ABSTRACT
Cauterisation with silver nitrate is commonly used to treat overgranulation. Silver nitrate has a high density and a high mass attenuation coefficient, and it is therefore highly radio-opaque. We present a case in which its topical application to an area of overgranulation was interpreted as a bony fragment by the reporting radiologist in a patient with a supracondylar humeral fracture whose radiograph after removal of K-wires showed a large radio-opaque lesion. Although not a new phenomenon, it is one not widely known, and it can lead to confusion and unnecessary further imaging.
Subject(s)
Caustics , Granulation Tissue/diagnostic imaging , Humeral Fractures/diagnostic imaging , Silver Nitrate , Artifacts , Cautery/methods , Child, Preschool , Diagnostic Errors , Female , Fracture Healing , Humans , RadiographyABSTRACT
Interruption of appropriate therapeutic warfarin therapy imposes a risk of morbidity and mortality on the patient. Strategies to reduce the risks of interruption impose relatively large costs in terms of prolonged hospital stay, medication and coagulation monitoring. We report a series of 47 consecutive surgical episodes on the hands of 39 patients without interruption of therapeutic warfarin anticoagulation and with an INR of between 1.3 and 2.9. There was no difficulty with intraoperative haemostasis. Two patients had minor bleeding-related complications with no long-term sequelae. The authors conclude that interruption to warfarin therapy is unnecessary if the INR is less than 3.0 and therefore inappropriate for therapeutically anticoagulated patients undergoing hand surgery.
Subject(s)
Anticoagulants/administration & dosage , Hand/surgery , International Normalized Ratio , Warfarin/administration & dosage , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/drug therapy , Female , Heart Valve Prosthesis , Hematoma/etiology , Hematoma/therapy , Hemostasis , Humans , Male , Middle Aged , Postoperative Complications , Stroke/prevention & control , Thromboembolism/prevention & control , Tourniquets , Treatment OutcomeABSTRACT
Patients with low cardiac output syndrome often have a reduced sensitivity to inotropes acting via the beta-adrenergic receptors. In this situation, drugs such as milrinone and piroximone may have a therapeutic advantage. Strips of human right atrial appendage were used to examine the inotropic actions of phosphodiesterase (PDE) inhibitors, measured as an increase in isometric tension in response to electrical stimulation at a frequency of 1 Hz. Cumulative concentration response curves were established for piroximone (an imidazalone derivative) and Milrinone (a bipyridine derivative.) Concentration response curves were then recorded to adrenaline in the presence or absence of the EC50 of each PDE inhibitor. The results indicate that these drugs, under the conditions employed in these experiments, have a significant inotropic effect when used alone. They also have a significant additive and potentiating effect when used in combination with adrenaline. Milrinone produced a significantly greater maximum tension as a percentage of basal tension, and has a lower EC50 than Piroximone.
