The comparison of high and standard definition computed tomography techniques regarding coronary artery imaging

Objective: The aim was to compare coronary high-definition CT (HDCT) with standard-definition CT (SDCT) angiography as to radiation dose, image quality and accuracy. Material and Methods: 28 patients with history of coronary artery disease scanned by HDCT (Discovery CT750 HD) and SDCT (Somatom Definition AS). The scan modes were both axial prospective ECG-triggered. The vessel diameters and vessel attenuation values of totally 280 measurements from 140 coronary arteries were analyzed by two experienced radiologists. All data was analyzed by intraclass correlation test. Image quality graded by motion and stair step artifacts (grade 1, poor, to grade 4, excellent), accuracy of vessel inner and outer diameters were compared between the two CT units using the independent samples t-test and Mann-Whitney U test. Results: The intraclass correlation coefficient (ICC) of measured vessel attenuation values in SDCT between the two radiologists was exceedingly good. The ICC was higher in HDCT. The radiation dose of HDCT was higher than that of SDCT. The mean tube current was 180 (mA) in HDCT and 147(mA) in SDCT with the same tube voltage (kVp). There was no significant difference between image quality. Conclusion: HDCT has a higher radiation dose but has much more atenuation and the spatial resolution which improve measurement accuracy for imaging coronary arteries

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures

Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p< 0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p= 0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p= 0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture

Percutaneous & Mini Invasive Achilles tendon repair

Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Transstomal Small Bowel Evisceration after Colonic Perforation Secondary to Ischemic Colitis

Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site

Antibiotic Susceptibility Rates and Beta-Lactam Resistance Mechanisms of Pseudomonas aeruginosa Strains

Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections including bacteremia, skin and wound infections, pulmonary disease, especially among indivuals with cycstic fibrosis, nosocomial urinary tract infections, endocarditis and meningitis. The mechanism of resistance to broad-spectrum beta-lactams in P.aeruginosa are overexpression of cephalosporinases and/or class A, B and D beta-lactamases. Recently PER-1 type beta-lactamase has been reported from Turkey, France, Italy, Romania, Hungary, Belgium, Russia, South Korea and India. OXA beta-lactamases have increasingly been reported in clinical strains of P.aeruginosa from various geographical origins. This study was aimed to investigate the antibiotic susceptibility of various P.aeruginosa clinical strains and to define the beta-lactamase enzymes leading to resistance. In this study, a total of 100 P.aeruginosa strains isolated from various clinical specimens (37 urine, 21 blood, 10 sputum, 5 bronchoalveolar lavage, 5 abscess, 5 wound swabs, 4 endotracheal aspirate, 3 throat swabs, 2 catheter tips, one of each pleural and peritoneal fluid) were included. According to Clinical and Laboratory Standards Institute (CLSI) recommendations, susceptibilities of isolates to various antibiotics were investigated by disk diffusion and agar dilution method, and beta-lactamase enzymes were detected by isoelectric focusing (IEF) method. PSE, PER-1, OXA-10-like beta-lactamase genes and MEX-R genes of isolates were investigated by polymerase chain reaction (PCR). According to MIC90 values, the most effective antibiotics were found to be imipenem (8 mu g/ml). The MIC90 values of amikacin, ciprofloxacin, cefepime, cefpirome, piperacillin + tazobactam, piperacillin, ceftazidime, ticarcilin, aztreonam and ticarcilin + clavulanic acid were 32, 64, 64, 64, 128/4, 512, 512, 512, 512 and 512/2 mu g/ml, respectively. Seven of the isolates were found to be ESBL positive by double-disk synergy method. It was detected that 10% of the isolates were imipenem-susceptible and 9% were intermediate susceptible. Phenotypical investigation of metallo-beta-lactamase enzyme in these strains by MBL E-test method did not reveal a positive result. PER-1 and OXA-10 like beta-lactamases were detected each in 11% of the isolates, and co-presence of PER-like and OXA-10 like enzymes were shown in 4% of the isolates. PSE gene was not found in any of the strains. The MEX-R gene was identified in 52% of the isolates. Antibiotic resistance mechanisms in P.aeruginosa strains seems to be complex. Determination of the resistance mechanisms and antibiotic susceptibility rates in P.aeruginosa will guide the proper antimicrobial therapy, reducing the emergence of resistant strains

Long-term follow-up of tonsillectomy efficacy in children with PFAPA syndrome

Introduction: The role of tonsillectomy in the periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome, is controversial. Although some studies reported high success rates with tonsillectomy, further investigations are needed with larger numbers of patients. Objective: To seek the long-term outcomes of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Methods: Case series; multi-center study. The study comprised 23 patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome who underwent surgery (tonsillectomy with or without adenoidectomy) between January 2009 and November 2014. Results: 21 (91%) of 23 patients had complete resolution immediately after surgery. One patient had an attack 24 h after surgery, but has had no further attacks. One patient had three attacks with various intervals, and complete remission was observed after 3 months. Conclusions: Tonsillectomy is a good option for the treatment of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Resumo: Introdução: O papel da tonsilectomia na síndrome da febre periódica, estomatite aftosa, faringite e adenite é controverso. Embora alguns estudos tenham relatado altas taxas de sucesso com a tonsilectomia, são necessárias mais pesquisas com um número maior de pacientes. Objetivo: Avaliar os resultados em longo prazo da tonsilectomia na síndrome de febre periódica, estomatite aftosa, faringite e adenite. Método: Série de casos; estudo multicêntrico. O estudo avaliou 23 pacientes com síndrome de febre periódica, estomatite aftosa, faringite e adenite submetidos a cirurgia (tonsilectomia com ou sem adenoidectomia) entre janeiro de 2009 e novembro de 2014. Resultados: Dos 23 pacientes, 21 (91%) apresentaram resolução completa imediatamente após a cirurgia. Um paciente apresentou um episódio 24 horas após a cirurgia, mas sem recorrência posterior. Um paciente teve três episódios com vários intervalos e a remissão completa foi observada após 3 meses. Conclusões: A tonsilectomia é uma boa opção para o tratamento da síndrome de febre periódica, estomatite aftosa, faringite e adenite. Keywords: Fever, Lymphadenitis, Stomatitis aphthous, Pharyngitis, Tonsillectomy, Palavras-chave: Febre, Linfadenite, Estomatite aftosa, Faringite, Tonsilectomi

Echocardiographic features of patients with COVID-19 infection: a cross-sectional study

COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 63.3 +/- 15.7 years, and 54% were male. The mean age of non-severe group (n = 46) was 49.7 +/- 21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6 +/- 5.9 mm vs. 33.1 +/- 4.8 mm, p = 0.003; LV 47.3 +/- 5.8 mm vs. 44.9 +/- 3.8 mm, p = 0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0 +/- 9.8% vs. 61.9 +/- 4.8%, p < 0.001; RV-FAC, 41.4 +/- 4.1% vs. 45.5 +/- 4.5%, p < 0.001), and pericardial effusions were more frequent (23% vs. 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses