Spinal anesthesia for endoscopic urological surgery--low dose vs. varying doses of hyperbaric bupivacaine

BACKGROUND AND OBJECTIVE: The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures. METHODS: Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 (Gr I), 7.5 (Gr II) or 10 mg (Gr III) of hyperbaric bupivacaine 0.5% combined with 25 microg of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons satisfaction, were noted. RESULTS: The maximum number of blocked segments was 14 +/- 1 (Gr I), 15 +/- 2 (Gr II) and 16 +/- 2 (Gr III). Time to T12 regression was significantly shorter for Gr I (53 +/- 13 min) than for Gr II (69 +/- 20 min) or Gr III (94 +/- 14 min). Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1(51 +/- 18 min) than in Gr II (86 +/- 19 min) and in Gr III (138 +/- 21 min). Ephedrine was used for 16 patients in Gr III (9.8 +/- 12.2 mg), 5 patients in Gr II (3.7 +/- 7.8 mg) and 2 patients in Gr I (0.5 +/- 1.5 mg). The difference is statistically significant between Gr III and the other groups. CONCLUSIONS: These results suggest that the use of a low dose of bupivacaine (5 mg) added to fentanyl (25 microg) for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 microg fentanyl.     

The role of bisphosphonate in the treatment of bone metastases from prostate cancer

Bachground: Bone metastasis is very frequent in prostate cancer. It is a turning point that marks the severity of the disease. Before metastasis become symptomatic, treatment preventing bone events should be indicated. Aim: To evaluate the role of bisphosphonate in the treatment of bone metastases from prostate cancer. Methods: A review of literature Results: Bisphosphonates play a very important role to prevent bone mass loss and to reduce bone complication events. Conclusion: Bisphosphonates are recommended as preventive treatment at the time of diagnosis of bone metastatic prostate cancer.     

Association of benign prostatic hyperplasia and hernia inguinale. A report of 55 cas

THE AIM: of this study is to evaluate the results of combined surgery of prostatic disease and inguinal hernia repair. METHODS:We report a retrospective study of 55 patients operated in the same operating time for benign prostatic hyperplasia and hernia inguinale, and present our criteria for patient selection, operative technique, and postoperative results. RESULTS:The mean age of our patient was 69 years with a range of 56 to 85 years. Open suprapubic prostatectomy was done in 53% of cases, transurethral prostatic resection in 47% of cases and prothetic hernioplasty in 60% of cases. The incidence of postoperative wound infection and recurrent hernia was 5,4 % and 6% respectively, witch compares favorably to results of herniorraphy and prostatectomy performed separately. Simultaneous repair of inguinal hernias and surgery of prostatic disease is effective and technically feasible.     

Colorectal cancer: new developments after the 2013 ECCO/ESMO congress

In 2013, at the congress of the European CanCer Organization and the European Society for Medical Oncology, colorectal cancer was the subject of various oral presentations and posters. In this article, we have selected the most innovative studies that are likely to change our daily practice.     

Cryptorchidism in adults. About 81 cases

Cryptorchidism is more often diagnosed and treated in pediatric age. Its occurence in adult provides opportunity to study its spontaneous course. This study has been realized on one series of 81 files of patients cryptorchides of age superior than 14 years. Cryptorchidism was unilateral in 87.6% of cases and bilateral in 12.4% of cases. The higher the location, the more important the glandular atrophy and histological lesions. Global rate of secretory azoospermia was 93% in relation with a seminiferous disertion and an intersitial fibrosis. The lesions are important when cryptorchidism is bilateral. In two patients there was a progression to malignancy. Occasional cases of return to normal semen after orchidopexy have been reported, and that should preclude systematic orchidectomy advocated by some. Orchidopexy remain a treatment of choice even in adults.     

Size discrimination in computed tomographic images. Effects of feature contrast and display window

Studies show that features on computed tomographic (CT) images in clinical formats become less detectable when the images are produced with wider CT display windows. We studied the effects of feature contrast and the display window on observer performance in higher-order tasks that involved discriminating small size differences between features on CT images. The features to be discriminated were pairs of disks (9.0 or 9.5 mm in diameter) superimposed on CT images of water phantoms. Sets of image stimuli for two different types of size-discrimination tasks were generated with various CT contrasts specified for the superimposed features and were produced on film transparencies with display windows ranging from 90 to 2880 Hounsfield units (HU) in width. Observers' performance improved with increasing CT contrast in both size discrimination tasks. Unlike performance in feature-detection tasks, however, size discrimination was unaffected by changing the CT display window over a factor of 16 (from 90 to 1440 HU). Performance fell only at the widest display window (2880 HU), for which CT noise was essentially invisible. These results suggest that the effect of changing the CT display window may depend on the spatial frequency content of image information required for a given task.