[Effect of a single intramuscular dose of dexamethasone on pain after circumcision. A randomized controlled study]. / Effet d'une dose unique intramusculaire de déxaméthasone sur la douleur après circoncision. Étude randomisée contrôlée.

OBJECTIVE: To assess the effect of a preoperative single dose of dexamethasone associated with penile block on pain after circumcision. STUDY DESIGN: Prospective randomized controlled study. PATIENTS AND METHODS: Forty male children aged 2 to 5 years, scheduled for circumcision under general anaesthesia, combined with penile block, were randomized into two groups. The dexamethasone group received dexamethasone 0.4 mg/kg preoperatively. The control group received the same volume of normal saline. Data compared between two groups were: postoperative pain assessed by the Objective Pain Scale collected in the recovery room, at 8 and 24 hours postoperatively (h0, h8 and h24), time to first analgesic request and the quality of sleep on the first postoperative night. RESULTS: Pain scores at h0 were similar between the two groups. The dexamethasone group showed significantly lower pain scores at h8 [0 (0-1) vs. 2 (0-3); P=0.04] and h24 [0 (0-0) vs. 0 (0-1); P=0.02]. The time to first analgesic administration was also significantly delayed in the dexamethasone group compared to the control group (240 vs 180 min; P=0.035). The quality of sleep was also better in children in the dexamethasone group (P=0.018). CONCLUSION: This study showed that the combination of a preoperative single dose of dexamethasone 0.4 mg/kg with penile block significantly improves the quality of analgesia after circumcision.

[Therapeutic problems of hydatic cyst in the liver dome: 120 cases]. / Prise en charge des kystes hydatiques du dôme du foie: à propos de 120 cas.

Our work plans to study problems of the hydatic cyst of the dome on the double therapeutic aspect and prognosis through a 120 study cases collected over a period of 19 years. In this retrospective study, the predominance is male 65.5% with an average of age of 36 years. The diagnosis is often carried late to the stage of complication (biliary rupture in 13 cases and pleurale at 4 invalids) or fortuitously. The pain of the right hypochondre is found in 79.16% of cases. The scanner remains the method of choice for the positive diagnosis. The tomography plays an important role in the exact topographic diagnosis and the count of cysts. Cysts were multiple in 41% of cases. The treatment is surgical. We deplore two death in this series and the morbidity was dominated by subphrenic abscess, pleuresie, biliary escapes, the suppuration of the residual cavity and the prolonged hyperthermy.

[Acute superior mesenteric vein thrombosis. A retrospective study of 9 patients]. / Thrombose aiguë de la veine mésentérique supérieure. Etude rétrospective de neuf cas.

AIM OF THE STUDY: To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. PATIENTS AND METHODS: Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. RESULTS: Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. CONCLUSION: Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.