[Effects of bupivacain infiltration on insulin, glucose, prolactin and cortisol responses to operative stress after unilateral inguinal hernoiraphy among 3-7 year-old children]

Operative stress and post-operative pain are important issues in medicine. After any types of surgery, the stress hormones release responding to pain. In this study we applied Bupivacain infiltration in surgical wounds of inguinal hernia amongst children aged 3-7 years and evaluated its effects on some stress hormones and plasma levels of glucose. In this prospective study, 116 children aged 3-7 years [24 females, 92 males] undergone unilateral repair of inguinal hernia under general anesthesia at Mofid children hospital during 2005-2007, were devided into 2 groups. Perincisional wound infiltration of 1-2 mg/kg of Bupivacain was performed in experimental group. In both groups, 10-15 mg/kg of Acetaminophen suppository were recommended at the recovery room. 4 ml of blood samples were obtained at three distinct stages [preincisional stage, at the end of operation and 4 hours after operation] to measure the insulin, prolactin cortisol and glucose plasma levels of subjects. Post operative pain was measured objectively by Hannalla scale. In both groups plasma prolactin levels increased at the end of operation along with insulin, cortisol and glucose. However, these differences became statistically significant just for insulin. There were no significant differences between other variables. In addition, although the plasma concentration of above mentioned variables became lesser in the 4[th] hour of postoperative period in experimental group, there were no statistically significant difference compared to those of control group. Wound infiltration of Bupivacain decreases the stress hormones and pain during the post-operative period. We recommend this type of infiltration applying long-acting anesthetic agents with fewer numbers of side-effects

[ comparison between one stage and stages pull-through in patients with hirschsprung's disease [HD]]

Pathology of Hirschsprung's disease is a ganglionic colon, and the most common symptoms is chronic constipation. Surgical intervention started with stages pull-through from last decades, but since 1980, many pediatric surgeons have performed on stage pull-through with excellent results. From 1992 to 1998, 40 patients with Hirschsprung's disease who were divided into 2 patient groups [20 patients in each group] operated with different stages [Swenson] and one-stage pull through procedures in Mofid children's hospital and the results of these 2 procedures were compared with each other. 6 years evaluation reveals one stage pull-through takes less time, has less cost, short staying in hospital, less complications and earlier recovery than stages procedures. One stage pull-through in HD is a safe and effective procedure, but most important point is patient selection

effect of music therapy on chronic pain in patients with cancer

Pain is considered as one of the complications in patients with cancer. Several methods are reported to have reduced the pain and among those, music therapy, as a noninvasive method, is sometimes used in cancer treatment to help reduce pain. To evaluate the effect of music therapy on scale of chronic pain in some patients with cancer. This semi-experimental study was performed in Tehran Central Hospital. A total number of 40 patients with cancer pain and age range of 18-70 years were studied. The degree of pain was measured with a scaled ruler [0-10]. The data was analyzed using Willcoxon statistical tests. Two equal groups of patients [20 females] and [20 males] were selected. The scale of pain in stages of pre and post-implementation of music therapy showed significant differences on the basis of variables including age, sex, duration and the type of tissue involved [alpha=%5, Z=1/645]. The data found in our study was indicative of a reduction in size of pain. Hence, music therapy is recommended as a noninvasive method to reduce pain

Treatment and postoperative complication of 420 patients with congenital megacolon

Hirschprung's disease is still one of the most important problems of pediatric surgery and its treatment has its own different complications and difficulties. Therefore, pediatric surgeons use different methods in each case. The objective of this study was to review the advantages and disadvantages of the Swenson's procedure over the past 20-years. In this survey, we reported 420 patients who in a 20-year interval [from 1981-2000] with the net diagnosis of Hirschprung's disease, were admitted to the pediatric surgery ward of Taleghani Medical Center, Tehran, Iran and operated on by Swenson's procedure. This survey has been carried out in 2 parts with descriptional method using patients' files and analytical method by using patients' observation and questionnaires. In the first step, they were 420 patients and in second step 216 patients were studied and the results of the first 10 years [190 cases] and the results of the second 10 years [230 cases] were analyzed alone and compared with each. The results revealed wound infection in 17 cases in the first 10 years [14.2%], with18 cases in the second [7.9%] giving a mean of 10.7%. Anastomosis leakage was 6.8% in the first and 2.2% in the second 10 years with a mean of 4.2%. Septicemia was 3.6% in the first and 0.9% in the second period with a mean of 4%. Intestinal obstruction was 4.2% in the first and 2.1% in the second 10 years with a mean of 3%. There was no mortality during the surgery and for one month after. The results of late complications are: rectal anastomosis stricture, 13% in the first and 3% in the second 10 years with a mean of 7.6%; inguinal hernia of 1.6% in the first and 0.4% in the second period with a mean of 1% and finally, the death rate due to enterocolitis was 1.6% in the first and 0.9% in the second 10 years. Altogether, 87% of patients and their parents were satisfied with bowel habits after operation; 10% were relatively satisfied and 3% were not satisfied at all. Age distribution at the time of diagnosis: 50% of 0-1 months; 23% of 1-12 months and 27% were above one-year-old. Three hundred and eleven patients [74%] were male and 109 [26%] were female. The youngest patient was 3-days-old and the oldest was a 14-year and 3-month-old boy. The most common denerved part of the intestine was sigmoid colon with 54.4% prevalence. Our results show that Swenson's method is a successful procedure in the treatment of Hirschprung's disease

Eventrantion of the diaphragm: a 10-year experience

Eventration of the diaphragm is a condition characterized by an attenuated but otherwise intact diaphragm. Twenty patients [age range: 2 days to 11 years] were treated for eventration of the diaphragm during a ten year period [1985-1995]. There were 11 girls and 9 boys with a mean gestational age of 37 weeks. 14 patients were born with cephalic presentation, 3 patients with breech delivery and 3 patients by caesarean section. In 5 cases with difficult delivery, forceps were used. Mean birth weight of patients was 2510 gm [range 900 to 3500 g]. The most common clinical manifestations of these patients were respiratory distress [16 cases] and failure to thrive [14 cases below 3rd percentile]. 50% of patients [10 cases] had from 1 to 5 associated anomalies. Cardiac anomalies were the most common [n= 5], followed by respiratory system anomalies [n= 4], malrotation [n= 3], and hiatal hernia [n= 2]. All patients had an elevated diaphragm in the chest radiograph [n= 20], but only some had paradoxical movement in fluoroscopic studies [n= 5]. In 8 patients GI contrast studies were performed and three patients were found to have malrotation. 15 patients had right, 3 patients left, and two patients bilateral diaphragmatic eventration. 18 patients underwent operation [plication], while two patients with small and asymptomatic eventration were not operated. Operative repair was performed with no mortality. Hospital stay was 14.5 days. 12/20 patients had come for follow-up and they were evaluated from 5 months to 10 years. All showed good results from diaphragmatic plication without respiratory distress or infection and gained weight from below the 3rd percentile to above the 10th percentile. Surgical correction is strongly recommended in patients with eventration of the diaphragm and failure to thrive or other clinical manifestations