A Case of Leukemia Cutis in an Inguinal Herniorraphy Scar

Leukemia cutis refers to the infiltration of the skin with leukemia cells. It is a rare extramedullary manifestation of leukemia, but it is a specific sign of disease progression and bad prognosis. Cases of leukemia cutis in sites of skin trauma or surgical scars have been described, but there are very few cases reported in literature. We report a case of a 65-year-old male previously diagnosed with chronic myelomonocytic leukemia that was showing clinical signs of progression to acute myeloid leukemia. He underwent right inguinal herniorrhaphy three months before and was showing poor wound healing. Surgical site infection was suspected, since blood tests showed prolonged neutropenia, so surgical wound debridement was performed. Pathological findings of removed tissue indicated infiltration by leukemic cells, which led to the diagnosis of leukemia cutis, not suspected until that moment. Therefore, we conclude that an exhaustive skin examination (especially in the presence of skin trauma or surgical scars), should be performed in patients with confirmed or suspected diagnosis of leukemia. Moreover, the possible diagnosis of leukemia cutis should be considered in leukemia patients who present cutaneous infectious complications or suboptimal healing following accidental skin trauma or surgery. In these cases, complementary anatomopathological studies should be performed.

A Comparative Study Between Magnesium Sulfate Versus Morphine Added to Bupivacaine in Ultra-Sound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia after Inguinal Herniorraphy

Background Inguinal hernia considered the third common disease in surgeries for adult after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of Magnesium sulfate added to Bupivacine verus Morphine to Bupivacaine in ultrasound guided transversus abdominis plane (TAP) block after inguinal herniorraphy regarding the pain relief and the amount of rescue analgesia used postoperative. Patients and Methods The study was conducted on 45 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in three groups of 15 patients each: Group - I (B): received TAP block with Bupivacaine only as a “Control Group”. Group - II (B-MO): received TAP Block with Bupivacaine plus Morphine. Group - III (B-Mg): received TAP block with Bupivacaine plus Magnesium Sulfate. The three groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total consumption of it in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed. Results The results of the study revealed that Magnesium added to bupivacaine better than Morphine added to Bupivacaine in transversus abdominis plane block regarding the postoperative analgesia after inguinal Herniorraphy. Conclusion In Conclusion the addition of MgSo4 as an adjuvant to bupivacaine in TAP block has shown superiority over either mono-therapy with bupivacaine or bupivacaine-Morphine combination in many aspects such as postoperative analgesic outcome assessed by VAS score, 1st time of rescue analgesia and without the pronounced side effects of the conventional postoperative opioids and less side effect than Morphine.