Comparison of pre and post surgical caudal block in reducing stress responses in children

Surgical stress stimulates the release of catecholamine and cortisol. Both of which have anti-insulin action resulting in an increase of plasma glucose concentration. The most common regional block in pediatric age group is caudal epidural analgesia. The aim of this study was to compare the stress response following pre and post surgical caudal block. After approval by our local ethics committee and written parental consent 70 children between two and seven years of age scheduled for elective lower abdominal procedures were enrolled in this study. Anesthesia was induced with fentanyl 1micro g/kg, midazolam 0.03mg/kg, propofol 3mg/kg, LMA was inserted, maintenance was with halothane 1-1.5%, N2O 3 lit/min, O2 3 lit/min. Halothane concentration was decreased to 0.6% in children who received pre surgical caudal block [20 minutes after block]. Children in group-A received pre surgical caudal block with 0.25% bupivacain 1ml/kg, those in group B received post surgical caudal block with same dosage and concentration. Demographic data were similar. Plasma glucose concentration were decreased during the course of this study in Group A, [P = 0.045]. However, in Group B the plasma glucose level increase 15 min after beginning of surgery [P = 0.001]. The hemodynamic changes with in group A was less than group B [P < 0.05]. In children, pre but not post surgical caudal block attenuates the stress response associated with lower abdominal surgery

Prevention of oliguric ATN following living renal transplantation by PRE-operative allopurinol

The incidence of pathologically documented oliguric A.T.N. following living renal transplantation was studied in 481 cases using different perfusion protocols with comprised together with surface cooling perfusion with 500 ml lactated Ringer's solution at room temperature to which 5000 units heparin were added together with 5 mg verapamil and 2 ml 2% procaine HC1 in the firs group, or 6 ml 2% procaine HC1 in the second and third groups. This was followed in the 3 groups by cold [0C] perfusion of 500 ml lactated Ringer's solution to which 500 units heparin were added. Perfusion time ranged form 3-5 minutes. Oliguric A.T.N. occurred in 6/159 cases [3.8%] of the first group and in 13/227 cases [5.7%] of the second group. Oliguric A.T.N. was not encountered in any of the 95 cases in whom allopurinol was given to both donor and recipient as 300 mg orally 48 and 24 hours preoperatively and using procaine HCL for perfusion. A.T.N. Was not related to the duration of the ischemia time [35-65 minutes], number of arteries or tissue matching which were comparable among the studied groups. Allopurinol is believed to protect against reperfusion injury mediated by free oxygen radicals

Prevalence of malnutrition in general surgical patients

The possibility of protein calorie malnutrition [PCM] was studied on one hundred consecutive patients admitted to the department of surgery at the Saint Georges hospital, Beirut, during the months of April and June 1991, regardless of age, sex and socio economic status. Data was completed on 94 of those cases. Multiple parameters were studied, including measurements of triceps and subscapular skinfold thickness, mid arm muscle circumference, percent weight loss, creatinine height index, serum albumin and transferring levels and total lymphocyte count. We found a prevalence of 81%, 65%, 53% and 31% of PCM, if one, two, three or at least four abnormal parameters are used respectively, to assess malnutrition. Defining malnutrition as the presence of at least three abnormal parameters, we conclude that 53% of the patients, on admission to the department of surgery, had evidence of PCM. Further studies are required to assess the impact of this prevalence on length of stay, morbidity and mortality

Asymptomatic cholelithiasis concomitant with other abdominal surgical conditions: risk of additional cholecystectomy and fate of untreated gall stones

Forty-seven cases of asymptomatic cholelithiasis have been encountered during celiotomy for various abdominal conditions. Concomitant cholecystectomy was performed in 34 cases [72.3%], with operative cholangiography in 20 cases of them, while the common bile duct was explored with removal of stones in 4 cases. No mortality cases were recorded while, 3 patients [8.8%] developed wound sepsis and another 4 [11.8%] developed chest problems. No cases of subphrenic abscess, retained CED stones, biliary fistula or burst abdomen were encountered. Cholecystectomy was not performed in 13 cases [27.7%], because of failure to appreciate the presence of gall stones, unstable condition of the patients, short life expectancy or fear of spread of infection. One patient was lost to follow-up, while 10 patients [83.3%] developed various biliary problems within one year after the primary operation. Four of them developed acute cholecystitis with one in the early postoperative period. In another 5 cases, cholelithiasis became symptomatic with development of obstructive jaundice in one of them. The tenth patient developed acute haemorrhagic pancreatitis, however he died despite of early surgical intervention. We conclude that, if asymptomatic gall stones are encountered during celiotomy for other conditions, cholecystectomy should be carried out unless specific contraindications exist, as it adds minimal morbidity to the primary procedure. Left untreated, cholelithiasis becomes symptomatic in most patients and may cause serious biliary problems and this can lead to subsequent operation which may require a more extensive procedure producing a greater morbidity

Fractures of the distal end of the femur in adults: conservative versus operative treatment

Sixty-five fractures of the distal end of the femur in 64 patients were analyzed to compare results of open and closed methods of treatment. Fractures were classified using the new AO-ASIF system which provides an adequate description of the distal femoral fractures. The rating system of Neer et al. Was used for evaluation of the end-results. The 44 patients [45 fractures] treated with internal fixation according to the AO recommendations-had an overall 80% excellent to satisfactory result, an average time to union of 4.3 months, and average knee motion range of 110.3 degrees. There were 3 postoperative infections, one nonunion, and no malunion. The 20 patients treated conservatively had an overall 65% excellent to satisfactory result, an average time to union of 5.4 months, and an average ranged of knee motion of 64.5 degrees. There were 3 D.V.t.; 2 nonunions, and 2 malunions. Conservative treatment is still an acceptable treatment modality, with good functional results in many of these fractures

medico-Legal study carried out on the postmortem of cases who died suddenly during or after general anesthesia and surgical operations

A Medico- Legal study carried out on the post- morterm of three cases were died suddenly and unexpectedly during and after G.A. and Major Operations which had been caused suspicions and fear for each of the Surgeon, Anasthetist and deceaseds relatives in which legal autopsy may play an important role in determination the causes of death. Death was occurred during G.A. and shortly after incision made by the Surgeon for thyroidectomy to a housewife aged 45 years. Whereas two male children aged 4 and 8 years were died 10 and 8 hours respectively after undergoing to Sigmoidectomy and Uretero- Lithotomy. Acute cardiac arrest under asyphysial conditions was the cause of death of the first case, whereas pulmonary embolism were the causes of death concerning the remainder cases