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Paladini A, Rawal N, Coca Martinez M, Trifa M, Montero A, Pergolizzi J, Pasqualucci A, Narvaez Tamayo MA, Varrassi G, De Leon Casasola O. Advances in the Management of Acute Postsurgical Pain: A Review. Cureus 2023; 15:e42974. [PMID: 37671225 PMCID: PMC10475855 DOI: 10.7759/cureus.42974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Despite the millions of surgeries performed every year around the world, postoperative pain remains prevalent and is often addressed with inadequate or suboptimal treatments. Chronic postsurgical pain is surprisingly prevalent, and its rate varies with the type of surgery, as well as with certain patient characteristics. Thus, better clinical training is needed as well as patient education. As pain can be caused by more than one mechanism, multimodal or balanced postsurgical analgesia is appropriate. Pharmacological agents such as opioid and nonopioid pain relievers, as well as adjuvants and nonpharmacologic approaches, can be combined to provide better and opioid-sparing pain relief. Many specialty societies have guidelines for postoperative pain management that emphasize multimodal postoperative analgesia. These guidelines are particularly helpful when dealing with special populations such as pregnant patients or infants and children. Pediatric pain control, in particular, can be challenging as patients may be unable to communicate their pain levels. A variety of validated assessment tools are available for diagnosis. Related to therapy, most guidelines agree on the fact that codeine should be used with extreme caution in pediatric patients as some may be "rapid metabolizers" and its use may be life-threatening. Prehabilitation is a preoperative approach that prepares patients in advance of elective surgery with conditioning exercises and other interventions to optimize their health. Prehabilitation may have aerobic, strength-training, nutritional, and counseling components. Logistical considerations and degree of patient adherence represent barriers to effective prehabilitation programs. Notwithstanding all this, acute postoperative pain represents a clinical challenge that has not yet been well addressed.
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Affiliation(s)
- Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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Trabelsi B, Ben Taleb I, Trifa M, Ben Ali M. Systematic preoperative tests prescription in elective surgery: it's high time to appraise! Tunis Med 2022; 100:541-546. [PMID: 36571743 PMCID: PMC9703908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period. AIM To assess the practice and the financial cost of the systematic prescription of preoperative tests. METHODS This was a retrospective study including all patients older than three years, scheduled for elective surgery from November 2018 to January 2019. Two attendings analyzed the data collected during the pre-anesthetic assessment and evaluated the usefulness of the ordered preoperative tests. The overall cost of prescribed preoperative tests and the cost generated by inappropriate prescriptions were also estimated. RESULTS This study included 1006 patients. The average age was 46.9 ± 22.05 years old. Five hundred and twenty three of them (51.98%) have no medical history. Among the planned procedures, 6.46% had an intermediate or major bleeding risk. Preoperative prescriptions were ordered by surgeons in 99% of cases. Prescriptions were justifiable in only 9.42% of cases. Abnormal findings were noted in 4.98% of the patients. The total cost was almost 80992 Dinars (≈ 24543 €). Complying the guidelines would save 70245 Dinars (≈ 21286 €) during the three months' study. CONCLUSION The routine prescription of preoperative complementary tests results in a significant additional economic cost. Developing national guidelines would change this attitude of unnecessary prescription.
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Affiliation(s)
- Becem Trabelsi
- 1. Service d’Anesthésie et de Réanimation de l’Hôpital Universitaire Mohamed Tahar Maamouri de Nabeul / Université Tunis El Manar, Faculté de Médecine de Tunis
| | - Ibtissem Ben Taleb
- 1. Service d’Anesthésie et de Réanimation de l’Hôpital Universitaire Mohamed Tahar Maamouri de Nabeul / Université Tunis El Manar, Faculté de Médecine de Tunis
| | - Mehdi Trifa
- 2. Service d’Anesthésie et de Réanimation de l’Hôpital d’Enfants Béchir Hamza de Tunis / Université Tunis El Manar, Faculté de Médecine de Tunis
| | - Mechaal Ben Ali
- 1. Service d’Anesthésie et de Réanimation de l’Hôpital Universitaire Mohamed Tahar Maamouri de Nabeul / Université Tunis El Manar, Faculté de Médecine de Tunis
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Ronca V, Chen QB, Lygoura V, Ben-Mustapha I, Shums Z, Trifa M, Carbone M, Mancuso C, Milani C, Bernuzzi F, Ma X, Agrebi N, Norman GL, Chang C, Gershwin ME, Barbouche MR, Invernizzi P. Autoantibodies in patients with interleukin 12 receptor beta 1 deficiency. J Dig Dis 2019; 20:363-370. [PMID: 31111679 DOI: 10.1111/1751-2980.12790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Interleukin 12 receptor beta 1 (IL-12Rβ1) deficiency is a primary immunodeficiency that exposes affected individuals to an augmented risk of intracellular pathogen-mediated infections. The paradoxical presence of autoimmune manifestations in immune-deficient patients has been recognized, but the basis of this phenomenon is unclear, with the role of frequent infections being a possible trigger to break tolerance. Our study aimed to analyze extensively a profile of autoantibodies in a clinically well-defined case series of patients with IL-12Rβ1 deficiency. METHODS Eight patients with IL-12Rβ1 deficiency referred to Children's Medical Center in Tunis, Tunisia, during 1995-2012 were enrolled in the study. Sixteen age- and gender-matched blood donors served as controls. Serum, liver-related autoantibodies immunoglobulin (Ig)G, IgM, IgA were tested by ELISA and by standard indirect immunofluorescence on Hep-2 cells. RESULTS We found a significant prevalence of liver autoantibodies in the study group. Regarding primary biliary cholangitis (PBC), two of eight patients were positive for MIT3 autoantibodies, both confirmed by immunofluorescence, and one patient was positive for PBC-specific antinuclear antibodies, sp100. Moreover, two patients had significantly increased gamma-glutamyltransferase levels and one had IgM levels twice the upper limit of normal. Intriguingly two patients were positive for anti-actin antibodies; a typical feature of autoimmune hepatitis type 1, along with a significant increase in IgG levels. CONCLUSIONS This is the first report of a serological analysis in patients with an IL-12Rβ1 deficiency. Despite the difficulty in interpreting the role of the IL-12, the evidence of liver-specific autoantibodies confirms the importance its signal in liver autoimmunity.
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Affiliation(s)
- Vincenzo Ronca
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Qu Bo Chen
- Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guandong Province, China
| | - Vasiliky Lygoura
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Imen Ben-Mustapha
- Laboratory of Immunology, Institut Pasteur de Tunis and University Tunis El Manar, Tunis, Tunisia
| | - Zakera Shums
- Department of Research and Development, Inova Diagnostics, San Diego, California, USA
| | - Mehdi Trifa
- Department of Anesthesia and Intensive Care, Tunis and Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Clara Mancuso
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Chiara Milani
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesca Bernuzzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Xiong Ma
- Key Laboratory of Gastroenterology and Hepatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nourhen Agrebi
- Laboratory of Immunology, Institut Pasteur de Tunis and University Tunis El Manar, Tunis, Tunisia
| | - Gary L Norman
- Department of Research and Development, Inova Diagnostics, San Diego, California, USA
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, California, USA
| | - Merrill Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, California, USA.,Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
| | - Mohamed-Ridha Barbouche
- Laboratory of Immunology, Institut Pasteur de Tunis and University Tunis El Manar, Tunis, Tunisia
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Trifa M, Tumin D, Whitaker EE, Bhalla T, Jayanthi VR, Tobias JD. Spinal anesthesia for surgery longer than 60 min in infants: experience from the first 2 years of a spinal anesthesia program. J Anesth 2018; 32:637-640. [DOI: 10.1007/s00540-018-2517-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/23/2018] [Indexed: 11/24/2022]
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Trifa M, Tumin D, Walia H, Lemanek KL, Tobias JD, Bhalla T. Caregivers' knowledge and acceptance of complementary and alternative medicine in a tertiary care pediatric hospital. J Pain Res 2018. [PMID: 29535550 PMCID: PMC5837374 DOI: 10.2147/jpr.s156585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The use of complementary and alternative medicine (CAM) therapies has increased in children, especially in those with chronic health conditions. However, this increase may not translate into acceptance of CAM in the perioperative setting. We surveyed caregivers of patients undergoing surgery to determine their knowledge and acceptance of hypnotherapy, acupuncture, and music therapy as alternatives to standard medication in the perioperative period. Materials and methods An anonymous, 12-question survey was administered to caregivers of children undergoing procedures under general anesthesia. Caregivers reported their knowledge about hypnotherapy, music therapy, and acupuncture and interest in one of these methods during the perioperative period. CAM acceptance was defined as interest in one or more CAM methods. Results Data from 164 caregivers were analyzed. The majority of caregivers were 20-40 years of age (68%) and mothers of the patient (82%). Caregivers were most familiar with acupuncture (70%), followed by music therapy (60%) and hypnotherapy (38%). Overall CAM acceptance was 51%. The acceptance of specific CAM modalities was highest for music therapy (50%), followed by hypnotherapy (17%) and acupuncture (13%). In multivariable logistic regression, familiarity with music therapy was associated with greater odds of CAM acceptance (odds ratio=3.36; 95% CI: 1.46, 7.74; P=0.004). Conclusion Overall CAM acceptance among caregivers of children undergoing surgery was 51%, with music therapy being the most accepted CAM method. Familiarity with music therapy was the only factor that was independently associated with accepting CAM in the perioperative period. The low acceptance for acupuncture and hypnosis in the perioperative situation may be related to insufficient parental knowledge and information.
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Affiliation(s)
- Mehdi Trifa
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hina Walia
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathleen L Lemanek
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Abstract
INTRODUCTION The aim of this review was to evaluate the current evidence regarding the use of dexmedetomidine as an adjuvant to local anesthetic agents (LAA) for caudal blockade anesthesia and analgesia in children. EVIDENCE ACQUISITION A literature search was performed of the Medline, Embase, and CINAHL databases using the keywords "dexmedetomidine" and "caudal". We included all studies that used caudal dexmedetomidine as an adjuvant to a LAA in children, excluding case reports, reviews, expert opinions, and animal studies. EVIDENCE SYNTHESIS Twenty-one publications met the inclusion criteria and included 1590 children. Fourteen compared the efficacy of adding dexmedetomidine to a LAA alone and seven compared dexmedetomidine to other adjuvants in combination with a LAA. The duration of postoperative analgesia was significantly longer in patients receiving a caudal epidural block with a LAA plus dexmedetomidine when compared to a LAA alone. Only one study demonstrated improved analgesia with a dose of dexmedetomidine ≥1 µg/kg. Dexmedetomidine provided longer postoperative analgesia than fentanyl and morphine, while the quality of postoperative analgesia was similar to dexamethasone or clonidine. Although higher sedation scores were associated with caudal dexmedetomidine in the majority of the trials, postoperative behavior scores were improved in these children. There were no reports of respiratory depression. Significant hemodynamic effects were uncommon, and occurred most commonly in patients receiving a higher dose of caudal dexmedetomidine (2 µg.kg-1). CONCLUSIONS There is sufficient evidence to recommend the addition of caudal dexmedetomidine to the LAA in patients undergoing lower extremity and infra-umbilical surgical procedures.
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Affiliation(s)
- Mehdi Trifa
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA - .,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia -
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Barbouche MR, Chen Q, Carbone M, Ben-Mustapha I, Shums Z, Trifa M, Malinverno F, Bernuzzi F, Zhang H, Agrebi N, Norman GL, Chang C, Gershwin ME, Invernizzi P. Comprehensive review of autoantibodies in patients with hyper-IgM syndrome. Cell Mol Immunol 2018; 15:610-617. [PMID: 29400703 DOI: 10.1038/cmi.2017.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/26/2017] [Indexed: 01/12/2023] Open
Abstract
Hyper-immunoglobulin M syndrome is an X-linked primary immunodeficiency disease caused by mutations in the CD40 ligand gene. The CD40 ligand has been recently highlighted as playing a key role in the pathogenesis of primary biliary cholangitis. In the present study, we assessed an extensive set of serum autoantibodies in a series of well-defined patients with hyper-immunoglobulin M syndrome. Serum, liver-related and liver-not-related autoantibodies IgG, IgM and IgA were tested by ELISA and standard indirect immunofluorescence in HEp-2 cells in 13 Tunisian patients (8 males and 5 females, aged 1-12 years) with hyper-immunoglobulin M syndrome during 1995-2012 and, as controls, 21 age- and gender-matched blood donors. The level of IgM antibody against MIT3 was significantly higher in patients than in controls (35.8 vs 10.7, P=0.002). Half of the hyperimmunoglobulin M syndrome patients were found to be anti-MIT3 IgM positive vs none of the controls (P<0.0001). Twenty-three percent of patients were found to be anti-sp100 antibody positive vs only 0.05% of controls. By immunofluorescence, 92.3% of patients were MIT3 IgM positive vs none of the controls. In conclusion, the IgM class of anti-MIT3 antibodies was shown to be present by both ELISA and immunofluorescence in most of the patients with hyper-immunoglobulin M syndrome. The presence of the hallmark of primary biliary cholangitis, a disease where the CD40 ligand is a key player, in an immunodeficiency disease caused by mutations in the CD40 ligand gene is very intriguing and opens new scenarios in understanding the immune pathogenesis of primary biliary cholangitis.
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Affiliation(s)
- Mohamed-Ridha Barbouche
- Laboratory of Immunology, Institute Pasteur de Tunis and Faculty of Medicine, University Tunis El Manar, Tunis, 1002, Tunisia
| | - Qubo Chen
- Humanitas Clinical and Research Center, Rozzano, 20089, Italy.,Clinical Laboratory, Guangdong Provincial Hospital of Chinese medicine, Guangzhou, 510000, China
| | - Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Monza (MB), 20900, Italy
| | - Imen Ben-Mustapha
- Laboratory of Immunology, Institute Pasteur de Tunis and Faculty of Medicine, University Tunis El Manar, Tunis, 1002, Tunisia
| | - Zakera Shums
- Department of Research and Development, Inova Diagnostics, San Diego, 92131, USA, CA
| | - Mehdi Trifa
- Department of Anesthesia and Intensive Care, Children Hospital Bechir Hamza, Tunis and Faculty of Medicine, University Tunis El Manar, Tunis, 1007, Tunisia
| | - Federica Malinverno
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Monza (MB), 20900, Italy
| | - Francesca Bernuzzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Monza (MB), 20900, Italy
| | - Haiyan Zhang
- Humanitas Clinical and Research Center, Rozzano, 20089, Italy.,Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Monza (MB), 20900, Italy.,Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State, Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 200001, Shanghai, China
| | - Nourhen Agrebi
- Laboratory of Immunology, Institute Pasteur de Tunis and Faculty of Medicine, University Tunis El Manar, Tunis, 1002, Tunisia
| | - Gary L Norman
- Department of Research and Development, Inova Diagnostics, San Diego, 92131, USA, CA
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, 95616, USA, CA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, 95616, USA, CA
| | - Pietro Invernizzi
- Humanitas Clinical and Research Center, Rozzano, 20089, Italy. .,Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Monza (MB), 20900, Italy.
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Belloumi D, Trifa M, Mahjoub S, Mouelhi H, Ben Salah N. Pratique du test ultime au lit du malade en Tunisie̊: résultats de deux enquêtes auprès des médecins. Transfus Clin Biol 2017. [DOI: 10.1016/j.tracli.2017.06.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jendoubi A, Naceur IB, Bouzouita A, Trifa M, Ghedira S, Chebil M, Houissa M. A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy: A prospective, double-blind, randomized, placebo-controlled study. Saudi J Anaesth 2017; 11:177-184. [PMID: 28442956 PMCID: PMC5389236 DOI: 10.4103/1658-354x.203027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Recently, there has been increasing interest in the use of analgesic adjuncts such as intravenous (IV) ketamine and lidocaine. OBJECTIVES To compare the effects of perioperative IV lidocaine and ketamine on morphine requirements, pain scores, quality of recovery, and chronic pain after open nephrectomy. STUDY DESIGN A prospective, randomized, placebo-controlled, double-blind trial. SETTINGS The study was conducted in Charles Nicolle University Hospital of Tunis. METHODS Sixty patients were randomly allocated to receive IV lidocaine: bolus of 1.5 mg/kg at the induction of anesthesia followed by infusion of 1 mg/kg/h intraoperatively and for 24 h postoperatively or ketamine: bolus of 0.15 mg/kg followed by infusion of 0.1 mg/kg/h intraoperatively and for 24 h postoperatively or an equal volume of saline (control group [CG]). MEASUREMENTS Morphine consumption, visual analog scale pain scores, time to the first passage of flatus and feces, postoperative nausea and vomiting (PONV), 6-min walk distance (6MWD) at discharge, and the incidence of chronic neuropathic pain using the "Neuropathic Pain Questionnaire" at 3 months. RESULTS Ketamine and lidocaine reduced significantly morphine consumption (by about 33% and 42%, respectively) and pain scores compared with the CG (P < 0.001). Lidocaine and ketamine also significantly improved bowel function in comparison to the CG (P < 0.001). Ketamine failed to reduce the incidence of PONV. The 6 MWD increased significantly from a mean ± standard deviation of 27 ± 16.2 m in the CG to 82.3 ± 28 m in the lidocaine group (P < 0.001). Lidocaine, but not ketamine, reduced significantly the development of neuropathic pain at 3 months (P < 0.05). CONCLUSION Ketamine and lidocaine are safe and effective adjuvants to decrease opioid consumption and control early pain. We also suggest that lidocaine infusion serves as an interesting alternative to improve the functional walking capacity and prevent chronic neuropathic pain at 3 months after open nephrectomy.
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Affiliation(s)
- Ali Jendoubi
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Imed Ben Naceur
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Abderrazak Bouzouita
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mehdi Trifa
- Department of Anaesthesia and Intensive Care, Children Hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Salma Ghedira
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mohamed Chebil
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mohamed Houissa
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
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Trifa M, Krishna S, D'Mello A, Hakim M, Tobias JD. Sugammadex to reverse neuromuscular blockade and provide optimal conditions for motor-evoked potential monitoring. Saudi J Anaesth 2017; 11:219-221. [PMID: 28442963 PMCID: PMC5389243 DOI: 10.4103/1658-354x.203024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade (NMB) via a mechanism that differs completely from acetylcholinesterase inhibitors. By encapsulating rocuronium, sugammadex can provide recovery of neuromuscular function even when there is a profound degree of NMB. We report anecdotal experience with the use of sugammadex to reverse NMB to facilitate intraoperative neurophysiological monitoring (motor evoked potentials) in an adolescent with scoliosis during posterior spinal fusion. Its potential application in this unique clinical scenario is discussed, and potential dosing schemes are reviewed.
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Affiliation(s)
- Mehdi Trifa
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Senthil Krishna
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ajay D'Mello
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mumin Hakim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph Drew Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Trabelsi B, Trifa M, Ben Khalifa S. Tigecycline-based therapy for glycopeptide-resistant Enterococcus faecium infection in a pediatric intensive care unit. Tunis Med 2016; 94:336-337. [PMID: 28051225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Affiliation(s)
- Mehdi Trifa
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Children Hospital Bechir Hamza, University Tunis El Manar, Tunis, Tunisia.
| | - Thomas Engelhardt
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Sonia Ben Khalifa
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Children Hospital Bechir Hamza, University Tunis El Manar, Tunis, Tunisia
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Lundblad M, Trifa M, Kaabachi O, Ben Khalifa S, Fekih Hassen A, Engelhardt T, Eksborg S, Lönnqvist PA. Alpha-2 adrenoceptor agonists as adjuncts to peripheral nerve blocks in children: a meta-analysis. Paediatr Anaesth 2016; 26:232-8. [PMID: 26671834 DOI: 10.1111/pan.12825] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Adult meta-analyses have verified that adjunct use of alpha-2 adrenoceptor agonists (A2AA) together with local anesthetics (LA) will prolong the duration of peripheral nerve blocks. The standard use of A2AAs for peripheral nerve blockade has recently been recommended also in children, but the evidence base in support of this suggestion has to date been equivocal. The purpose of this meta-analysis was to produce evidence-based data regarding the effect in children. METHODS Following a thorough literature search, five randomized controlled trials were included in a meta-analysis. Raw data from all studies were gathered and aggregated into patients randomized to receive plain LA (Group PLA) or LA mixed with either adjunct clonidine or dexmedetomidine (Group ADJ). The main outcome parameter was block duration (time to first administration of supplemental analgesic based on predetermined pain scores) analyzed by survival statistics. The total number of supplemental analgesic doses during the first 24 postoperative hours and serious side effects were included as secondary outcomes. RESULTS Pooling of the study data generated 141 patients in Group PLA and 142 patients in Group ADJ (overall n = 283; age: 0.8-13 years; weight 8-47 kg). Block duration was significantly prolonged (9.75 h vs 3.75 h) compared to the use of plain LA. Survival statistics verified a beneficial effect of using adjunct A2AAs [the log rank (Mantel-Cox) test (P = 0.0078), Gehan-Breslow-Wilcoxon test (P = 0.0027), and hazard ratio (1.653; 95% CI: 1.142 to 2.395)]. The number of patients that needed ≥ 2 doses of supplemental analgesics was higher in Group PLA (n = 19) compared to Group ADJ (n = 6) (P = 0.0088). No serious side effects were reported. CONCLUSION This meta-analysis provides evidence-based support for the use of adjunct alpha-2 adrenoceptor agonists when performing peripheral nerve blocks in children.
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Affiliation(s)
- Märit Lundblad
- Department of Paediatric Anaesthesia & Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology & Pharmacology, Section of Anaesthesiology & Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Mehdi Trifa
- Faculty of Medicine, Department of Anaesthesia and Intensive Care, Children Hospital Bechir Hamza, University of Tunis El Manar, Tunis, Tunisia
| | - Olfa Kaabachi
- Faculty of Medicine, Department of Anaesthesia and Intensive Care, Kassab Orthopedic Institute, University of Tunis El Manar, Tunis, Tunisia
| | - Sonia Ben Khalifa
- Faculty of Medicine, Department of Anaesthesia and Intensive Care, Children Hospital Bechir Hamza, University of Tunis El Manar, Tunis, Tunisia
| | - Amjed Fekih Hassen
- Faculty of Medicine, Department of Anaesthesia and Intensive Care, Children Hospital Bechir Hamza, University of Tunis El Manar, Tunis, Tunisia
| | - Thomas Engelhardt
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Staffan Eksborg
- Childhood Cancer Research Unit Q6:05, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Per-Arne Lönnqvist
- Department of Paediatric Anaesthesia & Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology & Pharmacology, Section of Anaesthesiology & Intensive Care, Karolinska Institutet, Stockholm, Sweden
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Belloumi D, Ben Salah N, Trifa M, Ben Lakhal F, El Borgi W, Hafsia R. Résultats d’une enquête d’évaluation des pratiques transfusionnelles des médecins anesthésistes réanimateurs du secteur privé du Grand Tunis. Transfus Clin Biol 2015. [DOI: 10.1016/j.tracli.2015.06.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Trifa M, Ben Yahia MM, Saada S, Akrout S, Ghlala A, Fakhfakh R, Fekih Hassen A, Ben Khalifa S. [Thrombopenia and the nature of the microorganism in infected critically ill children]. Arch Pediatr 2014; 21:1073-8. [PMID: 25125030 DOI: 10.1016/j.arcped.2014.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 11/28/2013] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thrombopenia is correlated with sepsis and mortality in pediatric intensive care units. The purpose of this study was to find an association between thrombopenia and the microorganism type to guide the choice of empiric antibiotic therapy in infected critically ill children. MATERIALS AND METHODS We conducted a prospective descriptive study, including all newborns, infants, and children admitted to a pediatric surgical intensive care unit from 1st January to 31st December 2009. We identified patients who developed an infection and/or thrombopenia (platelet count less than 100,000/mm(3)) during hospitalization. RESULTS One hundred ninety-seven patients were included (57 newborns, 41 infants, 99 children). Ninety patients developed 100 infectious episodes during the study period. Of the 57 newborns enrolled in the study, 31 (54%) developed 37 infections. Seventy-six microorganisms (55 Gram-negative bacilli [GNB], 17 Gram-positive cocci, two Gram-negative cocci, two fungal pathogens) were identified during 65 infectious episodes in 55 patients. Thirty-four episodes of thrombopenia were observed in 30 patients. Thrombopenia was observed only in infected patients (P<0.001). Thrombopenia was associated with infections caused by GNB (26/28 vs 20/37, P=0.001) and by Klebsiella (16/28 vs 6/37, P=0.001) and may be associated with infections caused by GNB producing extended-spectrum beta-lactamases (P=0.07). Gram-positive cocci infections were correlated to the non-occurrence of thrombopenia (P=0.02). Postoperative peritonitis was also significantly associated with thrombopenia (P=0.03). The mortality rate in our patients was 12.7% (22.8% in neonates). There was an association between thrombopenia and death in univariate analysis (11/25 vs 19/172, P<0.001). Multivariate logistic regression analysis did not confirm thrombopenia as an independent predictive factor of mortality in children. CONCLUSION Because of the relatively high proportion of resistant GNB, an empiric antibiotic therapy combining a carbapenem and an aminoglycoside may be indicated in infected critically ill children developing thrombopenia.
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Affiliation(s)
- M Trifa
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie.
| | - M M Ben Yahia
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie
| | - S Saada
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie
| | - S Akrout
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie
| | - A Ghlala
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie
| | - R Fakhfakh
- Service d'épidémiologie et de médecine préventive, faculté de médecine, université Tunis El Manar, Tunis, Tunisie
| | - A Fekih Hassen
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie
| | - S Ben Khalifa
- Service d'anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d'enfants, Bab Saadoun, 1006 Tunis, Tunisie
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Bouchoucha S, Gafsi K, Trifa M, Saied W, Ammar C, Nessib MN, Smida M, Ben Ghachem M. [Intravenous antibiotic therapy for acute hematogenous osteomyelitis in children: short versus long course]. Arch Pediatr 2013; 20:464-9. [PMID: 23566577 DOI: 10.1016/j.arcped.2013.02.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 01/09/2013] [Accepted: 02/10/2013] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the results of two antibiotic therapy protocols for osteomyelitis with different durations of intravenous treatment. This was a prospective randomized study of children treated for acute hematogenous osteomyelitis. Patients in group 1 (G1) received 7 days of intravenous antibiotics, whereas patients in group 2 (G2) received 14 days. Treatment was deemed effective if there were no signs of chronic osteomyelitis at the last follow-up. Fifty-three patients were included in the study (G1=27, G2=26). After a mean follow-up of 11.5 months, none of the patients in either group showed signs of chronic osteomyelitis. In conclusion, a shortened treatment of 7 days of intravenous antibiotic therapy is as effective as a longer treatment.
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Affiliation(s)
- S Bouchoucha
- Service d'orthopédie de l'enfant et de l'adolescent, hôpital d'enfants de Tunis, 1007 Tunis Jabbari, Bab Saadoun, Tunisie.
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Fekih Hassen A, Ben Khalifa S, Ghribi A, Trifa M. Ropivacaine 0.2% versus Bupivacaine 0.25% in para-umbilical block in children. Tunis Med 2013; 91:12-15. [PMID: 23404591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Para-umbilical block was an old block that regains a new interest. No study was available using Ropivacaine in this block. AIM To compare quality of analgesia after using Ropivacaine 0.2% to Bupivacaine 0.25% in para-umbilical blocks. METHODS In a prospective randomized double blind study we included one to six years old children, scheduled for umbilical herniorrhaphy. The children were randomized in two groups to receive in para-umbilical block by side: Ropivacaine 0.2%: 0.2 ml.kg-1 (group GR) or Bupivacaine 0.25%: 0.2 ml.kg-1 (group GB). RESULTS The data of 75 children (GR= 38; GB= 37) were analyzed. The groups were comparable regarding the demographics' characters. The scores of Children's Hospital of Eastern Ontario Pain Scale in different postoperative times were comparable between the two groups. No difference was noted in the time of the first analgesic request. The two groups were comparable regarding the peroperative analgesia. No complication was recorded in this study. CONCLUSION Ropivacaine 0.2% is equivalent to the Bupivacaine 0.25% concerning postoperative and peroperative analgesia in the para-umbilical block for umbilical herniorrhaphy.
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Affiliation(s)
- Amjed Fekih Hassen
- Department of anaesthesia and intensive care, Children's Hospital, Tunis, Tunisia - Tunis Medical School, Tunis El Manar University
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Ellouze O, Trifa M, Ben Lazreg R, Fekih Hassen A, Ben Khalifa S. [Postoperative hyponatremic encephalopathy in an infant]. Ann Fr Anesth Reanim 2012; 31:929-930. [PMID: 23062227 DOI: 10.1016/j.annfar.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 09/07/2012] [Indexed: 06/01/2023]
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Fekih Hassen A, Ben Khalifa S, Raddaoui K, Askri A, Trifa M. [Risk factors for nosocomial infection in pediatric burn patients]. ACTA ACUST UNITED AC 2012; 31:591-5. [PMID: 22766466 DOI: 10.1016/j.annfar.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 03/13/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of our study was to determine risk factors associated with nosocomial infections in children hospitalized for skin burn. STUDY DESIGN Prospective study including children hospitalized for skin burn. METHODS We collected demographic characteristic, mode of admission, mechanism of burn, extent of burn surface by the tables of Lund and Browder, depth of the lesions according to clinical criteria and evolution, type of invasive care (urinary catheterization, central catheterization or mechanical ventilation), nosocomial infection and its time of occurrence, prescription of empirical antibiotic therapy and evolution during hospitalization. The criteria for "American Burn Association" were used to define a severe burn in children. RESULTS One hundred eighty-two children were included. In univariate analysis, six risk factors were significantly associated with the occurrence of nosocomial infection: extent of burn surface, severe burn, urinary catheterization and its duration and central catheterization and its duration. Extent of burn surface greater than 10% of total body surface is an independent factor of the occurrence of nosocomial infection (P=0.009) in Multivariate analysis. CONCLUSION In our study, extent of burn surface greater than 10% of total body surface is as an independent risk factor for the occurrence of nosocomial infection.
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Affiliation(s)
- A Fekih Hassen
- Service d'anesthésie réanimation, hôpital d'enfants de Tunis, Tunisie.
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20
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Bouchoucha S, Drissi G, Trifa M, Saied W, Ammar C, Smida M, Nessib MN, Ben Alaya N, Ben Ghachem M. [Epidemiology of acute hematogenous osteomyelitis in children: a prospective study over a 32 months period]. Tunis Med 2012; 90:473-478. [PMID: 22693089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis (AHO) in children. METHODS Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed. RESULTS 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization (18.66%). Fever higher than 38° on admission was found in 92.8% of patients. Creactive protein (CRP) was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. A micro organism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible (SAMS) was the predominant germ. Staphylococcus aureus methicillin resistant (SAMR) accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections. CONCLUSION The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy.
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Trifa M, Ben Khalifa S, Jendoubi A, Zribi N, Regaya T, Engelhardt T. Clonidine does not improve quality of ropivacaine axillary brachial plexus block in children. Paediatr Anaesth 2012; 22:425-9. [PMID: 22309507 DOI: 10.1111/j.1460-9592.2012.03809.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The addition of clonidine to peripheral nerve blocks is controversial in children. OBJECTIVE The aim of our study was to evaluate the effect of clonidine added to ropivacaine in pediatric axillary brachial plexus block (ABPB). METHODS Children aged 1-6 years, scheduled to undergo forearm or hand surgery, were recruited into this prospective, double-blind controlled trial. Patients were randomly allocated to receive an ABPB either with ropivacaine 0.2% 0.4 ml · kg(-1) plus saline in 1 ml (RS) or ropivacaine 0.2% 0.4 ml · kg(-1) plus clonidine 1 μg · kg(-1) in 1 ml (RC). Primary endpoints were quality of postoperative analgesia as assessed by pain scores and total 24-h postoperative analgesia requirements. Secondary outcomes were time to first analgesia request and duration of motor blockade. RESULTS Sixty patients were recruited (n = 30 per group) into the study. Pain scores were comparable throughout the first 24 h between the two groups. Ten children in the (RS) and six in (RC) groups required supplementary analgesia during the first 24 h (P = 0.24). Children who required further analgesia did so after 288 ± 94 min in the (RS) and 437 ± 204 min in the (RC) group (P = 0.06). There was no difference in the duration of motor block [186 ± 71 and 154 ± 56 min, P = 0.12 for (RS) and (RC), respectively]. CONCLUSION Ropivacaine (0.2% 0.4 ml · kg(-1) ) for ABPB provides sufficient postoperative analgesia in children scheduled for forearm or hand surgery. The addition of clonidine to ABPB does not improve overall postoperative analgesia but may increase the time to first analgesia request.
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Affiliation(s)
- Mehdi Trifa
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Children Hospital of Tunis, University Tunis El Manar, Tunis, Tunisia.
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Fekih Hassen A, Zayani MC, Friaa M, Trifa M, Ben Khalifa S. [Epidemiology of pediatric traumatic brain injury at the Children's Hospital of Tunisia, 2007]. Tunis Med 2012; 90:25-30. [PMID: 22311444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The traumatic brain injury is a major cause of morbidity and mortality in the paediatric population. Adequate knowledge of their epidemiology is necessary to develop targeted preventive campaigns, and to estimate the needs for care facilities. AIM To specify the demographic and epidemiologic characteristics of paediatric traumatic brain injury. METHODS Longitudinal retrospective study including children hospitalized for traumatic brain injury in the Hospital of Child of Tunis during the 1-year period (2007). RESULTS Our study comprised 298 children with an average age of 5.9 ± 3.9 years and a sex-ratio with 2. Minor traumatic brain injury represented 92.6 % of the cases and severe traumatic brain injury represented 5.4 %. One child of 6 had another traumatism. Accidents at home were the most frequent causes (64.1 %). Traffic accidents represented 27.9 % of the mechanisms. In 90.6 % of the cases the transport was assured by clean means. The cerebral scanner, produced at 89.9 % of the patients, revealed cerebral lesions in 49.7% of the cases. Neurosurgical indications were carried in 5 children. The death rate was 2.1 %. At three months of the exit of the hospital, 97.2 % of the children had a good recovery. CONCLUSION The paediatric traumatic brain injury is a frequent and serious pathology. The epidemiologic studies can contribute to the development of prevention program in order to decrease its incidence in the target population.
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Trifa M, Bouchoucha S, Smaoui H, Frikha M, Ben Marzouk S, Ben Ghachem M, Kechrid A, Fekih Hassen A, Ben Khalifa S. Microbiological profile of haematogenous osteoarticular infections in children. Orthop Traumatol Surg Res 2011; 97:186-90. [PMID: 21371961 DOI: 10.1016/j.otsr.2010.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 07/24/2010] [Accepted: 10/19/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Staphylococcus aureus, Kingella kingae and β-hemolytic streptococcus are presently the most frequently identified bacteria in child haematogenous osteoarticular infection. OBJECTIVE To determine the microbiological profile (bacteria and antibiotic susceptibility) of osteoarticular infections in a paediatric hospital, so as to adapt treatment protocols to the ecology of the bacteria isolated. PATIENTS AND METHODS Prospective descriptive study, including children admitted for acute osteomyelitis or septic arthritis. A series of blood cultures was performed systematically on admission. In case of surgery, local samples were taken for bacteriology. Antibiotherapy was initiated and subsequently adapted to the bacteriological findings. RESULTS One hundred and six children were included. Thirty-five were under (Group 1) and 71 over 3 years of age (Group 2). Ninety-five underwent surgery. Peroperative samples were positive in 61 cases and blood culture in 23. Bacteria were isolated in 22 patients in G1. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated in five neonates who had passed through intensive care. Staphylococcus aureus was the most frequently isolated bacterium in G2 (n=40), and was methicillin-resistant (MRSA) in six children. DISCUSSION Methicillin-susceptible Staphylococcus aureus was the most frequently isolated microorganism. Other than neonates who had passed through intensive care and the six patients with community-acquired MRSA infection, all isolated bacteria were susceptible to second-generation cephalosporins. LEVEL OF EVIDENCE II, prospective descriptive prognostic study.
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Affiliation(s)
- M Trifa
- Department of anaesthesia and intensive care, Children's Hospital, Bab Saadoun, 1006 Tunis, Tunisia.
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Bouchoucha S, Barsaoui M, Saied W, Trifa M, Ben Khalifa S, Benghachem M. Bilateral stress fractures of the femoral neck with no risk factor : a case report. Tunis Med 2011; 89:295-297. [PMID: 21387238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Stress fractures of the femoral neck are uncommon. They are caused by either excessive stress or bone fragility. AIM To report a case of bilateral stress fracture of the femoral neck in a 15-year-old girl without any risk factors OBSERVATION We report a case of bilateral stress fracture of the femoral neck in a 15-year-old girl in whom no risk factors were found. One of the fractures was displaced at first diagnosis and was successfully treated by closed reduction and valgus subtrochanteric osteotomy. The other fracture was initially undisplaced but displacement occurred later despite internal fixation with a dynamic hip screw. CONCLUSION A high index of suspicion of stress fractures of the femoral neck must be kept in mind even without risk factors. Delays in diagnosis and displacement should therefore be avoided.
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Affiliation(s)
- Sami Bouchoucha
- Department of paediatric orthopaedics, Children's Hopsital, Tunis, Tunisia
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Bouchoucha S, Benghachame F, Trifa M, Saied W, Douira W, Nessib MN, Ghachem MB. Deep venous thrombosis associated with acute hematogenous osteomyelitis in children. Orthop Traumatol Surg Res 2010; 96:890-3. [PMID: 20833120 DOI: 10.1016/j.otsr.2010.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/06/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Deep venous thrombosis (DVT) is rare in children. It may complicate acute hematogenous osteomyelitis (AHO). OBJECTIVE The present study assessed the incidence of DVT in community-acquired AHO, and compared clinical and laboratory characteristics with AHO without DVT. PATIENTS AND METHODS A prospective study included patients treated for community-acquired AHO between April 2007 and December 2009. RESULTS Seventy patients were included: mean age, 7.7 years. Seven developed DVT. All involved Staphylococcus aureus. The isolated Staphylococcus aureus was significantly more often methicillin-resistant than methicillin-susceptible (p=0.04). C-reactive protein, erythrocyte sedimentation rate, positive blood culture and incidence of pulmonary staphylococcus were significantly higher in patients with DVT. These patients also had significantly more febrile days. One patient with DVT died from severe refractory respiratory failure. DISCUSSION DVT was observed in 10% of cases of community-acquired AHO. DVT was associated with more severe onset, with extensive local disease. Surgery was often needed to drain a subperiosteal abscess. DVT can cause invasive and life-threatening infection through septic emboli, particularly to the lungs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- S Bouchoucha
- Pediatric Orthopaedics Department, Tunis Children's Hospital, place Bab Saadoun, 1007 Tunis Jabbari, Tunisia.
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Ben Khalifa S, Dehdouh A, Hmamouchi B, Trifa M, Hassen AF. [Paediatric anaesthesia in Maghreb: training, practice, barriers]. Ann Fr Anesth Reanim 2010; 29:576-578. [PMID: 20609556 DOI: 10.1016/j.annfar.2010.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- S Ben Khalifa
- Service d'anesthésie-réanimation pédiatrique, hôpital d'Enfants, rue Jebel Lakdhar, Tunis, Tunisie.
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Trifa M, Khalifa SB, Gargouri F, Kaouech N, Friaa M. [Effects of hydroxyzine on tolerance of facial mask during induction in children]. ACTA ACUST UNITED AC 2010; 29:53-4. [PMID: 20074897 DOI: 10.1016/j.annfar.2009.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 10/29/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of hydroxyzine as a premedication agent for the acceptance of facial mask during induction of general anaesthesia in children. STUDY DESIGN Prospective randomized single-blind study including ASA 1 and 2 children, aged between 1 and 9 years and undergoing outpatient surgery. PATIENTS AND METHODS Patients were randomly allocated to receive orally either 1mg/kg hydroxyzine (G1) or water 0.1 ml/kg (G2) one hour before induction of standardized inhalational anaesthesia. Tolerance of facial mask was assessed with a 3-points scale (good, moderate or poor). Chi-square and Student's t-test were used in statistical analysis; p values less than 0.05 were considered statistically significant. RESULTS One hundred patients were included (G1 = 49, G2 = 51). Demographic data were similar in both groups. Acceptance of facial mask was significantly better in G1 than in G2 (p = 0,002). CONCLUSION Hydroxyzine provided better acceptance of facial mask than placebo during induction of general anaesthesia in children.
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Affiliation(s)
- M Trifa
- Service d'anesthésie-réanimation, hôpital d'Enfants, Tunis, Tunisie.
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Ben Khalifa S, Blidi S, Trifa M, Skhiri A, Drira M, Regaya T, Fekih Hassen A. Time to extubation in infants undergoing pyloromyotomy -- isoflurane inhalation vs remifentanil infusion. Middle East J Anaesthesiol 2009; 20:277-280. [PMID: 19583078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) associated with metabolic alkalosis, could induce late anesthesia recovery, especially when opioids are used. The aim of this study was to compare the time of extubation and the quality of perioperative analgesia in infants scheduled for pyloromyotomy, receiving either isoflurane inhalation or remifentanil infusion. METHODS Thirty full-term infants scheduled for pyloromyotomy were prospectively studied. A standardized anesthetic induction was performed. For maintenance of anesthesia, infants were randomly allocated to receive either isoflurane 0.75% of inspired concentration (GI n = 15), or remifentanil as a continuous infusion of 0.4 microg x kg(-1) x mn(-1) (GR n = 15). At the beginning of skin closure, the anesthetic was discontinued and 15 mg x kg(-1) of paracetamol administered. Non parametric tests were used in statistical analysis. RESULTS The time to extubation was similar in both groups. The intraoperative heart rate was significantly lower in the GR group. CONCLUSION Remifentanil provided better intraoperative analgesia than isoflurane in infants undergoing pyloromyotomy without increasing time to extubation.
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Affiliation(s)
- Sonia Ben Khalifa
- Department of Anesthesia and Intensive Care, Children's Hospital, Tunis
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Trifa M, Chaabane Z, Dridi S, Sebai B, Missaoui A, Fekih Hassen A, Ben Khalifa S. The analgesic effects of ropivacaine in ilioinguinal-iliohypogastric nerve block in children--concentration or volume? Middle East J Anaesthesiol 2009; 20:83-87. [PMID: 19266831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The aim of the present study was to compare the analgesic effects of ripovacaine when used as high concentration/small volume, versus its use as high volume/low concentration, in ilioinguinal-iliohypogastric nerve block in children. METHODS This is a prospective single-blind randomized study consisting of 72 children ASA I & II, 3-9 years of age, scheduled for outpatient elective surgery. Children were randomly assigned into two equal groups (36 each), to receive ropivacaine 0.8 mg.kg(-1), for ilioinguinal-iliohypogastsric block, either as: 1 mg.ml(-1) (0.8 ml.kg(-1)) G1 group, or 2 mg.ml(-1) (0.4 ml.kg(-1)) G2 group. The postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), at the end of surgery (H0), at one (H1), tow (H2), four (H4) and six (H6) postoperative hours. Parents were requested to record their child's pain every 6 hours during the first 24 postoperative hours, using the postoperative pain measurement for Parent Scale. RESULTS CHEOPS score H0 was significantly lower in G2 as compared to G1 group (p = 0.03). Only 2 children in G2 as compared to 8 children in G1 group, required i.v. paracetamol administration after surgery (p = 0.04). In group G1, two children required paracetamol at home and three developed a postoperative transitory femoral nerve block (p = 0.23). CONCLUSIONS Ropivacaine when used with high concentration/small volume is more efficient than when used a high volume/low concentration, for ilioinguinal-iliohypogastric nerve block in children.
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Affiliation(s)
- Mehdi Trifa
- Dept. of Anesthesia & IC, Children's Hospital, Tunis, Tunisia.
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Trifa M, Simon L, Hamza J, Bavoux F, des Roziers NB. Haemolytic anaemia associated with high dose intravenous immunoglobulin therapy in a child with Guillain-Barré syndrome. Arch Dis Child 2003; 88:836-7. [PMID: 12937119 PMCID: PMC1719657 DOI: 10.1136/adc.88.9.836-b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mhiri MN, Trifa M, Bahloul A, Hadiji S, Beyrouti MI. [Kidney contusions and traffic accidents. Apropos of the Tunisian experience]. Ann Urol (Paris) 1998; 31:243-5. [PMID: 9480626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors report a retrospective series of 45 cases of blunt renal trauma from a total of 685 cases of blunt abdominal trauma observed between 1989-1993. This multicentre trial was designed to illustrate the severity of this type of trauma and to place it in the context of road accidents in Tunisia.
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Affiliation(s)
- M N Mhiri
- Service d'Urologie, CHU Habib Bourguiba, Sfax, Tunisie
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Trifa M, Njeh M, Bahloul A, Jemal S, Mhiri MN. [Traumatic rupture of the anterior urethra. Apropos of 18 cases]. Ann Urol (Paris) 1998; 31:313-7. [PMID: 9480639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors report a retrospective series of 18 cases of rupture of the anterior urethra, with a mean age of 25 years (range: 10 to 45 years). The mechanism of the lesion was trauma by falling onto the perineum (12 cases), road accident (4 cases) and sexual intercourse (2 cases). Urine drainage was ensured by suprapubic catheter (15 cases) or urethral catheter (1 case). The two cases of rupture of the urethra associated with lesions of the corpora cavernosa required urgent surgical repair. In the other cases, simple urine drainage was sufficient to treat partial ruptures of the urethra (11 cases) with only one case of urethral structure. However, end-to-end urethrorraphy was performed in the 4 patients with total rupture of the urethra, with early failure in 3 cases, attributed to delayed surgery. Finally, the course of urethral rupture associated with rupture of the corpora, cavernosa was favourable in terms of both micturition and sexual function.
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Affiliation(s)
- M Trifa
- Service d'Urologie, CHU Habib Bourguiba, Sfax, Tunisie
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Krid M, Bahloul A, el Haddad N, Trifa M, Mosbah AF, Mhiri MN. [Kidney injuries in children. Apropos of 65 cases]. Ann Urol (Paris) 1998; 31:259-65. [PMID: 9480629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors report a retrospective series of 65 cases of renal contusion in children affecting 45 boys and 20 girls between the ages of 10 months and 15 years (mean age: 10 years). The causes of renal trauma were dominated by household accidents (53.8%) and road accidents (33.8%). Associated extrarenal lesions were observed in 21.5% of cases. 55.4% of the 65 contusions were considered to be benign, 27.7% of moderate severity and 16.9% were serious. The blunt trauma affected a pathological kidney in 19 cases. Exclusively medical treatment was recommended in 31 patients, while surgery was indicated in the other 34 patients. Apart from one death in a context of multiple trauma, few complications were observed in the group of operated patients and consisted of 4 cases of urinary fistula and 4 cases of infection, all of which resolved.
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Affiliation(s)
- M Krid
- Service d'Urologie, E.P.S. Sahloul, Sousse, Tunisie
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Bahloul A, Krid M, Trifa M, Mosbah AT, Mhiri MN. [Contusions to the pathologic kidney. A retrospective study, apropos of 34 cases]. Ann Urol (Paris) 1998; 31:253-8. [PMID: 9480628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors report a retrospective study of 34 cases of blunt renal trauma affecting a pathological kidney out of a total of 156 cases of renal trauma. The patients were between the ages of 3 and 60 years, with a male predominance (sex-ratio: 2.4). The predominant cause of trauma was a household accident, in 15 cases (44%). The clinical features were dominated by haematuria and pain. The underlying renal disease was dominated by renal stones (15 cases, 44%) and ureteropelvic junction (UPJ) abnormality (10 cases, 29%). Twelve patients with benign trauma and minimal underlying renal disease were treated conservatively. Surgery was indicated in the remaining 22 patients, but only 20 were actually operated. Nephrectomy was performed in 9 patients and partial nephrectomy was performed in 3 patients. Treatment consisted of UPJ plasty in 2 cases, uretero-caliceal anastomosis in one case, stone surgery in 4 cases and suture of ruptured renal pelvis in one case. The postoperative course was marked by the development of a urinary fistula in 1 patient, cured by drainage and deterioration of hydronephrosis in one patient. Lastly, one patient died from Wilms' tumour. This disease therefore tends to have a fairly benign course, which nevertheless depends on the underlying renal disease.
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Affiliation(s)
- A Bahloul
- Service d'Urologie, C.H.U Habib Bourguiba, Sfax, Tunisie
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35
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Trifa M, Langar W, Hadj Slimane M, Jmel S, Bahloul A, Mhiri MN. [Renal cell adenocarcinomas. Report of 64 cases]. Ann Urol (Paris) 1997; 31:117-122. [PMID: 9273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors report 64 renal cell carcinomas observed in 64 patients over a period of 14 years (1982-1995). The mean age was 58 years (range: 20 to 80 years). Male involvement was observed in 34 cases (53%). The clinical symptoms were nonspecific, consisting of haematuria (26 cases), back pain (33 cases) and tumour (8 cases). Twenty patients presented with paraneoplastic syndromes and 4 presented with metastases. The tumour was an incidental finding in 6 cases. Fifty two patients were treated by radical nephrectomy and two by partial nephrectomy. The tumour was associated with venous involvement in 2 cases, lymphatic involvement in 4 cases and distant metastases in 2 cases. The overall 5-year survival was 37% with a poor prognosis in the case of lymph node involvement or metastases and in the case of secondary local recurrence (4 cases) or distant metastases (2 cases).
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Affiliation(s)
- M Trifa
- Service d'Urologie, CHU H. Bourguiba, Tunisie
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Eschwege P, Randrianjohany A, Trifa M, Alexandre L, Blanchet P, Decaux A, Richard C, Charpentier B, Benoit G. [Impact of weight difference between donor and recipient on the function of the transplanted kidney]. Prog Urol 1996; 6:257-9. [PMID: 8777419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this retrospective study was to determine whether the difference between the donor's weight (wd) and the recipient's dry weight (wr) could influence the function of renal transplants. METHODS Between 1987 and 1994, 185 patients with a mean age of 43.3 years +/- 12 were transplanted with a locally harvested cadaver kidney, corresponding to 120 men (42.2 years +/- 1.4) and 65 women (45 years +/- 12.8). The weight variation between donors and recipients (wd - wr) was 0.06 for men and 0.22 for women. The serum creatinine of recipients at 1 year was 147 mumol +/- 41.7. We used analysis of variance for univariate statistical analysis and multiple linear regression for multivariate analysis. RESULTS On univariate analysis, the serum creatinine at 1 and 2 years was significantly higher (p < 0.02 and p < 0.035 respectively) when the donor's weight was 10% lower than the recipient's weight. Multivariate analysis, taking into account the donor's age and sex and the recipient's serum creatinine, confirmed the influence of the donor-recipient weight difference on serum creatinine at 2 years (p0.03), but also the role of the donor's age at 1 and 2 years (p < 0.0001 and p < 0.0004, respectively). CONCLUSION In our study, the donor-recipient weight difference was a factor influencing the recipient's serum creatinine at 2 years. The donor's age also influences the recipient's serum creatinine, 1 and 2 years after renal transplantation.
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Affiliation(s)
- P Eschwege
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin Bicêtre
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Eschwege P, Trifa M, Randrianjohany A, Blanchet P, Desportes L, Decaris J, Joseph L, Larue JR, Charpentier B, Jardin A. Effects of donor and recipient weight differences on serum creatinine levels in renal transplantation. Transplant Proc 1995; 27:2456. [PMID: 7652880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P Eschwege
- Department of Urology, Hôpital de Bicêtre, Université Paris-Sud, France
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Trifa M. [Urethral instability in women. Etiopathogenesis and therapeutic approach]. J Urol (Paris) 1994; 100:36-39. [PMID: 8089530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The urodynamic significance of uretral instability has long been debated. Based on a review of the literature, we attempted to investigate the still debated aetiopathogenisis and explain certain therapeutic difficulties.
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Affiliation(s)
- M Trifa
- Clinique Urologique, Hôpital Cochin, Paris
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Mhiri MN, Rebai T, Trifa M, Chaabouni MN, Kharrat M. [Perineo-scrotal liposarcoma. Apropos of 3 cases]. J Chir (Paris) 1993; 130:27-31. [PMID: 8496254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors report 3 rare cases of liposarcoma occurring in the perineal or paratesticular regions. They review literature data concerning this particular form of soft tissue sarcoma and emphasize on prognosis which depends mainly on its histo-pathologic type.
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Affiliation(s)
- M N Mhiri
- Service urologie, C.H.U. Bourguiba, Sfax, Tunisie
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Mhiri MN, Trifa M, Sellami M, Mhiri C, Letaief Y, Souissi T. [Regional portal hypertension revealing malignant adrenal cortical carcinoma]. J Chir (Paris) 1992; 129:172-5. [PMID: 1639890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors report a rare case of regional portal hypertension secondary to splenic vein obstruction by left adrenal carcinoma metastasis. They review the principal literature data concerning regional portal hypertension and adrenal cortical carcinoma.
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Affiliation(s)
- M N Mhiri
- Service d'Urologie, CHU H. Bourguiba, Tunisie
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