POSTOPERATIVE THORACIC COMPUTED TOMOGRAPHY CHANGES IN PATIENTS UNDERGOING VALVE REPLACEMENT SURGERY

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The purpose of the study is to highlight that prolonged blocks with spinal anesthesia are not usually due to neurologic defects. Consent for data publication was obtained. A 35-year-old female patient with right upper tibial chondrosarcoma was planned to undergo excision and reconstruction with a free vascularized fibular graft. The patient had no significant medical history. We gave spinal anesthesia, which is to be continued with general anesthesia after regression of the sensory level. After 3 hours, we evaluated the patient for the second time to find sensory block at T10 level. It was decided to carry out these evaluations hourly and wait for general anesthesia. Ten hours after the spinal anesthesia, the sensory block was still at T10 level. After 13 hours, the surgical procedure was finished, and the sensory block was still at T10 level and the motor block according to the Bromage scale remained at grade 4. A computed tomography was performed and did not reveal signs of spinal compression, spinal canal stenosis, or other anomalies (magnetic resonance imaging was unavailable). A complete motor and sensory recovery from the spinal block was observed 20 hours after spinal anesthesia. We present a case of major microscopic surgery done over 13 hours with a single shot of spinal anesthesia in a 35-year-old female patient. Complete recovery of sensory and motor blocks has been after 20 hours. We also review other cases of unusually prolonged spinal blocks and the possible differential diagnosis for that. Keywords Prolonged anesthesia; Prolonged block; Spinal block; Spinal anesthesia; Regional anesthesia; Dexamethasone

The purpose of the study is to highlight that prolonged blocks with spinal anesthesia are not usually due to neurologic defects. Consent for data publication was obtained. A 35-year-old female patient with right upper tibial chondrosarcoma was planned to undergo excision and reconstruction with a free vascularized fibular graft. The patient had no significant medical history. We gave spinal anesthesia, which is to be continued with general anesthesia after regression of the sensory level. After 3 hours, we evaluated the patient for the second time to find sensory block at T10 level. It was decided to carry out these evaluations hourly and wait for general anesthesia. Ten hours after the spinal anesthesia, the sensory block was still at T10 level. After 13 hours, the surgical procedure was finished, and the sensory block was still at T10 level and the motor block according to the Bromage scale remained at grade 4. A computed tomography was performed and did not reveal signs of spinal compression, spinal canal stenosis, or other anomalies (magnetic resonance imaging was unavailable). A complete motor and sensory recovery from the spinal block was observed 20 hours after spinal anesthesia. We present a case of major microscopic surgery done over 13 hours with a single shot of spinal anesthesia in a 35-year-old female patient. Complete recovery of sensory and motor blocks has been after 20 hours. We also review other cases of unusually prolonged spinal blocks and the possible differential diagnosis for that. Keywords Prolonged anesthesia; Prolonged block; Spinal block; Spinal anesthesia; Regional anesthesia; Dexamethasone

SUMMARY Colonoscopy has a broad range of indications including evaluating lower gastrointestinal disorders. Also therapeutic applications of colonoscopy nowadays carry promising technical improvements. Colonoscopy has revolutionized the clinical management of colonic diseases. Colonoscopy represents a cost effective means for detection of colorectal lesions due to its relatively low incremental costs. Aim of the work: The aim of the present study is to evaluate the value of colonoscopy in diagnosis and management of lower gastrointestinal disorders in Upper Egypt. Patients and Methods: One hundred patients underwent lower gastrointestinal endoscopy, 62 males and 38 females with a mean age (36.6y.) All selected patients were complaining of lower gastrointestinal disorders in the previous six months. Patients were subjected to thorough history taking & full clinical examination, stool analysis, test for occult blood in stool, complete blood picture, erythrocyte sedimentation rate, chest x ray, abdominal ultrasonography, total colonoscopy with colonic biopsy when indicated & histopathological examination of the biopsy with H & E staining. Conclusions: Inflammatory and/or ulcerative colorectal lesions are the most common colonic lesions as they were detected in (30%) of patients; of which non specific colitis (40%), ulcerative colitis (26.7%), bilharzial colitis (20%), Crohn's disease (6.7%), amoebic colitis (3.3%) and one case was diagnosed as adenocarcinoma grade III (3.3%). The relative decreased number of schistosomal colitis and amoebic colitis can be attributed to the effectiveness and the widespread use of anti-schistosomal and anti amoebic drugs respectively. Colorectal polyps are the second commonest colorectal lesions (16%). Adenomatous polyps represent 37.5% of cases of colorectal polyps in our study. Colorectal carcinoma is a common malignant neoplasm in Egypt; it represented (8%) of all cases in our study. The high proportion of patients with normal colonic mucosa in spite of different colonic manifestations; may be attributed to functional bowel disorders especially irritable bowel syndrome. Colonic diverticulosis is not rare in our country probably due to the western cultural influence in our diet and lifestyle.

Abstract Rationale: Airway remodelling is clinically defined as persistent airflow obstruction despite aggressive antiinflammatory therapies. Assessment of airway remodelling by analysis of serum markers has been developed as minimally invasive procedures. Aim of the work: Evaluate the usefulness of estimation of serum MMP-9, TIMP-1 and their ratio, as non-invasive markers of airway remodelling in asthmatics. Patients and methods: The study included 68 asthmatics and 20 controls. Patients were classified according to levels of asthma control, severity and disease duration. Serum samples were taken to estimate levels of MMP-9, TIMP-1 and their ratio. Results: Serum MMP-9, TIMP-1, and MMP-9/TIMP-1 were significantly higher in asthmatics than controls, in uncontrolled vs. controlled asthma (P0.001). Also they were significantly higher in severe and moderate asthma than in mild asthma (P0.000), and in patients with disease duration >5 years vs. 5 years (P˂0.001). There was significant positive correlation between studied parameters (p0.000) and significant negative correlation between the biomarkers and FEV1 (p0.001). Conclusion: Serum MMP-9, TIMP-1, and MMP-9/TIMP-1 could be considered as non-invasive markers of airway remodelling that can bypass biopsy sampling. Serum sample is easily handled and not subjected to technical error as sputum or BAL fluid.

Abstract Rationale: Airway remodelling is clinically defined as persistent airflow obstruction despite aggressive antiinflammatory therapies. Assessment of airway remodelling by analysis of serum markers has been developed as minimally invasive procedures. Aim of the work: Evaluate the usefulness of estimation of serum MMP-9, TIMP-1 and their ratio, as non-invasive markers of airway remodelling in asthmatics. Patients and methods: The study included 68 asthmatics and 20 controls. Patients were classified according to levels of asthma control, severity and disease duration. Serum samples were taken to estimate levels of MMP-9, TIMP-1 and their ratio. Results: Serum MMP-9, TIMP-1, and MMP-9/TIMP-1 were significantly higher in asthmatics than controls, in uncontrolled vs. controlled asthma (P0.001). Also they were significantly higher in severe and moderate asthma than in mild asthma (P0.000), and in patients with disease duration >5 years vs. 5 years (P˂0.001). There was significant positive correlation between studied parameters (p0.000) and significant negative correlation between the biomarkers and FEV1 (p0.001). Conclusion: Serum MMP-9, TIMP-1, and MMP-9/TIMP-1 could be considered as non-invasive markers of airway remodelling that can bypass biopsy sampling. Serum sample is easily handled and not subjected to technical error as sputum or BAL fluid.