Background: Dexmedetomidine (DEX) has sedative, analgesic, sympatholytic, anesthetic-sparing and hemodynamic-stabilizing properties. This study aims to evaluate the effects of intrathecal DEX as an adjuvant to hyperbaric bupivacaine in the prevention of shivering in patients who underwent surgeries under Intrathecal anesthesia. Methods: A prospective double-blind, controlled, randomized study was conducted on 100 patients aged above 21 years old, ASA I & II undergoing lower limb orthopedic surgeries under intrathecal anesthesia. Patients were subdivided randomly into 2 equal group; Group Bupivacaine-Dexmedetomidine (BD): 5 µg dexmedetomidine diluted in 0.5 ml 0.9% normal saline was added to 12.5 mg heavy bupivacaine 0.5% and Group Bupivacaine (B): 0.5 ml 0.9% normal saline was added to 12.5mg heavy bupivacaine 0.5% (3ml volume). Results: Shivering occurred in 9 patients (18%) in group BD and 23 patients (46%) in group B with a significant decrease in group BD compared to group B (P = 0.003). The relative risk of developing shivering was decreased 53% (95% Confidence Interval: 74 – 16%) with group BD compared to group B. Tsai and Chu score was significantly better in group BD (P = 0.013). Conclusion: The use of intrathecal DEX (5μg) in conjugation with heavy bupivacaine help decrease the incidence and intensity of shivering when compared with heavy bupivacaine alone in surgeries under spinal anesthesia.

Background and aim: Total thyroidectomy has been the treatment of choice for patients with malignant thyroid disease. However, the efficacy and safety of this procedure for patients with benign disease is still a matter of debate. The aim of this study was to evaluate safety and efficacy of total thyroidectomy in treatment of bilateral benign thyroid disease.Methods: A total of 60 patients underwent total thyroidectomy between January 2013 and May 2014 at General Surgery Department in Tanta University Hospital. Patients with thyroid cancer or suspicion of thyroid malignancy were excluded. Type of benign disease, cancer incidence (histopathological surprise), complication rates, and local recurrence rate in the follow-up period were evaluated.Results: Diagnoses before surgery were; Euthyroid multinodular goitre (n = 42, 70%), Graves disease (n = 11, 18.2%), toxic multinodular goitre (n = 5, 8.3%), and recurrent goitre (n = 2, 3.4%). Temporary unilateral recurrent laryngeal nerve palsy occurred in one patient (1.7%). We observed no temporary or permanent bilateral recurrent laryngeal nerve injury. Temporary hypocalcemia occurred in 5 patients (8.3%) with no permanent hypocalcemia. Postoperative seroma occurred in one patient (1.7%). There was no postoperative hemorrhage, infection or mortality. During the follow-up period, we observed no disease recurrence.Conclusion: Total thyroidectomy is safe and is associated with a low incidence of disabilities, recurrent laryngeal nerve palsy and hypoparathyroidism. Furthermore, it seems to be the optimal procedure, when surgery is indicated, for Graves disease and multinodular goitre, as total thyroidectomy has the advantages of immediate and permanent cure and no recurrences. It also eliminates the requirement of completion thyroidectomy for incidentally diagnosed thyroid carcinoma.

The aim of the present research is to compare between sleeve gastrectomy with sideto-side jejunoileal anastomosis and sleeve gastrectomy in the treatment of morbid obesity in a prospective randomized manner.Patiens and methods: This study was performed in General Surgery Department, Tanta University Hospitals, Egypt on 32 patients with morbid obesity. Patients were randomly categorized into 2 groups through a computer randomization program. Group J included 17 patients operated by sleeve gastrectomy plus a side-to-side jejunoileostomy. This group was compared to 15 patients undergoing conventional sleeve gastrectomy (Group S). The mean length of follow up was 22.4 ± 5.68 months in Group J patients and 21.1 ± 5.05 months in Group S patients.Results: For group J, mean operative time was 111.0 ± 16.9 versus 79.0 ± 18.9 minutes for group S (p less than 0.0001). Mean hospitalization time was 5.35 ± 1.50 versus 3.73 ± 0.884 days (p: 0.0010).Time to return to normal activity was 19.6± 3.47 and 18.1 ± 3.28 days (p 0.21). There was no mortality. For Group J, 3 patients (17.65%) had superficial wound infection,2 patients (11.76%) developed postoperative atelectasis, 2 patients (11.76%) developed gallbladder stones and1 patient (5.88 %) developed incisional hernia. Reversing the anastomosis was not necessary in any patient. For Group S, splenic injury occurred in 1 patient (6.67%), 2 patients (13.33%) had superficial wound infection,1 patient (6.67%) had deep wound infection with partial disruption, 2 patients (13.33%) developed postoperative atelectasis,1 patient (6.67%) developed gallbladder stones and1 patient (6.67%) developed depression 6 months after surgery. Six months after operation, the mean BMI decreased by 23.35% and 12.89% (p: 0.058). Twelve months after operation, the mean BMI decreased by 29.19% and 18.68% (p: 0.039). Two years after operation, the mean BMI decreased by 32.74% and 17.63% (p: 0.026). Mean duodenum to cecum transit time was 17.6 ± 7.52 versus 43.7 ± 20.6 minutes (p less than 0.0001). Seven patients with preoperative diabetes in Group J had normal fasting glucose in the first 3 postoperative months. Five (83.33%) out 6 diabetic patients in Group S discontinued all diabetic medication within the first 9 postoperative months. Four (80%) out of 5 patients in group J with preoperative hypertension showed complete disease resolution within the first 6 postoperative months, compared to 3 (60%) out of 5 patients in the group S over the same period of time. All of 9 patients (100%) in Group J with preoperative dyslipidemia had normal lipid profiles within the first 6 postoperative months. Only 3 out of 7 (42.86 %) patients from group S had normal lipid profiles within the first 6 postoperative months and 5 out of 7 (71.43 %) at one year. Seven of the 8 patients in Group J with sleep apnea (87.5 %) and 7 out of 9 patients in Group S (77.78 %) showed complete improvement 1 year after surgery. The rest showed partial improvement. All of the patients were satisfied with the results of the procedure. The mea...

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