Tension Pneumoperitoneum: A Rare Complication of Cardiopulmonary Resuscitation (CPR).

Tension pneumoperitoneum is a surgical emergency. Although rare, failure to diagnose and treat the condition may be lethal. Hence, being aware of this phenomenon, particularly in scenarios involving cardiopulmonary resuscitation (CPR), is important. Existing literature emphasises immediate abdominal needle decompression as the initial management followed by close monitoring and keeping a low threshold for surgical intervention as a definitive measure. We decided to write up this case report to raise awareness that a tension pneumoperitoneum can result as a complication of CPR, a well-known and widely practiced algorithm.

Density of Bismuth Boro Zinc Glasses Using Machine Learning Techniques.

Machine learning techniques have been employed to predict the glass densities of xBi2O3-(70 - x)B2O3-20Li2O-5Sb2O3-5ZnO glasses using a data set of 2000 various B2O3 rich glasses using their chemical composition and ionic radius. The experimental density of present glasses strongly depends on Bi2O3 content which is increasing with bismuth content. The increasing density in bismuth doped glasses because the BO3 are converted into BO4 units, and besides BO3 units are less heavy than the BO4 units. The FTIR studies also confirm that the intensity of B-O-B bond decreasing with increasing Bi2O3 content which suggested that B-O-B bond in bond ring isolated to BO3 units transformed into BO4 units. In Raman Spectra the stretching vibrations of BO4 units shifting towards higher wavelengths with increasing Bi2O3 content. This shifting conforms that there is a structural changes in the glass-matrix and borate units converting from BO3 to BO4 units. The prepared glasses along with B2O3 rich glass data set train on various AI model such as gradient descent, Random Forest regression and Neural Networks to predict present density of glasses. Among the various models RF regression analysis model is successfully acceptable for the glass data with the highest R2 value 0.983 which end result conform that the predicted and experimental values correlated. ANNs stood the effective technique in prediction of glass density with the optimum performance resulting with Tanh as the activation function (R2 = 0.950). The minimum cost 0.018 obtained in the case of gradient decent function which also shows the better performance of regression model.

Lateral epicondylitis: a review of pathology and management.

Lateral epicondylitis, or 'tennis elbow', is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments.

Synthesis, X-ray structure, and pharmacological activity of some 6,6-disubstituted chromeno[4,3-b]- and chromeno- [3,4-c]-quinolines.

Some chromeno[4,3-b]quinolines 4a-i were obtained from beta-chloro carboxyaldehydes 3a-c with different aniline derivatives namely, aniline, 4-fluoroaniline, and 2-aminophenol. Surprisingly, 3a-c reacted with 2-aminothiophenol and afforded the chromeno[3,4-c]quinoline derivatives 5a-c. Single-crystal X-ray diffraction studies of 4e and 5b provided good support for the established structure. Compounds 4b and 5b showed significant anti-inflammatory and ulcerogenic score activities compared to that of indomethacin.

CT guided diagnostic foot injections.

AIM: To describe a CT technique for guiding diagnostic and therapeutic injections in the hind- and mid-foot. MATERIALS AND METHODS: Over a period of 50 months, 28 individuals were referred for diagnostic and therapeutic hind- and mid-foot injections before possible arthrodesis. A CT technique was developed that allowed entry into the various joints using a vertical approach. Numbers of joints injected were as follows: posterior subtalar, 21; talonavicular, 4; calcaneonavicular, calcaneocuboid, navicular-cuneiform and 5th metatarsocuboid joints, 1 each. RESULTS: All injections but one were technically successful. Significant relief of symptoms was noted by 16 participants, whereas for 9 there was no improvement and for 3 a partial response was achieved. CONCLUSION: CT is a simple and safe alternative to fluoroscopy for guiding diagnostic and therapeutic foot injections, and may be the technique of choice in cases of disordered anatomy.

Significance of interferon-gamma in coronary artery bypass surgery.

BACKGROUND: Gamma interferon (IFN-gamma) is produced by activated natural killer and T cells under pathologic circumstances. The objective of our study was to compare the level of IFN-gamma in open and endoscopic methods of vein harvesting for coronary artery bypass surgery (CABG). METHOD: Ninety samples of human saphenous veins harvested from patients prepared for CABG. Pre- and post-procedure sera of the patients, in addition to supernatants of 3-day endothelial cell culture, were analyzed for IFN-gamma. RESULTS: The mean preoperative IFN-gamma level (0.09+/-0.03 pg/mL) and that for postoperative sera (0.08+/-0.02 pg/mL) were not significantly different (P = 0.2). The mean IFN-gamma level in endothelial cell culture from the endoscopic (0.18+/-0.21 pg/mL) and the open method (0.19+/-0.39 pg/mL) were not significant (P = 0.89). CONCLUSION: We recommend the endoscopic method of vein harvesting because of its lower morbidity and earlier hospital discharge.

A cytokine analysis of the effect of cell saver on blood in coronary bypass surgery.

BACKGROUND: Increasing concern about the transmission of viral disease has generated greater interest in the use of salvaged blood as a means of alleviating the demand for homologous blood and expediting resuscitation during massive hemorrhage. Autologous blood processed by autotransfusion devices has become increasingly common in major surgery and is now largely viewed as safe and efficacious. However, there may be serious complications and sequelae associated with the use of processed blood, such as adult respiratory distress syndrome (ARDS) and renal failure. Complement cascade activation resulting from blood coming into contact with autotransfusion equipment leads to enrollment of leukocytes and release of large concentrations of cytokines, which may contribute to the development of organ failure. Our study evaluated cytokine release during cell saver (CS) blood salvage in the course of coronary artery bypass grafting (CABG) surgery. MATERIALS AND METHODS: Forty-five patients randomly selected for CABG were evaluated. All had received at least one unit of autotransfused blood by means of the Haemonetics Cell Saver System 5 (Haemonetics Corp., Braintree, MA). Each patient had four blood samples taken (pre-operative, CS container, autotransfusion from the blood bag, and one hour post-transfusion). These samples were then centrifuged and the sera were collected. An enzyme linked immunosorbent assay (ELISA) test, using the Biosource Cytoscreen solid phase "sandwich" ELISA kit (Biosource International, Camarillo, CA) was conducted to determine levels of the cytokines Interleukin (IL) 1, 2, 4, 6, 8, and 10, tumor necrosis factor (TNF), intracellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM). RESULTS: Significantly increased concentrations of the pro-inflammatory cytokines IL-1, 2, 4, 6, and 8, TNF, ICAM, and VCAM were noted throughout all time periods studied. The same effect was observed for the anti-inflammatory cytokine IL-10. CONCLUSION: Statistically significant increases in both the circulating levels of the pro-inflammatory and anti-inflammatory cytokines studied were recorded. It is our contention that the presence of IL-10, a down-regulator of inflammation, is responsible for attenuating the possible deleterious effects of the pro-inflammatory cytokines observed. However, morbidity and mortality, as well as the future patency of the bypass grafts, have not been correlated with the use of the autologous method of transfusion.

Intercellular and vascular cell adhesion molecule levels in endoscopic and open saphenous vein harvesting for coronary artery bypass surgery.

BACKGROUND: Numbers of intercellular and vascular cell adhesion molecules (ICAM and VCAM) and major ligands on endothelial cells for adherence of activated polymorphnuclear leukocytes, macrophages, and lymphoid cells increase in many inflammatory disorders and after trauma to different tissues. METHODS: Samples of human saphenous veins were harvested from 90 randomly selected patients who underwent coronary artery bypass graft (CABG) surgery, utilizing two different techniques (open and endoscopic). Endothelial cells were collected from the vein samples and cultured for 72 hours. Pre- and postoperative sera, in addition to the supernatants from the cultures, were analyzed for ICAM-1 and VCAM-1 using enzyme-linked immunosorbent assay. RESULTS: Mean preoperative levels of ICAM-1 and VCAM-1 (0.95 +/- 0.58 ng/mL and 1.81 +/- 1.03 ng/mL, respectively) did not differ significantly from that of postoperative sera (0.98 +/- 0.451 ng/mL and 1.74 +/- 1.05 ng/mL, respectively) (p = 0.77 and p = 0.73, respectively). Mean ICAM-1 and VCAM-1 levels in endothelial cell culture supernatants did not differ significantly between the endoscopic (0.16 +/- 0.05 ng/mL and 0.23 +/- 0.10 ng/mL, respectively) and the open method (0.18 +/- 0.08 ng/mL and 0.30 +/- 0.27 ng/mL, respectively) (p = 0.19 and 0.13, respectively). CONCLUSION: Our findings indicate that endoscopic and open saphenectomies are technically comparable in their effects on ICAM-1 and VCAM-1 synthesis during saphenous vein harvesting for CABG. We recommend the endoscopic method for its low morbidity and earlier hospital discharge.

Anti-heat-shock protein 70 kDa antibodies in vascular patients.

INTRODUCTION AND AIM OF STUDY: there is recent evidence that the immune system plays an essential role in the pathogenesis of atherosclerosis, with both cellular and humoral mechanisms being involved. Heat-shock proteins (HSPs) have been detected in atherosclerotic lesions, and antibodies to HSPs have also been found to be raised in patients with carotid stenoses. The aim of our study was to examine the level of anti-HSP70 antibodies in patients with other vascular diseases. MATERIALS AND METHODS: a questionnaire was designed for the subjects in the study, with documentation of clinical details and ankle-brachial pressure index. Patients with concomitant infection, malignancy, hepatorenal failure, or recent surgery were excluded. Enzyme-linked immunosorbent assay (ELISA) was used to identify anti-HSP70 antibodies in the sera in different dilutions. Graphs of optical density (OD) vs. negative log dilution were plotted, the gradient of which was taken to be the estimated optical density for each subject (proportional to antibody level). Our groups consisted of controls (n =21, mean age 59.0+/-19.2), lower limb claudicants ( n =19, mean age 60.0+/-12.6), patients with lower-limb critical ischaemia ( n =22, mean age 68.5+/-10.07), and patients with abdominal aortic aneurysms ( n =20, mean age 69.9+/-6.2). RESULTS: we found no correlation between age and the estimated OD in our subjects (Spearman's correlation coefficient ( r )=0.123, one-tailed p value was 0.135). Patients with intermittent claudication, critical lower limb ischaemia, and aneurysms had higher estimated OD, and therefore higher anti-HSP70 antibody levels, than controls (Mann-Whitney test p =0.0127, 0.0037, 0.0008, respectively). CONCLUSIONS: our data provide the first evidence of a correlation between anti-HSP70 antibodies and different types of vascular diseases, suggesting that HSP70 might be involved in the pathogenesis and propagation of atherosclerosis. Since the immune response to HSPs can be modulated, this opens up the possibility of new therapeutic approaches.