The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: a randomized controlled double-blind study / 대한마취과학회지

Background@#The thoracic retrolaminar block (TRLB) is a relatively new regional analgesia technique that can be used as an alternative to the thoracic paravertebral block. This study aimed to evaluate the postoperative analgesia effects of ultrasound-guided TRLB in children undergoing open cardiac surgery via median sternotomy incision. @*Methods@#Sixty-six patients aged 2–8 years were recruited. In the TRLB group, 0.25% bupivacaine 0.4 ml/kg was injected into the retrolaminar space on both sides at the level of the T4 lamina. Patients in the control group were injected with 0.9% saline. The primary outcome measure was fentanyl consumption in the first 24 h post-extubation. The secondary outcome measures were the total intraoperative fentanyl consumption, postoperative modified objective pain score (MOPS), and time to extubation. @*Results@#The total intraoperative fentanyl requirements and fentanyl consumption in the first 24 h post-extubation were significantly lower (P < 0.001) in the TRLB group (9.3 ± 1.2; 6.9 ± 2.1 μg/kg, respectively) than in the control group (12.5 ± 1.4; 16.6 ± 2.8, respectively). The median (Q1, Q3) time to extubation was significantly shorter (P < 0.001) in the TRLB group (2 [1, 3] h) than in the control group (6 [4.5, 6] h). The MOPS was significantly lower (P < 0.05) in the TRLB group than in the control group at 0, 2, 4, 8, 12 and 16 h post-extubation. @*Conclusions@#Bilateral ultrasound-guided TRLB is effective in providing postoperative analgesia in children undergoing open cardiac surgery via median sternotomy incision.

A Novel Method to Decrease Shoulder Tip Pain during Cesarean Section

Objective:To investigate the efficacy of the placement of two towels around uterus before delivery of fetes upon the incidence of intraoperative shoulder tip pain (STP) during cesarean section.Methods:Two hundred and sixty parturient were scheduled to undergo elective cesarean section under spinal anesthesia were randomized to do packing around the uterus before uterine incision or placebo (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were operative time, amount of intraoperative blood loss, incidence of hypotension, and the Need of post-opertive morphine.Results:Shoulder tip pain was recorded only in 7 cases (5.4%) in towel placement group compared to 25 cases (19.2%) in placebo group (P value, 0.001). The need of post-operative morphine was statistically significant lower in Towel placement group (33.8%) compared to (47.7%) in control group (P value, 0.023).Conclusion:Packing around the uterus just before uterine incision decreases the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section

Bone mineral density and trabecular bone score in patients with non-radiographic axial spondyloarthropathy

Background: spondyloarthropathies (SpA) are a group of chronic inflammatory rheumatic conditions that share multiple clinical features including axial and/or peripheral arthritis, enthesitis, absence of serum rheumatoid factor and presence of common extra articular manifestations. Objective: the aim of this work is to study bone mineral density and trabecular bone score at patients with non-radiographic axial spondyloarthropathy. Patients and Methods: this study is a cross sectional study in which 200 patients having chronic back pain selected from those attending the outpatient clinic and inpatient of Al-Azhar University Hospitals, Damietta and were divided into two groups: 1- (Group A, study group): (160) patients had inflammatory low back pain fulfilling Calin criteria for inflammatory low back pain. 2- (Group B, control group): (40) patients had mechanical low back pain not fulfilling criteria of inflammatory back pain. Results: regarding results of clinical examination, there was significant increase of arthritis, dactylitis, enthesitis and psoriasis in Group A when compared to Group B (43.3%, 16.7%, 30.0%, 20.0% vs 3.3%, 0.0%, 3.3% and 3.3% respectively). In addition, there was significant increase of arthritis plus dactylitis and arthritis plus enthesitis in Group A when compared to Group B (16.7%, 30.0% vs 3.3% and 0.0% respectively). Conclusion: results of the present study proved that, both bone mineral density and trabecular bone scores showed early changes in patients with non-radiographic axial spondylo-arthropathy. In addition, both correlated with each other and with results of axial magnetic resonance imaging. Thus, they are advocated in diagnosis of nr. SPA

Airway inflammatory biomarker: could it tailor the right medications for the right asthmatic patient?

Asthma is a heterogeneous disease, in which asthmatic patients present with different clinical phenotypes, variable endotypes, and different response to asthma medicines. Thus, we are faced with an asthma paradox; asthma is diagnosed subjectively by clinical history and treated with biologically active drugs. To solve this paradox, we need objective airway biomarkers to tailor the proper medications to the proper patient. Biomarkers should have one or more of the following characteristics: 1] could differentiate poor symptoms perceivers from over-perceivers, 2] could predict disease activity and hence disease outcome, 3] could clarify asthma phenotype responders from non-responders, and finally 4] could characterize different clinical asthma phenotypes. Therefore, we have conducted a review of literature trying to apply those four parameters to different airway inflammatory biomarkers. We found that FeNO fulfilled the four proposed clinical parameters of airway inflammatory biomarkers whereas; serum periostin was the single best systemic biomarker of airway luminal and tissue eosinophilia in severe uncontrolled TH2 asthma phenotype. Thus, this may be considered a trial towards tailoring the proper medication to the proper patient. However, application of biomarkers in clinical practice requires easier and cheaper techniques together with standardized methods for sample collection and analysis

Tarsal tunnel syndrome in patients with rheumatoid arthritis, electrophysiological and ultrasound study

Tarsal tunnel syndrome [TTS] is an entrapment neuropathy of the tibial nerve at the ankle. Rheumatoid arthritis is one of the systemic causes that has been responsible for TTS. In this study thirty feet of patients diagnosed as rheumatoid arthritis with complaints of burning pain or paresthesia on the plantar aspect of the foot and toes with 15 feet of age and sex matched control subjects were included. The aim of this study: To detect TTS among patients with rheumatoid arthritis. All patients included in this study were subjected to history taking, clinical examination [general and local], nerve conduction studies and ultrasonography of both tarsal tunnels. In this study, we detected the presence of TTS in rheumatoid arthritis patients group and none was found in the control group. A total of 28 cases were confirmed as having TTS. In the patients group a strong statistically significant correlations were found between ultrasonographic and electrodiagnostic findings. So it is concluded that TTS is detected in patients suffering from rheumatoid arthritis and that the use of both methods could lead to more reliable confirmed diagnosis which could lead to better management

Efficacy and safety of intraoperative radio frequency ablation in management of hepatocellular carcinoma

The present study is a prospective one involving 15 consecutive patients with hepatocellular carcinoma [HCC] from January 2003 to December 2005. Clinical and laboratory examinations, abdominal ultrasonography and spiral CT scanning were performed. All patients were subjected to intraoperative radiofrequency ablation of HCC after confirmation by core biopsy. Enhanced dynamic CT was done at 1 month postoperative and every 3 months during follow-up period. Males were 12 with age of 41-69 year [53.2 +/- 7.4]. Underlying cirrhosis due to viral hepatitis was in all, and HCV was the most common [75%], and patients [85%] were categorized in Child B classification. Serum alpha feto protein was above 400 ng/ml in 60%. 12 patients had unifocal HCC [nodules mean diameter of less than 3 cm in 6, 3 to 5 cm in 4, and more than 5 cm in 2], and 3 patients had multifocal HCC [nodules mean number of less than 3 cm in 2 and 3 to 5 cm in 1]. The mean number of RF application session to achieve complete necrosis in patients with were 1.52 [unifocal] and 2.49 [multifocal HCC]. The mean hospital stay was 14.9 days, with neither mortality nor major complications, but Minor complications in 30%. After one month, complete ablation of HCC nodules was achieved in 10 patients with reduction of alpha fetoprotein in 11 patients. 2/5 with partial ablation were multifocal nodules. Total mortality during follow-up in late post-operative period [1 year] was 6 out of 15 patients. 5 of them are the patients with partial ablation. 3 patients out of 9 patients developed evidence of local recurrence detected by enhanced dynamic CT and raising of serum alpha fetoprotein

effect of portal vein branch plus heterochronous hepatic artery branch ligation on liver regeneration [Experimental study]

The proliferative capacity of non-ligated liver lobes was designned experimental study on dogs in which portal vein and hepatic artery ligation was done either simultaneously or heterochronously. Dogs were divided into four groups: G I [control G]; laparotomy was performed without vascular ligation, G II; dogs were subjected to ligation of the right lateral and median branches of portal vein alone, G III, dogs were subjected to hepatic artery branches ligation 48h after portal vein branches ligation. G IV, dogs were subjected to ligation of the same branches of the portal vein and hepatic artery simultaneously. Dogs from each group were subjected to a liver biopsy before and 24, 48, 72, and 168h [one week] after surgery. Standard serum liver functions were tested before ligation, 72 hs and one week after ligation. Hepatic regeneration in the non-ligated lobe was assessed through histopathological study, DNA quantitation of the hepatic nuclei by the computerized image analysis system and estimation of proliferation marker in hepatic tissue. In this study, the labeling index of the nuclear factor NF Kappa B [PI05], a novel monoclonal antibody specific for PI05 protein, was determined immunohistochemically. Results showed induction of the NK kappa B [P105] labeling index showed maximum levels G III. Quantitative determination of serum glutamicoxaloacetate transaminase [GOT] showed peak levels in G IV at 24h after surgery. Our finding for this index that heterochronous partial portal vein and hepatic artery ligation [i.e., G III] is effecttive, because this procedure leads to an increase in the compensatory hypertrophy of the nonligated liver lobes that depends on the regenerative capacity of the lobes themselves. In contrast, in G IV [i.e., synchronous ligation of portal vein and hepatic artery branches] liver regeneration did not occur due to the severe systemic damage induced by infectious necrosis in the ligated lobe. The serial changes in liver function in G III indicate that the use of this technique may minimize dysfunction in the remaining hypertrophied liver lobes, similar to findings in G II. So, the PVBL plus heterochronous HABL procedure is safer and more effective than PVBL alone, or PVBL plus simultaneous HABL. A better knowledge of the events following such heterochronous ligation should improve the clinical outcome of hepatic resection for liver diseases

resukts of primary repair of the flexor tendos of the fingers in zone II injuries

We operated on 57 patients with flexor tendon injuries of the fingers in zone II of the hand. In 27 patients, there were contra-indications for primary repair. Thus primary repair using the MKS, continuous running circumferential epi-tendinous sutures and applying immediate post-operative mobilization using splints was done in 30 patients. The splints included rubber band protection of the involved digits and allowed active extension-to-passive flexion. Excellent end-results were obtained in 22 cases [73.33%], good re5ults in 4 cases [13.33%], fair results in 3 cases [10%] and poor results in one case [3.33%] according to the scoring system of Buck-Gramcko. Superficial wound infection occurred in 2 cases [6.66%] while flexion contracture and stifness occurred in 3 cases [10%] for which tenolysis was necessary. Statistical analysis of the results showed that the results of treatment were not affected significantly by age or sex of the patient. Higher incidence of satisfactory end-results was seen in cases with single finger injury, single tendon injury, in patients who sustained their injuries due to sharp objects and in injuries involving the right hand. All unsatisfactory cases had multiple finger injuries, multiple tendon injuries and were in patients with left hand injuries

Role of Nitric oxide and some cytokines in neonatal septicemia

Bacterial sepsis is a life-threatening event. Some cytokines and recently, nitric oxide [NO] have been incriminated in the pathogenesis of sepsis, especially in the mechanisms by which sepsis progresses to septic shock. The aim of the present work is to determine whether NO level is increased in neonates with bacterial sepsis and if it is related to the levels of the inflammatory mediators namely interleukin-6 [/L-6] and tumor necrosis factor-alpha [TNF-alpha]. The study was conducted on twenty neonates with bacterial sepsis proved by history, clinical examination and laboratory investigations. Ten healthy age and sex matched-neonates were taken as a control. All cases were subjected to blood, cerebrospinal fluid and urine cultures and estimation of serum tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and serum NO [nitrite+nitrate] [the stable and catabolic products of NO]. Neonates with bacterial sepsis had a significantly higher serum TNF-alpha serum /L-6 and serum NO [nitrite + nitrate] than controls. There were significant positive correlations between serum levels of TNF-alpha [ng/ml], 12-6 [pg/ml], NO [nitrite +nitrate] [[micro mol/L] and I/T leukocytic ratios, Complete cure had occurred in 14 cases [70%], while 6 cases had succumbed [30%]. All succumbed cases had low systolic pressure <50 mmHg and oliguria, a picture denoting septic shock. In conclusion, levels of serum IL-6, TNF-alpha and plasma nitric oxide are elevated in neonatal septicemia. However, these mediators may be prognostic for survival rather than diagnostic, since, immature/total leukocytic ratio is still a rapid and easy method for suspicion of the case, together with the clinical picture

effect of recombinant human erythropoietin on the erythropoiesis of preterm infants

Anemia of prematurity [AOP] is characterized by a low reticulocytic count and a low erythropoietin level, for which many preterm infants receive multiple blood transfusions. The present study investigated whether early treatment of such infants with a low dose of recombinant human erythropoietin [r-HuEPO] would stimulate erythropoiesis and reduce the need for blood transfusion. Twenty preterm infants were enrolled in the study. Ten infants were assigned to receive r-HuEPO in a dose of 150 IU/kg/dose twice weekly for 2 weeks. Ten preterm infants served as a control group. Hematologic measurements, and transfusion requirements were followed for 28 days. The mean hemoglobin and hematocrit levels showed a progressive and significant decrease by days 7, 14 and 28 p<0.0001 in both the study and control groups. However, the level was higher in the r-HuEPO treated group throughout the study. The corrected reticulocytic count on the other hand increased significantly in r-HuEPO treated infants on days 7, 14 and 28 [p<0.0001] while it decreased significantly in the control group. The need for blood transfusion was significantly less in the r-HuEPO treated group. The early use of small dose of r-HuEPO 150 IU/kg twice weekly effectively stimulated erythropoiesis, and reduced the need for blood transfusion in preterm infants

Granulocyte macrophage colony stimulating factor as a marker for neonatal sepsis

To evaluate Granulocyte Macrophage Colony Stimulating Factor [GM-CSF] as an early marker of neonatal sepsis.: forty-five newborn infants of varying gestational age were included in the study. Thirty-five neonates with suspected sepsis [group I] were classified according to the results of blood culture into: subgroup Ia: 17 infants with positive blood culture and subgroup Ib: 18 infants with negative culture. Ten healthy neonates served as control group [group II]. The GM-CSF level was measured in all the studied subjects. Comparison of mean GM-CSF levels by group was accomplished by an analysis of variance.: the mean GM-CSF levels in subgroup Ia was significantly higher than that of subgroup Ib and II. The mean GM-CSF level in subgroup Ib was significantly higher than that in group II. The mean GM-CSF level was 45.76 pg/ml in subgroup Ia, 22.81 pg/ml in subgroup Ib and 6.40 pg/ml in group II [P<0.0001]. The GM-CSF level was positively correlated with the immature or band cell/total neutrophil ratio in subgroup Ia.: GM-CSF level represents a reliable early marker for neonatal infection

Some observation on hemorrheological abnormalities in patients with bilharzial corpulmonale

Some hemorrheological parameters were studied in 20 patients with bilharzial corpulmonale and compared to their values in 20 patients with bilharzial hepatic fibrosis and 10 normal control individuals of matched age and sex in order to evaluate the role of these factors in the etiopathogenesis of schistosomal corpulmonale. The study revealed significant alterations in the studied hemorrheologic parameters in patients with schistosomal corpulmonary that correlate with the severity of pulmonary hypertension. The changes in liver size, presence of ascites or splenectomy did not disturb much this relationship. However, these changes should be considered as one of the pathophysiologic mechanisms underlying the pathogenesis of this syndrome

Biological effect of estrogens isolated from guava seeds

Guava [Psidium guajgva, f. Myrtaceae] seeds extract was subjected to treatment with Girard's reagent T for separation of ketons. The purified extract was subjected to adsorption type high-performance liquid chromatography [HPLC]. Estrone identified in the extract amounted 254 micro g/100 g seeds. Estrone content corrected for recovery [73%] should be 348 micro g per 100 g guava seeds. The biological activity of guava seeds estrogen was evaluated as change in tissue weight, RNA/DNA-ratio and protein content of mice uteri as compared to a group of animals treated with 1 micro g diethylstil-besterol [DES] together with a control group. For all uteri parameters, highly significant differences between mice treated with guava seeds extract and controls was observed. The seeds extract was found to be 68%, 77% and 64% as potent as DES for uterine weight, RNA/DIVA-ratio and protein content, respectively. The amount of estrone per gram seeds [relative to the effect of 1 micro g DES] that caused increase in uterine weight, RNA/DNA-ratio and protein content were 4.06, 4.60 and 5.14 micro g respectively. The correlation between the HPLC analysis results [3.48 micro g per gram seeds] and that of biological activity was discussed