Protective effect of glucosamine and risedronate (alone or in combination) against osteoarthritic changes in rat experimental model of immobilized knee / 대한해부학회지

ultrasound guided technique of central venous catheterization versus anatomical landmark guided technique in medical intensive care patients

Background: Central venous catheterization [CVC] is an important procedure in the practice of emergency medicine. Insertion of CVC is amongst the most frequently performed invasive procedures in ICU. In severely ill and long-stay patients, inserted CVCs enable relatively safe and painless application of parenteral nutrition, long-term antibiotics, chemotherapy, intravenous fluids, and blood components and are also used for repetitive blood sampling. Furthermore, CVCs are used for invasive hemodynamic monitoring, hemodialysis, plasmapheresis and in case of shortage of a peripheral access. With the increasing availability of bedside ultrasound, emergency physicians have begun to incorporate this new technology to reduce error and improve patient care

Objective: To compare the outcome of an ultrasound guided technique versus an anatomical landmark guided technique for central venous catheterization

Patients and methods: The present study was performed on one hundred patients of both sexes; the study was conducted at El-Hussein University Hospital. They were scheduled for insertion of central venous line for various purposes. The patients were assigned into two groups each group formed of fifty patients [n=50]. Group [A]: Anatomical guided technique for insertion of CVC, Group [B]: Ultrasound guided technique for insertion of CVC. Patients with local infection, known vascular abnormalities, untreated coagulopathy [INR more than 1.5, platelets less than 50000/mm3 ] and age less than 16 years old were excluded from the study

Results: A total of 100 patients were included. The outcome of each group was recorded regarding success rate, number of attempts and access time in seconds. The use of ultrasound guided central venous catheterization has better outcome and higher-safety in comparison to anatomical landmark-based technique. Ultrasound guidance elevated significantly the success rate of central venous catheterization than anatomical landmark-based technique. In addition, the access time was reduced in a significant trend by using ultrasound guidance. In the same manner the average number of attempts needed for accessing the vein was limited significantly when Ultrasound guidance was applied. The incidence of hematoma formation, arterial puncture and malposition was reduced in a significant trend by using ultrasound guidance in comparison to landmark-based techniques. When comparing ultrasound guidance to anatomical landmark-based guidance we found that all mechanical complications were significantly lower when central venous catheterization was carried out by means of ultrasound guidance

Conclusion: Ultrasound examination of the region of interest offers some additional information compared to clinical examination as Position of the vessel, Patency of the vessel, Size of the vessel and Stenosis or hematoma. The implementation of ultrasound guidance improves success and reduces complication rate during central venous catheterization

Diaphragmatic excursion assessment by ultrasound versus volume associated weaning parameters as a prediction in extubation in critically Ill patients

Background: Liberating a patient from ventilator is a continuous process as with any disease condition which starts with recognition of patient being ready to be weaned from ventilator by letting the patient breathe on T-piece and, if successful proceeding to SBT followed by extubation, if it is tolerated well [simple weaning]. Otherwise letting patient on ventilator till next such trial being successful. Difficulty in weaning from mechanical ventilation is one of the most frequently encountered problems in MICU. An estimated 20% of mechanically ventilated patients face failed extuabtion [requiring reintubation within 48 h of extuabtion]

Aim of the study: This study was designed to assess the value of the excursion of diaphragm tested by ultrasonography to predict weaning from mechanical ventilation versus volume associated weaning parameters in medical intensive unit's patients

Patients and Methods: A prospective study was carried out on 30 patients ready for weaning. All patients were divided into two equal groups.Group A [successful weaning group] and Group B [failed weaning group]

Results: Of the entire group of 30 patients, 21 patients [70%] had succeeded extubation and 9 patients [30%] failed. By applying cut-off level 1cm determined in our study the sensitivity and specificity of mean liver and spleen displacement were 95.2% and 88.9% respectively, which is higher than Pi max [85.7% and 77.8%] by cut-off level

Conclusions: The present study concluded that ultrasonographic measurement of liver and spleen displacement during SBT before extubation is a good method for predicting extubation outcome

Effect of hemodialysis on blood ammonia level among cirrhotic patients undergoing hemodialysis

Background: Uremia results in a characteristic breath odor [uremic fetor] which is largely due to its high ammonia content. Earlier studies have shown a strong correlation between breath ammonia and blood urea levels and a 10-fold reduction in breath ammonia after hemodialysis in patients with chronic kidney disease. Potential sources of breath ammonia include: [i] local ammonia production from hydrolysis of urea in the oropharyngeal and respiratory tracts by bacterial flora, and [ii] release of circulating blood ammonia by the lungs. While the effects of uremia and hemodialysis on breath ammonia are well known while their effects on blood ammonia are unknown and were explored here

Methods: Blood samples were obtained from 56 hemodialysis patients [immediately before and after dialysis]. Blood levels of ammonia, creatinine, arterial blood gases, and electrolytes were measured

Results: There was significant fall in serum creatinine following hemodialysis with significant increase in blood ammonia. Moreover, cirrhotic patients with high-bicarbonate showed a significant more increase in ammonia and significant increase in incidence of hyper-ammonemia to that of non-cirrhotic and low-bicarbonate. Furthermore, the increase in serum bicarbonate showed a significant correlation to the change of blood ammonia following dialysis

Conclusion: The fall in blood creatinine concentration following hemodialysis is paradoxically accompanied by a rise in blood ammonia in hemodialysis subjects, contrasting the reported effect on breath ammonia. The mechanism of the post-hemodialysis rise in blood ammonia may be due alkalotic change in PH. The observed rise in blood ammonia level was directly related to the rise in blood bicarbonate and with aggravation of alkalotic state in cirrhotic patients. The rise in blood bicarbonate is associated with increased incidence of hyper-ammonemia among cirrhotic patients

Developmental and histological studies of fungiform papillae in fetal human tongue

This study was designed to evaluate the histological development of fungiform papillae of human tongue during the prenatal period. Lateral Sagittal sections were taken at autopsy from the anterior two-third of 18 aborted fetuses of 8, 10, 12, and 20 weeks of gestations and 2 stillborn infants at 40 weeks of gestation. Twenty specimens were prepared in paraffin and stained for histological study. The gestational ages were calculated after measuring the Crown Rump Length [C.R.L.]. It was found that the first appearance of fungiform papillae was nearly about the 10th week of gestation, before the appearance of filiform papillae, most of the developed fungiform papillae were cylindrical in shaped with appearance of nerve plexus, at 12th week they reached mushroom shaped with narrow base and broad apex and became differentiated into primary and secondary papillae, also presumptive taste buds were noticed at this age in the form of multiple local thickening of papillary epithelium. At 20th week of gestation the taste buds became more developed, the papillae appeared more vascular. At full term [40th week] the fungi form papillae reached full maturity. It is concluded that this study suggests that the development of fungi form papillae requires an epithelial and mesenchymal interaction during morphogenesis

protective effect of vitamin c on irradiated testes of albino rat

The increased exposure to radiation in medicine or industries increases the hazards of radiation on various organs of the human body. The aim of this work was to evaluate the protective effect of anti oxidant [vitamin C] against the effect of radiation on rat testes. Thirty adult albino rats were divided into three groups, each contained ten rats .The first group [G.1] was exposed to 415 r [G.1'] or 622 r [G.1"] using x-ray source for one minute per day for one week. The second group [G.2] was exposed to 415 r [G.2'] or 622 r [G.2"] using x-ray source for one minute per day for one week, in addition to vitamin C equivalent to 86.9 mg./liter orally for the two sub groups for the same period . The third group [G.3] was a control group. The examined testes of G.1 showed damaged germinal epithelium with remaining some layers of spermatogonia. There was no affection of spermatocytes, mature sperms, Sertoli cells and Leydig cells, the lumen contained little sperms and debris of germ cells [G.1'] .While for [G.1"] there was marked damage of the seminiferous tubules with irregular outline, destruction of spermatogonia, spermatocytes and spermatids with pyknotic type of nuclear degeneration and the lumen was devoid of mature sperms. The examined testes of the [G.2] showed evidence of almost complete recovery for G .2' and marked recovery for G.2". It is concluded that anti oxidants were essential to patients exposed to x-ray , to guard against its hazards