Objective: To assess the effect of warm saline on bleeding and surgical field visibility during endoscopic sinus surgery and septorhinoplasty. Methods: The study included 100 patients, of both males and females, aged 28-58 years, classed I and II by the American Society of Anesthesiologists (ASA), and assigned for elective functional endoscopic sinus surgery and septorhinoplasty under general endotracheal induced hypotensive anesthesia, at King Hussein Hospital, King Hussein Medical City (KHMC), Amman, Jordan, during the period Jan.2014-Feb.2015. Patients were assigned using sealed envelopes into two groups: group I (n=50): patients received warm saline of up to 48 Degree Celsius (DC) during surgery for packing and irrigation and group II (n=50): patients received room temperature normal saline of up to 20 DC, with the use of vasoconstrictors (in functional endoscopic sinus surgery and septorhinoplasty) and microdebriders (only in functional endoscopic sinus surgery). Results: Blood loss was 201.43ml in group I, while room temperature normal saline administration (group II) was correlated with 257.34 ml of blood loss (P<0.05). Conclusion: The administration of topical warm saline of up to 50 DC attained a significant decrease in blood loss and duration of surgery. It enhanced the surgical site visibility and increased the surgical satisfaction during functional endoscopic sinus surgery and septorhinoplasty.

Acute myeloid leukemia (AML) is a highly heterogeneous hematopoietic malignancy characterized by excessive proliferation and accumulation of immature myeloid blasts in the bone marrow. AML has a very poor 5-year survival rate of just 16% in the UK; hence, more efficacious, tolerable, and targeted therapy is required. Persistent leukemia stem cell (LSC) populations underlie patient relapse and development of resistance to therapy. Identification of critical oncogenic signaling pathways in AML LSC may provide new avenues for novel therapeutic strategies. The phosphatidylinositol-3-kinase (PI3K)/Akt and the mammalian target of rapamycin (mTOR) signaling pathway, is often hyperactivated in AML, required to sustain the oncogenic potential of LSCs. Growing evidence suggests that targeting key components of this pathway may represent an effective treatment to kill AML LSCs. Despite this, accruing significant body of scientific knowledge, PI3K/Akt/mTOR inhibitors have not translated into clinical practice. In this article, we review the laboratory-based evidence of the critical role of PI3K/Akt/mTOR pathway in AML, and outcomes from current clinical studies using PI3K/Akt/mTOR inhibitors. Based on these results, we discuss the putative mechanisms of resistance to PI3K/Akt/mTOR inhibition, offering rationale for potential candidate combination therapies incorporating PI3K/Akt/mTOR inhibitors for precision medicine in AML.

Objective:To assess the postoperative outcome between pudendal nerve block and caudal block after open lateral internal sphincterotomy for chronic anal fissure.Methods:Our prospective, randomized and double blind investigation included 123 patients, of both sexes, aged 25-56 years, classed I-II by the American society of anesthesiologists and scheduled for elective open internal lateral sphincterotomy for anal fissure at King Hussein hospital, KHMC, Amman, Jordan, during the period from Jan. 2013 to Feb. 2015. Patients were divided into two groups. Group I included 62 patients (GI, n=62) operated under pudendal nerve block with local infiltration anesthesia and group II included 61 patients (GII, n=61) operated under caudal block. Postoperative pain, surgical duration, period of hospital admission, back to regular working activity and 4 weeks evaluation were compared between the two groups.Results:Postoperative outcome was more enhanced in group II but not significant than in group I. Patients in G-I experienced moderate pain for a mean of 5. 3 days in comparison with 4. 3 days in G-II. P>0. 05. Three patients (4. 9%) in G-II in comparison with 5 patients (8. 1%) in G-I had more hospital stay than 24 hours. Patients in G-II went back to normal activity after a mean of 7. 5 days in comparison with 8. 0 days in G-I.Conclusion:Undergoing open lateral internal sphincterotomy with the aid of Pudendal nerve block is an excellent, easy and safe alternative anesthesia to caudal anesthesia.