Comparison of Analgesic Efficacy between Bupivacaine with Dexamethasone and Bupivacaine Alone in Caudal Block for Pediatric Patients Undergoing Open Inguinal Hernia Repair

Background Open inguinal hernial repair surgeries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most used techniques in pediatrics is caudal block. Objective To evaluate the analgesic effect of dexamethasone when given caudally as an adjuvant to caudal block vs bupivacaine alone in caudal block for children undergoing open inguinal hernial repair surgeries. Methods The study is a prospective double – blinded randomized controlled trial conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group BD who would receive caudal dexamethasone added to Bupivacaine and Group B who would receive caudal block with Bupivacaine. Results Dexamethasone addition shows statistically significance difference between two groups according to FLACC scale at 4h, 8h and 12h. The duration of adequate analgesia (FLACC pain score 4 or less) was significantly higher in group BD compared to group B. Conclusion Dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than bupivacaine alone in caudal block at similar doses in controlling postoperative pain.

Combined laparoscopic and thoracoscopic surgical repair of Bochdalek hernia in an adult: a case report

Background Bochdalek hernia is a rare disease in adults. Diaphragmatic hernia in adults has been repaired using minimally invasive surgery through laparoscopy or thoracoscopy. However, the literature regarding the combined use of laparoscopy and thoracoscopy for the repair of Bochdalek hernia is limited. Case presentation A 26-year-old man diagnosed with Bochdalek hernia was managed through combined abdominal and thoracic endoscopic surgery. On laparoscopy, the omentum prolapsed into the left thoracic cavity through the posterolateral area of the left diaphragm. On thoracoscopy, no adhesions of the omentum were seen in the thoracic cavity. The omentum was drawn back to the abdominal cavity, and a 4 × 3-cm hernial orifice was identified. The hernia orifice was repaired through simple closure with sutures laparoscopically. The patient’s postoperative course was uneventful with no recurrences within the first year post-surgery. Conclusion Combined laparoscopic and thoracoscopic surgery is a safe and effective method for Bochdalek hernial repair in adults.

Blunt Trauma Leading to Anterior Abdominal Wall Hernia

Traumatic abdominal wall hernia (TAWH) has a reported incidence of around 1%. It is defined as herniation of intra-abdominal organs following trauma without skin penetration. High-energy trauma is often associated with intra-abdominal injury. Treatment options vary from non-operative management to surgical repair either open or laparoscopic. We present a case of a middle-aged male who presented with a history of rickshaw roll over injury. On examination, there was tender abdominal swelling with abrasions. Computerized Tomography (CT) scan confirmed the diagnosis of TAWH and free fluid in abdomen. Emergency exploratory laparotomy was performed. Mesenteric tears were repaired and primary restoration of abdominal wall was done. The patient was discharged on a fourth post-operative day without any complications. Management of TAWH should be tailored according to individual patient presentation. Midline exploratory laparotomy with the primary hernial repair is an operative intervention of choice for those with high-energy injury as there is an increased chance of accompanying visceral trauma. Keywords: Laparotomy; Trauma; Hernia.

A Case Report of BCR-ABL-JAK2-Positive Chronic Myeloid Leukemia with Complete Hematological and Major Molecular Response to Dasatinib

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm (MPN) that harbors the Philadelphia chromosomal translocation resulting in the uncontrolled production of mature granulocytes. Commonly, patients are diagnosed with CML during blood work for other reasons or enlarged spleen. The diagnosis is based on WHO criteria that require the demonstration of Philadelphia chromosome. Typically, <i>JAK2</i> mutation is not found in <i>BCR-ABL1</i>-positive MPN (CML). Most patients with CML are <i>JAK2</i> negative. It is rare for CML Philadelphia-positive patients to have a coexisting <i>JAK2</i> mutation. Little is known regarding the effect of <i>JAK2</i> mutation on the disease course of CML, the complications, and the response to treatment. We report the case of a 57-year-old man with no previous medical illness who presented with elevated white blood cell count on perioperative assessment for hernial repair; on further workup, he was diagnosed with Philadelphia-positive CML. He was found to have <i>JAK2</i> mutation and was started on treatment with dasatinib and achieved hematological and cytogenetic remission with loss of the <i>JAK2</i> mutation. Patients with <i>JAK2</i>-positive <i>BCR-ABL</i>-positive CML had a good hematological and cytogenetic response to dasatinib. In such rare coexistence of <i>JAK</i> and <i>BCR-ABL</i>, dasatinib is a good option due to multi-kinase activity.