A comparative clinical evaluation of the outcome of patients treated for bilateral fracture of the mandibular condyles

AimTo compare open reduction and internal fixation (ORIF) with closed treatment and maxillomandibular fixation (CRMMF) for management of bilateral subcondylar fractures of the mandible.Patients and methodsThis study involved a retrospective analysis of bilateral subcondylar fractures of the mandible treated at Government Dental College, Rohtak from 2007 to 2010. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic results. Patients were followed up weekly for 4 weeks and then at 2, 3 and 6 months after surgery. At these visits, careful attention was paid to clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening and occlusion.ResultsThe patient sample ranged in age from 19 to 55 years, with an average age of 28.2 years. In total, 44 patients with 88 mandibular subcondylar fractures were included in the study. Out of these, 20 patients were managed by closed treatment and 24 by ORIF of the subcondylar fractures (19 unilateral and 5 bilateral).Regarding mouth opening/lateral excursion/protrusion, significant (p = 0.00) differences were observed between both groups (open 37.6/11.5/5.9 mm versus closed 31.5/7.8/3.1 mm). The visual analogue scoring revealed significant (p = 0.00) difference with less pain in the operative treatment group (1.3 open versus 7.2 closed). Statistically significant difference was found between two groups for occlusion (p = 0.00).ConclusionThe current retrospective study shows that operative treatment was superior in all objective and subjective functional parameters. It is concluded that if either of the condyles is displaced ORIF is the most satisfactory method of treatment.     

Relationship between central corneal thickness and progression of visual field loss in patients with open-angle glaucoma

ObjectiveTo determine whether a relationship exists between central corneal thickness (CCT) and visual field (VF) progression in treated patients with open-angle glaucoma and asymmetric corneal thickness.DesignRetrospective chart review.ParticipantsWe studied 100 charts of patients with open-angle glaucoma and also bilateral CCT and VF data.MethodsCharts from 2 glaucoma subspecialty practices were reviewed. The CCT and the rate of progression and event analysis of visual field data were assessed in all subjects. Subanalysis was performed for subjects whose CCT asymmetry was ≥ 16 μm.ResultsThe mean CCT was 544 ± 40 μm OD and 541 ± 40 μm OS. The mean CCT difference between fellow eyes was 15 ± 11 μm (range, 1 to 52 μm). There was no significant intrasubject difference in the mean deviation (MD) and the pattern standard deviation (PSD) (p =0.917 and p = 0.704, respectively; paired t test). The more advanced VF MDs and PSDs were found in the thin eyes of 47 and 50 subjects, respectively (p = 0.459 and p = 0.317, respectively; χ²). Of the 65 subjects whose visual field indexes were available, 34 had the more rapid visual field index rates of progression in the thin eye (p = 0.400; χ²). Of the 27 subjects for whom event analysis was available, 15 had the worse progression category in the thin eye (p = 0.453, χ2). Subgroup analysis of 48 subjects with ≥ 16 μm CCT asymmetry did not find any significant difference in analyses of field progression between fellow eyes.ConclusionsNo relationship was found between CCT and VF loss in treated patients with primary open-angle glaucoma or normal-tension glaucoma with asymmetrical CCT. Specifically, the thin eye did not have the more advanced VF loss or more rapid VF progression.     

Treatment of Hypertension in Children With Catecholamine‐Secreting Tumors: A Systematic Approach

Management of blood pressure in children with pheochromocytoma and other catecholamine‐secreting tumors (CSTs) is unique and challenging. The authors report a single‐center experience using sequential α‐adrenergic blockade (phenoxybenzamine), increased fluid intake, and β‐blockade for presurgical management of 10 CSTs in children. In this retrospective review, mean duration for blood pressure control in preparation for surgery was 4.5±2.6 weeks. Intraoperative hypertension was noted transiently (<2 hours) in eight patients (80%) and was treated with continuous infusion of short‐acting antihypertensive agents. Two (20%) patients required vasopressor medication infusion to manage intraoperative hypotension. Only two (20%) patients developed postoperative hypotension and required vasopressor medication infusion for <24 hours. All antihypertensive medications were discontinued in the immediate (≤4 days) postoperative period in 80% of patients. In conclusion, a systematic and multidisciplinary approach utilizing adrenergic blockade is effective in treating children with CSTs.     

Rigid Bronchoscopic Placement of Fogarty Catheter as a Bronchial Blocker for One Lung Isolation and Ventilation in Infants and Children Undergoing Thoracic Surgery: A Single Institution Experience of 27 Cases

One-lung ventilation (OLV) is a challenging task in infants and children as few techniques are possible because of narrow anatomy. The aim of this study is to evaluate and experience lung isolation with Fogarty catheters as a bronchial blocker placed by rigid bronchoscope for OLV in infants and children with lung pathologies requiring surgical management in an industrial hospital. This study is a prospective study carried out in J.L.N. Hospital and Research Centre, Bhilai (CG), from January 2011 to December 2014. The study was designed to place Fogarty catheter for achieving OLV using rigid bronchoscope in children. The patient and anaesthesia characteristics, placement and positioning of Fogarty catheters, intraoperative course, complications and recovery of the patient were studied. The data were then compared with the relevant and available literature. Over the study period of 4 years, 27 cases were included, out of which 22 (81.48 %) cases had suppurative lung disease, three cases (11.11 %) had hydatid cyst of the lung, whereas one case (3.7 %) each of congenital lobar emphysema and congenital cystic adenomatoid malformation of the lung, respectively. In all cases general anaesthesia was provided using single lumen endotracheal tube and one lung ventilation achieved by parallel placement of Fogarty catheter as a bronchial blocker with rigid bronchoscope. The surgical management included thoracotomy with decortication in 21 cases, thoracotomy with excision of hydatid cyst in 3 cases, video-assisted thoracoscopic surgery, thoracotomy with left upper lobectomy and thoracotomy with left lower lobectomy in one case each, respectively. There were no major intraoperative and postoperative complications. There was no mortality in our study. We conclude that rigid bronchoscope can be safely and effectively used to place Fogarty catheter in main bronchus in infants and children for achieving OLV.     

Pharmacologic Treatment of Pediatric Hypertension

Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children. These medications are well tolerated by children with acceptable safety profile. The choice of agent is usually driven by underlying etiology of hypertension, profile of its side effects, and clinician’s preference. This article will review currently available pediatric data on mechanism of action, common adverse effects, pediatric indication, recent clinical trial, and newer drugs in the common classes of antihypertensive medications.     

Morphine priming rescues high-dose morphine-induced biological perturbations

In in vitro studies, macrophage morphine priming (MP; preincubation with low-dose morphine) attenuated the effects of high-dose morphine (HDM) on macrophage capabilities of killing and containment of phagocytosed bacteria. In in vivo studies, mice received either normal saline (control), HDM, or MP twice daily for 10 consecutive days. All HDM-treated mice showed a significant peritoneal bacterial leak; none of the control and only 2 of 12 mice receiving MP showed peritoneal bacterial leak. HDM-treated mice showed decreased macrophage migration into the peritoneal cavity; however, MP inhibited this effect. In in vitro studies, macrophages and bone-marrow cells harvested from HDM-treated mice showed not only enhanced apoptosis but also decreased migration across the filter of a Boyden chamber; nevertheless, MP inhibited these effects of HDM. MP also attenuated the proapoptotic effect of HDM; however, this effect was prevented by treatment with pyrrolidine derivative of dithiocarnamate, an inhibitor of nuclear factor- kappa B. These results suggest that MP provides protection against HDM-induced degradation of the host defense barrier through preservation of macrophage function.     

Morphine-induced degradation of the host defense barrier: role of macrophage injury.

The effect of morphine on the degradation of the host defense barrier in rats and mice was studied. Mice received either 3 or 11 doses of morphine. Mice receiving 11 doses of morphine showed gram-negative bacteremia and bacterial growth in samples of peritoneal fluid (PF), liver, spleen, kidneys, heart, and lungs; PF and tissue samples from only 1 control mouse showed bacterial growth, and no control mice had bacteremia. Mice receiving 11 doses also had suppressed bone marrow macrophage colony formation. Monocytes and peritoneal macrophages harvested from morphine-treated mice showed greater injury than did those from control mice. Pretreatment of mice with naloxone inhibited morphine-induced macrophage injury and degradation of the host defense barrier. In in vitro studies, morphine attenuated the killing of bacteria phagocytosed by macrophages and also facilitated their escape. This study indicates that morphine-induced monocyte and macrophage injury may be linked to degradation of the host defense barrier.     

Association between transient acute kidney injury and morbidity and mortality after lung transplantation: A retrospective cohort study

Purpose

Acute kidney injury (AKI) is a common occurrence after lung transplantation (LTx). Whether transient AKI or early recovery is associated with improved outcome is uncertain. Our aim was to describe the incidence, factors, and outcomes associated with transient AKI after LTx.

Materials and Methods

We performed a retrospective cohort study of all adult recipients of LTx at the University of Alberta between 1990 and 2011. Our primary outcome transient AKI was defined as return of serum creatinine below Kidney Disease–Improving Global Outcome AKI stage I within 7 days after LTx. Secondary outcomes included occurrence of postoperative complications, mortality, and long-term kidney function.

Results

Of 445 LTx patients enrolled, AKI occurred in 306 (68.8%) within the first week after LTx. Of these, transient AKI (or early recovery) occurred in 157 (51.3%). Transient AKI was associated with fewer complications including tracheostomy (17.2% vs 38.3%; P < .001), reintubation (16.4% vs 41.9%; P < .001), decreased duration of mechanical ventilation (median [interquartile range], 69 [41-142] vs 189 [63-403] hours; P < .001), and lower rates of chronic kidney disease at 3 months (28.5% vs 51.1%, P < .001) and 1 year (49.6% vs 66.7%, P = .01) compared with persistent AKI. Factors independently associated with persistent AKI were higher body mass index (per unit; odds ratio [OR], 0.91; 95% confidence interval, 0.85-0.98; P = .01), cyclosporine use (OR, 0.29; 0.12-0.67; P = .01), longer duration of mechanical ventilation (per hour [log transformed]; OR, 0.42; 0.21-0.81; P = .01), and AKI stages II to III (OR, 0.16; 0.08-0.29; P < .001). Persistent AKI was associated with higher adjusted hazard of death (hazard ratio, 1.77 [1.08-2.93]; P = .02) when compared with transient AKI (1.44 [0.93-2.19], P = .09) and no AKI (reference category), respectively.

Conclusions

Transient AKI after LTx is associated with fewer complications and improved survival. Among survivors, persistent AKI portends an increased risk for long-term chronic kidney disease.