Annales chirurgiae et gynaecologiae
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Sufficient placental blood flow is mandatory for the well-being of the fetus. The delicate balance between uterine perfusion pressure and uterine vascular resistance can be critically disturbed during epidural anaesthesia. Maternal hypotension is common when extensive block for Caesarean Section is used. ⋯ Epinephrine (less than or equal to 50 micrograms), added to the local anaesthetic, will not decrease IBF. IBF can be severely reduced in pregnancy-induced hypertension (PIH) since the fetus is chronically asphyxiated it is crucial to avoid any further decrease in IBF. Extensive sympathetic blockade (T8) using epidural analgesia (10 ml dose of 1.a.) has been shown to significantly (p less than 0.01) improve IBF in parturients with PIH by decreasing uteroplacental vascular resistance.
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The most important complications following gastrointestinal surgery are related to disruption of anastomoses. The fate of a gastrointestinal anastomosis is influenced by many factors. Among these, care in the anaesthetic management and postoperative treatment may reduce the incidence of complications. ⋯ The prevention of high intra-luminal pressures and excessive longitudinal traction across anastomoses may be aided by care in the administration of neostigmine, and possibly by the avoidance of morphine for provision of intra-operative and postoperative analgesia. Maintenance of, or improvements in, oxygen supply to an anastomosis may be achieved by avoiding hypoxia, hypocapnia and hypovolaemia, and by the use of regional anaesthetic techniques during surgery and/or in the post-operative period. In addition, sedative and analgesic therapy may influence the incidence of postoperative ileus, and may thus contribute to morbidity.
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Comparative Study
The predictive value of three diagnostic procedures in the evaluation of palpable breast tumours.
In a prospective study of 200 palpable breast tumours of 200 women, the diagnostic specificity and sensitivity of clinical examination, mammography, and fine needle aspiration were compared, alone and in combinations. All tumours were excised and examined histologically, and 38 were malignant. The diagnostic sensitivity of clinical examination was high, 98% (91-99), whereas the specificity was rather low, 48% (36-60). ⋯ It is concluded that the possibility of distinguishing between malignant and benign palpable breast tumours is not increased by adding mammography and/or fine needle aspiration, but the discovery of two non-palpable malignant tumours by mammography underscores the importance of this method in disclosing subclinical malignant lesions. The study disclosed a statistical possibility of overlooking a few malignant tumours when using these three procedures. Therefore, we advise that all palpable breast tumours should be excised.
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This review includes a brief discussion of the indications and pitfalls of regional anaesthetic techniques commonly used during parturition. Emphasis is given to the physiological changes of pregnancy and the potential effects on the fetus. The criteria for the choice of local anaesthetic are also presented.