IPVP significantly reduces blood loss during TURP. It would almost certainly be unethical to expose a number of patients with large prostate to a dangerous procedure simply to provide a controlled study. We now routinely use IPVP in the prostate of 40g or larger. IPVP permits a safe, rapid TURP. Blood loss is considerably reduced and blood transfusion is not required. We keep the postoperative BP carefully controlled at the preoperative level using sublingual Nifedipine. We therefore reduce both the preoperative and the post-operative blood loss (AU)

Perivascular vasopressin versus tourniquet as haemostatic agents during myomectomy: a prospective randomised trial - abstract

This study sought to assess the efficacy of perivascular vasopressin compared to tourniquet in minimising bleeding and its sequelae at myomectomy. It was a prospective randomized trial carried out at the University Hospital of the West Indies, Kingston, Jamaica. Thirty-eight women with symptomatic uterine fibroids scheduled for myomectomy were recruited after satisfying eligibility criteria. There were 18 patients in the vasopressin group and 20 in the tourniquet group. Myomectomy was performed after the injection perivascularly of either 10 units vasopressin in 20 ml normal saline or with the use of a Foley catheter tourniquet around the uterine vessels. The efficacy of each method was measured by looking at differences in pre- and post-operative haemoglobin and haematocrit, changes in intraoperative pulse and blood pressure, measured blood loss, need for blood transfusion and evidence of post-operative febrile morbidity. Pre-operative variables were almost identical in both groups. The use of vasopressin resulted in less blood loss with a mean of 254 ml versus 401 ml for tourniquet (p = 0.09) approaching significance. This resulted in a similar fall in the haemoglobin mean, 1.7 versus 2.2 (p = 0.248). Of the 20 patients who received tourniquet 5 had to have blood transfusion compared to one of the 18 receiving vasopressin. There were no significant differences in highest post-operative pulse and temperature. The results suggest that vasopressin is as effective in preventing blood loss as the tourniquet and is probably better, reducing the need for transfusion during myomectomy (AU)

Intramyometrial vasopressin as a haemostatic agent during myomectomy

OBJECTIVE: To assess the efficacy of intramyometrical vasopressin for minimising bleeding and its sequelae at myomectomy. DESIGN: A randomised placebo controlled trial. SETTING: University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group. INTERVENTION: Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline). MAIN OUTCOME MEASURES: The efficacy of vasopressin was measured by comparing pre- and post-operative haemoglobin levels and haematocrit, changes in intra-operative pulse and blood pressure, measured blood loss, need for blood transfusion post-operative febril morbidity in the treatment and control groups. RESULTS: The use of vasopressin resulted in median blood loss of 225 ml (range150-400ml) compared with 675 ml (range 500-800ml) in the placebo group (p<0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7g/dl vs 5.3g/dl, P<0.001) and haematocrit (median 5 percent vs 13 percent, P<0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P=0.03). There were no significant differences between the groups in intra-operative pulse and blood pressure or post-operative white blood cell counts or temperature. CONCLUSION: The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy (AU)

Intraprostatic vasopressin before TURP - abstract

Intraprostatic vasopressin reduces the bothersome small vessel prostatic bleeding encountered during routine transurethral prostatectomy. Ten units vasopressin in 0.5 ml diluted with 1.5 ml normal saine are injected transrectally into the prostate gland. A single injection suffices for the procedure. TURP proceeds rapidly and safely. Large amounts of prostate tissue can be removed. Less blood is lost and blood transfusion is therefore less often required (AU)

The results of abdominal myomectomy

A survey of the records of 103 consecutive patients who underwent abdominal myomectomy revealed that menorrhagia and infertility were the commonest presenting complaints. The overall successful pregnancy rate was only 28.8 percent, but the procedure was corrective in two-thirds of patients with leiomyomata-related infertility. Intra-operative blood loss, post-operative adhesion formation and recurrence of tumour remain major drawbacks of myomectomy (AU)