Effect of scalp infiltration with lidocaine on the circulatory response to craniotomy.

BACKGROUND: The purpose of the present study was to evaluate the influence of infiltration anesthesia of the projected line of incision in the skin of head on the hemodynamic response of the circulatory system, and the essential dose of opioids in 100 patients who underwent craniotomy. MATERIAL AND METHODS: The patients were divided into 4 groups: IA - brain tumors, no infiltration anesthesia; IB - cerebral aneurysms, no infiltration anesthesia; IIA - brain tumors + infiltration anesthesia; IIB - cerebral aneurysms + infiltration anesthesia. In the patients from groups IIA and IIB, the projected line of skin incision was injected with a 1% lidocaine solution (9.94+/-1.95 ml) five minutes before commencing surgery. RESULTS: No statistically significant differences were found between the various groups in regards to their weight, the time between infusion of the first dose of fentanyl and skin incision, the mean heart rates at time points T1 (prior to induction of anesthesia), T2 (prior to skin incision) or T3 (after skin incision), or mean arterial pressure values (MAP) at time points T1 or T2. A significant increase in MAP values (P<0.05) caused by skin incision was recorded in groups IA (from 95.2+/-9.85 to 119+/-10.6 mm Hg) and IB (from 88.4+/-11.5 to 100.3+/-11.4 mm Hg). In group IIA, MAP increased insignificantly, while in group IIB the MAP values did not change. CONCLUSIONS: Infiltration anesthesia of the projected line of skin incision in the head enabled maintenance of stability in the circulatory system and lower doses of opioids administered before commencing surgery.

Necrotising enterocolitis (NEC)--methods of treatment and outcome: a comparative analysis of Scottish (Glasgow) and Polish (Western Pomerania) cases.

AIM OF THE WORK: The aim of the work was to compare methods of treatment and outcome in newborns with necrotising enterocolitis (NEC) in two regional centres. METHODS: Medical files of 125 newborns with NEC, treated from 1990 to 1995 in two centres--Royal Hospital for Sick Children, Glasgow, Scotland, and Western Pomerania, Poland have been analysed retrospectively. The following criteria have been studied: birth weight, gestational age, sex, risk factors, initial NEC symptoms, time of onset of the disease, x-ray findings, NEC staging, treatment protocols, outcome and complications. RESULTS: The overall mortality was 32.8%; 34.4% in Glasgow vs. 31.3% in Pomorze. Higher incidence of NEC in the group of full-term babies was observed: 31.2%. Drainage under local anaesthesia was performed in 27 Scottish newborns; none of the Polish babies were treated by this method. CONCLUSIONS: The overall results of different treatment protocols in both centres are similar. However, Scottish newborns tended to be younger, smaller and more severely ill. Less aggressive treatment-- i.e. peritoneal drainage can be a successful alternative for these tiny, very sick babies.

[NEC--neonatal necrotising enterocolitis--methods of treatment and outcome: a comparative analysis of Scottish (Glasgow) and Polish (Western Pomerania) cases]. / NEC--obumierajace zapalenie jelit noworodka--sposób postepowania i wyniki leczenia: analiza porównawcza materialu szkockiego (Glasgow) i polskiego (Pomorze Zachodnie).

The aim of the work was to perform a comparative analysis of medical files of 125 neonates with necrotising enterocolitis treated between 1990 and 1995 in two regional centres: Glasgow (Scotland) and Western Pomerania (Poland), and to search for factors constituting an indication for surgery in NEC. The following data contained in the medical documentation of NEC cases have been analyzed: maternal risk factors, perinatal abnormalities, neonatal risk factors, procedures performed in the neonate, feeding practices, clinical and radiological signs, time of onset of the disease, clinical staging of NEC according to Bell (modified by Walsh and Kliegman), methods of treatment, postoperative course and outcome. The analysis was performed in the whole material and in the subgroup of newborns weighing < 1500 g (low/extremely low birth weight babies). Glasgow neonates with NEC had significantly lower birth weight, gestational age, platelet count, and sodium level when compared to Pomeranian newborns, while the latter had significantly lower leukocyte count and shorter time of onset of the disease. In the subgroup of newborns weighing less than 1500 g, Glasgow neonates had significantly lower birth weight, gestational age, platelet count, and sodium level when compared to Pomeranian newborns, while the latter had significantly lower 1 minute Apgar score, pH and base excess (BE) values. Glasgow clinical NEC stage was significantly more severe (IIB-IIIB) when compared to Pomeranian neonates. A higher proportion of full-term neonates in the present study--31.2%--was diagnosed with NEC than in the literature. Hyponatremia with severe acidosis and low platelet count (especially below 100 x 10(9)/L) may constitute an easily available laboratory finding serving as an indicator for surgical intervention in NEC. Statistical analysis revealed that the selection of treatment was influenced in the Glasgow group by birth weight and in the Pomeranian group by the clinical stage of NEC. Overall mortality was 32.8% in the whole group of 125 neonates, 34.4% in the Glasgow and 31.2% in the Pomeranian group. However, Glasgow neonates had significantly lower birth weight and gestational age and were more severely ill. The mortality in the subgroup of Scottish neonates with primary peritoneal drainage was 55.5%, the majority presenting with significantly lower birth weight and stage IIIB of necrotising enterocolitis. In conservatively treated neonates, mortality was 13% in the whole group, 9% in the Glasgow group and 15% in the Pomeranian group. Overall mortality in neonates treated surgically was 46.6%. In the Glasgow group it was 23% without and 42% with primary peritoneal drainage, respectively. Surgical mortality in the Pomeranian group was 42%. Overall mortality was 5.6% in full-term newborns, 3.2% in the Glasgow group and 7.8% in the Pomeranian group. Primary peritoneal drainage is a valuable, mildly invasive method of initial, and in some cases final, treatment in severely ill NEC babies, especially with low birth weight. This method was not used in the Pomeranian group.

[A rare case of intracranial hematoma complicating bacterial endocarditis]. / Rzadki przypadek krwiaka wewnatrzczaszkowego w przebiegu bakteryjnego zapalenia wsierdzia--opis przypadku.

Endocarditis is an infectious and inflammatory disease of cardiac valves with other coexisting symptoms affecting heart and other organs and systems. Patients with cardiac valves diseases are in the group of high risk. The authors present a case of successfully treated endocarditis affecting mitral valve prosthesis in the course of staphylococcus septicaemia complicated by intracranial haematoma.