Eventration, central bilateral diaphragmatic paralysis and congenital hernia in adults

Background: Hypospadias is a common congenital anomaly in which the anterior urethra is incompletely developed and does not extend to the tip of the glans penis. The present study was aimed to study the clinical prole of hypospadias. Settings and Design:This was a prospective, observational study. Methods: This prospective study was conducted at Department of General Surgery, LLR & Associated Hospitals, GSVM Medical College, Kanpur, India, from January 2019 to October 2020, on 72 patients of hypospadias, after taking clearance from the Institutional Ethical Committee, and taking proper informed consent for participation. Data collected for each patient included age, sex, demography, symptoms with duration, and relevant past and treatment history. Results: The most common age of presentation was between 1-5years of age (48.61%, n=35). Distal hypospadias (DH) was the most common site. (47.22%, n=34). 4.16% (n=3) patients presented with urethrocutaneous stula. Chordee was more commonly seen in patients with mid & proximal penile hypospadias (64.70%, n=33). In the present study, 4.1% (n=3) had associated undescended testis, 4.1% (n=3) had an associated bid scrotum and 1.3% (n=1) had an associated congenital hernia. Conclusions: Most cases of hypospadias present before 10 years of age. Distal hypospadias is the most common type. Chordee is associated most commonly with proximal penile and mid penile hypospadias. It may also be associated with other congenital anomalies like, undescended testis, bid scrotum or congenital hernias

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Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102962 ◽

2022 ◽

pp. rapm-2021-102962

Author(s):

Constantin Robles ◽

Nick Berardone ◽

Steven Orebaugh

Keyword(s):

Total Sample ◽

Shoulder Surgery ◽

Diaphragmatic Paralysis ◽

Postanesthesia Care Unit ◽

Phrenic Nerve Palsy ◽

Diaphragmatic Dysfunction ◽

Postoperative Assessment ◽

Respiratory Parameters ◽

Breath Sounds ◽

Arthroscopic Shoulder Surgery

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.Methods30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.Results10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.ConclusionAlthough injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.

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