[Study of risk factors of permanent functional limitations on 210 hemodialysed patients]

The aim of the study is to identify risk factors that can worsen the disability in chronic hemodialysis patients. A transversal study was conducted on a total of 210 patients. Data was collected using a 42-item questionnaire, and univariate and multivariate statistical analyses were conducted. Univariate analysis reveals that male sex, advanced age, small stature, low weight, unemployment, lifestyle, lack of sport, hypertension or diabetes, co-morbid conditions, polysulfane filter, time on dialysis, diffuse and chronic pain with high analog visual score are all aggravating disability. Multivariate study confirms advanced age, male sex, hemiplegia, cardiac failure and high analog visual scale as factors aggravating handicap in hemodialysis patients. Modifiable and non modifiable factors can be identified in the disability of dialysis patients. The approach for such patients should be targeted and multifactorial with emphasis on the role of physical rehabilitation and exercises

Prevention of hypotension after spinal anesthesia for cesarean section: 6% hydroxyethyl starch 130/0.4 [Voluven] versus lactated Ringer's solution

The aim of this study is to compare the efficacy of HES 130/0.4, a new hydroxyethyl starch, to lactated Ringer's solution [LR] in the prevention of hypotension after spinal anesthesia for cesarean section [CS]. One hundred and twenty nonlaboring ASA I and II women having non urgent CS were enrolled in this prospective and randomized study. Subjects were randomly assigned to receive prior to anesthesia either 1 liter of LR [Gr I: n = 59] or 500 ml of HES 130/0.4 [Gr II: n = 61] Blood pressure was measured until discharge from the post anesthesia care unit. Hypotension was treated with IV boluses of 3 mg of ephedrine. The nausea scale was recorded. Arterial and venous umbilical blood gazes were obtained. Data were compared using Mann-Whitney U-test and Student's t-test [p < 0.05 was significant]. Thirty-nine patients in Gr II while 48 pts in Gr I experienced hypotension [p = .033]. The total dose of ephedrine was statistically smaller in Gr II compared with Gr I [p = .001]. Nausea after induction of spinal anesthesia occurred with similar frequency in both groups. Neonatal outcome was excellent and similar in both groups. HES 130/0.4 is more effective than LR to prevent hypotension following spinal anesthesia for CS; its routine use in this purpose should be considered

[Specific problem related to oro maxillo facial sphere and hwaring in 340 Lebanese musicians practicing wind instruments]

The aim of this study is to detect the problems related to wind instruments in order to determine the contributing factors. This study is a prospective study of a sample of Lebanese wind-instruments musicians. Questionnaire of 17 items about personal data, musical activities in general and specific problems related to wind instruments. 340 response out of 400 [85%]. Gender: male 100%. Age: 28.5 +/- 6.5 years [13-50]. Practice of any physical activity: 57.5%. Smokers: 40.5%. Data about musical practice-Years of practice: 6.5 +/- 5.5. Daily practice: 2.5 +/- 1.5 hours with 35 +/- 2 rest periods of 16.5 +/- 15 minutes. Weekly practice: 5 +/- 2 days. Data about medical problems-Hear loss 34%; respiratory difficulties: 19.5%; wound of lips muscles: 5%; gums and tongue lesions: 7.8%; myospasms of the cheeks and lips: 34.5%; dental problems: 30.7%temporo-mandibular disorders [TMD]: 22.5%. There is a high association between risk factors and pathology. Risks related to the instrument's use: hear loss [p=0.001], traumas to lips muscles [p=0.065], myospasms [p=0.064], TMD [p=0.000]. Other factors: physical activity is beneficial; smoking is harmful [breathing difficulties, spasms, headaches]. Factors influencing the different problems: age [31 +/- 7 years]; years of practice [9 +/- 6]; hours of practice per day [2 +/- 15]; days of practice per week [4.5 +/- 2.5]. Wind instruments are related to problems of mouth, facial muscles and hearing. This may lead musicians to stop their activities or to irreversible professional disabilities. A medical follow-up during the musicians training is needed to prevent these problems

accuracy of non-invasive nasal capnography in morbidly obese patients after bariatric surgery

To assess the accuracy of nasal capnography for the monitoring of ventilation in extubated morbidly obese patients, following bariatric surgery. prospective descriptive study. Post-anesthesia care unit. 25 consecutive morbidly obese patients admitted to the PACU after open bariatric surgery. Patients had a nasal cannula designed to administer oxygen [3 L/min] and to sample expired CO[2] by a coaxial catheter. Capnographic waveform, end-tidal CO[2] [ETCO[2]] and respiratory rate [RRd] were displayed by a capnometer [Datex-Ohmeda]. Arterial CO[2] pressure [PaCO[2]] was measured by blood gas analysis. Respiratory rate was measured by visual inspection of chest breathing motions [RRm]. Differences between PaCO[2] and ETCO[2] and between RRd and RRm were calculated for every simultaneous set of measurements. Bias, precision, limits of agreement [bias +/- 2 precisions] between PetCO[2] and PaCO[2] were respectively as follows: 3.1, 1.4, 0.3 to 5.9 mmHg with a Pearson correlation coefficient of 0.6 and a P value of 0.001. As for RRd v/s RRm the values were: 2, 0.5, 1 to 3 breaths per minute and 0.8 with the same P value for the Pearson coefficient. Limits of agreement between PaCO[2] and ETCO[2] pressure and between RRd and RRm are clinically acceptable. Nasal capnography is accurate for the monitoring of ventilation in extubated morbidly obese patients, following bariatric surgery

Gastric pneumatosis as a manifestation of ischemic infraction of the stomach. Report of a case and review of the literature

Gastric pneumatosis is a very rare entity, and of the hollow viscera, the stomach is the least often reported site for intramural gas. To describe a patient with gas in the gastric wall associated with pneumoperitoneum and diffuse ischemic changes of the small and large bowels. Old man with past history of hemodialysis for renal failure and a diffuse vascular atherosclerosis presenting with an acute abdomen. The CT scan of the abdomen revealed a gastric pneumatosis with pneumoperitoneum and complete thrombosis of the coeliac trunk. Laparotomy showed gastric infarction with peritonitis and diffuse changes through the gastrointestinal tract. A therapeutical abstention was decided in agreement with the family. The patient developed septic shock under broad spectrum antibiotic coverage and died after 12 hours of multiple organs failure. Surgeons, internists and gastroenterologists should be aware of the possibility of gastric pneumatosis in some cases. Underlying disease are important to clarify in order to apply the adequate treatment

Addition of small doses of clonidine to bupivacaine in ilioinguinal and iliohypogastric nerve block following spinal anesthesia for inguinal herniorraphy

Addition of clonidine to bupivacaine improves and prolongs analgesia following central blocks. In peripheral nerve blocks, divergent results have been reported. The aim of this study was to determine the efficacy of clonidine mixed with bupivacaine on postoperative analgesia provided by an ilioinguinal and iliohypogastric nerve block following herniorrhaphy in adult patients. After institutional approval and informed consent, 60 adult patients scheduled for unilateral inguinal herniorrhaphy under spinal anaesthesia were included in this prospective and randomized study. At the end of surgery, patients received an ilioinguinal and iliohypogastric block with 20 ml of 0.25% bupivacaine mixed with 1 mcg/kg of clonidine [group I] or mixed with 1 ml of 0.9% saline [group II]. Visual Analogue Scores [0-10 cm] at rest and during mobilization, sedation, hemodynamic variation and first analgesic request were recorded at 2, 6, 12, 18 and 24 postoperative hours. Statistical analysis was performed by two-way ANOVA, Fisher, Student and Mann-Whitney tests. P

Infection du site operatoire en chirurgie cardiaque Etude prospective multidisciplinaire.

In an attempt to define the incidence of surgical wound complications following open heart surgery, 210 consecutive patients were included in a prospective monocentric study. All were adults with a mean age of 61 years. The different variables incriminated in pathogenesis of surgical wound infections were analyzed in order to evaluate their respective influence. No cases of mediastinitis were noted. The incidence of surgical wound infections was 5.5%. Body mass index > 25 and extensive surgical saphenous dissection in the lower extremities were the only two factors found to show as statistical significance