Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anaesthesia.

BACKGROUND: Caudal epidural block (CEB) failure or complications are not unheard even among experienced anaesthesiologists and are usually due to sacral hiatus (SH) anatomy variations. The aim of the present study is to observe, record and analyse important anatomical features of SH and correlate them with potential CEB limitations. MATERIALS AND METHODS: The SH of 155 complete and undamaged Greek adult dry sacra of known sex were included in the study. Three non-metric (shape of SH and location of hiatal apex and base in relation to level of sacral/coccygeal vertebra) and five metric parameters (height of the SH, transverse width of the SH at the base, anteroposterior diameter of the SH at the level of its apex and the distance from the sacral apex and base to the upper border of S2 foramina) were evaluated. RESULTS: Inverted U (34.83%) and inverted V (26.45%) were the commonest shapes. Hiatal apex and base were most commonly related to the level of S4 (78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual distance were 19.05 ± 8.65 mm, 5.39 ± 1.84 mm and 12.41 ± 3.16 mm, respectively, whereas mean distance between the upper border of S2 foramen and the apex and base of the SH were 46.34 mm and 63.48 mm, respectively. Anatomical variations of SH that might be responsible for CEB failure, such as elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and narrowing (< 3 mm) at the apex of SH were found in 17.43% of sacra (male 10.94% and female 25.22%). CONCLUSIONS: This study suggests a potential risk of failure of CEB in Greek patients, especially in females, which should be kept in mind while giving caudal epidural anaesthesia.

[Comparing Onset Times and Vascular Punctures in axillary Blocks with Nerve Stimulation or Ultrasound: Randomised Trial].

The use of ultrasound (US) guidance in regional anaesthesia has evolved in the last then years and has even been considered the fatest and safest way to identify peripheral nerves and vascular structures thus eliminating the risk of injuring them. Prior to US guidance, peripheral nerve stimulation (PNS) was the gold standard procedure of the last twenty years, still being used in the present alone or alongside US guidance. However, sometimes -especially in vessel rich areas such as the axillary plexus- it is hard to avoid injuring vascular structures with blind techniques such as PNS. The study's hypothesis was that out-of-plane US guided peri-neural axillary plexus block has a better success rate, faster onset and less intravascular punctures than the PNS method.

Cortisol and perioperative period. Could be certified any correlation? .

AIM: The purpose of this study is to investigate the correlation of general, epidural or spinal anesthesia on fluctuations of the perioperative cortisol concentrations. MATERIAL AND METHODS: Seventy five (75)--ASA physical status I, II--patients who were scheduled to undergo a medium severity surgery with general, spinal and epidural anesthesia, were enrolled in this study. These patients were divided in three groups. Twenty five (25) of these patients where received general anesthesia (group G) , twenty five (25) of these patients where received spinal anesthesia (group R) and twenty five (25) of these patients where received epidural anaesthesia (group Ep). Five blood samples were collected from each patient at intervals: A) 1h preoperative, B) immediately after the introduction in anesthesia and the intubation for group G, after the process of spinal anesthesia completion for group S and after the process of epidural anesthesia completion for group E, C) at the end of the surgery, D) 8h, and E) 24h after the operation. The quantitative determination of cortisol that was possible with the electro- chemiluminescence immunoassay method, detected the fluctuation of perioperative cortisol concentrations. RESULTS: The cortisol levels (µg/dl) of group G were: A) 18.7056, B)18.8272, C)22.1384, D)25.232, E)19.4344. The cortisol levels (µg/dl) of group Ep were: A)28.8132, B)22.6876, C)23.002, D)21.92, E)16.36. The cortisol levels (µg/dl) of group R were: A)19.1688, B)16.0988, C)15.5656, D)18.5992, E)20.35. CONCLUSIONS: In conclusion we found that there is correlation between the type of anaesthesia and the fluctuation of perioperative cortisol levels. We would like to point out the fact that there is statistically significant correlation between the age and the preoperative value of cortizol concentration (Stage A) in the blood serum of the patients who participated in this study.

Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.

Diabetic patients, and especially elderly patients in a low-nutritional or immunocompromised state, are prone to a variety of opportunistic infections. 'Myiasis' is a term that refers to non-iatrogenic infestation of tissues by larvae, commonly known as maggots, of dipterous flies. Myiasis as a complication of fracture treatment by means of external fixation of long bones has not been reported. We present three diabetic patients, who suffered maggot infestation of their external fixation pin holes, and their outcome. Diabetes, immobilization, poor hygiene and low immune status are predisposing factors for developing myiasis, an extremely rare complication for external fixation of fractures.

Acenocoumarol associated priapism: report of a case.

We report on a 20-year-old man presenting with priapism while receiving oral acenocoumarol for the treatment of deep vein thrombosis. To the authors' knowledge, it is the first reported case of acenocoumarol-associated priapism.