<strong>I</strong><strong>ntroduction:</strong> Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our e...<strong>I</strong><strong>ntroduction:</strong> Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. <strong>Material and Methods:</strong> This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. <strong>Result:</strong> We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. <strong>Conclusion:</strong> Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.展开更多
Introduction: Study compare spinal anesthesia using hyperbaric bupivacine (0.5% - 0.75%) between fixed dose and height adjusted dose during elective cesarean section. Methods: Hundred parturients who had given their c...Introduction: Study compare spinal anesthesia using hyperbaric bupivacine (0.5% - 0.75%) between fixed dose and height adjusted dose during elective cesarean section. Methods: Hundred parturients who had given their consent and were scheduled for elective cesarean section under spinal anesthesia, were divided into four groups—first group received 0.5% hyperbaric bupivacine fixed dose, the second group received 0.5% hyperbaric bupivacine in a dose adjusted to the height, the third received 0.75% hyperbaric bupivacine fixed dose, the fourth group received 0.75% hyperbaric bupivacine in a dose adjusted to height. The anesthesia onset time, haemodynamic changes, side effects and fetal outcome observed. Results: Spinal block provide excellent surgical anesthesia in all patients. Anesthesia onset time is longer in adjusted than fixed groups, in 0.5% (5 ± 0.816 vs. 3.84 ± 0.746) (P Conclusion: Adjusting dose of hyperbaric bupivacine (0.5% - 0.75%) to patient’s height, decreases the dose of bupivacine in use, it also provide adequate anesthesia for elective cesarean section with decrease the use of vasopressors, the incidence and severity of maternal hypotention also markedly reduced.展开更多
AIM： To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS： A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure...AIM： To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS： A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.RESULTS： The indications included intradiverticular papilla in 26 patients （49%）, stenosis of a previous sphincterotomy in 19 patients （35.8%）, small size of the papilla in 4 patients （7.5%）, Billroth R gastrectomy in 3 patients （5.6%）, and coagulopathy in one patient （1.9%）. The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients （39.6%） had calculi with a diameter equal to or greater than 10 ram. Seven patients （13.2%） presented complications： haemorrhage in 1 patient （1.9%） and mild pancreatitis in 6 patients （11.3%）. The mean hospital stay in case of complications was of 3 ± 0.63 d.CONCLUSION： Sphincteroplasty is highly effective, with a compllcation rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.展开更多
Background: There is a debate about the dose of hyperbaric bupivacine for spinal anesthesia for cesarean delivery in obese parturients. While it is concessive that the dose of spinal bupivacine is reduced in pregnant ...Background: There is a debate about the dose of hyperbaric bupivacine for spinal anesthesia for cesarean delivery in obese parturients. While it is concessive that the dose of spinal bupivacine is reduced in pregnant compared with non-pregnant parturient due to many factors. But it is still controversial whether local anesthetic should further reduce in obese patients or not. In this perspective, observation study, we tested the influence of BMI on vasopressor requirements and block height. Methods: Three groups of 40 parturients, group A (Body mass index (BMI) 2), group B (BMI 30 - 45 Kg/m2) and group C (BMI > 45 kg/m2) requiring elective cesarean section were recruited all patients received 12.5 mg subarachnoid hyperbaric bupivacine combined with 20 ug fentanyl. Dermatomal levels were assessed after subarachnoid injection using touch sensation at 2 minutes interval for first 10 minutes then every 5 minutes. Vasopressor requirements in the first 45 minutes after subarachnoid injection, and maximum block heights using touch sensation were assessed as primary outcomes. Secondary outcomes were extent of motor block (peak flow rate), technique difficulty (number of attempts), maternal side effects and neonatal outcomes. Results: There was no significant difference in mean blood pressure (MBP) between group A and B but the difference was significant in group C in relation to other two groups, mean number of hypotensive episodes was significantly higher in group C than group A, B with no significant difference in incidence between group A and B (P Conclusion: Sensory testing using touch modality to detect extent of anesthesia, showed at 25 minutes after spinal anesthesia induction, significantly higher level in group C than the other two groups. Vasopressor requirements during the first 45 minutes of spinal anesthesia were not different between group A, B but significantly higher in group C. Time for regression of anesthesia was longer in group C, which may be helpful regarding longer surgical time. Single shots spinal anesthesia of 12.5 mg hyperbaric bupivacine produce clinically equivalent effect in parturients with BMI 2 with no need for dose reduction but caution and dose adjustment recommended in parturients with BMI > 45 Kg/m2.展开更多
<b>Background and Aims:</b> Multiple, nonpharmacological and pharmacological measures have been used for attenuating stress response of intubation with variable results. N-methyl-D-aspartate (NMDA) recepto...<b>Background and Aims:</b> Multiple, nonpharmacological and pharmacological measures have been used for attenuating stress response of intubation with variable results. N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inflammation. NMDA receptors are located in peripheral and the central nervous system. Magnesium is also a NMDA receptor blocker. <b>Aim of the Study:</b> To evaluate the effect of nebulized magnesium sulfate on reduce the stress response induced tracheal intubation <b>Material and Methods:</b> Following institutional ethical committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 100 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery requiring tracheal intubation. Patients will be recruited in the study divided into two equal groups;Patients in Group A: will receive nebulized magnesium sulfate in 3 ml (240 mg) over 15 min. While group B: will receive nebulized normal saline in 3 ml over 15 min, ending 5 min before the induction of anesthesia. SBP, DBP, HR, and blood glucose level will be measured at the following intervals;Baseline (before induction), after premedication (sedation), after induction, after ETT intubation, 3 min later, 6 min later. <b>Results:</b> Preoperative magnesium sulfate nebulization has a significant effect (p value < 0.001) on attenuating the stress response (SBP, DBP, HR, and SBG) to tracheal intubation at the following intervals;post ETT intubation, 3 min later, and 6 min later. <b>Conclusion:</b> Magnesium sulfate significantly reduces the stress response of intubation.展开更多
Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural b...Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.展开更多
BACKGROUND Recent studies in non-colorectal malignancy have associated T resident memory(T_(RM)) cells with improved patient survival. It is unknown if T_(RM) plays a role in colorectal cancer(CRC).AIM To examine the ...BACKGROUND Recent studies in non-colorectal malignancy have associated T resident memory(T_(RM)) cells with improved patient survival. It is unknown if T_(RM) plays a role in colorectal cancer(CRC).AIM To examine the potential role of T_(RM) cells in providing immunogenicity in CRC stratified by microsatellite instability(MSI) and BRAF status.METHODS Patients with known MSI and BRAF mutation status were eligible for inclusion in this study. CRC tumour sections stained with haematoxylin and eosin were microscopically reviewed and the images scanned prior to assessment for location of invading edge and core of tumour. Sequential sections were prepared for quantitative multiplex immunohistochemistry(IHC) staining. Opal Multiplex IHC staining was performed with appropriate positive and negative controls and imaged using a standard fluorescent microscope fitted with a spectral scanning camera(Mantra) in conjunction with Mantra snap software. Images were unmixed and annotated in in Form 2.2.0. Statistical analysis was performed using Graphpad Prism Version 7 and Stata Version 15.RESULTS Seventy-two patients with known MSI and BRAF status were included in the study. All patients were assessed for MSI by IHC and high resolution capillary electrophoresis testing and 44 of these patients successfully underwent quantitative multiplex IHC staining. Overall, there was a statistically significant increase in CD8+ T_(RM) cells in the MSI(BRAF mutant and wild type) group over the microsatellite stable(MSS) group. There was a statistically significant difference in CD8+ T_(RM) between high level MSI(MSI-H):BRAF mutant [22.57, 95% confidence interval(CI): 14.31-30.84] vs MSS [8.031(95%CI: 4.698-11.36)], P = 0.0076 and MSI-H:BRAF wild type [16.18(95%CI: 10.44-21.93)] vs MSS [8.031(95%CI: 4.698-11.36)], P = 0.0279. There was no statistically significant difference in CD8 T cells(both CD8+CD103-and CD8+CD103+T_(RM)) between MSI-H: BRAF mutant and wild type CRC.CONCLUSION This study has shown that CD8+ T_(RM) are found in greater abundance in MSI-H CRC, both BRAF mutant and MSI-H:BRAF wild type, when compared with their MSS counterpart. CD8+ T_(RM) may play a role in the immunogenicity in MSI-H CRC(BRAF mutant and BRAF wild type). Further studies should focus on the potential immunogenic qualities of T_(RM) cells and investigate potential immunotherapeutic approaches to improve treatment and survival associated with CRC.展开更多
This study evaluated biofilm formation and antibiotic susceptibility in 36 clinical S. aureus isolates recovered from orthopaedic patients and detected the presence of intercellular adhesion and adhesin genes. Staphyl...This study evaluated biofilm formation and antibiotic susceptibility in 36 clinical S. aureus isolates recovered from orthopaedic patients and detected the presence of intercellular adhesion and adhesin genes. Staphylococcus aureus was isolated from nasal swab, wound and urine specimens collected from orthopaedic patients in National Orthopaedic Hospital Dala, Kano over a period of three months. The isolates were identified using rapid identification kit for Staphylococcus species. The antibiotics susceptibility of the isolates was determined using modified disc diffusion method. Phenotypically, the biofilm formation was assessed using the Congo red agar method and microtitre plate assay. Polymerase chain reaction (PCR) analysis was used to detect biofilm-associated genes and characterize the isolates. The isolation rate of S. aureus from the samples (n = 134) was 26.8%, mainly from nasal swab (36%) and wound swab (36%). A total of 19 (52.7%) of the isolates showed positive for slime production. Majority of the isolates 29/36 (81.6%) were biofilm positive with only 2 (5.5%) and 5 (13.8%) as strong biofilm-formers and moderate biofilm-formers respectively. Molecular evaluation of the biofilm-associated genes in 12 S. aureus isolates revealed the prevalence of bbp genes (25%), clfA genes (16.6%) and the icaA (8.3%). None of the isolates harboured the fnbA and cna genes. There is no significant difference (P > 0.05) in the antibiotic resistance pattern between biofilm-positive and biofilm-negative S. aureus isolates. This result revealed that phenotypically most of the S. aureus isolates were biofilm formers but few of them chromosomally harbour the biofilm-associated genes.展开更多
<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">An intensive care unit (ICU) is a special unit of a hospital ...<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">An intensive care unit (ICU) is a special unit of a hospital that provides intensive treatment for patients with severe or life-threatening illnesses and injuries, which require constant care and close monitoring with life support equipment. The mortality rate is still very high in most ICUs especially in the developing countries due to late presentation of patients, unavailability of well trained staff and lack of life support equipment. There has not been any previous study on the mortality pattern in ICU of Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA). It is against this background that we embarked on this retrospective descriptive hospital based study of the mortality pattern in ICU of a Tertiary Hospital in Abakaliki, South-eastern Nigeria. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">This is a retrospective descriptive hospital based study. The admission and discharge registers of the ICU ward were used to extract information on biodata, diagnosis, duration and outcome of all admissions from January to December 2019 (12</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">months). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 174 (male 113, female 71) patients were admitted over the 12</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">months period with mean age of 46.31</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">12.28</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">years. Seventy</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">one (40.8%) of the patients died from predominantly stroke, acute abdomen, trauma, sepsis, renal failure, acute diabetic complications and cancer in descending order. Acute diabetic complications had 100% case fatality rate, followed by stroke (71%), renal failure (62.5%), cancer (60%), sepsis (55.5%), acute abdomen (34%) and trauma (23%). The mean duration of ICU admission was 4.2 days for the non-survivors and 6.3 days for survivors. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The ICU mortality rate was high and constituted of mainly stroke, acute abdomen and trauma which are essentially preventable. Female sex, medical diagnosis and ICU admission duration of less than 6 days were associated with higher ICU mortality.</span></span>展开更多
<b><span>Background: </span></b><span>The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective bl...<b><span>Background: </span></b><span>The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective block. These include ropivacaine 0.5% and lidocaine 1.5% with adrenaline.</span><span> </span><b><span>Objective:</span></b><span> To evaluate lidocaine 1.5% with adrenaline as an alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks.</span><span> </span><b><span>Methodology:</span></b><span> This was a 6</span><span>-</span><span>month prospective and randomized study (July 15, 2019 to January 15, 2020) conducted in the Department of Anesthesia at Ignace Deen National Hospital in Conakry, Guinea.</span><span> </span><b><span>Results:</span></b><span> A total of 38 patients were enrolled: 19 in each group. The mean age was 45.8 ± 16.9 years in the lidocaine with adrenaline group compared to 43.9 ± 20 years in the ropivacaine group. The mean onset time in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The mean duration of axillary block was 233.3 ± 57.5 minutes in the lidocaine group versus 260.4 ± 74 minutes in the ropivacaine group (p = 0.21). The performance was identical in both groups with 89.5% of the effective blocks in the lidocaine group and in the ropivacaine group (p = 1). The cost of consumables for the ropivacaine group was 60 euros compared to 15 euros for the lidocaine group.</span><span> </span><b><span>Conclusion:</span></b><span> Lidocaine 1.5% with adrenaline is a good alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks in resource-limited countries.</span>展开更多
Background and Aims: Hypothermia is considered a common problem with anesthesia. Spinal anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intrav...Background and Aims: Hypothermia is considered a common problem with anesthesia. Spinal anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) meperidine with intrathecal (IT) meperidine on the prevention of shivering during spinal anesthesia in patients underwent knee arthroscopy. Aim of the Study: The aim of this work is to study the effect of meperidine either intravenous (IV) vs intrathecal (IT) on controlling postoperative shriving after knee arthroscopy. Materials and Methods: This study will be conducted in accordance with the principles of the ethics committee Benha University hospitals. Full written informed consent will be obtained from all patients before inclusion in the study, and a prospective randomized double-blinded study was conducted in adult patients undergoing knee arthroscopy under spinal anesthesia. Cases are divided into three equal groups (20 patients in each). Group IT: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intrathecal meperidine (25 mg). Group IV: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intravenous meperidine (25 mg). Group C: will receive spinal anesthesia (12.5 mg heavy bupivacaine) only postoperatively. Incidence and degree of shivering (SS), sedation score (RSS), pain score (VAS), hemodynamics, and PONV will be measured at the following intervals: 0 min (once arrived at PACU), 20 min later, 40 min later, 80 min later. Results: Shivering was observed in 0%, 0%, and 10.5% of patients in Groups IT, IV, and C, respectively. There was a significant difference between Group IT and IV compared to Group C (P Conclusion: We concluded that IT meperidine and IV meperidine comparably can decrease intensity and incidence of shivering compared to control group as well as decrease the requirement for additional doses of meperidine for shivering control without any hemodynamic side effect. And intrathecal meperidine showed better postoperative pain control and less postoperative nausea and vomiting (PONV).展开更多
Despite their ubiquitous use for rendering patients unconscious for surgery, our understanding of how general anesthetics cause hypnosis remains rudimentary at best. Recent years have seen increased interest in ＂top-...Despite their ubiquitous use for rendering patients unconscious for surgery, our understanding of how general anesthetics cause hypnosis remains rudimentary at best. Recent years have seen increased interest in ＂top-down＂ cortico-centric theories of anesthetic action. The aim of this study was to explore this by investigating direct cortical effects of anesthetics on cerebrocortical evoked potentials in isolated mouse brain slices. Evoked potentials were elicited in cortical layer IV by electrical stimulation of the underlying white matter. The effects of three anesthetics （ketamine, etomidate, and isoflurane） on the amplitude, latency, and slope of short-latency evoked potentials were quantified. The N2/P3/N4 potentials - which represent the early cortical response - were enhanced by etomidate （increased P3-N4 slope, P 〈0.01）, maintained by ketamine, and reduced by isoflurane （lower N2/P3 amplitude, P 〈0.01）. These effects closely resemble those seen in vivo for the same drugs and point to a cortical mechanism independent of effects on subcortical structures such as the thalamus.展开更多
文摘<strong>I</strong><strong>ntroduction:</strong> Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. <strong>Material and Methods:</strong> This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. <strong>Result:</strong> We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. <strong>Conclusion:</strong> Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.
文摘Introduction: Study compare spinal anesthesia using hyperbaric bupivacine (0.5% - 0.75%) between fixed dose and height adjusted dose during elective cesarean section. Methods: Hundred parturients who had given their consent and were scheduled for elective cesarean section under spinal anesthesia, were divided into four groups—first group received 0.5% hyperbaric bupivacine fixed dose, the second group received 0.5% hyperbaric bupivacine in a dose adjusted to the height, the third received 0.75% hyperbaric bupivacine fixed dose, the fourth group received 0.75% hyperbaric bupivacine in a dose adjusted to height. The anesthesia onset time, haemodynamic changes, side effects and fetal outcome observed. Results: Spinal block provide excellent surgical anesthesia in all patients. Anesthesia onset time is longer in adjusted than fixed groups, in 0.5% (5 ± 0.816 vs. 3.84 ± 0.746) (P Conclusion: Adjusting dose of hyperbaric bupivacine (0.5% - 0.75%) to patient’s height, decreases the dose of bupivacine in use, it also provide adequate anesthesia for elective cesarean section with decrease the use of vasopressors, the incidence and severity of maternal hypotention also markedly reduced.
文摘AIM： To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS： A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.RESULTS： The indications included intradiverticular papilla in 26 patients （49%）, stenosis of a previous sphincterotomy in 19 patients （35.8%）, small size of the papilla in 4 patients （7.5%）, Billroth R gastrectomy in 3 patients （5.6%）, and coagulopathy in one patient （1.9%）. The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients （39.6%） had calculi with a diameter equal to or greater than 10 ram. Seven patients （13.2%） presented complications： haemorrhage in 1 patient （1.9%） and mild pancreatitis in 6 patients （11.3%）. The mean hospital stay in case of complications was of 3 ± 0.63 d.CONCLUSION： Sphincteroplasty is highly effective, with a compllcation rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.
文摘Background: There is a debate about the dose of hyperbaric bupivacine for spinal anesthesia for cesarean delivery in obese parturients. While it is concessive that the dose of spinal bupivacine is reduced in pregnant compared with non-pregnant parturient due to many factors. But it is still controversial whether local anesthetic should further reduce in obese patients or not. In this perspective, observation study, we tested the influence of BMI on vasopressor requirements and block height. Methods: Three groups of 40 parturients, group A (Body mass index (BMI) 2), group B (BMI 30 - 45 Kg/m2) and group C (BMI > 45 kg/m2) requiring elective cesarean section were recruited all patients received 12.5 mg subarachnoid hyperbaric bupivacine combined with 20 ug fentanyl. Dermatomal levels were assessed after subarachnoid injection using touch sensation at 2 minutes interval for first 10 minutes then every 5 minutes. Vasopressor requirements in the first 45 minutes after subarachnoid injection, and maximum block heights using touch sensation were assessed as primary outcomes. Secondary outcomes were extent of motor block (peak flow rate), technique difficulty (number of attempts), maternal side effects and neonatal outcomes. Results: There was no significant difference in mean blood pressure (MBP) between group A and B but the difference was significant in group C in relation to other two groups, mean number of hypotensive episodes was significantly higher in group C than group A, B with no significant difference in incidence between group A and B (P Conclusion: Sensory testing using touch modality to detect extent of anesthesia, showed at 25 minutes after spinal anesthesia induction, significantly higher level in group C than the other two groups. Vasopressor requirements during the first 45 minutes of spinal anesthesia were not different between group A, B but significantly higher in group C. Time for regression of anesthesia was longer in group C, which may be helpful regarding longer surgical time. Single shots spinal anesthesia of 12.5 mg hyperbaric bupivacine produce clinically equivalent effect in parturients with BMI 2 with no need for dose reduction but caution and dose adjustment recommended in parturients with BMI > 45 Kg/m2.
文摘<b>Background and Aims:</b> Multiple, nonpharmacological and pharmacological measures have been used for attenuating stress response of intubation with variable results. N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inflammation. NMDA receptors are located in peripheral and the central nervous system. Magnesium is also a NMDA receptor blocker. <b>Aim of the Study:</b> To evaluate the effect of nebulized magnesium sulfate on reduce the stress response induced tracheal intubation <b>Material and Methods:</b> Following institutional ethical committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 100 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery requiring tracheal intubation. Patients will be recruited in the study divided into two equal groups;Patients in Group A: will receive nebulized magnesium sulfate in 3 ml (240 mg) over 15 min. While group B: will receive nebulized normal saline in 3 ml over 15 min, ending 5 min before the induction of anesthesia. SBP, DBP, HR, and blood glucose level will be measured at the following intervals;Baseline (before induction), after premedication (sedation), after induction, after ETT intubation, 3 min later, 6 min later. <b>Results:</b> Preoperative magnesium sulfate nebulization has a significant effect (p value < 0.001) on attenuating the stress response (SBP, DBP, HR, and SBG) to tracheal intubation at the following intervals;post ETT intubation, 3 min later, and 6 min later. <b>Conclusion:</b> Magnesium sulfate significantly reduces the stress response of intubation.
文摘Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.
文摘BACKGROUND Recent studies in non-colorectal malignancy have associated T resident memory(T_(RM)) cells with improved patient survival. It is unknown if T_(RM) plays a role in colorectal cancer(CRC).AIM To examine the potential role of T_(RM) cells in providing immunogenicity in CRC stratified by microsatellite instability(MSI) and BRAF status.METHODS Patients with known MSI and BRAF mutation status were eligible for inclusion in this study. CRC tumour sections stained with haematoxylin and eosin were microscopically reviewed and the images scanned prior to assessment for location of invading edge and core of tumour. Sequential sections were prepared for quantitative multiplex immunohistochemistry(IHC) staining. Opal Multiplex IHC staining was performed with appropriate positive and negative controls and imaged using a standard fluorescent microscope fitted with a spectral scanning camera(Mantra) in conjunction with Mantra snap software. Images were unmixed and annotated in in Form 2.2.0. Statistical analysis was performed using Graphpad Prism Version 7 and Stata Version 15.RESULTS Seventy-two patients with known MSI and BRAF status were included in the study. All patients were assessed for MSI by IHC and high resolution capillary electrophoresis testing and 44 of these patients successfully underwent quantitative multiplex IHC staining. Overall, there was a statistically significant increase in CD8+ T_(RM) cells in the MSI(BRAF mutant and wild type) group over the microsatellite stable(MSS) group. There was a statistically significant difference in CD8+ T_(RM) between high level MSI(MSI-H):BRAF mutant [22.57, 95% confidence interval(CI): 14.31-30.84] vs MSS [8.031(95%CI: 4.698-11.36)], P = 0.0076 and MSI-H:BRAF wild type [16.18(95%CI: 10.44-21.93)] vs MSS [8.031(95%CI: 4.698-11.36)], P = 0.0279. There was no statistically significant difference in CD8 T cells(both CD8+CD103-and CD8+CD103+T_(RM)) between MSI-H: BRAF mutant and wild type CRC.CONCLUSION This study has shown that CD8+ T_(RM) are found in greater abundance in MSI-H CRC, both BRAF mutant and MSI-H:BRAF wild type, when compared with their MSS counterpart. CD8+ T_(RM) may play a role in the immunogenicity in MSI-H CRC(BRAF mutant and BRAF wild type). Further studies should focus on the potential immunogenic qualities of T_(RM) cells and investigate potential immunotherapeutic approaches to improve treatment and survival associated with CRC.
文摘This study evaluated biofilm formation and antibiotic susceptibility in 36 clinical S. aureus isolates recovered from orthopaedic patients and detected the presence of intercellular adhesion and adhesin genes. Staphylococcus aureus was isolated from nasal swab, wound and urine specimens collected from orthopaedic patients in National Orthopaedic Hospital Dala, Kano over a period of three months. The isolates were identified using rapid identification kit for Staphylococcus species. The antibiotics susceptibility of the isolates was determined using modified disc diffusion method. Phenotypically, the biofilm formation was assessed using the Congo red agar method and microtitre plate assay. Polymerase chain reaction (PCR) analysis was used to detect biofilm-associated genes and characterize the isolates. The isolation rate of S. aureus from the samples (n = 134) was 26.8%, mainly from nasal swab (36%) and wound swab (36%). A total of 19 (52.7%) of the isolates showed positive for slime production. Majority of the isolates 29/36 (81.6%) were biofilm positive with only 2 (5.5%) and 5 (13.8%) as strong biofilm-formers and moderate biofilm-formers respectively. Molecular evaluation of the biofilm-associated genes in 12 S. aureus isolates revealed the prevalence of bbp genes (25%), clfA genes (16.6%) and the icaA (8.3%). None of the isolates harboured the fnbA and cna genes. There is no significant difference (P > 0.05) in the antibiotic resistance pattern between biofilm-positive and biofilm-negative S. aureus isolates. This result revealed that phenotypically most of the S. aureus isolates were biofilm formers but few of them chromosomally harbour the biofilm-associated genes.
文摘<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">An intensive care unit (ICU) is a special unit of a hospital that provides intensive treatment for patients with severe or life-threatening illnesses and injuries, which require constant care and close monitoring with life support equipment. The mortality rate is still very high in most ICUs especially in the developing countries due to late presentation of patients, unavailability of well trained staff and lack of life support equipment. There has not been any previous study on the mortality pattern in ICU of Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA). It is against this background that we embarked on this retrospective descriptive hospital based study of the mortality pattern in ICU of a Tertiary Hospital in Abakaliki, South-eastern Nigeria. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">This is a retrospective descriptive hospital based study. The admission and discharge registers of the ICU ward were used to extract information on biodata, diagnosis, duration and outcome of all admissions from January to December 2019 (12</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">months). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 174 (male 113, female 71) patients were admitted over the 12</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">months period with mean age of 46.31</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">12.28</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">years. Seventy</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">one (40.8%) of the patients died from predominantly stroke, acute abdomen, trauma, sepsis, renal failure, acute diabetic complications and cancer in descending order. Acute diabetic complications had 100% case fatality rate, followed by stroke (71%), renal failure (62.5%), cancer (60%), sepsis (55.5%), acute abdomen (34%) and trauma (23%). The mean duration of ICU admission was 4.2 days for the non-survivors and 6.3 days for survivors. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The ICU mortality rate was high and constituted of mainly stroke, acute abdomen and trauma which are essentially preventable. Female sex, medical diagnosis and ICU admission duration of less than 6 days were associated with higher ICU mortality.</span></span>
文摘<b><span>Background: </span></b><span>The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective block. These include ropivacaine 0.5% and lidocaine 1.5% with adrenaline.</span><span> </span><b><span>Objective:</span></b><span> To evaluate lidocaine 1.5% with adrenaline as an alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks.</span><span> </span><b><span>Methodology:</span></b><span> This was a 6</span><span>-</span><span>month prospective and randomized study (July 15, 2019 to January 15, 2020) conducted in the Department of Anesthesia at Ignace Deen National Hospital in Conakry, Guinea.</span><span> </span><b><span>Results:</span></b><span> A total of 38 patients were enrolled: 19 in each group. The mean age was 45.8 ± 16.9 years in the lidocaine with adrenaline group compared to 43.9 ± 20 years in the ropivacaine group. The mean onset time in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The mean duration of axillary block was 233.3 ± 57.5 minutes in the lidocaine group versus 260.4 ± 74 minutes in the ropivacaine group (p = 0.21). The performance was identical in both groups with 89.5% of the effective blocks in the lidocaine group and in the ropivacaine group (p = 1). The cost of consumables for the ropivacaine group was 60 euros compared to 15 euros for the lidocaine group.</span><span> </span><b><span>Conclusion:</span></b><span> Lidocaine 1.5% with adrenaline is a good alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks in resource-limited countries.</span>
文摘Background and Aims: Hypothermia is considered a common problem with anesthesia. Spinal anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) meperidine with intrathecal (IT) meperidine on the prevention of shivering during spinal anesthesia in patients underwent knee arthroscopy. Aim of the Study: The aim of this work is to study the effect of meperidine either intravenous (IV) vs intrathecal (IT) on controlling postoperative shriving after knee arthroscopy. Materials and Methods: This study will be conducted in accordance with the principles of the ethics committee Benha University hospitals. Full written informed consent will be obtained from all patients before inclusion in the study, and a prospective randomized double-blinded study was conducted in adult patients undergoing knee arthroscopy under spinal anesthesia. Cases are divided into three equal groups (20 patients in each). Group IT: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intrathecal meperidine (25 mg). Group IV: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intravenous meperidine (25 mg). Group C: will receive spinal anesthesia (12.5 mg heavy bupivacaine) only postoperatively. Incidence and degree of shivering (SS), sedation score (RSS), pain score (VAS), hemodynamics, and PONV will be measured at the following intervals: 0 min (once arrived at PACU), 20 min later, 40 min later, 80 min later. Results: Shivering was observed in 0%, 0%, and 10.5% of patients in Groups IT, IV, and C, respectively. There was a significant difference between Group IT and IV compared to Group C (P Conclusion: We concluded that IT meperidine and IV meperidine comparably can decrease intensity and incidence of shivering compared to control group as well as decrease the requirement for additional doses of meperidine for shivering control without any hemodynamic side effect. And intrathecal meperidine showed better postoperative pain control and less postoperative nausea and vomiting (PONV).
基金supported in part by the Waikato Medical Research Foundation
文摘Despite their ubiquitous use for rendering patients unconscious for surgery, our understanding of how general anesthetics cause hypnosis remains rudimentary at best. Recent years have seen increased interest in ＂top-down＂ cortico-centric theories of anesthetic action. The aim of this study was to explore this by investigating direct cortical effects of anesthetics on cerebrocortical evoked potentials in isolated mouse brain slices. Evoked potentials were elicited in cortical layer IV by electrical stimulation of the underlying white matter. The effects of three anesthetics （ketamine, etomidate, and isoflurane） on the amplitude, latency, and slope of short-latency evoked potentials were quantified. The N2/P3/N4 potentials - which represent the early cortical response - were enhanced by etomidate （increased P3-N4 slope, P 〈0.01）, maintained by ketamine, and reduced by isoflurane （lower N2/P3 amplitude, P 〈0.01）. These effects closely resemble those seen in vivo for the same drugs and point to a cortical mechanism independent of effects on subcortical structures such as the thalamus.
