Assessment of the Safety and Efficiency of a Preperitoneal Continuous Infusion Using Bupivacaine after Abdominal Laparotomy in Digestive Carcinology.

The purpose of this paper is to evaluate the safety and efficacy of continuous preperitoneal wound infiltration using bupivacaine after abdominal laparotomy in relation to plasma bupivacaine concentration and visual analog scale. Our study was performed on 60 adult patients with digestive cancer, operated at laparotomy, and randomized into two groups: bupivacaine and saline groups. The wound infiltration was through a multiperforated catheter along the scar. For the bupivacaine group, 0.25% bupivacaine was used; however, for the saline group, only saline (0.9%) was infiltrated. The pain was assessed by using the visual analog scale (VAS) in both groups. Plasma bupivacaine concentration was measured by high-performance liquid chromatography. The bupivacaine group had significantly lower postoperative morphine consumption and lower postoperative pain than the saline group (P < 0.0001). The majority of patients in the bupivacaine group had significant relief with the VAS scores of less than 3/10 cm at rest and 6/10 cm on mobilization. However, for the saline group, the VAS scores were higher than 6/10 cm either at rest or with mobilization. There was no clinical sign of toxicity and no technical complications for the bupivacaine group. Only eleven patients required morphine in this group, but the majority of patients received morphine at different doses in the saline group. Plasma bupivacaine was at very low concentrations. Overall, the current study has confirmed that continuous preperitoneal wound infiltration as postoperative analgesia is a simple, effective, and safe technique. It allows decreasing of morphine consumption and subsequently canceling their side effects.

Aspergillosis ball graft as complication of Covid-19 infection: Case report.

Invasive pulmonary aspergillosis is a severe presentation of aspergillosis fungal infection, with a high mortality rate. Many Covid-19-associated pulmonary aspergillosis cases have been described in the literature giving rise to a major dilemma for physicians: discriminate a simple colonization from an invasive infection. In this paper, we will describe the case of a 40-year-old immunocompetent man with no medical history was admitted to the intensive care unit for Covid-19 infection with lung damage initially estimated at 50%-75%. Two weeks later, patient condition got worse, with a thoracic CT showing a newly developed, well limited lung cavitation indicative of an aspergillosis fungus ball.

[Treatment of postoperative peritonitis in the Intensive Care Unit: a retrospective study of 46 cases]. / Les péritonites postopératoires en réanimation: étude rétrospective, à propos de 46 cas.

We conducted a study of 46 patients admitted to the Intensive Care Unit with postoperative peritonitis. The incidence of postoperative peritonitis in this setting was 2.7%. The average age of patients was 53.3 years, with a sex ratio of 1.2. Submesocolic surgery was the most common cause of postoperative peritonitis (65.2%), mainly occurring in the colorectal region (48%). Clinical signs were dominated by fever (78%), abdominal pain (57%) and extra-abdominal signs. The mean time between symptom onset and diagnosis was 7.3 days. Reoperation was performed on the basis of clinical and biological criteria in 56.5% of cases. Therapeutic management was based on perioperative reanimation, treatment of organ dysfunctions, probabilistic antibiotic therapy and middle laparotomy. The bacteriological profile was dominated by BGN (79%). The loosening of the anastomotic sutures was the direct cause of PPO in 57% of patients. Mortality rate was 60%. The main prognostic factors were: renal failure, the number of patients with organ failure, PT<50%, the need for ventilation and the use of catecholamines.

Paracetamol self-poisoning: when oral N-acetylcysteine saves life? a case report.

Paracetamol is the most widely drug involved in accidental paediatric exposures and deliberate self-poisoning cases because of its availability. N-acetyl cystein is the main treatment for this poisoning. We report a case of a 24-year-old Arab female who has deliberately ingested 100 tablets of 500 mg paracetamol each (50g). Her first examination was normal. She has received oral N-acetyl cystein (NAC) 6 hours after the ingestion. Serum paracetamol level done 18 hours post ingestion was 900 mg/l. On review the next days, she did not develop any symptoms of liver failure. However, due to the massive paracetamol ingestion associated with high serum paracetamol levels, oral NAC was continued for 3 days. The patient was discharged well on the fifth day of hospitalization. Our patient has ingested one of the highest paracetamol overdose (50g) with the highest paracetamol blood levels ever reported in medical literature. She was treated, six hours after ingestion, with oral NAC for 3 days without any side effects.

[TURP syndrome: about a case]. / TURP syndrome: à propos d'un cas.

We report the case of a 78-year old patient, with no particular past medical history, who underwent transurethral resection of the prostate (50 g) under spinal anesthesia for benign hypertrophy. 90 minutes after the beginning of the procedure, the patient had nausea, vomiting, visual fog and bradycardia, suggesting TURP syndrome. Ionogramme objectified a serum sodium level of 118meq/L, hence the patient was treated with 3% hypertonic saline solution, with good evolution. This study describes a common but moderate occurrence of TURP syndrome whose management was facilitated by patient's alertness during spinal anesthesia.

[Facial mucormycosis complicating severe angiocholitis: about a case]. / Une mucormycose faciale compliquant une angiocholite grave: à propos d'un cas.

Mucormycosis is an opportunistic fungal infection occurring in immunocompromised patients. It is a serious life threatening condition. Even though diagnosed early, mucormycosis has a mortality rate reaching 50%. We report the case of mucormycosis in a diabetic patient hospitalized in Intensive Care Unit for severe angiocholitis. Evolution was lethal.

Transurethral resection of prostate syndrome: report of a case.

We report a case of transurethral resection of prostate (TURP) syndrome. A 78-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypotension, cyanosis, hypoxemia and coma. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 125 mmol/L). Medical treatment consisted of hypertonic saline solution 3%, volume expansion, intubation and ventilation. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.

Traumatic manubriosternal dislocation: A new method of stabilization postreduction.

Traumatic manubriosternal dislocation is a rare lesion. In the literature, only a few case reports of patients treated surgically are published. In this case, we report an unstable posterior dislocation of the manubriosternal joint in a 50-year-old women caused by direct trauma. An open reduction was performed, and the manubriosternal joint was fixed by two staples. We are the first to use this alternative technique. At the last follow-up, the result was very good without complication.

Intrathoracic phrenic nerve neurofibroma.

The usual location of intrathoracic neurogenic tumors is the posterior mediastinum. Those in a mediastinal anterior or middle location arise from the intrathoracic phrenic nerve, which is extremely rare and causes a problem for etiologic diagnosis. We report what is, to our knowledge, the second case of a mediastinal neurofibroma originating from the phrenic nerve of a 59-year-old woman without von Recklinghausen disease. Diagnosis was suggested by the radiologic features and confirmed by histologic aspects after excision. The prognosis after complete resection is excellent.