Effect of Mild Hypothermia on Morbidity and Mortality in Post AMI Cardiogenic Shock

Background: Acute myocardial infarction (AMI) complicated with cardiogenic shock is still associated with a significant death rate. Other interventions, including intra-aortic balloon counter pulsation and medical therapy, failed to improve prognosis in large-scale randomised studies, with the exception of early revascularization. Recently, mild therapeutic hypothermia, in which patients are lowered to 33°C over the course of 24 hours, has been proposed as a therapy option for cardiogenic shock patients. The purpose of this study is to determine the impact of mild hypothermia on morbidity and mortality associated with post-AMI cardiogenic shock. Methods: This randomized, controlled, unblinded trial was conducted on 50 patients with AMI complicated by CS. Patients were randomly allocated into two equal groups; group I received MTH to 33°C for 24-36 h and group II (control group) did not receive MTH. Patients were subjected to full history taking, general and clinical examination, laboratory examination, echo, chest ultrasound (US), coronary angiography data and mild therapeutic hypothermia protocol. Results: Stroke until day 30, duration of mechanical ventilation, length of ICU stay, duration of inotropic support, mortality and pulmonary congestion by US were insignificantly different between both groups. Arterial lactate and mean arterial blood pressure (MAP) at 4h, 6h, 8h, 10h, 12h, 14h, 16h, 18h, 20h were significantly increased in group I than Group II (P value<0.05). and were insignificantly different between both groups at 0h, 2h, 22h, 24h, 26h, 28h, 30h. Serum creatinine at 24h, 48h was significantly increased in group I than Group II (p value <0.05) and was insignificantly different between both groups at 0h. Conclusions: Therapeutic hypothermia (TH) didn’t improve short term outcomes in patients with post AMI cardiogenic shock.

Gastritis Associated with Initially Pediatric Crohn's Disease and Ulcerative Colitis / 대한소아소화기영양학회지

PURPOSE: The aim of this study is to determine the involvement of the upper gastrointestinal system (GIS) in patients diagnosed with Crohn's disease (CD), ulcerative colitis (UC), and non-inflammatory bowel disease (IBD) and to compare their differences. METHODS: This study included patients aged between 2 and 18 years who underwent colonoscopy and esophagogastroduodenoscopy (EGD) for the first time due to the prediagnosis of IBD. In EGD, samples were taken from duodenum, antrum, corpus, and esophagus; and gastritis, duodenitis, and esophagitis were identified through histopathologic examination. The data gathered the ends of the research were compared between IBD with non-IBD groups and between CD-UC with non-IBD groups, and the presence of significant differences between groups were determined. RESULTS: In our study, 16 patients were diagnosed with CD, 13 with UC, 3 with undeterminate colitis, and 13 with non-IBD. In the histopathological examination of the groups, GIS involvement was found in 94.1% of patients diagnosed with IBD and in 38.5% of non-IBD patients. Moreover, the difference was found to be statistically significant (p=0.032). No significant difference was found between the CD and UC groups. Gastritis was mostly observed in 93.8% of CD-diagnosed patients, 76.8% of UC-diagnosed patients, 81.2% of IBD-diagnosed patients, and 38.5% of non-IBD-diagnosed patients. On the other hand, significant differences were found between CD and non-IBD groups (p=0.03), UC and non-IBD groups (p=0.047), and IBD and non-IBD groups (p=0.03). CONCLUSION: The results of the study show that gastritis was highly observed in UC- and CD-diagnosed patients than in non-IBD-diagnosed patients.

Acute vanishing bile duct syndrome after the use of ibuprofen

We present a case report of a 7-year-old patient who developed toxic epidermal necrolysis [TEN] and vanishing bile duct syndrome [VBDS] after oral ibuprofen intake. Acute VBDS is a rare disease with unknown aetiology, often presenting with progressive loss of the intrahepatic biliary tract. TEN is an immune complex-mediated hypersensitivity reaction involving the skin and mucosa, which is induced by drugs or infectious diseases, sometimes leading to systemic symptoms. The patient in this case report was treated with supportive care, a steroid and ursodeoxycholic acid, with complete recovery observed by the end of the 8[th] month. This case report suggests that ibuprofen can cause acute vanishing duct syndrome

Does the use of radio frequency ultrasonic dissector in tonsillectomy have a beneficial effect over the use of laser?

To compare the intra- and post- operative morbidities on the use of radiofrequency ultrasonic dissector [US] with the use of laser during tonsillectomy in the same patients. A randomized comparative study was implemented where all patients underwent tonsillectomy at Al-Hada Armed Forces Hospital, Taif, and Aouhod Hospital, Al-Madinah, Kingdom of Saudi Arabia during the period January 2000 to December 2005 were recruited for the study. Radiofrequency US was used in one side, and laser was used in the other side of the same patient. Intra- and post- operative blood losses, and duration of the operation, in addition to postoperative pain score were recorded. Five hundred and twenty-eight patients were recruited for the study. The mean operation duration was significantly shorter in the US group as compared to the laser group [p < 0.01]. Intraoperative blood loss was significantly lesser in the US group [p < 0.001]. Post-operative pain score was significantly lower among US subjects [p < 0.001]. No significant difference in postoperative hemorrhage was detected between the compared groups. The use of US in tonsillectomy showed a beneficial effect on intraoperative blood loss, duration of the operation, as well as, postoperative pain over the use of laser

comparison of different hemorrhoidectomy procedures

To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel [HS] and classical methods. Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS [n=22], closed HS [n=22], Miligan Morgan [n = 22], and Ferguson [n = 21] hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time. Bleeding volume was significantly lower in Groups I-II [p < 0.001]. Operation time was significantly shorter in Group I [p < 0.001]. Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III [p < 0.001] compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III [p < 0.004]. Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV [p < 0.001]. Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III [p < 0.007] and similar in closed hemorrhoidectomy group. The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain