Penetrating chest injury afflicting coronary artery fistula-A delayed and asymptomatic occurrence.

We present here a case of a symptomatic chest injury with a nail gun causing a delayed occurrence of coronary artery fistula to the left pulmonary artery presenting with unstable angina 4 years after the initial injury, three of which were symptom-free. The patient underwent successful surgical closure of the fistula and removal of the foreign body.

Virtue of adding prokinetics to proton pump inhibitors in the treatment of laryngopharyngeal reflux disease: prospective study.

OBJECTIVE: This study aimed to assess the virtue of adding prokinetics to proton pump inhibitors (PPIs) in the treatment of laryngopharyngeal reflux (LPR) with regard to symptom and sign improvement and reduction in recurrence rates after cessation of treatment. PATIENTS AND METHODOLOGY: One hundred patients were divided by blind random card selection into two groups, 50 per group. The first group received itopride, a prokinetic agent, with a PPI, and the second group received a PPI and a placebo, both for a period of 8 weeks. They were followed up on a monthly basis for 16 weeks, with documentation of the symptom and sign scores with each visit and with photographic documentation. RESULTS: Eighty-seven patients completed the study. The results showed significant improvement in group A when compared to group B with regard to improvement rates and degrees of subjective and objective improvement, with significantly less recurrence of symptoms. CONCLUSION: Adding prokinetics to PPIs in the treatment of LPR improves the outcome, shortens the need for oral medication, and reduces the rates of recurrence of symptoms.

Mixed venous versus central venous oxygen saturation in patients undergoing on pump beating coronary artery bypass grafting.

OBJECTIVE: To examine the validity of central venous oxygen saturation (ScvO(2)) as a numerical substitution of mixed venous oxygen saturation (SvO(2)) in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG). MATERIALS AND METHODS: Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter (PAC) as a part of our routine intraoperative monitoring. SvO(2) and ScvO(2) were simultaneously measured 15 minutes (T1) and 30 minutes (T2) after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass (T3 and T4), and 15 and 30 minutes after admission to intensive care unit (T5 and T6). RESULTS: ScvO(2) showed higher reading than SvO(2) all through our study. Our results showed perfect positive statistically significant correlation between SvO(2) and ScvO(2) at all data points. Individual mean of difference (MOD) between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. CONCLUSIONS: In on pump beating CABG patients; ScvO(2) and SvO(2) are not interchangeable numerically. ScvO(2) is useful in the meaning of trend; our data suggest that ScvO(2) is equivalent to SvO(2) , only in the course of clinical decisions as long as absolute values are not required.