Background
Pneumoperitoneum is defined as the presence of free air in the peritoneal cavity. It is a surgical emergency that represents in 90% of the cases with a hollow viscus perforation and its feared consequences of sepsis and death. On the other hand, spontaneous pneumoperitoneum is a benign surgical entity occurring in newborns that requires no surgical intervention.
Cases presentation
In this series, we report three cases of benign spontaneous pneumoperitoneum in neonates treated at Jordan University Hospital between 2004 and 2021. Two of them were treated by exploration laparotomy but no gross pathology could be identified; one case was successfully treated conservatively with observation alone.
Conclusion
This case series recognizes the presence of such entity which can be treated conservatively, eliminating the unnecessary burden of morbidity and mortality of surgery in such age group.
Primary cutaneous lymphoma is a heterogeneous group of diseases. Primary cutaneous CD4+ small/medium Tcell lymphoma (CD4+ SMTCL) is one of the rare subtypes; representing only 2-3% of all cutaneous lymphomas. It was recently described as lymphoproliferative disorder because of its indolent clinical behavior and many similarities with cutaneous pseudolymphoma. This disease is a provisional entity according to latest World Health Organization (WHO) classification of hematolymphoid tumors. CD4+ SMTCL has a n excellent 5-year survival of 60-85%. CD4+ SMTCL usually present with a solitary skin lesion of the head and neck region, and most of reported cases were treated with local managements only. The common clinical presentations and histological features are still not well understood, and no optimal therapy is established. We report a case of primary cutaneous CD4+ small/medium Tcell lymphoma, our patient presented with a facial skin lesion that was treated with excision only.
Objective
We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers.
Background
The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12–14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines.
Methods
A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8–10 mmHg) vs. standard-pressure (12–14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022).
Results
one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons.
Conclusion
low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care.
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