MRI has a pivotal and established role in detection and staging of gynecological malignancy. Diffusion-Weighted Imaging (DWI)can demonstrate abnormal signals emitted by pathological foci based on differences in molecular diffusion. It also permits the quantitative evaluation of the Apparent Diffusion Coefficient (ADC) that may be useful for distinguishing between malignant and benign tissues and for monitoring therapeutic outcomes. On this basis, the aim of this study was to assess the added value of DWI and ADC values in the evaluation of gynecological malignancy. Materials and methods: Twenty patients with suspected gynecological pathology are examined by MRI.Site of origin of the lesion(corporeal or cervical), zonal distribution, lesion size, lesion shape and signal characteristics were determined. the bladder, rectum, pelvic side wall muscles and lymph nodes were evaluated for each study. descriptive statistical values such as sensitivity, specificity and positive and negative predictive values were measured for each MR imaging findings. Results: MR stage was comparable to operative stage in all cases. The sensitivity and specificity of DWI in detection of abnormal endometrium was 100%. DWI and ADC maps allow differentiation of benign from malignant zones of cervix with sensitivity and specificity 100%. Sensitivity of the ADC in assessment of regional nodal spread was 100% with specificity 67%. Conclusion: Conventional MRI findings in conjunction DWI and quantitative measurement of the apparent Diffusion Coefficient (ADC)are effective method in the diagnosis and staging of gynecological cancer.

MRI has a pivotal and established role in detection and staging of gynecological malignancy. Diffusion-Weighted Imaging (DWI)can demonstrate abnormal signals emitted by pathological foci based on differences in molecular diffusion. It also permits the quantitative evaluation of the Apparent Diffusion Coefficient (ADC) that may be useful for distinguishing between malignant and benign tissues and for monitoring therapeutic outcomes. On this basis, the aim of this study was to assess the added value of DWI and ADC values in the evaluation of gynecological malignancy. Materials and methods: Twenty patients with suspected gynecological pathology are examined by MRI.Site of origin of the lesion(corporeal or cervical), zonal distribution, lesion size, lesion shape and signal characteristics were determined. the bladder, rectum, pelvic side wall muscles and lymph nodes were evaluated for each study. descriptive statistical values such as sensitivity, specificity and positive and negative predictive values were measured for each MR imaging findings. Results: MR stage was comparable to operative stage in all cases. The sensitivity and specificity of DWI in detection of abnormal endometrium was 100%. DWI and ADC maps allow differentiation of benign from malignant zones of cervix with sensitivity and specificity 100%. Sensitivity of the ADC in assessment of regional nodal spread was 100% with specificity 67%. Conclusion: Conventional MRI findings in conjunction DWI and quantitative measurement of the apparent Diffusion Coefficient (ADC)are effective method in the diagnosis and staging of gynecological cancer.

Background: Postoperative pain associated with total knee replacement surgery (TKR) is considerable and requires adequate analgesia. Objectives: To study the additive effect of femoral nerve block (FNB) and 0.2 mg intrathecal morphine (ITM) compared with either technique alone for postoperative analgesia in patients undergoing (TKR) under spinal anesthesia. Design: Prospective double-blind randomized comparative study. Setting: University hospital. Methods: Sixty ASA I–III subjects undergoing unilateral TKR were enrolled in a randomized, parallel group, double-blind study receiving 15 mg hyperbaric bupivacine spinal anesthesia plus 0.2 mg ITM (Group M), FNB (Group F), or 0.2 mg ITM and FNB (Group MF) for postoperative analgesia. Assessment parameters included; postoperative morphine PCA consumption in first 48 h postoperative, time to first request for rescue analgesia, pain scores, length of hospital stay and adverse effects. Results: The time to the first administration of rescue intravenous morphine PCA, was longer in the MF group (8.21 ± 0.85 h) compared with the M (6.31 ± 1.45 h, P0.001) and F (4.99 ± 1.0 h, P0.001) groups. Morphine consumption was lower in MF group [6.3 ± 0.47 (6-7) mg] vs. [11.2 ± 1.32 (9-14) mg] and [13.75 ± 0.72 (13-15) mg] in M and F groups, respectively (P0.001). From the fourth till the 48th h postoperatively, VAS scores were significantly decreased in the FM group compared with M and F groups (p0.001). There were no recorded differences among groups in the length of hospital stay or postoperative adverse effects. Limitations: This study is limited by its small sample size. Conclusion: The combination of 0.2 mg ITM and single-shot FNB provided superior postoperative analgesia after TKR compared with either technique alone.

Background: Postoperative pain associated with total knee replacement surgery (TKR) is considerable and requires adequate analgesia. Objectives: To study the additive effect of femoral nerve block (FNB) and 0.2 mg intrathecal morphine (ITM) compared with either technique alone for postoperative analgesia in patients undergoing (TKR) under spinal anesthesia. Design: Prospective double-blind randomized comparative study. Setting: University hospital. Methods: Sixty ASA I–III subjects undergoing unilateral TKR were enrolled in a randomized, parallel group, double-blind study receiving 15 mg hyperbaric bupivacine spinal anesthesia plus 0.2 mg ITM (Group M), FNB (Group F), or 0.2 mg ITM and FNB (Group MF) for postoperative analgesia. Assessment parameters included; postoperative morphine PCA consumption in first 48 h postoperative, time to first request for rescue analgesia, pain scores, length of hospital stay and adverse effects. Results: The time to the first administration of rescue intravenous morphine PCA, was longer in the MF group (8.21 ± 0.85 h) compared with the M (6.31 ± 1.45 h, P0.001) and F (4.99 ± 1.0 h, P0.001) groups. Morphine consumption was lower in MF group [6.3 ± 0.47 (6-7) mg] vs. [11.2 ± 1.32 (9-14) mg] and [13.75 ± 0.72 (13-15) mg] in M and F groups, respectively (P0.001). From the fourth till the 48th h postoperatively, VAS scores were significantly decreased in the FM group compared with M and F groups (p0.001). There were no recorded differences among groups in the length of hospital stay or postoperative adverse effects. Limitations: This study is limited by its small sample size. Conclusion: The combination of 0.2 mg ITM and single-shot FNB provided superior postoperative analgesia after TKR compared with either technique alone.

Background: Postoperative pain associated with total knee replacement surgery (TKR) is considerable and requires adequate analgesia. Objectives: To study the additive effect of femoral nerve block (FNB) and 0.2 mg intrathecal morphine (ITM) compared with either technique alone for postoperative analgesia in patients undergoing (TKR) under spinal anesthesia. Design: Prospective double-blind randomized comparative study. Setting: University hospital. Methods: Sixty ASA I–III subjects undergoing unilateral TKR were enrolled in a randomized, parallel group, double-blind study receiving 15 mg hyperbaric bupivacine spinal anesthesia plus 0.2 mg ITM (Group M), FNB (Group F), or 0.2 mg ITM and FNB (Group MF) for postoperative analgesia. Assessment parameters included; postoperative morphine PCA consumption in first 48 h postoperative, time to first request for rescue analgesia, pain scores, length of hospital stay and adverse effects. Results: The time to the first administration of rescue intravenous morphine PCA, was longer in the MF group (8.21 ± 0.85 h) compared with the M (6.31 ± 1.45 h, P0.001) and F (4.99 ± 1.0 h, P0.001) groups. Morphine consumption was lower in MF group [6.3 ± 0.47 (6-7) mg] vs. [11.2 ± 1.32 (9-14) mg] and [13.75 ± 0.72 (13-15) mg] in M and F groups, respectively (P0.001). From the fourth till the 48th h postoperatively, VAS scores were significantly decreased in the FM group compared with M and F groups (p0.001). There were no recorded differences among groups in the length of hospital stay or postoperative adverse effects. Limitations: This study is limited by its small sample size. Conclusion: The combination of 0.2 mg ITM and single-shot FNB provided superior postoperative analgesia after TKR compared with either technique alone.

Objective: Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, or their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study design: prospective, randomized, double blinded. Setting: academic medical center. Patients and Methods: Ninety ASA I-III patients aged 30-50 years were divided randomly into three groups: Morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg morphine in 1 ml volume intrathecally. Ketamine group (group K) received 0.1 mg/kg ketamine in 1ml volume instead of morphine. Morphine + Ketamine group (group K+M): patients received both 0.3 mg morphine plus 0.1 mg/kg of Ketamine in 1 ml volume intrathecally. Postoperative total morphine consumption, first request of analgesia, VAS, and side effects were recorded. Results: Total PCA morphine was significantly decreased in group M+K compared to groups M and K. Time to first request of analgesia was prolonged in groups M and M+K compared to group K (p˂0.001). VAS in group M+K was reduced from 2 till 24 hours and in group M at 12 and 18 hours postoperatively compared to group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M+K compared to group M till 6 hours postoperatively. No other side effects observed. Conclusions: Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison to either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Objective: Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, or their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study design: prospective, randomized, double blinded. Setting: academic medical center. Patients and Methods: Ninety ASA I-III patients aged 30-50 years were divided randomly into three groups: Morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg morphine in 1 ml volume intrathecally. Ketamine group (group K) received 0.1 mg/kg ketamine in 1ml volume instead of morphine. Morphine + Ketamine group (group K+M): patients received both 0.3 mg morphine plus 0.1 mg/kg of Ketamine in 1 ml volume intrathecally. Postoperative total morphine consumption, first request of analgesia, VAS, and side effects were recorded. Results: Total PCA morphine was significantly decreased in group M+K compared to groups M and K. Time to first request of analgesia was prolonged in groups M and M+K compared to group K (p˂0.001). VAS in group M+K was reduced from 2 till 24 hours and in group M at 12 and 18 hours postoperatively compared to group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M+K compared to group M till 6 hours postoperatively. No other side effects observed. Conclusions: Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison to either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Objective: Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, or their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study design: prospective, randomized, double blinded. Setting: academic medical center. Patients and Methods: Ninety ASA I-III patients aged 30-50 years were divided randomly into three groups: Morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg morphine in 1 ml volume intrathecally. Ketamine group (group K) received 0.1 mg/kg ketamine in 1ml volume instead of morphine. Morphine + Ketamine group (group K+M): patients received both 0.3 mg morphine plus 0.1 mg/kg of Ketamine in 1 ml volume intrathecally. Postoperative total morphine consumption, first request of analgesia, VAS, and side effects were recorded. Results: Total PCA morphine was significantly decreased in group M+K compared to groups M and K. Time to first request of analgesia was prolonged in groups M and M+K compared to group K (p˂0.001). VAS in group M+K was reduced from 2 till 24 hours and in group M at 12 and 18 hours postoperatively compared to group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M+K compared to group M till 6 hours postoperatively. No other side effects observed. Conclusions: Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison to either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Objective: Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, or their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study design: prospective, randomized, double blinded. Setting: academic medical center. Patients and Methods: Ninety ASA I-III patients aged 30-50 years were divided randomly into three groups: Morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg morphine in 1 ml volume intrathecally. Ketamine group (group K) received 0.1 mg/kg ketamine in 1ml volume instead of morphine. Morphine + Ketamine group (group K+M): patients received both 0.3 mg morphine plus 0.1 mg/kg of Ketamine in 1 ml volume intrathecally. Postoperative total morphine consumption, first request of analgesia, VAS, and side effects were recorded. Results: Total PCA morphine was significantly decreased in group M+K compared to groups M and K. Time to first request of analgesia was prolonged in groups M and M+K compared to group K (p˂0.001). VAS in group M+K was reduced from 2 till 24 hours and in group M at 12 and 18 hours postoperatively compared to group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M+K compared to group M till 6 hours postoperatively. No other side effects observed. Conclusions: Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison to either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Background: Gabapentin is a novel drug used for the treatment of postoperative pain. Oral morphine has gained acceptance as the treatment of choice for patients with chronic cancer pain but also can be used to treat acute postoperative pain. Objectives: The aim of this study was to compare the efficacy of pre-operative oral Gabapentin with oral morphine on post-operative pain relief and total analgesic consumption after major abdominal cancer surgeries. Study design: A randomized double blind study. Sitting: Academic medical center. Methods: 60 ASA I-III patients (age ≥18 years) who were scheduled for Elective major abdominal cacer surgery. Patients were randomly Divided into one of two groups. Group I (gabapentin group): patients Received gabapentin capsules 900mg 1 hr. pre-operatively. Group II (morphine group): patients received morphine sulphate 30mg tab 1 hr. Preoperatively. At the end of the operation patients were monitored for vital signs after 30 min, 1h, 2h, 4h, 6h, 12h, 24h hours. The severity of pain was assessed using visual Analog scale after 30min, 1h, 2h, 4h, 6h, 12h, 24h hours post-operative. The time of the first analgesic request and total morphine consumption in 24 hours were recorded. The level of sedation, incidence of side effects were recorded and treated. Results: The post-operative heart rate was reduced significantly in group I compared to group II in the first half an hour of the postoperative period (P 0.01),and there was statistically significant difference between studied groups as regards post-operative MAP in the first hour (P 0.01) The mean postoperative VAS score was significantly reduced in group I compared to group II in the first two hours post-operative period group I compared to group II in the first two hours post-operative period (P 0.01). There was significant prolongation in the first request of analgesia in the group I (7.65± 4.970) compared to that of group II (5.34±3.66). There was reduction in the total amount of postoperative morphine consumption in group I (7.43±4.39) in comparison to group II (13.47±4.73) with (p 0.044). there was significant reduction in number of patients developed nausea and vomiting in group I. Sedation score was higher in group I compared to group II. Limitations: This study is limited by its small sample size. Conclusion: pre-operative use of oral gabapentin 900mg significantly reduced postoperative pain and decreased the need for opioids with less side effect than 30 mg sustained release oral morphine.