Chronic intestinal pseudo-obstruction in newborn: a case report

Chronic intestinal pseudo-obstruction (CIPO) is a rare and serious disorder of the gastrointestinal tract motility with the primary defect of impaired peristalsis. Symptoms are consistent with a bowel obstruction, although mechanical obstruction cannot be identified. It is a rare differential diagnosis for neonatal intestinal obstruction. Herein we report a case of neonate with non-resolving intestinal pseudo-obstruction, presenting since birth as progressive abdominal distention. The diagnosis was made by exclusion of mechanical causes of intestinal obstruction via thorough imaging studies.

Anticoagulation for cerebral venous thrombosis with subarachnoid hemorrhage: a case report

To report the success of anticoagulation [AC] treatment in a case of cerebral venous thrombosis [CVT] with subarachnoid hemorrhage [SAH] in view of the limited evidence seen in the literature supporting such a treatment option. A 38-year-old lady with CVT and SAH presented 12 h after the onset of symptoms. AC with low-molecular-weight heparin was started 4 days later, when the repeated brain CT showed regression of the SAH. Heparin was changed to warfarin, and she was asymptomatic over a 12-month follow-up period. In a limited number of small studies, AC has been found to be beneficial for cases of CVT with hemorrhagic complications. The proper time to start AC in such cases was not clearly defined, and a delay of 4-33 days was observed after the onset of symptoms. In cases of spontaneous intracranial hemorrhage [ICH] in general, active bleeding is usually confined to the first 6 h, and chances of hematoma enlargement are higher in the first 24 h. On the other hand, it has been advised to rule out a coincidental vascular malformation and to radiologically confirm regression [or at least non-progression] of the ICH before starting AC. AC for cases of CVT may remain beneficial in the presence of SAH. The time to start AC for CVT with hemorrhagic complications is unclear; however, AC was successful when given 4 days after the onset of symptoms in our case. It may be wise to repeat CT after at least 24 h from the onset of symptoms [to confirm regression or at least non-progression of the ICH] before starting AC. It may also be prudent to perform magnetic resonance angiography, or digital subtraction angiography to rule out a coincidental intracranial aneurysm before AC

role of arthroscopic acromioplasty in the treatment of chronic impingement syndrome in elderly age group

Twenty five cases of chronic impingement syndrome above 50 years of age whether associated with partial thickness rotator cuff tears or not are included in this study. The most common presenting symptoms are night pain and weakness. The most important signs are impingement sign and impingement injection test. Radiological examination shows Type III and Type II acromion in almost all cases. All these cases had at least three months course of conservative treatment but with no improvement. All cases were assessed using UCLA scoring system. All cases were treated by arthroscopic technique starting with arthroscopic subacromial bursectomy, then release of coracoacromial ligament and then excision of the anterior acromion. Most cases showed marked improvement as regard pain and function score. Twenty one cases had satisfactory results while four cases unsatisfactory results, Thus, arthroscopic acromioplasty proved to be as effective as open technique with better cosmesis, shorter hospital stay and preservation of deltoid attachments

anti-pruritic effect of ondansetron after epidural morphine

Pruritus is a common and difficult to treatsideeffectafterneuraxialopioidadministration. We investigated ninety [90]patients with pruritus [more than '4' onvisual analog scale on which '0' representsno pruritus and '10' represents the worstimaginable pruritus] after 3mgepiduralmorphine in a randomized, double- blindand placebo-controlled study. The patientswere divided into two groups [45 patientseach] according to the drug given to treatpruritus: group"O" given 8mg ondansetronin 100 ml of 0.9%Nacl [ondansetron group]and group"C" given 100 ml of 0.9%Naclonly [control group]. A decrease in pruritusscore more than '4' points on visual analogscale [VAS], within 60min. after starting thetest infusion, was considered a treatmentsuccess. Hemodynamicchanges[arterialblood pressureandheartrate],arterialoxygen saturation [SaO2], changes in thelevel of pain andsedation and other sideeffects were checked regularly during thestudy period [24hrs]. Residual pruritus orrecurrence ofpruriticsymptomswerereportedduring24hrsfollowingthetreatment. We found a significantly highertreatmentsuccessrateingroup"O"comparedtogroup"C"[75%and%respectively],[p<0.05].Also,therecurrence rate of pruritus within 24hrs afterneatment was significantly lower in group"O" than group "C" [9%and40% respectively][P<0.05]. There was no significant difference [p>0.05] between the two groups regarding: the severity of pruritus, hemodynamic effects, pain and sedation scores or in the side effects. Among the successfully treated patients, none complained of residual pruritus 24hrs after treatment. So, 8mg ondansetron given by intravenous infusion is an effective treatment of pruritus associated with epidural morphine. It is safe and well tolerated in this clinical situation