Brachial plexus block [axillary block] for emergency orthopedic pediatric surgery versus deep sedation

Our study was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary [brachial plexus] block regional anesthesia [ABRA] [32 children] or deep sedation with ketamine and midazolam [30 children]. This was a prospective randomized unmasked controlled comparative trial conducted in hospital emergency department. The 2 groups were similar in age [older than 4 years], fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation. The primary outcome measure was procedural distress during manipulation as measured with the Children's Hospital of Eastern Ontario Pain Scale [CHEOPS]. The mean CHEOPS score was 6.4 +/- 2.8 in the group with axillary block and 7.5 +/- 1.6 in those receiving deep sedation; the difference between the CHEOPS scores in the 2 groups was not statistically significant [P = 0.126, 95% CI: 2.5, 0.3]. Axillary block was used successfully in 26[90%] of the 32 children. No patient in either group experienced any adverse events

value of Hetastarch in prophylaxis against renal impairment in cirrhotic patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is an ominous complication of the late stage liver disease. Renal impairment in the course of SBP is a frequent event and constitutes the most important predictor of hospital mortality in these patients. Administration of intravenous albumin was applied for prevention of SBP related renal impairment and it reduced the incidence of renal impairment and mortality in comparison with treatment with antibiotic alone. Because albumin is expensive and not available in some settings, we worked to assess the possible use of Hetastarch and assess its beneficial effects in prevention of SBP related renal impairment. The present study was conducted on 60 patients with liver cirrhosis, ascites and SBP. The patients were divided into two groups: Group [1]: 30 subjects who received empirical antibiotic plus plasma expander for treatment of SBP and Group [2]: 30 subjects who received empirical antibiotic alone. The plasma expander chosen was Hetastarch [the colloidal solution hydroxyethyl starch [Haes-steril] in a dose of 500 cc every 8 hours/5 days [20 ml/kg B. wt/day] due to its relative less side effects on coagulation process. It was found that the administration of Hetastarch as a artificial plasma expander decreased renal impairment in patients with liver cirrhosis and spontaneous bacterial peritonitis. The incidence of renal impairment was significantly lower among patients treated with antibiotic therapy plus plasma expander [13.3%] than those treated with antibiotic alone [36.6%]. Patients received Hetastarch showed maintenance of renal function allover the follow up period, higher urine output, better renal profile than other group not treated by Hetastarch. We concluded that treatment with Hetastarch was safe and effective and it can be considered as an alternative to albumin in prophylaxis against renal impairment in cirrhotic patients with SBP

Thyroid hormones in ascitic fluid of patients with hepatosplenic bilharziasis

Twenty male patients with ascitis due to hepatosplenic bilharziasis were studied for the clinical evaluation of their thyroid function and quantitative estimation of serum thyroid hormones T[3] and T[4] using enzyme immunological tests. All were clinically euthyroid. Both hormones were significantly lower in the patients group compared to a control group of twenty male. The results were discussed