Laparatomy due to gastrointestinal complications after open heart surgery.

AIM: Abdominal complications following open heart surgery remain rare but fatal events with mortality rates of 14.5% up to 100%. Manifestations and managements of these complications are varying. Approximately, 25% of patients with gastrointestinal complications require surgical management with obviously higher mortality risks. The aim of this study was to determine the perioperative prognostic factors of gastrointestinal complications with surgical consequences after cardiac surgery. METHODS: The study enrolled 15.737 patients who underwent open heart surgery between January 2002 and September 2007. Sixteen (0.1%) persons required laparatomy due to postoperative gastrointestinal complications. Additionally, the preoperative, operative, and postoperative risk factors for this condition were studied. RESULTS: Among the patients enrolled, 15.737 patients underwent open heart surgery while 16 (0.1%) required laparatomy procedures due to gastrointestinal complications. They were comprised of 11 (68.8%) men and 5 (31.3%) women at a mean age of 62.88±12.56 years. There was a history of hypertension in 9 (56.3%) patients, hypercholesterolemia in 11 (68.8%), renal failure in 4 (25%), previous CABG in 2 (12.5%) and PTCA in 2 (12.5%). Morbidity and mortality were significantly higher in this group of patients with a mortality rate of 68.8% (68.8% versus 1.6%). CONCLUSION: Our multivariate logistic regression model identified the following parameters to be the prognostic factors for gastrointestinal complications with surgical consequences: a history of previous CABG, previous PTCA, preoperative renal failure, preoperative anticoagulant agent use, valve surgery, combined valve and CABG surgery, and intra-aortic balloon pump requirement with OR of 51.95, 4.623, 26.436, 0.140, 5.43, 11.469 and 3.76, respectively.

Sonodynamic therapy and common head and neck cancers: in vitro and in vivo studies.

Carcinogenesis is a complex multi-stage process associated with abnormal oncogenic signals in various signaling pathways. HNSCC (Head and neck squamous cell carcinoma) includes the majority of head and neck cancers (HNC). Also, HNSCC indicates a tumors heterogeneous group that derives from the squamous epithelium of the oropharynx, hypopharynx, oral cavity, and larynx. The main cancer management approach contains chemotherapy, radiation, and surgery separately or in combination. Each therapeutic approach has a limitation that influences cancer therapy procedures. Different treatment manners, stimuli-responsive therapeutic methods can improve on-target responses and reduce side effects. Sonodynamic therapy (ST) shows promising potential as an alternative treatment for cancer in the last few years. There is a hypothesis that shows ST using sonosenitizer in combination with low-intensity ultrasound (LIUS) could be useful in all kinds of cancer without focusing on specific target proteins, molecules, and/or genes. This review study discussed the application of ST for the treatment, ST mechanisms, and also, advances in the treatment of HNCs approaches in the recent decades.

Effect of gender and type 2 diabetes mellitus on heart rate recovery in patients with coronary artery disease after cardiac rehabilitation.

AIM: The purpose of this study was to clarify whether type 2 diabetic patients with coronary disease are subject to similar benefits on heart rate recovery (HRR) as non-diabetic coronary individuals after cardiac rehabilitation, assessing separately male and female subjects separately. METHODS: Data used for the analyses were from an eight-week phase II cardiac rehabilitation including 284 patients with ischemic heart disease who were managed at Tehran Heart Center between July 2004 and January 2006. The heart rate parameters were compared between diabetic and non-diabetic subjects before and after cardiac rehabilitation. Diabetic and non-diabetic patients had similar age and left ventricular ejection fraction. RESULTS: Among men, non-diabetic patients achieved greater improvement in peak heart rate and HRR. Additionally, lower resting heart rate was found in non-diabetic men after rehabilitation. In women > or = 50 years, there was no significant difference between diabetic and non-diabetic. The non-diabetic women < 50 years showed significantly higher peak heart rate and HRR compared with diabetics women. CONCLUSION: These results indicate that the benefit of cardiac rehabilitation in HRR is significantly lower in type 2 diabetic men. Improvement of HRR is not associated with diabetic status in women > or = 50 years. The response to cardiac rehabilitation in women may appear to be more influenced by age at menopause rather than diabetes mellitus.

Effects of body mass index on early outcome of coronary artery bypass surgery.

AIM: Obesity is commonly thought to be a risk factor for morbidity and mortality after cardiac surgery. The aim of the present study is to evaluate the effects of variations in body mass index on in-hospital outcome of coronary artery bypass grafting (CABG). METHODS: The authors conducted a retrospective review of 10191 consecutive patients who had undergone isolated CABG at the center from February 2002 to November 2006. Patients were divided into four groups according to Body Mass Index (BMI). Underweight patients (BMI<18.5 kg/m(2)) were assigned to group 1 and obese patients (BMI 30 kg/m(2)) were put into group 4. Patients with normal BMI and those who were overweight were placed in group 2 and 3 respectively. RESULTS: Analysis of the BMI groups showed: of 10191 patients 0.7% was underweight; 31.2% of cases had normal BMI, 47.1%; overweight and 21.0% were obese. Compared with other groups, the members of the obese group were younger, included more women and were more likely to have all the risk factors for coronary artery disease except for cigarette smoking (P<0.0001). The underweight patients had an excess of left main coronary artery disease, previous history of myocardial infarction. In-hospital mortality did not show any difference between groups (P=0.46). There was a significant increase in postoperative gastrointestinal complications among the underweight group in comparison with other groups (P=0.027). CONCLUSIONS: According to this study, obese patients undergoing CABG are not at a greater risk of perioperative death and other adverse outcomes compared to normal weight. After CABG, underweight patients are at higher risk of developing gastrointestinal complications compared to normal patients.

Concomitant carotid endarterectomy and coronary artery bypass grafting versus staged carotid stenting followed by coronary artery bypass grafting.

AIM: Significant carotid stenosis (>or=70%) in patients undergoing coronary artery bypass grafting (CABG) can increase the risk of perioperative cerebral vascular accident (CVA). In this study, we compared the results of two common operative strategies: concomitant carotid endarterectomy and CABG versus carotid stenting and CABG. METHODS: This cohort study was conducted from January 2001 to September 2006. Significant carotid artery stenosis was detected in patients who were candidates for CABG at the Tehran Heart Center. The stenosis was detected by carotid Doppler screening and was confirmed by magnetic resonance angiography. Reluctant patients or those with previous major CVA, significant bilateral carotid stenosis and intracranial lesions were excluded. Patients were divided into 2 groups. Group A underwent concomitant carotid endarterectomy and CABG (n=19), while carotid stenting and CABG were done in group B (n=28). RESULTS: The mean age in group A was 67.37+/-7.09 years and 65.57+/-8.13 years in group B. The mean hospital stay (days) was 18.68+/-7.95 in group A and 26.35+/-77.04 in group B (P=0.01). The median charge was dollars 252.79 in group A and dollars 2206.66 in group B (P <0.0001). There was a significant difference in frequency of hypotension and bradycardia between the 2 groups (P <0.05). There were 2 cases of in-hospital mortality in each group (10.5% and 7.1%, respectively). Two postoperative strokes occurred in group A and 3 in group B (10.5% and 10.7%, respectively). CONCLUSION: Concomitant carotid endarterectomy and CABG is as safe as carotid stenting and CABG, with fewer neurologic events and less hypotension, bradycardia, cost and shorter hospital stay.

Early mortality predictors in coronary artery bypass grafting patients required intra-aortic balloon pump in perioperative and postoperative periods.

AIM: The intra-aortic balloon pump (IABP) is commonly used for decreasing myocardial oxygen demand by systolic unloading in perioperative heart failure. The aim of this study was to determine perioperative prognostic factors for in-hospital mortality in coronary artery bypass grafting patients who received the intraaortic balloon pump. METHODS: A total of 271 patients who underwent coronary artery bypass grafting and received intra-aortic balloon pump perioperatively between January 2002 and September 2006 were studied. The preoperative, operative and postoperative risk factors for early death were evaluated. RESULTS: Early mortality rate in the study population was 17.3%. From variables entered into multivariate logistic regression the following parameters were identified as prognostic factors for early death: left main disease, diabetes, postoperative renal failure and cardiac arrest (P<0.05). The minor and major intra-aortic balloon pump related complications were not significant in univariate and multivariate analysis and its rate was 3.6%. CONCLUSION: According to our study the mortality of IABP group is low compared to other studies, as well as IABP-associated complications. Also it revealed that there is no correlation between IABP-associated complications and early mortality.

Capillary gas chromatographic determination of phenylpropanolamine in pharmaceutical preparation.

Analytical procedure has been developed for the gas chromatographic determination of phenylpropanolamine (PPA) using trifluoroacetylacetone (FAA) as derivatizing reagent. Elution is carried out from the column HP-5 (30 mx0.32 mm i.d.) with film thickness 0.25 microm at initial column temperature 70 degrees C for 5 min, followed by heating rate 10 degrees C/min up to 120 degrees C. Injection port temperature was maintained at 270 degrees C. Nitrogen flow rate was 2 ml/min and detection was by FID. The linear calibration curve was obtained with 30-150 microg/ml PPA with detection limit of 6.0 microg/ml. The method was used for the determination of PPA from Sinutab and Tavegyl-D tablets. The relative standard deviation (R.S.D.) for the analysis of pharmaceutical preparation was obtained within 0.4-0.9%.

Experimental microneurosurgery of the trigeminal nerve: surgical technique for ganglionectomy and rhizotomy in the cat.

The techniques of two experimental surgical operations on the trigeminal nerve are described, namely, excision of the trigeminal ganglion (ganglionectomy) and division of the trigeminal root (rhizotomy), in the cat. These techniques have been developed with the specific aims of achieving the trigeminal lesion and also preserving a satisfactory postoperative quality of life for the animal in order to make it possible to study the long-term effects of trigeminal dennervation. To the best of our knowledge, a detailed description of such a surgical methodology is lacking; reporting of these procedures may facilitate future research on the trigeminal nerve.

Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair.

OBJECT: A classification is proposed to organize anterior cranial base fractures systematically according to their location and size. The goal of this study was to determine whether these two variables, irrespective of cerebrospinal fluid (CSF) rhinorrhea, are related to the long-term risk of posttraumatic meningitis and, hence, to standardize decision making concerning surgical repair of associated CSF fistulas. METHODS: With the aid of high-resolution thin-section coronal computerized tomography (CT) scanning, anterior cranial base fractures were classified into the following four major types: I, cribriform; II, frontoethmoidal; III, lateral frontal; and IV, complex (any combination of the other three types). Fractures with a maximum bone displacement that extended farther than 1 cm in any plane were classified as "large" and those less than 1 cm as "small." The authors used this classification in a study of 48 patients who were treated by conservative (20 patients) or surgical (28 patients) means. The results showed a gradation of risk: the fracture most likely to develop infection was a large cribriform (Type I) and the least likely was a small lateral frontal (Type II). Statistical analysis showed that the trend for an increased infection rate was related to the cumulative effect of three variables in the following order: 1) prolonged duration of rhinorrhea (analysis of variance [ANOVA], p = 0.017); 2) large size of fracture displacement (ANOVA, p = 0.079); and 3) fracture's proximity to the midline (ANOVA, p = 0.015). CONCLUSIONS: In this series, microsurgical repair was accompanied by a minimum complication rate. Hence, the authors recommend that patients with fractures that combine the aforementioned variables should be considered to have a high long-term risk of infection and their injury should be surgically repaired as soon as the posttraumatic edema has subsided. This applies to the following fractures: large cribriform (Type I) with transient rhinorrhea lasting 5 to 8 days and large frontoethmoidal (Type II) with prolonged rhinorrhea lasting longer than 8 days. Furthermore, the authors conclude that this classification can improve the management of posttraumatic CSF fistulas of the anterior cranial base and may provide insights into the mechanisms underlying their spontaneous repair and susceptibility to meningitis.

Obstetricians must ask about domestic violence.

PIP: Women are at increased risk of domestic violence during pregnancy and the postpartum period. Domestic violence results in increased rates of miscarriage, premature birth, low birth weight, chorioamnionitis, fetal injury, and fetal death. The UK Royal College of Obstetricians and Gynecologists has recommended that domestic violence education should be an integral part of medical training. Its report, "Violence Against Women," urges obstetricians to conduct at least one interview with pregnant women that is not attended by the partner or family members in order to facilitate the disclosure of sensitive information. If violence is detected and the woman's health and safety are at risk, rules of confidentiality no longer apply.^ieng

King in a maverick style.

PIP: This article features Maurice King, who is advocating a one-child world. King was born in 1927 in Ceylon (now Sri Lanka) and studied at Trinity Hall, Cambridge, and St. Thomas Hospital, London. He first worked as a pathologist, moving to Africa in 1956. He was always willing to fight injustice, objecting to not being allowed to train black Africans. He authored ¿Medical Care in Developing Countries,¿ considered the ¿Bible¿ of the primary health care movement. By 1985, he was teaching public health medicine at Leeds University, having spent most of his time in Africa working on various projects for the WHO, and was focusing on primary health care. His other great cause then was nuclear disarmament. His lecture to the Royal Society of Medicine on health of Africa in 1988 ignited his interest in demography. He had then championed ideas, which initially provoked outrage, such as the case with ¿entrapment,¿ the hardinian taboo, and now his concept of the lockstep. He had claimed that the US State Department, together with UN, the World Bank and the Roman Catholic Church, is actively preventing population issues being discussed fully. He may appear on the surface as obsessed with imposing a one-child world and paranoid about the role of the US; but a closer analysis reveals a deep affection for Africa and a missionary zeal to surmount the problems of overpopulation.^ieng

Neonatal disease profile in Larkana before and after establishment of neonatal ward.

This is a study of 2050 neonatal admissions excluding neonatal tetanus in children hospital CMC Larkana from December, 1988 to July, 1993. Six hundred and eighty-nine cases were admitted in General Paediatrics Ward before establishment of neonatal unit and 1361 cases were admitted in neonatal ward. The aime of study was to compare the disease pattern and mortality rates before and after establishment of a neonatal unit in the same hospital. Number of admissions significantly increased after the establishment of neonatal unit but there was no decline in the mortality. Changes in disease pattern were observed particularly for Gastroenteritis and miscellaneous (undetermined) category. Seventy percent of admissions were males in Ist week of their life. Commonest cause of admission and mortality was birth anoxia.

Variability in lipid profile in patients with acute myocardial infarction from two tertiary care hospitals in Pakistan.

OBJECTIVE: To investigate changes in total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol and triglycerides in serum of Pakistani patients with AMI due to age, gender, body mass index (BMI), diabetes, hypertension, and smoking, and also find out the prevalence of hypercholesterolemia, hypertriglyceridemia, "low HDL-cholesterol" and "isolated low-HDL cholesterol" in them. PATIENTS AND METHODS: Serum samples from 451 consecutive AMI patients (250 from National Institute of Cardiovascular Diseases, Karachi and 201 from Armed Forces Institute of Cardiology, Rawalpindi) were analyzed for total cholesterol, HDL-cholesterol and triglycerides using kit methods. LDL-cholesterol was determined using the Friedewald formula. RESULTS: Mean serum concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides in AMI patients were found to be 181 +/- 50 mg/dl, 35.7 +/- 11.3 mg/dl, 110 +/- 47 mg/dl and 177 +/- 127 mg/dl, respectively. Mean levels of total cholesterol and HDL-cholesterol were not significantly affected by age, gender, BMI, diabetes mellitus, hypertension and smoking. Mean LDL-cholesterol concentration, however, was found to be significantly increased in diabetes mellitus (p=0.047), while age, gender, BMI, hypertension and smoking had no significant effect on the levels of this lipoprotein. Mean levels of triglycerides were significantly decreased in older patients (>50 years) compared to younger (<50 years) ones (p=0.019). Gender, BMI, diabetes mellitus, hypertension and smoking, however, had no effect on triglyceride levels The frequencies of hypercholesterolemia, hypertriglyceridemia, "low HDL-cholesterol" and "isolated low-HDL-cholesterol" were found to be 30.6%, 30.1%, 48.6% and 34.1%, respectively. CONCLUSION: High prevalence of hypertriglyceridemia and low HDL-cholesterol (which constitute a component of metabolic syndrome) in Pakistani AMI patients is suggestive that these two lipid abnormalities could be playing a major role in the development of atherosclerosis in Pakistani population.

Armodafinil versus Modafinil in Patients of Excessive Sleepiness Associated with Shift Work Sleep Disorder: A Randomized Double Blind Multicentric Clinical Trial.

Aim. To compare the efficacy and safety of armodafinil, the R-enantiomer of modafinil, with modafinil in patients of shift work sleep disorder (SWSD). Material and Methods. This was a 12-week, randomized, comparative, double-blind, multicentric, parallel-group study in 211 patients of SWSD, receiving armodafinil (150 mg) or modafinil (200 mg) one hour prior to the night shift. Outcome Measures. Efficacy was assessed by change in stanford sleepiness score (SSS) by at least 2 grades (responder) and global assessment for efficacy. Safety was assessed by incidence of adverse events, change in laboratory parameters, ECG, and global assessment of tolerability. Results. Both modafinil and armodafinil significantly improved sleepiness mean grades as compared to baseline (P < .0001). Responder rates with armodafinil (72.12%) and modafinil (74.29%) were comparable (P = .76). Adverse event incidences were comparable. Conclusion. Armodafinil was found to be safe and effective in the treatment of SWSD in Indian patients. The study did not demonstrate any difference in efficacy and safety of armodafinil 150 mg and modafinil 200 mg.