AIM:The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration.MATERIAL AND METHODS:In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well.RESULTS:The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren’t any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention.CONCLUSIONS:Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.
Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis (PD). The study aimed to analyze the peritonitis rate, the cause, the outcomes, and the association of peritonitis with the survival of patients on peritoneal dialysis. Patient data were collected retrospectively from medical charts. A total of 96 patients received peritoneal dialysis in the PD center from 1 January 1999 to 31 December 2018. Episodes of peritonitis (n=159) were registered in 54 (56.3%) patients. The study population was divided into two groups, a group of patients (n=54) who experienced peritonitis and a group of patients free of peritonitis (n=42). The peritonitis rate was 0.47 episodes per patient year. The majority of causative microorganisms were gram-positive bacteria (53.5%). Outcomes of the episodes of peritonitis were resolved infection in 84.9% of episodes, catheter removal in 11.3% of episodes, and death in 3.8% of the episodes of peritonitis. A Kaplan–Meier analysis and log-rank test revealed that the group with peritonitis tended to survive significantly longer than the peritonitis-free group. A 67% reduction rate in the risk of patient mortality was observed for the peritonitis group compared with the peritonitis-free group (hazard ratio: 0.33, 95% CI 0.19-0.57, P=0.000). The prevention and management of PD-related infections, resulted in their worldwide reduction, supporting the use of PD as a first-line dialysis modality.
The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition. Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task. Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years. On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51.5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated.
Introduction:Surgery is supposed to modulate the production of carbon monoxide by the reduction of heme oxygenase activity or transcriptional regulation of inducible heme oxygenase. On the other hand, the inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Furthermore, methemoglobin is maintained at a constant level. However, excessive production of methemoglobin relative to total methemoglobin reductase activity results in methemoglobin increase.Aim:The aim of our study was to investigate the perioperative variations of carboxyhemoglobin and methemoglobin during urologic surgeries, and at the same time to evaluate the changes in methemoglobin as a possible indicator of nitric oxide generation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemoglobin and methemoglobin and the influence of blood transfusion on their changes.Material and methods:The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18–60 years without any history of respiratory disease, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels were determined preoperatively, after preoxygenation, and postoperatively.Results:COHb levels were decreased postoperatively in both groups. The average values of COHb between the two groups were statistically significantly different (p=0.00). MetHb levels increased postoperatively in the group of smokers and decreased in the group of non-smokers. There were no statistically significant differences in the average postoperative MetHb levels between the two groups.Conclusion:Changes in carboxyhemoglobin and methemoglobin concentrations in arterial blood occur during urologic surgery, although these amplitudes are small when compared with carbon monoxide intoxication and methemoglobinemia. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during urologic surgery.
Introduction: The inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Determination of the level of carboxyhemoglobin and methemoglobin can identify patients with increased risk for development of postoperative pulmonary complications. Material and Methods: Thirty patients scheduled for elective urologic surgery under general endotracheal anesthesia were allocated in two groups (n = 15 each). The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both group's carboxyhemoglobin and methemoglobin levels were determined preoperatively, after preoxygenation, and one hour after completing the anesthesia. Postoperative pulmonary complications were assessed and recorded during the period of hospitalization. Results: The average values of carboxyhemoglobin between the two groups were statistically significantly different. Postoperative carboxyhemoglobin was higher in smokers compared to control non-smokers group (p = 0.000). On the other hand, methemoglobin was higher in the control non-smokers group compared to smokers, but without statistical significance (p = 0.88). Regarding postoperative pulmonary complications, 13.3% of the patients in the control non-smokers group and 26.6% of the patients in smokers group had pulmonary complications. Conclusion: In our sample there was a difference between the incidence rates of postoperative pulmonary complications; however, we cannot confirm the hypothesis that carboxyhemoglobin and methemoglobin can serve as predictors for postoperative pulmonary complications.
Multicystic dysplastic kidney is a rare congenital anomaly of the kidney and urinary tract. The association with the posterior urethral valve is also very rare. Here we present a patient with both entities and prenatal resolution of the cysts. A 10-week old baby was referred for nephrourological work up due to prenatal diagnosis of the left multicystic kidney. He had serial US scans during the pregnancy. Immediately before delivery the cysts were not seen (prenatal resolution). There were no extrarenal anomalies. The first postnatal ultrasound scan revealed normal sized right kidney without dilatation of the pelvicalyceal system. The bladder had normal thickness of the wall. Technetium-99m dimercaptosuccinic acid scan showed no activity on the left side, and the right kidney appeared normal. At two months of age, a poor urinary steam was observed and additional urologic work up was indicated on clinical suspicion of PUV. Voiding urethrocystography revealed posterior urethral valve and the baby underwent cytoscopic valve resection. Conclusion: We present a rare association of two congenital anomalies of the kidney and urinary tract with prenatal involution of the multicystic dysplastic kidney that is extremely rare event as seen in our case. Presence of posterior urethral valve must be suspected in a male baby with a poor urinary stream even when his ultrasound scan of urinary system appears normal.
A clinical case of a post-castration complication in a bitch is reported. In the paralumbar region, a fistula-forming granuloma located caudally to the left kidney was observed. Granuloma was formed around a piece of multifilament non-absorbable thread used for ligature during an ovariohysterectomy performed two years ago. The operative removal of the granuloma was accompanied by left nephrectomy. The post operative period was smooth and 4 months later, the dog was clinically healthy.
Aim: aim of the study was to evaluate the efficiency of two different surgical treatments of vesicoureteral reflux (VUR) on succesfull rate and patient outcome. Methods: Retrospective study on children with primary VUR and their surgical treatment from 1999 to 2014 in the University Clinic for Pediatric Surgery in Skopje. A total of 76 children (114 ureters) with VUR ranging from second to fifth grade were treated surgically, 44 patients (67 ureters) with an open surgical technique and 32 patients (47 ureters) with endoscopic treatment "STING" procedure. The following parameters were analyzed: duration of the intervention, duration of the hospitalization, the need for antibiotics and analgesic therapy and the need for blood and blood derivatives transfusion. The result of the surgical treatment was also validated. A good result was considered when reduction of VUR by 2 degrees with the endoscopic method or by 3 degrees in the open surgical technique was noticed. Results: Using open surgical technique, patients were hospitalized for an average of 9 days (range from 5 to 13 days). All children received double antibiotic therapy. The need for analgesics lasted for 3 to 4 days. 90% of treated children needed blood and/or blood derivatives transfusion. Success rate with this method was 93.8%. Endoscopic procedure was performed as a one-day surgical procedure. The average duration was 15 minutes. Single, prophylactic dose of antibiotic was ordinated. There was no need for blood and/or blood derivatives transfusion. The overall success of the treatment was about 70%. Conclusion: Open surgical procedure is used for more complicated cases, VUR grade IV-V or by previously failed. Endoscopic, "STING" procedure was commonly used for patients with VUR grade greater than 2, after previously failed conservative treatment, febrile urinary infection despite antibiotic prophylaxis and/or emergence of new scarring in the renal parenchyma. Patient assessment and decision for what method will be used must always be done individually for each child.
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