Does moist exposed burn ointment [MEBO] promote healing of chronic pressure ulcers? a multicenter randomized clinical study

Amulticenter, randomized, controlled study to assess the efficacy and safety of MEBO [Julphar Gulf Pharmaceutical Industries, UAE, and SanTou MEBO Pharmaceutical CO., LTD., China] in healing of chronic pressure ulcers. Eighty seven patients with 182 chronic pressure ulcers treated at six hospitals from different areas in world, between January 2003 and January 2009, were randomized into 2 groups; those in group 1 [n=46] received MEBO while those in group 2 [n=41] received Fucidin [Leo Pharmaceutical Denmark]. Data collected prospectively included demographics, nutritional status, underlying predisposing disease and co-morbidities, Ulcer surface area [SA] and healing index [HI] were calculated and compared at two-week intervals for 12 weeks. Patients in both groups had similar demographic, clinical, biochemical features, and ulcer characteristics. There was a significant increase in HI and reduction in ulcer SA on weeks two and four respectively, that was maintained through 12 weeks in patients treated with MEBO. More than half of ulcers [56.5%] treated with MEBO had complete healing [HI=1] by 12 weeks, as opposed to only 19.6% of those treated with Fucidin [P<0.00l]. Moreover, none of the patients receiving MEBO had a HI of<50% of their ulcers by 12 weeks as compared to 26.8% of those receiving Fucidin [P<0.00l]. No adverse effects or allergic reactions of topical ointment were encountered in either group. In addition to its safety, MEBO significantly promotes the healing of chronic pressure ulcers with significant increase in HI of any given ulcer as early as two weeks following initiation of treatment, and complete healing of more than 50% of ulcers by 12 weeks

Voice changes after thyroidectomy: role of external laryngeal nerve

To evaluate a technique to protect the external laryngeal nerve during thyroidectomy.Randomized controlled trial. Patients randomized into group A or B using closed envelops method. Alexandria university hospital is a teaching hospital. It is the referral center serving seven million people. Forty four consecutive patients admitted to Alexandria university hospital for thyroidectomy. Fourpatients had voice abnormalities on preoperative voice analysis. They were excluded. All patients underwent thyroidectomy. Group A had conventional mass ligature of the superior poleof thyroid gland while group B had individual ligation of the branches of the superior thyroid artery afteridentification of the external laryngeal nerve whenever possible. Abnormal readings on postoperative voice analysis and abnormal electromyogram of thecricothyroid muscles. Observers performing voice analysis tests were blinded as regards patient group. Postoperativeelectromyography of the cricothyroid revealed signs of nerve injury in five patients of group A but none in groupB. Multi-dimensional voice program, fundamental frequency range, fundamental frequency and maximum pressurelevel all showed significant postoperative change in group A but not of those in group B [level of confidence95%].Identification of external laryngeal nerve and/or ligation of the terminal branches of the superiorthyroid vessels seems to help prevent external laryngeal nerve injury

MRCP as compared to ERCP in patients with obstructive jaundice

Magnetic resonance cholangiopancreatography MRCP was performed in 300 consecutive patients with clinical diagnosis of obstructive jaundice. These patients were divided into three groups. Group one included 120 patients in whom ERCP was performed within 72 hours prior or after MRCP. Group two included 20 patients in whom ERCP was failed [12 patients] and patients refused the procedure [8 patients]. Group three included 160 patients in whom MRCP was done as the primary diagnostic modality. Ultrasonography was done in conjunction with MRCP in all groups. The results of MRCP matched that of ERCP as regards to the determination of presence or absence of obstruction and its level. ERCP has a major advantage of its ability to perform a therapeutic drainage procedure simultaneously with imaging which was not possible with MRCP

Effect of different modalities of treatment on the quality of life of breast cancer patients in Egypt

The impact of breast cancer therapy on the quality of life [QL] of Egyptian women was studied. Patients were divided into four groups: 1: mastectomy alone; 2: surgery plus radiotherapy; 3: surgery plus chemotherapy; and 4: triple modality. The results revealed that all the four domains of QL of women having adjuvant therapy [groups 2, 3, or 4] were significantly altered compared to those who underwent mastectomy alone. Triple modality adversely affected global QL the most compared to radiotherapy or chemotherapy; radiotherapy had significantly less effect on QL compared to chemotherapy. Triple modality predicted the worst QL. QL measures should be incorporated with the traditional end points for evaluation of treatment and patients given health education on the effects of each therapy

Breast reconstruction with the tram flap: surgical and nursing challenges

The present study was conducted to explore the pre- and postoperative surgical and nursing problems encountered in 22 patients with locally advanced breast cancer treated with TRAM flap reconstruction, and to evaluate the nurses intervention in meeting with these problems and improving the final outcome of the procedure. Using the closed envelop method, 12 patients were randomly selected as the experimental group who was cared for according to an approved and definite nursing care protocol. The remaining 10 patients constituted the control group and was cared for according to hospital routine. The overall complication rate of the entire population was 41.4%. Nurses intervention resulted in a significantly less rate of postoperative complications as compared with the controls [25% versus 60%, respectively] and improved patient satisfaction with the outcome of the procedure. Based on these data, it may be concluded that the nurses role is more than vital in achieving successful surgical outcome. Besides ameliorating the potential postoperative complications, nurses help the patients to consider the short-term risks, the long-term health concerns, the safety issues and their available options

Amelioration of hepatic ischemic injury

The present study was performed to examine the efficacy of some pharmacological agents in ameliorating the injury associated with experimental hepatic ischemia and reperfusion [1/R] in rats. Animals were subjected to a two-thirds hepatectomny following a 60-minute period of ischemia of the unresected liver. Subsequent survival of the animals is dependent upon a regenerative response within the unresected previously ischemic hepatic tissue. Control animals were given 0.5 ml of saline solution and all died within 72 hours. Protection against fatal injury [80% 10-day survival] [P<0.01] was achieved with a combination of 12.5 micro mol adenosine triphosphate-magnesium chloride [ATP-MgCL[2]] and 600 U superoxide dismutase [SOD] in 0.5 ml of saline administered intravenously 30 minutes before hepatic reperfusion. The improved survival was reflected by a significant reduction [P<0.05] in the serum levels of alanine aminotransaminase [ALT] and lactate dehydrogenase [LDH] postoperatively. Based on these data, it can be concluded that a combination of ATP and SOD ameliorates the hepatic injury associated with I/R, reduces hepatic necrosis and cytosolic enzyme loss, and allows the liver to recover and regenerate. From a clinical point of view, such actions would be likely to protect the liver during I/R injury experienced during hepatic resection and liver ransplantation and to enhance graft function after implantation