The Effects of Sildenafil on the Treatment of Neonatal Chronic Lung Disease

Background: Bronchopulmonary dysplasia is one of the most common disorders in premature infants and this study aimed to investigate the role of sildenafil in the treatment of neonatal chronic lung diseases. Methods: In a placebo-controlled clinical trial study, a total of 40 neonates were included and randomly divided into control and intervention groups; sildenafil tablets were used at a dose of 2mg per kg for 8 hours in the intervention group and placebo with the same characteristics in the control group. After a period of 10 days, oxygen demand, type of respiratory support, changes in pulmonary artery pressure, Length of hospital stay, and systemic blood pressure changes were measured. Results: Duration of admission significantly decreased in the intervention group (P value = 0.006). For the neonates in the control group from approximately 11 days after the start of treatment (11/47±9/19) and for those in the intervention group from approximately 8 days after the start of treatment (8/21±3/84), respiratory support with positive pressure was changed to respiratory support with free flow oxygen. No severe systolic or diastolic blood pressure change was observed in any of the groups. Decrease in pulmonary pressure was significantly higher in the intervention group than that in the control group (21/1% and 68/4%, respectively) (P value: 0.003). Conclusion: The results of the study showed that sildenafil significantly reduced the length of hospital stay, the duration of the need for respiratory support and oxygen administration, and corrected the pulmonary pressure. No specific side effects were foun

Preventive Role of Wire-Guided Cannulation to Reduce Hyperamylasemia and Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography

Background and Study Aims. The usefulness of wire-guided cannulation for avoiding hyperamylasemia and pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is conflicting, and therefore we designed this study to determine whether wire-guided cannulation reduces the rate of post-ERCP hyperamylasemia and pancreatitis and compare its efficacy to conventional method. Patients and Methods. Seven hundred and forty-eight patients with hepatobiliary diseases consecutively underwent diagnostic or therapeutic ERCP at the unit of Taleghani referral hospital in Tehran. Among them, 546 patients were eligible for wire-guided cannulation and underwent this procedure and others underwent sphincterotome biliary cannulation using contrast injection as the conventional method. Results. Patients in the two groups were comparable in terms of gender and age. Successful biliary cannulation was achieved similary in the guidewire and conventional group (89.2% versus 86.4%) that in 5.4% and 14.1% of them it was difficultly performed, respectively (P=0.003). The main pancreatic duct was more visualized in 99.0% of patients in conventional group in comparison with 79.0% in another group (P<0.001). Multivariate regression analysis showed that wire-guided cannulation had a protective role for post-ERCP hyperamylasemia (OR: 0.336, 95% CI: 0.181–0.623, P<0.001). However, there were no significant differences between the two groups in rates of other procedure-related complications, such as, pancreatitis, bleeding, and perforation. Conclusion. The use of guidewire cannulation in comparison with conventional method can be accompanied with lower post-ERCP hyperamylasemia, and therefore selection of this cannulation technique especially in high-risk group is recommended

Is ESR Important for Predicting Post-ERCP Pancreatitis?

Background Pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), resulting in substantial morbidity and occasional mortality. There are notable controversies and conflicting reports about risk factors of post-ERCP pancreatitis (PEP). Aim To evaluate the potential risk factors for PEP at a referral tertiary center, as a sample of the Iranian population. Materials and Methods Baseline characteristics and clinical as well as paraclinical information of 780 patients undergoing diagnostic and therapeutic ERCP at Taleghani hospital in Tehran between 2008 and 2012 were reviewed. Data were collected prior to the ERCP, at the time of the procedure, and 24-72 hours after discharge. PEP was diagnosed according to consensus criteria. Results Of the 780 patients who underwent diagnostic ERCP, pancreatitis developed in 26 patients (3.3%). In the multivariable risk model, significant risk factors with adjusted odds ratios (ORs) were age 30 (OR = 6.414, P < 0.001). Female gender, history of recurrent pancreatitis, pre-ERCP hyperamylasemia, and difficult or failed cannulation could not predict PEP. There was no significant difference in the rate of PEP in wire-guided cannulation versus biliary cannulation using a sphincterotome and contrast injection as the conventional method. Conclusions Performing ERCP may be safer in the elderly. Patients with high ESR may be at greater risk of PEP, which warrants close observation of these patients for signs of pancreatitis after ERCP