Predictive factors of occult cystobiliary fistulas during conservative treatment of hepatic hydatid cyst: a prospective study.

BACKGROUND: Occult cystobiliary fistula (CBF) is a common complication of hepatic hydatid cyst (HHC). It is often the cause of high morbidity of conservative treatment of HHC. This study aimed to determine the predictive factors of occult CBF to establish the indications for the investigation and treatment of these CBFs. METHODS: This was a prospective study that included all operated HHCs over a 3-year period. HHCs complicated with large CBFs were not included in the study. Systematic cholecystectomy and methylene blue test for all cysts were performed. RESULTS: A total of 46 patients operated on with 113 cysts were included in this study. The median cyst size was 6.7 cm (IQR, 1-38). A total of 114 CBFs were detected in 51 cysts (45.1%). The postoperative course was simple in 95.0% of cases. The specific morbidity rate was 2.7%. In a bivariate study, absence of mass and abdominal pain on palpation, hemoglobin level >11.55 g/dL, negative hydatid serology, cyst size, absence of calcifications, vascular compression, existence of a single cyst, and localization at segment VIII were predictive factors of occult CBF. At the end of the multivariate study, cyst size was determined to be the only predictive factor for occult CBF. A threshold of 3 cm was used. CONCLUSION: Cyst size is a major predictive factor for occult CBF.

Cystic Echinococcosis of the Liver: Correlation Between Intra-Operative Ultrasound and Pre-Operative Imaging.

Background: Imaging plays an essential role in the management of hepatic hydatid cysts (HCE). The objective of our study was to determine the correlation between pre-operative ultrasound, computed tomography (CT), and intra-operative ultrasound (IOUS) in studying the characteristics and complications of HCE. Patients and Methods: This was a prospective, descriptive, and analytical study conducted in the General Surgery Department of Habib Bourguiba Hospital in Sfax. The study included patients with HCE who underwent conservative surgery between April 2017 and June 2022. Results: We enrolled 49 patients with 94 cysts. At the end of our study, IOUS allowed for better detection of HCE (98.8%) regardless of the number of cysts per patient. IOUS and CT were accurate in studying the location of cysts (κ = 1), whereas pre-operative abdominal ultrasound was less efficient (κ = 0.870). IOUS was the best examination for detecting exocysts (κ = 0.961), studying daughter cysts (κ = 0.823), and exploring vascular relations, but it was less effective (κ = 0.523) in detecting calcifications. Regarding classifications, ultrasound and CT had similar results. However, IOUS was most reliable in differentiating between CE3b and CE4 types (κ = 0.653). Ultrasound, CT, and IOUS were not sensitive in detecting latent HCE suppurations and cystobiliary fistulas. Conclusions: Performing IOUS is essential to prevent recurrences and reduce post-operative morbidity.

The interest of intranasal clonidine in the prevention of perioperative children's anxiety: a prospective randomized trial.

Introduction: perioperative anxiety in children may lead to psychological and physiological side effects. Clonidine is in increasing use in the pediatric population as an anxiolytic, sedative, and analgesic because of its central alpha2-adrenergic agonist effect. Our study aimed to evaluate the effect of clonidine in the prevention of perioperative children´s anxiety. Methods: we conducted a prospective controlled randomized double-blinded clinical trial including children aged between 2 and 15 years undergoing tonsillectomy surgery. The patients were randomly allocated to receive either an intranasal dose of clonidine (4 µg/kg) (clonidine group) or an equal volume dose of saline solution (control group) 30 minutes before entering the operating room. The level of anxiety assessed using the m-YPAS score was recorded before premedication, at the time of parent-child separation, and at the time of installation in the operating room. Acceptance of premedication, degree of sedation on entering the operating room as well as agitation on awakening, and sedation on arrival post-anesthesia care unit were noted. Adverse effects were recorded during the surgical procedure and in the postoperative recovery room. Results: the number of patients analyzed was 78 with 39 patients in each group. There were no signification differences in demographic data and premedication acceptance between the two groups. Levels of anxiety before any premedication were similar in the two groups. However, the anxiety level 30 minutes after premedication and in the operating room was significantly lower in the clonidine group (p<0.001). Children who received clonidine showed better sedation on entering the operating room (p=0.002) as well as postoperatively on entering the post-anesthesia unit care (p=0.006). The hemodynamic and respiratory parameters recorded were statistically comparable. Conclusion: intranasal clonidine is an interesting premedication to prevent perioperative children´s anxiety with few side effects.

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial.

Introduction: laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly. Methods: we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications. Results: sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036). Conclusion: the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.

[The effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy: a prospective randomized controlled double-blind study]. / Intérêt de la déxaméthasone en intrapéritonéale dans l'analgésie post cholécystectomie laparoscopique: étude prospective contrôlée randomisée en double aveugle.

Introduction: the effect of intravenous corticosteroids on postoperative pain has been well demonstrated; however, few studies have focused on the efficacy of intraperitoneal corticosteroid use after laparoscopic surgery. The purpose of this study was to evaluate the effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy. Methods: we conducted a prospective, randomised, double-blind, controlled study, including patients scheduled for laparoscopic cholecystectomy and randomised into two groups: the group D (receiving 16 ml: 12 ml saline and 4 ml solution containing 16mg dexamethasone) and the group T (receiving 16 ml saline). The primary endpoint was: Visual Analogue Scale (VAS) for abdominal pain during the first 24 hours after surgery. The secondary endpoints were the incidence of shoulder pain, time to first request for analgesia, the consumption of morphine in the post-intervention surveillance room (PACU), the consumption of non-opioid analgesics and the incidence of nausea and vomiting during the first 24 hours after surgery as well as the presence of complications. Results: sixty patients were included in the study and divided into two groups of 30. Demographic parameters, duration of surgical and anesthesia procedures, as well as intraoperative fentanyl consumption were comparable between the two groups. Abdominal pain VAS values (p≤0.001), the incidence of shoulder pain (p<0.001), opioid and analgesic consumption (p<0.001) and the incidence of nausea (p=0.002) and vomiting (p=0.012) during the first 24 hours after surgery were significantly lower in group D. No complications related to dexamethasone administration were noted. Conclusion: intraperitoneal dexamethasone reduces postoperative pain after laparoscopic cholecystectomy.

Pericapsular nerve group block versus fascia iliaca block for perioperative analgesia in hip fracture surgery: a prospective randomized trial.

The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3rd, 6th, 12th, and 24th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3rd, 6th, 12th, and 24th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.

The effect of dexamethasone as an adjuvant in spinal anesthesia for femur upper extremity surgery: a prospective randomized trial.

Introduction: the aim of our study was to evaluate the efficacy of dexamethasone added to bupivacaine and sufentanil in spinal anesthesia to improve postoperative analgesia after femur upper extremity surgery. Methods: we conducted a prospective controlled, randomized double-blinded clinical trial including patients proposed for surgery of the upper extremity of the femur under spinal anesthesia. The patients were randomly allocated to receive intrathecally 10 mg hyperbaric bupivacaine 0.5% with 5µg sufentanil and 2 ml normal saline (control group) or 10 mg hyperbaric bupivacaine 0.5% with 5 µg sufentanil and 8 mg dexamethasone (Dexa group). The patients were evaluated for onset time and duration of sensory block, duration of pain-free period, overage consumption of morphine in the 6 first postoperative hours, hemodynamic parameters, nausea, and vomiting, or other complications. Results: fifty-eight patients were analyzed. There were no signification differences in demographic data and onset time of the sensory block between the two groups. Sensory block duration was 121.55 ± 16.42 minutes in the control group and 183.62 ± 33.93 minutes in the Dexa group which was significantly higher in the Dexa group (P<0.001). The pain-free period was longer in the Dexa group than in the control group (P<0.001). There was a reduction in morphine consumption during the first 6 postoperative hours in the Dexa group against the control group (p=0.02). The frequency of complications was not different between the two groups. Conclusion: the addition of intrathecal dexamethasone in spinal anesthesia improved the postoperative analgesia after femur upper extremity surgery.

Intravenous Dexamethasone Reduces Pain in Middle Ear Surgery.

Introduction: Few studies evaluated the treatment of postoperative pain in middle ear surgery. Materials and Methods: We conducted a randomized clinical trial to evaluate the efficacy of dexamethasone in the management of postoperative pain in middle ear surgery. Group G1 received an intravenous injection of 2 ml of physiological saline 30 minutes before the end of the procedure. Group G2 received a 2 ml intravenous solution containing 8 mg of dexamethasone, 30 minutes before the end of the procedure. Pain perception was measured by the Visual analog scale (VAS) every 10 min during the first hour and then every 6 hours during the 24 hours postoperatively. The delay of the first analgesic demand and the consumption of analgesics use during the first 24 hours postoperatively, were recorded. Results: VAS values were lower in G2at all measurement points during the first hour, as well as the first 24h postoperatively (Mann-Whitney test, P<0.05).The delay of the analgesic request was (0 (0-60) for G1 versus 0 (0-80) for G2, P=0.04, Mann-Whitney test). Morphine was used in 44% of the patients in G1 against 19% for G2 (P = 0.031). There was a significant difference between G1 and G2 in terms of the total dose of morphine consumed (P= 0.028, Mann-Whitney test). Paracetamol demand was lower in group 2 at all points of assessment during the first 24 hours postoperatively. Conclusions: Intravenous dexamethasone is effective in decreasing pain and analgesic requirement, during the first 24 hours postoperatively, in patients undergoing middle ear surgery.

A rare case of small intestinal metastasis from lung cancer.

We report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. He had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. It was peroperatively two small-bowel metastasis from lung cancer that we resect.

[Posterior reversible encephalopathy syndrome in patients with preeclampsia: case report]. / Le syndrome d´encéphalopathie postérieure réversible en cas de pré-éclampsie: à propos d´un cas.

Reversible posterior encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome. Diagnosis is suspected in pregnant women suffering from eclampsia when brain CT scan shows radiological images suggestive of this disease. We here report the case of a 25-year-old pregnant woman at 33 weeks' gestation with a history of pre-eclampsia presenting with convulsive seizures and high blood pressure following cesarean section. The patient was admitted to the Intensive Care Unit; clinical and radiological investigations revealed PRES syndrome. The clinical course was favorable after control of blood pressure by appropriate treatment and anticonvulsant therapy. Reversible posterior encephalopathy syndrome is a neurological manifestation rarely occurring in patients with pre-eclampsia, but it is not exceptional; then diagnosis should be suspected in patients with neurological signs. Brain MRI is the best diagnostic tool.

Intravenous lidocaine versus dexamethasone to prevent postoperative vomiting in children tonsillectomy: a prospective randomized controlled trial.

Introduction: we evaluate the effectiveness of lidocaine infusion compared to the intravenous dexamethasone and placebo on postoperative vomiting and first oral intake in children post tonsillectomy. Methods: we conducted a prospective double-blinded randomized and controlled clinical trial involving children aged between 3 and 13 years proposed for elective tonsillectomy without or with adenoidectomy under general anesthesia. They were randomized into 3 groups: lidocaine group included patients who received intravenous bolus of 2 mg/kg lidocaine over 5 minutes after the induction of anesthesia. Then, they received an infusion of 1.5 mg/kg/h until the end of the surgical procedure, dexamethasone group included patients who received intravenous dexamethasone 0.15 mg/kg administrated over 5 minutes after the induction of anesthesia followed by an identical rate of 0.9% saline and the saline group included patients who received an equivalent volume of 0.9% saline. For data analysis, we tested the normality of variables using the Shapiro-Wilk test. We used analysis of variance (ANOVA) or the Kruskal-Wallis test for between-group comparisons, as appropriate. The X2 test and Fisher´s exact test were used for inferences on proportions. A two-sided P-value was considered significant when p≤0.05. All analyses were performed with IBM SPSS≤ 25.0.0 for windows. Results: eighty-three (83) children were analyzed in our study and randomized into 3 groups: 27 children for each lidocaine and dexamethasone group and 29 children for the Saline group. The demographic data were not significantly different between the three groups such as age (p=0.246), gender (p=0.378), and body mass index (BMI) with p=0.233. The duration of surgery and anesthesia was also comparable in the 3 groups (p=0.893). Patients of the lidocaine and dexamethasone group had at least one episode of retching, vomiting, or both less than the saline group in the post-anesthetic care unit with p respectively 0.015 and 0,035, and in the ward with p respectively 0.004 and 0,038 Without a significant difference between the dexamethasone and the lidocaine group. The time to the first oral intake was significantly shorter in the dexamethasone group and the lidocaine group compared with the saline group (p=0.0001) with no statistical difference between the dexamethasone and lidocaine groups. Conclusion: lidocaine infusion is as effective as intravenous dexamethasone on postoperative vomiting as well as on oral intake in children post tonsillectomy.

[Predictive factors for anastomotic leakage after colon cancer surgery]. / Facteurs prédictifs de fistule anastomotique après colectomie pour cancer.

Introduction: in colon cancer surgery, anastomotic fistula (AF) is considered the most feared complication. The purpose of this study was to identify predictive factors associated with anastomotic fistula after colon cancer surgical resection and to describe the impact of this complication on mortality and postoperative length of stay. Methods: we conducted a retrospective, descriptive and analytical study in the Department of General Surgery at the Habib Bourguiba Hospital in Sfax, Tunisia from 1st January 2013 to 31 December 2020. Results: we collected data from the medical records of 163 patients who had undergone surgery for colon cancer. The average age of patients was 62.7 years with a sex ratio of 1.36. The postoperative course was uneventful in 64.4% of cases and complicated in 35.6% of cases. Surgical morbidity was mainly due to anastomotic fistulas (22 patients). This study demonstrated that predictors of the development of this complication were: diabetes p = 0.04, smoking p = 0.01, hypoalbuminaemia p = 0.01, preoperative haemoglobin less than 10g/dl, p < 0.01, anastomotic fistula located in the left colonic angle p = 0.02, perioperative transfusion p <0.01, and duration of surgery longer than 180 min p = 0.04. Moreover, the occurrence of anastomotic fistula was associated with specific mortality rate (9%) and significantly prolonged postoperative length of stay. Conclusion: the prevention of anastomotic fistulas should be part of a multimodal approach based on the correction of nutritional deficiencies and possible pre-operative anemia.

[Balloon catheter inflation with alkalinized lidocaine reduces post-operative laryngeal pain: a prospective, randomized controlled clinical trial]. / L'inflation du ballonnet de la sonde d'intubation par la lidocaïne alcalinisée réduit les douleurs laryngées post-opératoires: essai clinique prospectif contrôlé randomisé.

Introduction: post-operative laryngeal pain (POLP) is frequent and embarrassing. The purpose of this study is to assess the efficacy of endotracheal tube balloon (ETB) inflation with alkalinized lidocaine in the prevention of the POLP. Methods: we conducted a prospective, single-center, double-blind, randomized study including patients undergoing general anesthesia with tracheal intubation (OTI) with an expected duration of less than 240 min. Patients were divided into two equivalent groups: lidocaine (GL) group: patients with ETB inflated with alkaline lidocaine and the control group (GT): patients whose ETB was inflated with normal saline solution. The primary endpoint was the incidence of POLP in the first 24 hours after surgery and the secondary endpoint was the incidence of cough, dysphonia and postoperative vomiting, postoperative nausea and vomiting (PONV) in the first 24 hours after surgery. Statistical analysis was carried out using SPSS software version 25. The difference was considered significant when p< 0.05. Results: the study included 60 patients randomized into 2 groups of 30 patients each. Both groups were comparable with regard to their demographic and anesthetic criteria. ETB inflation with alkalinized lidocaine reduced the incidence of POLP, cough, dysphonia and PONV. No cases of balloon rupture or lidocaine toxicity were reported. Conclusion: ETB inflation with alkaline lidocaine prevents POLP.

Acute angle-closure glaucoma after total knee replacement surgery: case report and literature review.

An early and correct diagnosis improves the prognosis of post-operative Acute angle closure glaucoma (AACG). A 65 years-old monophtalmus man was operated for a total knee replacement surgery, under general anaesthesia without any adverse events. The day after, the patient described recurrent periorbital pain in his eye, with ocular hyperaemia, and reduced visual acuity. A diagnosis of AACG was made and conservative treatment was started to reduce the intraocular pressure. In the post-operative AACG, several predisposing local factors including genetic predisposition, female gender, hypermetropia, increased lens thickness and small corneal diameter, can be added to a pupillary block induced by adrenergic and anticholinergic drugs used in anaesthetic procedures as risk factors. An acute and intensive periorbital or ocular pain, with or without visual disturbance, must aware the physician.