RESUMO
Demirsoy U, Alparslan B, Sen MC, Anik Y, Akansel G, Görür G, Gürel B, Aksu G, Çorapçioglu F. More than Ophelia syndrome: Multiple paraneoplastic syndromes in pediatric Hodgkin lymphoma. Turk J Pediatr 2019; 61: 139-141. Paraneoplastic syndromes in Hodgkin lymphoma (HL) can be seen with different symptoms and organ findings within a significant time before definite diagnosis of the primary disease. Achalasia, Holmes-Adie pupil, and limbic encephalitis are rarely reported paraneoplastic components in pediatric HL. In this report, we present an 11-year-old girl who had all these three paraneoplastic components synchronously before HL was identified.
Assuntos
Síndrome de Adie/etiologia , Acalasia Esofágica/etiologia , Doença de Hodgkin/diagnóstico , Encefalite Límbica/etiologia , Síndromes Paraneoplásicas/diagnóstico , Criança , Feminino , HumanosRESUMO
BACKGROUND AND AIMS: Hypospadias is a common congenital malformation in pediatric patients. Surgical repair of this malformation is a painful procedure and has long-term effects. Pudendal and penile nerve blocks are commonly preferred techniques for maintaining postoperative analgesia. However, the conventional landmark-based penile block technique involves numerous potential complications and provides a shorter analgesic period compared to the pudendal block. A promising ultrasound-guided dorsal penile nerve block was recently described. We aimed to compare the analgesic effectiveness of ultrasound-guided penile nerve block with that of neurostimulator-guided pudendal nerve block. METHOD: Thirty-three patients aged 1-7 years were included in this prospective, double-blinded, randomized controlled trial. Patients were divided into two groups and received either ultrasound-guided dorsal penile nerve block or neurostimulator-guided pudendal nerve block. All blocks were performed by the same two anesthesiologists, and the same surgeons performed the surgical procedures. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale was used for postoperative pain management. The primary outcome of the study was time to first analgesic requirement. Secondary outcomes were FLACC scores at different time points, and types and cumulative doses of analgesic drugs. RESULTS: Dorsal penile nerve block provided longer analgesia than pudendal nerve block (32.29 ± 5.47 hours and 21.13 ± 3.53 hours, respectively; differences in mean: 11.16, 95% CI: 7.873-14.465) (P < .001). FLACC scores at the time of first analgesic requirement were significantly lower in dorsal penile nerve block group than pudendal nerve block group (median [IQR]: 2 [2-2.5] and 3 [3-5], respectively; differences in median: -1, 95% CI: -1.851 to -0.149) (P < .001). CONCLUSION: Ultrasound-guided dorsal penile nerve block provided a longer analgesic period and reduced opioid consumption compared to neurostimulator-guided pudendal nerve block.
Assuntos
Anestésicos Locais/administração & dosagem , Hipospadia/cirurgia , Bloqueio Nervoso/métodos , Nervo Pudendo/efeitos dos fármacos , Ultrassonografia , Analgesia , Criança , Pré-Escolar , Humanos , Masculino , Pênis/diagnóstico por imagem , Estudos Prospectivos , Distribuição AleatóriaAssuntos
Neoplasias Renais/patologia , Neoplasias Testiculares/secundário , Tumor de Wilms/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pré-Escolar , Humanos , Neoplasias Renais/terapia , Masculino , Doenças Raras , Tomografia Computadorizada por Raios X , Tumor de Wilms/terapiaRESUMO
STUDY OBJECTIVE: To evaluate and compare the analgesic effect of ultrasound-guided erector spinae plane (ESP) block with ultrasound-guided Quadratus Lumborum Block in pediatric lower abdominal surgeries. DESIGN: Randomized, prospective, double-blinded trial. SETTING: Operating room and surgical ward. PATIENTS: Sixty patients, aged 1 to 7â¯years with ASA scores of I-II scheduled for elective lower abdominal surgery were included in the study. INTERVENTIONS: Patients were randomized into two groups as ESPB group and QLB group. Ultrasound guided ESP block at L1 vertebral level was performed preoperatively using 0.5â¯ml/kg 0.25% bupivacaine (max 20â¯ml) to the patients in ESPB group. And ultrasound guided QLB block with transmuscular approach was performed preoperatively using 0.5â¯ml/kg 0.25% bupivacaine (max 20â¯ml) to the patients in QLB group. MEASUREMENTS: Face, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 3 and 6â¯h postoperatively. Analgesic requirements and time to first analgesic requirement were also recorded. MAIN RESULTS: Fifty-seven patients were included in the final analyses. No significant difference was determined between the groups' FLACC scores at 0, 1, 3 or 6â¯h postoperatively (pâ¯>â¯0.05). No significant difference was also determined in times to first analgesia between the groups (pâ¯>â¯0.05). CONCLUSIONS: This study shows that the ESPB provides similar postoperative analgesia to the QLB in pediatric patients undergoing lower abdominal surgery. Clinicians could decide according to their clinical experiences. CLINICAL TRIALS: https://clinicaltrials.gov/ct2/show/NCT03463382.
Assuntos
Abdome/cirurgia , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Bloqueio Nervoso/métodos , Músculos Abdominais/inervação , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais/inervação , Estudos Prospectivos , Ultrassonografia de IntervençãoRESUMO
The aim of this experimantal study which is applied on rats, is to determine the differences on the clotting factors over the application of low and high intraabdominal pressure (IAP) values in different periods of time in carbon dioxide (CO2) pneumoperitoneum. Thirty rats were randomized into five groups (n = 6): a control group (Group K) and 1 h and 6 mm Hg IAP (Group A), 2 h and 6 mm Hg IAP (Group B), 1 h and 12 mm Hg IAP (Group C) and 2 h and 12 mm Hg IAP were created with CO2 pneumoperitoneum (Group D). At the end of the experiment, plasma samples taken from subjects and fibrinogen, FII (prothrombin), FV, FVII, FVIII, FIX, FX, FXI, FXII, von willebrand's factor (vWF), ristocetin cofactor, protein C, protein S, antithrombin III (AT III) levels are studied. There were statistically significant differences in the mean levels of FII, FV, FVII, FVIII, FIX, FX, FXI, FXII, and protein S between the groups. A hypercoagulable state occurred with the following: increase in the coagulation parameters compared to the control group; increase in FVII in the group only Group C; decrease in AT III in all groups compared to the control group; decrease in protein C in the group only XII Group D compared to control group; decrease in protein S in all groups except group D compared to control group. CO2 insufflation predisposes to thromboembolic events both by inducing coagulation factors and by suppressing the fibrinolytic system contrary to the controversies in the literature.
RESUMO
Ewing sarcoma (ES) is a malignant neoplasm usually affecting the skeletal system. Extraskeletal ES is a rare tumor. To date, only 1 case of primary mesocolon ES has been previously reported in an adult. Herein, we present the first case of ES in the mesocolon in a child.