Prolongation of action of bupivacaine in caudal block in pediatrics: comparative study between addition of ketamine, clonidine and adrenaline

Regional anesthesia is considered an effective method for providing analgesia both intraoperatively and postoperatively and also decreases the total amount of general anesthesia required for surgery, provides more rapid recovery and faster wake up times. Caudal block is the most useful and common pediatric regional block as it is widely applicable and technically simple. Many factors influence the activity of caudally administrated local anesthetic solutions as dosage, addition of a vasoconstrictor e.g. epinephrine and addition of drugs as Ketamine and Clonidine. In this study, we compared the analgesic efficacy and side effects of Bupivacaine alone, Bupivacaine + Epinephrine, Bupivacaine + Clonidine and Bupivacaine + Ketamine. In the current study the addition of drugs to Bupivacaine has significantly extended the duration of caudal analgesia more than Bupivacaine alone especially with Ketamine and Clonidine

Serum matrix metalloproteinase-9 and tissue inhibitor of 3tetalloproteinase-1 in Egyptian patients with chronic liver disease: correlation with liver fibrosis

Chronic liver disease of different etiologies leads to cirrhosis. The main pathological mechanism of progression to cirrhosis is fibro genesis. Recognition of liver fibrosis or cirrhosis is difficult without liver biopsy. There is an urgent demand for a noninvasive reliable serum marker for liver fibrosis. Alterations in circulating matrix metalloproteinase-9 [MMPs] and tissue inhibitor of metalloproteinase-1 [TIMPs] concentrations and their correlation to the inflammatory activity and the histological changes are fairly well established, thus, the rationale of the present study was to evaluate the relationship between serum MMP-9, and TIMP-1 to liver status in patients with chronic liver disease. This study included 50 patients with chronic liver disease, 18 patients with chronic hepatitis, 22 patients with liver cirrhosis and 10 patients with hepatocellular carcinoma [HCC]. Twenty matched age and sex healthy volunteers were enrolled as control group. The obtained data showed that the lowest serum level of MMP-9 was found in chronic hepatitis patients compared to the control [P<0.05]. The MMP-9 serum level decreased during progression of chronic hepatitis to cirrhosis showing the least level in cirrhotic group. The serum TIMP-1 level was significantly higher in cirrhotic group compared to chronic hepatitis [P<0.05] and control [P<0.001] groups. Serum MMP-9 was negatively correlated to both the TIMP-1 level and to the histological severity of chronic hepatitis. There was a positive correlation between serum TIMP-1 and degree of fibrosis [r= 0.73, P< 0.001]. There were a statistically significant increase of MMP-9 [Pc0.001] and TIMP-l [P

Directive counselling in tinnitus retraining therapy

Tinnitus retraining therapy [TRT] focuses on the behavioural retraining of the associations induced by tinnitus perception and on inducing and further facilitating the process of habituation of tinnitus perception. It has two main elements: directive counselling which is more important and sound therapy.To determine the effects [success or failure] of counselling in TRT as a habituation method in the management of patients suffering from tinnitus. Full history taking, clinical examination [otoscopic, audiologic and medical], and categorisation of patients according to TRT categories in 137 chronic tinnitus patients into: groups I: 52 patients receiving counselling only [TRT Category 0], group II: 21 patients receiving counselling and noise generators [TRT category 1], and III: 34 patients receiving counselling and hearing aids [TRT category 2] and group IV 30 patients receiving medication. The Tinnitus H and icap Inventory [THI] translated into Arabic was used for scoring. A pre- and post-treatment score difference of at least 20 points revealed effectiveness of TRT compared to medical treatment.But was not revealed if the patient changed to a less severe h and icap with a score difference of 18.56 +/- 10.48. Although THI exists an important guide in individual management and monitoring to evaluate tinnitus treatment outcome, comparing the results with other studies is difficult due to the non-st and ardized scoring of the real improvement as well as the different questionnaires used.

Interposition jejunal loop with valve for management of biliary atresia

Kasai's operation has changed significantly the prognosis of patients with biliary atersia. However, postoperative ascending cholangitis is still a relatively frequent complication with high morbidity and mortality rates. Several surgical procedures to overcome the high incidence of postoperative ascending cholangitis after Kasai operation have been introduced. The aim of this study is to investigate the effect of the jejunal interposition hepatic portoduodenostomy with an intussusception type intestinal valve on the incidence of the post-operative cholangitis in cases of biliary atresia at our institute. Ten cases of biliary atresia [from June 1995 to January 1997], were included in the study. Seven were females and 3 males, with mean age at the time of operation of 67.8 days and mean body weight of 4.37 Kgm. There was no intraoperative mortality, while hospital mortality was 30%; the cause of death was not related to the surgical procedure. The remaining 7 patients were followed up for a period ranged from 6 to 17 months with a mean of 10.7. Three [42.8%] of the 7 patients did not develop any attacks of cholangitis, the other 3 developed one attack of grade I; cholangitis and the remaining one had 4 attacks of grade II; cholangitis and reoperation for him was considered. Upper GIT study using Gastrografin demonstrated competence of the artificially constructed valve in all survivors. The results obtained in this study demonstrate that interposition jejunal loop with an anti-reflux intestinal valve has prevented the incidence of cholangitis and reduced the number as well as the severity of the attacks of cholangitis in 85.7% of the studied patients with biliary aterisa

Malaria in Jeddah, Saudi Arabia

808 Malaria patients were reported from the Quarantina and Central Hospitals [Jeddah, Saudi Arabia] in the year 1980. Saudians and Yemenis were the most affected nationalities mainly with Plasmodium falciparum. Mortalities were recorded in extremes of age. Some cases were presented with atypical symptoms mostly in falciparum infection which stresses the need of routine blood film examination

Concomitant hepatic fasciola and hydatid infections in animals

Fasciola and hydatid infections were common among buffaloes.Mixed infections of the liver was extremely rare. Pathological changes of the liver were more prominent in mixed infection with more distortion of the liver tissue

Malignant malaria in Saudi Arabia

37 patients with falciparum malaria were presented with either signs and symptoms of cholera; collapse and shock; pneumonia; cerebral haemorrhage with coma; intestinal obstruction; uraemia skin; eruption with haematuria; typhoid fever or jaundice. In endemic areas, a thick blood film should be examined for malaria whatever the complaint of the patient or the primary diagnosis is

Urinary trichomoniasis in Jeddah, Saudi Arabia

Infection of the urinary tract with Trichomonas vaginalis was studied among some outpatients attending Jeddah Central Hospital. The relation of trichomoniasis to the sex, marital status, the reaction of urine, any accompanied bacterial infection, diabetes mellitus and associated symptoms were investigated. Seasonal variations were determined