Evaluating success of curettage in the surgical treatment of endometrial polyps

To determine treatment efficacy of curettage on endometrial polyp. The quasi-experimental pre-and-post study was conducted in 2011-12 at the gynaecology department of Imam Reza Hospital, Mashhad, Iran, and comprised patients who underwent hysteroscopy for endometrial polyp. Location, size, number and base condition of the polyps were recorded before the patient underwent curettage. Hysteroscopy was then performed and the condition of the remaining polyps was compared with initial findings. Also, the remaining polyps were resected. SPSS 13 was used for statistical analysis. There were 51 patients in the study with a mean age of 33.14 +/- 8.19 years [range: 23-59 years]. Besides, there were 82 polyps; 38[46.3%] having a narrow base, and 44[53.7%] having a wide base. The mean polyp size was 2.39 +/- 2.63cm.After performing curettage, 23[28.0%] polyps were removed completely, 39[47.6%] had size reduction, and 20[24.4%] had no change in size. Curettage could not significantly remove polyps [p<0.001].Polyps smaller than 2cm were more likely to have been removed compared to the bigger ones [p=0.003].Polyps with wide base were more significantly removed than those with narrow base [p<0.001].Further, those with wide base and also smaller than 2cm were removed more significantly than others [p<0.001].The location of polyps had no effect on removal probability by curettage [p=0.114]. Curettage was not found to be a reliable method for endometrial polyp removal. If hysteroscopy is not accessible, the size of the polyp should be determined by vaginal sonograghy to estimate the probability of its removal by curettage

Accidental intrathecal injection of magnesium sulfate for cesarean section

Magnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg [3.5 ml of 20% solution] was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four [TOF] reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked

[ incidence of hypotension, nausea and vomiting after spinal anesthesia for elective caesarean section: a comparison between bupivacaine 0.5% and lidocaine 5%]

Hypotension and nausea are common side effects during spinal anesthesia. This study compared the incidence of hypotension and nausea-vomiting induced by bupivacaine and lidocaine in parturients undergoing caesarean section under spinal anaesthesia. In this clinical trial, 120 parturients undergoing caesarean section were randomly allocated into two groups. 60 patients received subarachnoid lidocaine 5% [75-100 mg] and the other group of patients received bupivacaine 0.5% [12-15 mg]. If systolic blood pressure decreased to 80 mm Hg or less than 70% of the pre-anesthesia value, 5mg ephedrine was injected. We evaluated Blood pressure each 3 minutes up to 15 min and every 5 min thereafter till the end of the recovery stay. There was no statistically significant difference in the incidence of nausea -vomiting between the two groups after spinal anesthesia. On the other hand, there was significant difference in systolic blood pressure 12 minutes after the procedure and also a significant difference was noted in diastolic blood pressure 3, 9, 15, and 40 minutes after performing spinal anesthesia [P < 0.05]. The amount of ephedrine used in both groups did not show either any significant difference. Intrathecal bupivacaine may yield more hemodynamic stability than intrathecal lidocaine in elective cesarean section

Atrial fibrillation after off-pump versus on-pump coronary artery bypass graft surgery

Atrial fibrillation [AF] is the most common postoperative arrhythmic complication after coronary artery bypass graft surgery [CABG]. The aim of the present study was to compare AF prevalence after off-pump versus on-pump CABG. In this prospective study, performed between September 2008 and September 2009, 128 consecutive patients in our local cardiovascular surgery ward were allocated into two groups of off-pump [95 patients] and on-pump CABG [33 cases]. We compared preoperative risk factors such as left ventricular ejection fraction [LVEF]<%40, hypertension [HTN], and Cr>2mg/dl, site of grafting such as the left coronary descending artery [LAD], right coronary artery [RCA], and left circumflex artery [LCX] in the two groups of surgery techniques [on-pump versus off-pump CABG] with/without postoperative AF after 24 hours of surgery in the Intensive Care Unit, Statistical power of the study was 80%, and a P-value less than 0.05 was considered significant. The prevalence of AF was 15 [15.8%] in the off-pump group versus 7 [21.2%] in the on-pump group [p=0.67] 24 hours after CABG. In the on-pump group, there was no difference between age categories [p=0.11]. In the on-pump group, as opposed to the off-pump CABG group, there was no relationship between the surgery techniques with or without AF, LVEF <%40, and HTN. There was a significant relation with Cr more than 2 mg/dl in the on-pump CABG group [p=0.001] versus the off-pump CABG group [p=0.057]. There was no statistical relation between the type of vascular graft [LAD, RCA, and LCX] between the on-pump and off-pump CABG patients attributed to with or without AF. There was no reduction in the AF rate in the off and on-pump CABG versus off-pump CABG. It seems that there was another predictive factor for AF in the off and on-pump CABG groups, so further prospective trials with larger sample sizes are recommended

Inadvertent intrathecal injection of atracurium

This report relates how tracurium was given by mistake, intrathecally, during spinal anesthesia, to a 38-year-old woman, who was a candidate for abdominal hysterectomy. When no analgesia was observed, the mistake in giving the injection was understood. She was evaluated postoperatively by train of four ratio, measuring her breathing rate, eye opening, and protruding of tongue at one, two, twenty-four, and forty-eight hours, and then at one and two weeks, with the final evaluation the following month. The patient had normal timings during the operation and postoperation periods, and no abnormal findings were observed through the first month. This finding was contrary to several studies, which described adverse reactions due to accidental intrathecal injection of neuromuscular blocking drugs

Chest pain due to compression effect of hydatid cyst on LAD: rare presentation of hydatid cyst in heart

Cardiac hydatid cysts usually involve other organs and in different sites of the heart. Treatment of heart hydatid cysts is usually surgical, followed by continuous medical therapy. We present a male patient with a hydatid cyst in the interventricular septum with compression effect on the left anterior descending artery [LAD]; the cyst was diagnosed with echocardiography, CT imaging, and angiography. The patient was treated via surgical excision of the cyst under cardiopulmonary bypass, and the treatment was continued with medical therapy. A follow-up, the patient was in good physical condition. Cardiac echinococcosis is uncommon, accounting for 0.5% to 3% of all hydatid infestations in human beings[1]. All the heart walls and cavities can be the site of hydatid development but hydatid cysts of the heart are located most often in the left ventricle. Involvement of the interventricular septum is rare and can cause symptoms arising from the compression of the atrioventricular conduction pathway and obstruction of the right or left ventricular outflow tract[1,5]. Diagnosis is with echocardiography, CT imaging, and occasionally angiography[1,2,4] There is always the lethal hazard of cyst perforation. Early diagnosis and an integrated treatment strategy are crucial. The results of the surgical treatment of heart echinococcosis are better than those of the conservative strategy only. Extraction of the cyst combined with chemotherapy perioperatively or postoperatively is aimed at decreasing recurrence[2]