Chronic scrotal and inguinal pain after orchidopexy in a 13-year-old boy, treated by pulsed radiofrequency of the dorsal ganglia.

Chronic scrotal pain can be a difficult clinical entity to treat. Many different treatment options have been proposed. We describe the case of a young boy with chronic scrotal and inguinal pain on the right side, following two orchidopexies. After many therapies had failed, we treated the dorsal root ganglia of thoracic 12, lumbar 1 and lumbar 2 with pulsed radiofrequency, finally resulting in alleviation of his pain.

Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) programs are associated with reduced hospital morbidity and mortality. The aim of the present study was to evaluate whether the introduction of ERAS care improved the adverse events in colorectal surgery. In a cohort study, mortality, morbidity, and length of stay were compared between ERAS patients and carefully matched historical controls. METHODS: Patients were matched for their type of disease, the type of surgery, P-Possum (Portsmouth-Possum), CR-Possum (Colorectal-Possum) Physiological and Operative Score for Enumeration of Mortality and Morbidity (POSSUM), gender, and American Society of Anesthesiologists (ASA) grade. The primary outcome measures of this study were mortality and morbidity. Secondary outcome measures were fluid intake, length of hospital stay, the number of relaparotomies, and the number of readmissions within 30 days. Data on the ERAS patients were collected prospectively. RESULTS: Sixty-one patients treated according to the ERAS program were compared with 122 patients who received conventional postoperative care. The two groups were comparable with respect to age, ASA grade, P-Possum (Portsmouth-Possum), CR-Possum (Colorectal-Possum) score, type of surgery, stoma formation, type of disease, and gender. Morbidity was lower in the ERAS group compared to the control group (14.8% versus 33.6% respectively; P = <0.01). Patients in the ERAS group received significantly less fluid and spent fewer days in the hospital (median 6 days, range 3-50 vs. median 9 days, range 3-138; P = 0.032). There was no difference between the ERAS and the control group for mortality (0% vs. 1.6%; P = 0.55) and readmission rate (3.3% vs. 1.6%; P = 0.60). CONCLUSION: Enhanced Recovery After Surgery program reduces morbidity and the length of hospital stay for patients undergoing elective colonic or rectal surgery.

[Serum lactate level as a indicator of tissue hypoxia in severely ill patients]. / Serumlactaatconcentratie als maat voor weefselhypoxie bij ernstig zieke patiënten.

Adequate oxygen supply to the tissues is of vital importance to survive critical illness and trauma. Shock can be defined as an imbalance between oxygen demand and oxygen supply. Clinical features of shock, like hypotension, tachycardia, cold clammy skin et cetera, are poorly correlated with presence of tissue hypoxia. A high lactate level is an early sign of tissue hypoxia. In severely ill patients tissue hypoxia is the most important cause of increased lactate levels. Increased blood lactate levels are related to increased mortality. Optimizing oxygen supply by fluid resuscitation is the intervention of first choice.

Lactate measurements in critically ill patients with a hand-held analyser.

OBJECTIVE: To compare a recently introduced hand-held lactate analyser to a reference point of care analyser (POCI) and the hospital laboratory in a critical care setting. SETTING: 10-bed surgical/medical intensive care unit in a teaching hospital. PATIENTS AND METHODS: In 39 critically ill patients, 50 convenience measurement cycles consisting of three paired measurements at 30-min intervals were carried out with a hand-held analyser, reference POCI and hospital laboratory using arterial blood samples. Duplicate measurements with the hand-held analyser were done in 129 blood samples. RESULTS: Lactate levels ranged from 1.1 to 21.0 mmol/l. Regression analysis of the hand-held analyser and laboratory showed a slope of 1.01, bias of -0.38 mmol/l, R(2) = 0.97 and mean error of 14.9 %. Reference POCI versus laboratory: slope = 1.07, bias = -0.29 mmol/l, R(2) = 0.98 and mean error of 6.4 %. Hand-held analyser versus reference POCI: slope = 0.90, bias = 0.09 mmol/l and R(2) = 0. 92. The hand-held analyser showed acceptable precision. CONCLUSION: The hand-held lactate analyser can reliably measure arterial blood lactate levels in critically ill patients.