Axillary nerve block in comparison with intravenous midazolam/fentanyl for painless reduction of upper extremity fractures

The painful nature of fractures has made it inevitable to use various anesthetic techniques to reduce or immobilize fractured parts. In the present study, axillary nerve block was compared with intravenous midazolam/fentanyl to induce anesthesia for Painless Reduction of Upper Extremity Fractures. The subjects in the present clinical trial consisted of 60 patients with upper extremity fractures. They were randomly divided into two equal groups of intravenous sedation [IVS] with midazolam/fentanyl and axillary nerve block [ANB]. Rate of anesthesia induction, recovery time, and pain intensities at baseline, during the procedure and at the end of the procedure were recorded in both groups. Data was analyzed and compared between the two groups with SPSS 18 statistical software using appropriate tests. Demographic data, vital signs and means of pain intensities at the beginning of the procedure were equal in the two groups. In the IVS group, the overall duration of the procedure was shorter with more rapid onset of anesthesia [P<0.05]. In contrast, the recovery time was much shorter in the ANB group [P<0.001]. No life or organ threatening complications were observed in the two groups. Axillary nerve block can be considered an appropriate substitute for intravenous sedation in painful procedures of the upper extremity

Frequency of hyponatremia in gastroentric patients treated with intravenous hypotonic fluid

Acute gastroenteritis [AGE] is one of the most common infectious illnesses of childhood. While no treatment is needed for self-limited virus-induced AGE, dehydration caused by diarrhea and emesis is of great concern and should be treated vigorously. However, there is no consensus on the most appropriate electrolyte composition of intravenous fluids; therefore, according to basic protocols in our hospital which suggest hypotonic fluid therapy for AGE, investigators aimed to assess the frequency of hyponatremia in gastroenteritis patients treated with intravenous hypotonic fluid therapy. This descriptive observational study was conducted at 17 Shahrivar Pediatrics Hospital between September 2008 and January 2011. The patients' medical records were assessed and children aged between 1 month and 14 years with a diagnosis of gastroenteritis and dehydration were enrolled in the study. According to sodium concentration at TO, patients were divided into three groups: hyponatremic, hypernatrmic and isonatremic. The blood samples were analyzed for the sodium concentration at TO and during 24 hours. Statistical analyses were performed by T test and chi-square using SPSS18 and statistical significance was defined as a p-va/ue less than 0.05. The mean age of the participants was 16.43 +/- 11.1 months; 58 patients were male [67.4%] and 28 were female [32.6%]. At TO, 35 patients [40.7%] were hyponatremic, 2 patients [2.3%] were hypernatremic and 49 patients were isonatremic. Sodium concentration in the hyponatremic and isonatrmic group were 137.25 +/- 1.9 and 138.29 +/- 2.04 mEq/L respectively which showed a significant difference [p=0.028]. Our study showed that increased sodium intake could decrease acquired hyponatremia. It seems that hyponatremia could be prevented by administering high sodium concentration fluids

Huge myxoid liposarcoma of the esophagus: a case report

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare