Epidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery.

Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia. We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. Both groups received paracetamol and patient controlled analgesia with fentanyl for three days. Primary outcomes were numerical rating scores for pain (rest and dynamic over 72 hours) and total fentanyl use; complications and satisfaction scores were also noted. The study was terminated early after 42 patients had been randomised (epidural n=19; transversus abdominis plane block n=22; one excluded). No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed.

[Congenital melanocytic nevi: a study of 23 cases at a health center]. / Nevus melanocíticos congénitos: un estudio de 23 casos en un centro de salud.

OBJECTIVE: The purpose of this study was to further understand congenital melanocytic nevus. PATIENTS AND METHODS: For this purpose, the cases of 1,265 subjects that had consulted a general practitioner and pediatrician in a primary care center were studied. RESULTS: We found that the prevalence of small congenital melanocytic nevi (SCMN) was 1.8% in the 1,265 subjects examined. The male/female ratio was 9/14 with an age range between 1 and 14 years and a modal interval from 5 to 9 years. The location was preferentially found on the trunk (39.1%). In 29.4% of the prepubertal and 66.6% of the postpubertal subjects the diameter was greater than or equal to 1.5 cm. Raised texture was found in 65.2% and hairy in 34.8%. There was an association between the raised texture and the prepubertal stage. CONCLUSIONS: We conclude that the prevalence of CMN was 1.8%, with all being SCMN.

[Prevalence of intestinal parasites in a student population]. / Prevalencia de parasitosis intestinales en una población escolar.

OBJECTIVE: We performed a transversal descriptive study to know the prevalence of intestinal parasites of our children's community. A 891 fecal sample analyzed from an equal number of apparently healthy children, whose ages were between 5-14 years old, randomly selected by stratified sampling by years old. RESULTS: The study included 297 children of which 133 were parasitized. The percentage of parasitization obtained was of 44.78%; no differences with regard to sex. The 16.53% was poly-parasitic. The mean age of the parasitized subjects was 9.3 years old. The species encountered by decreasing frequency were: Giardia lamblia (36.36%), Entamoeba coli (10.43%), Entamoeba hartmanni (2.02%), Endolimax nana (1.34%), Enterobius vermicularis (1.34%), Ascaris lumbricoides (0.67%) and Trichuris trichiura (0.67%). CONCLUSIONS: The frequency of intestinal parasites is high in school-age children, probably due to the mid-low to low socioeconomic level to which this age-group belongs. The most-found parasite was Giardia lamblia. Significant differences (p <0.001) were only seen between the mean ages of parasitized subjects of Giardia and Entamoeba coli.

[Systemic amyloidosis: clinico-pathologic study of 69 cases]. / Amiloidosis sistémicas: estudio clínico--patológico de 69 casos.

A series of 69 cases of systemic amyloidosis is discussed (12 primaries; 7 due to myeloma; 44 reactive; 5 due to familiar mediterranean fever and 1 portuguese familiar polyneuropathy) in which their clinical aspects, topographical distribution of the deposit and histochemical characteristics are studied using the potassium permanganate technique. According to sings and symptoms of presentation and topography there is a remarkable overlapping in the five types of amyloidosis. Only macroglossia was more frequent in primary amyloidosis (p less than 0.001). However the potassium permanganate technique can help in the classification. Considering the first clinical diagnosis. 83% of primary amyloidosis and 100% of amyloidosis due to myeloma, were resistant to permanganate. 84% of reactive amyloidosis and 100% of familiar mediterranean fever, were sensitive. The only case of portuguese familiar polyneuropathy showed resistance.