Small bowel intussusception together with appendicitis in childhood: A case report

Simultaneous diagnosis of intussusception and appendicitis in the same patient have rarely been described in the pediatric population. We reported a small bowel intussusception case together with acute suppurative appendicitis. A 9 years old boy had abdominal colic pain and he had vomit frequently. On physical examination, he was awake, active and uncomfortable. Abdominal ultrasound (US) suggested ileoileocolic intussusception. Laparotomy was performed and an ileoileocolic intussusception was visualized. Ileoileocolic intussusception was reducted manually. After reduction appendix was visualized and it was acute suppurative appendicitis. Appendectomy was performed. Neither medical nor surgical problem occurred during long term follow-up. In conclusion, we though that it is important to examine the other pathologic conditions such as leading points, bowel complications and even appendicitis in case of intussusception

Myocardium utilizes more oxygen and glucose during tepid blood cardioplegic infusion in arrested heart

PubMed ID: 15876806The aims of this study were to evaluate myocardial metabolic activity during tepid blood cardioplegic infusion in the arrested heart in comparision with cold blood cardioplegia and to assess the early clinical outcomes of these patients. Thirty patients undergoing first elective coronary artery bypass grafting surgery were included and randomized to two groups (T for tepid and C for cold), 15 patients in each. Myocardial protection was similar in both groups except for the reinfusion of blood cardioplegia, which was 6°C in group C and 28°C in group T (same temperature as the body perfusion). The route of cardioplegic reinfusion was antegrade during the first reinfusion and retrograde during the second reinfusion. In order to assess myocardial metabolic activity, myocardial oxygen consumption (MVO2), myocardial glucose uptake, and myocardial lactate and acid production were all calculated. Arterial and coronary venous blood samples were obtained from the aortic root cannula and coronary sinus. During cardioplegic reinfusions in the ischemic period, the calculated values of myocardial oxygen extraction, oxygen consumption, and glucose uptake were higher in group T than in group C (P < 0.05). This difference was observed during both antegrade and retrograde delivery of cardioplegic solution. Myocardial lactate production was greater in group C than in group T during cardioplegic reinfusion, both antegradely and retrogradely (P < 0.05). In all patients, cardiopulmonary bypass was terminated in the first attempt. The clinical outcome was similar in both groups. The results of this study indicate that globally ischemic myocardium is able to utilize more oxygen and glucose during cardioplegic reinfusions at a tepid temperature in comparison to cold. In addition, the data showed evidence of less myocardial injury and better left ventricular function throughout the critical period of recovery from global ischemia for the heart protected by tepid cardioplegia. Copyright © 2005 by the International Heart Journal Association

Desmopressin usage in elective cardiac surgery

WOS: 000172821600008PubMed ID: 11698939Background. Desmopressin acetate (DDAVP) has been implicated as a promising agent to reduce blood loss in patients undergoing cardiopulmonary bypass. Methods. The effects of intraoperative desmopressin were studied in 66 patients undergoing coronary artery bypass grafting, randomized equally into desmopressin and control groups. The desmopressin group received 0.3 mug/kg desmopressin at the end of cardiopulmonary bypass. Results. Fibrinogen level of both groups significantly reduced at postoperative 2(nd) hr, whereas a significant rise was observed at postoperative 24(th) hr with an intergroup difference favoring the control group (p=0.0307). In the desmopressin group, the activation time of factor VIII shortened during the whole postoperative period being significant (p=0.0127) at postoperative 24th hr. Postoperative von Willebrand factor (vWF) levels of the desmopressin group were significantly higher than the preoperative ones. The control group did not show such important changes in factor VIII and vWF measurements. Platelet aggregation times of both groups prolonged at postoperative 2nd hr. The control group showed significant elevation in ADP induced aggregation time at 2nd hr and significant reductions of platelet activation percents in response to ADP, epinephrine, collagen and ristocetin at 2nd hr. Postoperative blood loss as well as blood transfusion need did not differ between the two groups. Conclusions. Despite the improved platelet functions, desmopressin does not seem to have obvious beneficial effects on postoperative hemostasis in patients without any bleeding disorder and undergoing elective cardiac surgery