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To investigate the implication of dexmedetomidine and magnesium sulphate addition to bupivacaine in caudal anesthesia in paediatric lower abdominal surgeries. Study design: Randomized controlled trial. Setting: Paediatric University Hospital. Subjects: 120 children undergoing surgeries in the lower half of the body under general anaesthesia with a supplementary caudal block using 1 ml/kg bupivacaine 0.25%. Methods: Participants were randomly allocated into four groups; group C (saline as an additive to bupivacaine), group MG (50 mg magnesium sulphate added to bupivacaine), group D (1 µg/kg dexmedetomidine added to bupivacaine), and group MGD (the same doses of both dexmedetomidine and magnesium sulphate were added to bupivacaine). Time to first analgesia request (1ry outcome), and pain assessment by The Face, Legs, Activity, Cry, Consolability (FLACC) score just after recovery, then every 30 min in the early two hours, then at the 4th, 6th, 12th,18th, and 24th hours were compared between the groups. Results: Time to first analgesia request was significantly longer in the three study groups compared to group C with p < 0.001 (median values of 5, 14.5, 13.5, and 20.47 h in groups C, D, MG, and MGD in consequence). FLACC scores were significantly higher in group C in comparison to the other study groups by the early 2nd, 4th, and 6th postoperative hours. The group MGD has significantly lowest FLACC at the 6th postoperative hour. Conclusion: The combination of dexmedetomidine and magnesium sulphate with bupivacaine caudal block can prolong the time to first analgesia request.

Objective. Hyperparathyroidism is a prevalent disease with parathyroid adenomas being the most common cause. Surgical excision remains the standard treatment for parathyroid adenoma. Successful preoperative localization of the parathyroid adenoma could facilitate the decision regarding the extent of surgical exploration. The aim of the current study was to assess the correlation between the preoperative values of parathyroid hormone and ionized calcium with the adenoma weight and volume in patient with primary hyperparathyroidism caused by single-gland adenoma. Patients and Methods. We did this retrospective review for all patients who were diagnosed with primary hyperparathyroidism due to a solitary parathyroid adenoma in our general surgery department over 4 years. SPSS software was used to get the correlation coefficient between the peak preoperative levels of calcium and parathyroid hormone with the parathyroid adenoma weight and volume. Results. Ninety-nine patients were included into the study. The average age at surgery was 62.65±12.00 years. The correlation coefficient between the adenoma volume and weight with the preoperative ionized calcium level was weakly positive (r=0.329, p<0.01) and (r=0.281, p=0.019), respectively, while the correlation with the preoperative parathyroid hormone level was stronger (r=0.708, p<0.01) and (r=0.650, p<0.01), respectively. Conclusions. The strong positive relationship between the preoperative parathyroid hormone and calcium levels with the parathyroid adenoma size and weight can help the surgeon to predict the volume of the involved gland and avoid an unnecessary dissection.

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Background Primary thyroid lymphoma (PTL) is a rare malignancy accounting for about 5% of all thyroid malignancies and less than 2% of extra-nodal lymphomas. Diffuse B-cell lymphoma is the most common pathological subtype of PTL. Patients and methods This is a retrospective review of all patients diagnosed with thyroid lymphoma in our hospital during the period from 2011 to 2021. All patients had clinical, radiological, and pathological evaluation. We have followed up these patients since diagnosis till now. Results Eight patients were included in our review. Four patients were males and four were females. Mean age at diagnosis was 63 ± 32 years of age. Diagnosis was confirmed only with tissue histology. Six patients had stage IIE disease and two had stage IVE disease. Four patients had disease related mortality. Of the other four patients, two had chemotherapy (RCHOP) and one had local radiotherapy; all achieved complete remission, and the last one had hemithyroidectomy to relieve airway compression and still under treatment. Conclusion Primary thyroid lymphoma is rare malignancy of the thyroid gland. Advanced stage and age at the time of diagnosis, the presence of compression manifestations, large tumor mass, and presence of distant metastasis, all are poor prognostic criteria. Our knowledge of the disease pathology, diagnosis, and management is still limited and more research studies are required.