Effects of abdominal compartment syndrome on gastric emptying time.

INTRODUCTION: Increase in intra-abdominal pressure may affect gastric emptying time but the precise effect has not been demonstrated. Effects of acute increase of intra-abdominal pressure on gastric emptying time can not be demonstrated in clinical or experimental studies. In this study we aimed to study the effect of increased intra-abdominal pressure on gastric emptying time. METHODS: Six male stray dogs that weighed 20-25 kg were studied. Following the induction of general anaesthesia, an abdominal catheter was placed and intra-abdominal pressure was raised at a rate of 5 cm H2O every 10 minutes using intra-abdominal administration of physiologic saline solution until 45 cm H2O pressure was reached. Gastric emptying time was measured scintigraphically at the beginning of the study (IAB 0 cm H2O ) and again four hours later when pressure reached the maximum value (IAP was 45 cm H2O). RESULTS: Gastric emptying time for baseline pressure was in average 51.83±13.16 whereas for 45 cm H2O pressure it was in average 90.83±26.96. This difference was found statistically significant (p<0.05). The differences between baseline values and values after increased intra-abdominal pressure were statistically significant (Tab. 4, Fig. 1, Ref. 26).

Effectiveness of air purifiers in intensive care units: an intervention study.

BACKGROUND: Effective design and operation of intensive care unit (ICU) ventilation systems is important to prevent hospital-acquired infections. Air purifiers may contribute. AIMS: To detect the number and types of micro-organisms present in the air and on high-touch surfaces in ICUs, and to evaluate the effectiveness of air purifiers in reducing the microbial load and thus the rate of nosocomial infections in ICUs. METHOD: This intervention study was conducted in two similar ICUs between May to November 2020. Novaerus air purifiers were located in the intervention ICU for 2 months. Routine cleaning procedures and high-efficiency particulate air filtration continued in the control ICU as well as in the intervention ICU. After 2 months, the air purifiers were moved to the other ICU for the next 2 months to reduce any possible bias in the results. Air and surface samples were evaluated. FINDINGS: Evaluation of changes in the intervention ICU over time revealed a significantly lower colony concentration in the air and on surfaces on Day 60 compared with Day 1 (Pair<0.001 and Psurface<0.001). There was a significant positive correlation between the number of colonies detected and the rate of hospital-acquired infections in the intervention ICU (r=0.406, P=0.049) and in the control ICU (r=0.698, P=0.001). CONCLUSION: Using air purifiers in addition to heating, ventilation and air conditioning systems in hospitals may be an effective way to reduce the microbial load in the air and on surfaces, and thus hospital-acquired infections.

Procalcitonin levels as an early marker in patients with multiple trauma under intensive care.

This prospective study investigated the levels of procalcitonin (PCT) and C-reactive protein (CRP) in patients with various types and severity of multiple trauma, and their relationship to trauma-related complications. Adult multiple-trauma patients (n = 113) admitted to the intensive care unit (ICU) in the first 24 h after trauma were included. The Injury Severity Scores (ISS), and PCT and CRP levels were measured in the first 24 h (day 1), on day 7 and on the final day of their ICU stay. Survival at 30 days was recorded. Mean PCT and CRP levels were both significantly higher on day 7 compared with day 1 and the final assessment day in patients with an ISS > 20. Levels of PCT were significantly higher in cases with sepsis, severe sepsis or septic shock compared with cases who developed systemic inflammatory response syndrome (SIRS), however levels of CRP were significantly higher only in cases with severe sepsis or septic shock, but not in cases with sepsis alone. These data support the view that PCT levels may be a better indicator than CRP levels in the early diagnosis of septic complications in patients with multiple trauma.

Two-prong splint in the treatment of proximal humeral fracture.

Twenty-nine patients with two-, three- and four-part proximal humeral fractures were treated by two-prong splint. At the latest follow-up, 22 patients had excellent and satisfactory results according to the Neer criteria, with only two failures. Avascular necrosis was detected in only one patient. Given these results, we conclude that the present method can be the treatment of choice for these injuries.

Focal liver lesions: comparison of dual-phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement.

The purpose of this study was to compare dual-phase spiral computed tomography (CT) and magnetic resonance imaging (MRI) using dynamic gadolinium enhancement for liver lesion detection and characterization. Twenty-two consecutive patients underwent dual-phase spiral CT and MRI for the evaluation of focal liver disease within a 1-month period. Spiral CT and MR images were interpreted prospectively, in a blinded fashion by separate, individual, experienced investigators, to determine lesion detection and characterization. Liver lesions were confirmed by surgery and pathology in 6 patients, and by clinical and imaging follow-up in the other 16 patients. Pathological correlation of a primary extrahepatic malignancy was available in 5 of the 16 patients who had metastatic liver disease. Spiral CT and MRI detected 53 and 63 lesions, and characterized 39 and 62 true positive lesions, respectively. A kappa statistic test was applied to assess agreement between MR and CT results. MR versus CT for lesion detection resulted in a kappa statistic of 0.54 (95% confidence interval), indicating moderate agreement, and 0.32 (95% confidence interval) for lesion characterization, indicating only slight agreement. More lesions were detected on MR images than CT images in 6 (27%) patients, with lesions detected only on MR images in 4 (18%) patients. More lesions were characterized on MR images in 9 (41%) patients. In 9 patients with a discrepancy between MR and CT findings, the MR images added information considered significant to patient management in all 9 cases. MRI was moderately superior to dual-phase spiral CT for lesion detection, and was markedly superior for lesion characterization, with these differences having clinical significance.

Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma.

A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. Biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited.

Two-prong splint in the treatment of proximal humeral fracture.

Twenty-nine patients with two-, three- and four-part proximal humeral fractures were treated by two-prong splint. At the latest follow-up, 22 patients had excellent and satisfactory results according to the Neer criteria, with only two failures. Avascular necrosis was detected in only one patient. Given these results, we conclude that the present method can be the treatment of choice for these injuries.

Chronic renal failure in a patient with Sotos syndrome due to autosomal dominant polycystic kidney disease.

Sotos syndrome is characterised by accelerated growth, acromegalic appearance, mental retardation and social maladjustment. Most cases are sporadic, but familial cases have also been reported. We report a case of Sotos syndrome presenting with chronic renal failure due to autosomal dominant polycystic kidney disease (ADPKD). Ultrasonographic examination of the patient, his father and other family members revealed polycystic kidneys. Renal failure was present only in the Sotos case, who also had considerably larger cysts than other family members. We suggest that the underlying mechanism responsible from the somatic overgrowth in Sotos syndrome may also be linked with the development of larger cysts and earlier onset of renal failure in ADPKD. Although Sotos syndrome has been associated with urological abnormalities, chronic renal failure is very rare. To our knowledge, Sotos syndrome associated with ADPKD has not been reported before.