Non-cardiogenic pulmonary oedema in the course of verapamil intoxication.

Only three cases of non-cardiogenic pulmonary oedema secondary to high dose verapamil ingestion have been described in the literature. This report describes two girls, who developed pulmonary oedema in the course of massive dose verapamil ingestion (total of 6000 mg and 7200 mg). Left ventricule size and function was normal on transthoracic echocardiograms in both of these patients. They were treated successfully with mechanical ventilatory support. The report emphasises that this fatal complication may be seen with verapamil overdose and underlying mechanisms and therapeutic approach are discussed.

Effect of pentoxifylline on the ischemia-reperfusion injury of the intestine.

Intestinal ischemia is a common clinical event and reperfusion results in further tissue damage exceeding that of ischemia alone. The present study was designed to test this and to assess the role of pentoxifylline, (administered intravenously as a bolus dose of 25 mg/kg in 1 ml normal saline, followed by continuous infusion of 0.2 mg/kg/minute for 95 minutes), in ischemia-reperfusion injury of the rat intestine. Intestinal ischemia was produced by occlusion of the superior mesenteric artery (SMA) with interruption of the collateral flow for 30 minutes. Reperfusion was established by declamping the (SMA) for 1 hour and evaluation of the mucosal damage was determined using a grading scale from 0 to 5, with estimation of mean mucosal thickness, villous height and crypt depth. The grade of mucosal damage, mucosal thickness, villous height and crypt depth were 2.2, 407 microns, 210 microns, and 196 microns respectively in the ischemia group, and 3.6, 327 microns, 156 microns, and 171 microns respectively in the ischemia reperfusion group, while these values in ischemia reperfusion with administration of pentoxifylline group were 2.5, 505 microns, 294 microns, and 200 microns respectively. The severity of the tissue injury increased considerably after reperfusion of the ischemic intestine and pentoxifylline was effective in attenuating the reperfusion injury significantly.

Role of diltiazem in ischemia-reperfusion injury of the intestine.

It is well recognized that reperfusion causes tissue damage in excess of that produced by ischemia alone. The present study was designed to test this and to evaluate the role of the calcium antagonist, diltiazem (400 micrograms/kg body weight administered intravenously over 95 min), in ischemia-reperfusion injury of the intestine. Intestinal ischemia was produced by occlusion of the superior mesenteric artery (SMA) with interruption of the collateral flow for 30 min. Reperfusion was established by declamping the SMA for 1 h, and mucosal injury was assessed using a grading scale from 0 to 5. The severity of mucosal damage increased significantly after 1 h of reperfusion, from a mean grade of 2.1 in the ischemia group to 3.8 in the ischemia-reperfusion group (p < 0.01). Diltiazem was effective in the amelioration of histologic changes of reperfusion injury and reduced the degree of mucosal injury from a mean grade of 3.8 in the ischemia-reperfusion group to 2.5 in the diltiazem group (p < 0.05). This study strongly suggests that calcium ions are involved in the pathogenesis of ischemia-reperfusion injury and that diltiazem attenuates this injury by preventing the intracellular calcium influx that occurs during reperfusion.

Volvulus of the sigmoid colon.

Between 1983 and 1986, 18 patients with colonic volvulus (94.4% sigmoid, 5.6% caecal) were seen at Karadeniz Medical Faculty. There were 11 male and 7 female patients, with a mean age of 68 years. In 66.6% and 22.2% of patients respectively a palliative procedure or a Hartmann operation were performed. The recurrence rate in the palliative group was 30%. The mortality rate for all patients with volvulus was 16.8%. The palliative procedures were successful in patients in good general condition and without bowel necrosis, whereas the Hartmann operation gave successful results in patients with bowel necrosis.

[Prevention of wound infection in elective colon surgery by the use of systemic ceftriaxone and ornidazole]. / Elektif kolon cerrahisinde sistemik seftriakson ve ornidazolun yara enfeksiyonunda profilaktik etkisi.

In this study prophylactic effects of ceftriaxone and ornidazole on the patients undergoing elective colon surgery was studied in the surgical clinics, Medical Faculty of Karadeniz Technical University. Colon cleaning with Nichol's method was performed in all cases. But kanamycin and metronidazole were given instead of erythromycin and metronidazole. One hour before the operation ceftriaxone 1 gr. and ornidazole 500 mg. (IV, IM) were administered. Those antibiotics were followed by ceftriaxone 2 gr. daily and ornidazole 1 gr. daily (IV, IM) three days after operation. The wound infection were observed in the postoperative period (5%). The average hospitalization time of the cases were 12 days. This period was 18 days and 21 days in the cases having infection. Side effects related the drugs were not observed and there were no significant laboratory changes.