ABSTRACT
The Himachal Pradesh acute coronary syndrome registry highlighted a prehospital delay of 780 min. Additional door-to-needle time delay by 1 h increases the hazard ratio of death by 20%. We conducted a retrospective (group 1) and a prospective (group 2) analysis of 63 patients each to measure the impact of a fast-track protocol in the emergency department (ED) on the door-to-needle time in ST-elevation myocardial infarction (STEMI). The fast-track protocol involved zero cost to the hospital and saved 63 precious door-to-needle minutes for patients with STEMI. Thrombolysis in ED can save 33 precious minutes wasted in shifting patients to the coronary care unit.
ABSTRACT
Background: Chronic radiation proctitis is known to be a difficult to treat condition. Argon Plasma Coagulation (APC) though being effective requires prolonged sessions and has limited availability. Formalin, by virtue of its chemical cauterizing effects, has been found to be effective in patients with bleeding radiation cystitis and hemorrhagic proctitis. Our goal was to study the effectiveness of 4% formalin instillation in resistant patients of chronic hemorrhagic radiation proctitis. Methods: 13 patients with chronic radiation proctitis were treated with instillation of 50 ml 4% formalin into the rectum (3 minutes for 3 times). The total mucosal contact time was approximately 10 minutes. Their clinical response, tolerance to treatment and complications were assessed. Patients who did not have complete response were given another session(s) a week later. Results: The mean (SD) age of patients was 48.62±11.66 years. Twelve patients (92%) were female who received radiotherapy for carcinoma cervix and 1(08%) was male with carcinoma prostate. The overall clinical response rate was 100%; eight patients (61.5%) had complete cessation of bleeding while 5 patients (38.5%) had significant cessation of bleeding. Eight patients needed only one session, four needed 2 sessions and one patient needed 3 sessions for the clinical response. Serious complications were not observed . No recurrence of symptoms was seen during follow-up Conclusion: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated, inexpensive, technically simple and safe procedure.