The clinical course of a term neonate (birthweight 3.14 kg) who developed thrombosis of the left common and internal iliac veins on day 21 following recovery from Streptococcus mitis septicemia, with shock diagnosed on day 13, is reported. Subcutaneous low molecular weight heparin (LMWH) was commenced (1.5 mg/kg 12 hourly for 10 days) after 13 h of standard heparin infusion, due to difficulties in securing a peripheral venous access. The inflammation of the left leg was completely resolved by day 5 of LMWH therapy. Prothrombin time, activated prothrombin time and fibrinogen levels were within normal limits during LMWH therapy. Treatment-related side effects, such as thrombocytopenia and bleeding tendency were not noted. Doppler studies 6 weeks after discharge home on day 33 revealed complete resolution of the thrombus. Apart from septicaemia and shock, the presence of an indwelling central venous catheter and a history of untreated maternal diabetes were additional risk factors for thrombosis. Because it is as effective as standard heparin, LMWH may be a therapeutic option for thrombosis in high-risk neonates, particularly given its ease of administration by the subcutaneous route, predictable pharmacokinetics and reduced incidence of adverse effects such as bleeding complications.

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2016) Postoperative analgesia of ultrasound guided rectus sheath catheters versus continuous wound catheters for colorectal surgery: A randomized clinical trialAbstract Purpose: The purpose of this study was to evaluate the postoperative analgesia and morphine requirements of ultrasound guided rectus sheath catheters versus continuous wound catheters in midline open colorectal surgery patients. Methods: Sixty patients of both sexes aged 40-65 years were randomized into 2 equal groups to receive postoperative analgesia through either a wound catheter continuous infusion (group I) or rectus sheath catheters (group II). The trial is registered in the Australian New Zealand Clinical Trials Registry: ACTRN12615000636550. Results: Heart rate and mean arterial blood pressure increased significantly in group I at 12 and 24 h as compared to time 0 and 48 h (P < 0.05). There was a significant increase in heart rate and mean arterial blood pressure in group I as compared to group II at all-time intervals (p < 0.05). There was a significant decrease in Visual analogue score at rest and with movement and in group II as compared to group I at all-time intervals (p < 0.05). Concerning the need for rescue analgesia, 8 patients (26%) in group I required rescue analgesia; 7 patients of them required only one dose and one patient required two doses. In group II two patients (6.6%) required rescue analgesia, and both required one dose. The total morphine consumption was lower and the patient satisfaction was better in group II compared with group I (p = 0.005). There were no serious complications in the two groups.

Background: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality of life, occupational activities, and social interactions. Objectives: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up. Study Design: This is a randomized single-blinded trial. Setting: This study took place in a single hospital. Methods: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed. Results: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year followup. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups. Limitations: The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described. Conclusions: This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection.

Acute kidney injury (AKI) necessitating renal-replacement therapy has been associated with high mortality rates in critically ill patients. Usual methods to study AKI encompass the assessment of serum and urine biomarkers. Hypoxia is a major pathophysiological feature of AKI, which necessitates continuous bedside monitoring of renal tissue oxygenation in intensive care unit (ICU) patients. Research has made continuous bladder urine oxygen pressure (PuO2) monitoring possible in humans. Although the value of bladder PuO2 does not represent an absolute value of medullary tissue oxygen pressure (Po2), bladder PuO2 can be considered a window into the renal medullary oxygenation. Bladder PuO2 can be monitored by using probes with oxygen sensors inserted into the urinary bladder. Additionally, PuO2 can be measured manually by using a blood gas analyzer machine. PuO2 monitoring can be potentially helpful in early diagnosis and/or prevention of AKI and guide therapeutic interventions aimed at improving renal oxygen delivery in those patients.