Outcome of biliary tract surgery in unknown cirrhotics: a case-control study.

The substantial risk of biliary surgery in patients with liver cirrhosis may be reduced by preoperative preparation but the problem of the unknown cirrhotic remains. We studied 18 patients found incidentally to have cirrhosis at surgery. The perioperative complications and the outcome in these patients was compared with 18 non-cirrhotic patients, computer matched for age and sex, undergoing the same operations. Mean blood loss at operation was 324 ml (SD 218.1 ml) in the cirrhotic group and 105 ml (SD 74.7 ml) in the control group (P < 0.01). The postoperative complication rate was 38% in cirrhotics, but zero in controls (P < 0.01). The length of hospital stay was significantly increased in the cirrhotic group (P < 0.01). There was no mortality in either group. The incidental finding of cirrhosis at biliary surgery is associated with increased peroperative bleeding and increased morbidity. There is no increase in mortality in such patients.     

压电频移中和萃取法测定微克量枸橼酸维静宁

用涂圈压电石英晶体频移一中和萃取法测定枸橼酸维静宁(咳必清),检出限0.02μg,在0.05～1.6μg范围内呈线性,相关系数0.999,变异系数为2.3%。与经典的中和萃取法相比,本法具有明显的优越性。     

Gastroprotective effect of cardamom, Elettaria cardamomum Maton. fruits in rats

Cardamom, the fruits of Elettaria cardamomum Maton. (Zingiberaceae) commonly known as "Heel khurd" is used in Unani system of medicine to treat gastrointestinal disorders. A crude methanolic extract (TM), essential oil (EO), petroleum ether soluble (PS) and insoluble (PI) fractions of methanolic extract, were studied in rats at doses of 100-500, 12.5-50, 12.5-150 and 450 mg/kg, respectively for their ability to inhibit the gastric lesions induced by aspirin, ethanol and pylorous ligature. In addition their effects on wall mucus and gastric acid output were recorded. All fractions (TM, EO, PS, PI) significantly inhibited gastric lesions induced by ethanol and aspirin but not those induced by pylorus ligation. TM proved to be active reducing lesions by about 70% in the EtOH-induced ulcer model at 500 mg/kg. The PS fraction reduced the lesions by 50% at 50 and 100mg/kg (no dose response was observed) with similar effect than the PI fraction at 450 mg/kg. In the aspirin-induced gastric ulcer, the best gastroprotective effect was found in the PS fraction, which inhibited lesions by nearly 100% at 12.5mg/kg. In our experimental conditions, the PS extract at doses >or=12.5mg/kg proved to be more active than ranitidine at 50mg/kg.     

An office-based serological test for detection of current Helicobacter pylori infection: is it useful?

OBJECTIVE: To compare the accuracy of a new office-based serological test for the detection of current Helicobacter pylori infection with gastric histopathology. METHODS: An office-based serological test for detection of current H. pylori infection was performed in 92 consecutive patients with dyspeptic symptoms. The result of this test was compared blindly with the rapid urease test and histopathology for H. pylori on gastric biopsies. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this test were calculated against the histopathology. RESULTS: Among 92 patients, H. pylori was detected by histopathology and rapid urease test in 61 (66%) and 56 (60%) patients, respectively. Meanwhile the serological test diagnosed current H. pylori infection in 55 patients (59%). On comparison against the histology, the sensitivity and specificity of this new serological test was 85 and 90%, respectively. The positive predictive value and negative predictive value of this test were 94 and 76%, and the accuracy was 87% in this study. CONCLUSION: The specificity and sensitivity of the serological test was found comparable with histopathology in the diagnosis of current H. pylori infection. This test is a useful tool for rapid diagnosis of H. pylori in out patients' setting.     

Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial

The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.     

Cost effectiveness analysis of using multiple neuromodalities in treating severe traumatic brain injury in a developing country like Malaysia

OBJECTIVE: The aim of this study was to determine the cost-effectiveness of using baseline neuromonitoring (BNM) compared with multimodality monitoring (M3) for severe traumatic brain injury (TBI). METHODS: Sixty-two patients with severe TBI underwent a prospective observational study where they were divided into two groups of patients receiving treatment with M3 (32 patients) and BNM (30 patients). The macro and micro costings were performed on each patient. The Barthel Index score after 1 year was used as an outcome measurement tool for both groups. The cost-effectiveness (CE) ratio was calculated using the Poisson regression model. RESULTS: The costs of equipment and consumables between the groups was statistically significant (p < 0.001) after correcting for age and severity of injury. Other cost categories were not significantly different. The crude CE ratios were 168.66 (95% CI: 168.32, 169.03) and 144.16 (95% CI: 143.87, 144.45) for BNM and M3 respectively. The two crude CE ratios were significantly different (p < 0.001). It was calculated by controlling or adjusting age, gender, Glasgow Coma Score, Marshalls classification at admission and type of injury. The adjusted CE ratios were 171.32 (95% CI: 170.97, 171.68) and 141.50 (95% CI: 141.26, 141.79) for BNM and M3, respectively. The two adjusted CE ratios were significantly different ( p< 0.001). CONCLUSION: The application of M3 for severe TBI was more cost-effective than BNM. All calculations were made at 3.8 Malaysian Ringgit (MYR) to the United States dollar (USD).     

Intensive care management after inadvertent intravascular injection of liquid paraffin

Medication errors in the hospitals are not uncommon even in the developed countries. A 30 years old lady was admitted with 32 weeks pregnancy with gastroenteritis followed by intrauterine death. In the high dependency unit of obstetric department, accidentally 50 milliliters of liquid paraffin was administered intravenously. With 12 days of vigorous treatment comprising mechanical ventilation with positive end-expiratory pressure, an emergency hysterotomy to avoid the complications of intrauterine death; 3 cycles of plasmapheresis; and ultimately broncho-alveolar lavage, her condition improved and she was discharged from hospital.