In vitro and in vivo resuscitation with adenosine retains cardiomyocyte structure and function following hemorrhagic shock in rats

Successful treatment of hemorrhage requires restoration of normal cardiac function following resuscitation. However, many interventions used to attempt to restore cardiac function may cause additional myocardial injury, cardiac dysfunction and failure. The purpose of this study was to examine the ability of therapeutic intervention using adenosine to protect the heart from contractile dysfunction and post-resuscitation injury following hemorrhagic shock. Male Spargue-Dawley rats were divided into 3 groups: 1] In vivo hemorrhagic shock [1hour] followed by in vitro treatment with adenosine and ex vivo resuscitation using the Langendorff apparatus [60 minutes], 2] In vivo hemorrhagic shock [1 hour] followed by in vivo treatment with 20 microM adenosine and resuscitation [30 minutes] then ex vivo perfusion [60 minutes] and 3] In vivo hemorrhagic shock [2 hours] followed by in vivo treatment with 20 microM adenosine and resuscitation [30 minutes] then ex vivo perfusion [60 minutes]. Arterial blood samples were collected for measurements of TNF-alpha. Treatment with adenosine before resuscitation from hemorrhagic shock significantly improved left ventricular contractile function compared to the untreated resuscitated group. Treatment with adenosine also decreased the inflammatory response to shock by lowering the levels of TNF. In conclusion, treatment with adenosine before resuscitation of hemorrhagic shock protected the heart from post-resuscitation myocardial dysfunction and injury in rats

Resuscitation with adenosine retains cardiomyocyte structure following hemorrhagic shock in rats

Despite the improvement in resuscitation strategies, the incidence of post-resuscitation myocardial injury and failure remains high. Hemorrhagic shock activates an inflammatory response that can lead to myocardial cellular injury. Adenosine has been shown to protect the heart against ischemia reperfusion injury. However, the cardioprotective effects of adenosine following hemorrhagic shock may reduce myocardial injury by decreasing the inflammatory response to shock in rats. After 60 min on hemorrhage, 10 rats were randomized in vivo resuscitation with [n=8] microM adenosine for 30 min. heart Biopsies were collected from histological and electron microscopy examination. Light microscopy demonstrated decreased neutrophil infiltration, absence of contraction band necrosis and hydropic degeneration in the adenosine treated group compared to the hemorrhage untreated. Electron microscopy showed relative preservation of myocardial structure with absence of mitochondrial swelling in the hemorrhage treated group. These findings suggest that treatment with adenosine before in vivo resuscitation of hemorrhagic shock protected the heart from post-resuscitation myocardial injury in rats and the mechanism could be mediated by lowering the inflammatory response to shock

Clinicopathological pattern of malignant parotid gland tumors in Saudi Arabia

To report our experience of varied presentations and diverse histopathological spectrum of parotid gland malignancies. This retrospective analysis incorporated patients with histological evidence of malignant parotid tumors at King Khalid University Hospital, Riyadh, Saudi Arabia over a 20-year period from 1984 through 2004. The medical records of these patients were analyzed for their demographic characteristics, clinical features, operations performed, and pathological diversity. Thirty-two patients comprised this study group. There is a male preponderance over females with a ratio of 2.2:1 22 men and 10 women and mean age of 51.8 range 28-81 years. A painless lump was the most frequent clinical manifestation observed in 23 71.8% patients followed by facial nerve dysfunction in 14 43.7% patients. Parotidectomy was performed in 22 68.7% patients: 16 superficial and 6 total. A partial facial nerve sacrifice was undertaken in 14 43.7%, and total nerve sacrifice in 9 28.1% patients. Four 12.5% patients presented with cervical lymph node metastases necessitating radical neck dissection. Nine 28.1% patients had mucoepidermoid carcinoma, 8 25% adenoid cystic carcinoma, 6 18.7% adenocarcinoma, not otherwise specified, and 2 6.2% were reported to have carcinoma in pleomorphic adenoma. Twenty 62.5% specimens revealed high-grade aggressive lesions, and out of these, 19 59.3% patients presented with stage III/IV disease. Malignant parotid tumors are exceedingly rare, occurring at a relatively earlier age group with male preponderance, and invariably declare at a late clinical stage in our community. Histopathological features hallmark a locally advanced disease with an aggressive behavior

Validity of leukocyte count to predict the severity of acute appendicitis

To ascertain whether white blood cell [WBC] count with differential analysis may predict severity of disease in acute appendicitis. We conducted this retrospective study on appendectomy patients from 1996 to 2001, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. We reviewed patient's age, gender, duration of symptoms, temperature on admission, WBC count including differential and the histological diagnosis of the appendicular specimen. We further analyzed the data of those patients found to have acute, gangrenous and perforated appendicitis to determine the correlation between a high WBC count and a more advanced form of appendicitis. Out of an aggregate of 232 patients, 162 were males and 70 females with a mean age of 23.7 years [range, 12-70 years]. Mean duration of symptoms was 1.9 +/- 1.1 days, mean temperature 37.8 +/- 1.4 degree celcius, with reported elevated WBC count in 167 [71.9%] and normal in 65 [28.1%] cases. Mean WBC counts in acute were 14.5 +/- 7.3 x 109/L, gangrenous 17.1 +/- 3.9 x 109/L and perforated appendicitis 17.9 +/- 2.1 x 109/L. This reflected a persistently higher WBC count in the complex [gangrenous, perforated] appendicitis compared with acute appendicitis [p less than 0.05]. The differential analysis showed neutrophilia in 123 [53%] and lymphopenia in 112 [48%] cases and out of these, 116 [94%] with neutrophilia and 107 [95%] with lymphopenia were reported to have appendicitis. A high WBC with differential count is a reliable indicator of the severity of appendicitis and signifies a more advanced stage

Resources, services, patients and staff perception of eye care at the primary health care level in the Kingdom of Saudi Arabia

Incorporating a primary eye care system into the delivery of eye care services was determined to be the most efficient and cost effective method of dealing with the major preventable and curable causes of blindness, and the large backlog of eye patients in the Kingdom of Saudi Arabia, as identified by the 1984 King Khaled Eye Specialist Hospital National Eye Survey. Primary health care centers [PHCCs] located in rural and urban areas of the country offer a vital first line of defense in the fight against blindness. A total of 116 PHCCs were selected by an equal-proportion allocation formula from a total of 1.663 existing in 1990 throughout the Kingdom. This 7% sample was further divided into urban and rural, proportional to each of the five provinces. Four different types of questionnaires were developed inviting responses by staff, as well as from patients, attending these centers. Responses to these questionnaires revealed some strengths and many weaknesses of these resources and services in relation to equipment, staffing, supplies, staff training, patient education, etc. Findings showed that a considerable number of PHCCs lacked basic, inexpensive medical equipment and drugs essential for the diagnosis and treatment of common eye disorders [e.g., visual acuity charts were lacking in 37.9%, handheld magnifying lenses in 81.6%, and Schiotz tonometers in 99.0%]. The PHCCs also scored low in continuing staff medical education. When comparing provinces, PHCCs in the Eastern Province show considerably more development than those in the remainder of the country. Conclusions: The information provided by this survey emphasizes the importance of utilizing the existing, primary health care system in a more efficient and cost effective way. Currently, most eye problems are managed in secondary or tertiary health care facilities, with only limited bendfit derived from the existing primary health care centers where the majority of common, less complicated problems can be managed. The survey results may be utilized to review the effectiveness of the existing primary health care system as the first line of defense against blindness and enhance their ability to absorb a large proportion of eye problems