Ketorolac and Predicted Severe Acute Pancreatitis: A Randomized,Controlled Clinical Trial

Objective: We evaluated the effect of ketorolac on reducing the severity of acute pancreatitis.Design and Setting: Randomized clinical trial performed in a University hospital.Participants: There were 56 adult patients, with predicted severe acute pancreatitis, randomly divided into two groups.Methods: The patients in the study group received intravenous ketorolac, 10 mg, three times daily from the time of enrollment for a maximum of 5 days, as needed, along with standard medical treatment. Primary outcome measure was the change in the serum level of high sensitive C-reactive protein (hs-CRP). Patients were also followed up in terms of hospitalization duration, need for intensive care unit (ICU), organ failure development, persistent organ failure, pancreatic necrosis, nutritional assessment, and mortality. The study continued to gather clinical follow-up information up to 4 months.Results: Serum level of hs-CRP was significantly lower in the ketorolac group compared with the control group on days 3, 4, and 5. There were no significant differences in organ failure, pseudocyst formation, acute necrotic collection, mortality, and ICU transfer between groups. Days of hospitalization were significantly lower in the study group. The feeding start time was significantly shorter in the study group with no need for tube feeding in the ketorolac group. Frequency of NPO (not per oral) was significantly lower in the ketorolac group.Conclusion: The use of ketorolac may improve feeding outcomes and shorten length of hospitalization in predicted severe acute pancreatitis.     

Computational fluid dynamics-based study of possibility of generating pulsatile blood flow via a continuous-flow VAD

Until recent years, it was almost beyond remedy to save the life of end-stage heart failure patients without considering a heart transplant. This is while the need for healthy organs has always far exceeded donations. However, the evolution of VAD technology has certainly changed the management of these patients. Today, blood pumps are designed either pulsatile flow or continuous flow, each of which has its own concerns and limitations. For instance, pulsatile pumps are mostly voluminous and hardly can be used for children. On the other hand, the flow generated by continuous-flow pumps is in contrast with pulsatile flow of the natural heart. In this project, having used computational fluid dynamics, we studied the possibility of generating pulsatile blood flow via a continuous-flow blood pump by adjusting the rotational speed of the pump with two distinct patterns (sinusoidal and trapezoidal), both of which have been proposed and set based on physiological needs and blood flow waveform of the natural heart. An important feature of this study is setting the outlet pressure of the pump similar to the physiological conditions of a patient with heart failure, and since these axial pumps are sensitive to outlet pressures, more secure and reliable results of their performance are achieved. Our results show a slight superiority of a sinusoidal pattern compared to a trapezoidal one with the potential to achieve an adequate pulsatile flow by precisely controlling the rotational speed.     

烟雾吸入伤后血管紧张素转化酶的变化及意义

采用大鼠烟雾吸入伤模型，动态观察了伤后支气管肺泡灌洗液（BALF）及血浆中血管紧张素转化酶（ACE）活性的变化，辅以动脉血气分析，肺水量及BALF中总蛋白和白蛋白含量测定。结果发现，动物伤后出现急性呼吸衰竭和严重肺水肿，BALF中总蛋白和白蛋白含量均显著增加；血浆及BALF中ACE活性亦明显升高，且与BALF中蛋白水平的变化明显相关，提示ACE不仅是吸入伤后血管内皮细胞损伤的标志，而且可作为血管通透性增加及诊断严重吸入性损伤的早期敏感指标。     

Telescopic-assisted radiofrequency adenoidectomy: a prospective randomized controlled trial

OBJECTIVES/HYPOTHESIS: The objective was to conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of transoral telescopic-assisted radiofrequency adenoidectomy in young children. STUDY DESIGN: Prospective randomized controlled trial. METHODS: One hundred twenty patients who were 36 months of age or less and planned to undergo adenoidectomy or adenoidectomy with insertion of tympanostomy tubes were included in the study. Children were prospectively and randomly assigned into two equal treatment groups: the telescopic-assisted adenoidectomy using radiofrequency curette and the conventional adenoid-curette adenoidectomy. The main parameters included visual analogue scale score for nasal breathing, amount of blood loss, operating time, completeness of adenoid resection, smoothness of postoperative recovery, and complications. RESULTS: Both groups had a significant improvement in the visual analogue scale score after surgery with no evidence for a significant difference between the conventional adenoid-curette and radiofrequency groups. The amount of blood lost during radiofrequency adenoidectomy was minimal, with a mean difference of 31 mL and a median difference of 26 mL. There was a tendency for shorter operative time in the radiofrequency group, but this did not reach a statistical significance. No evidence for a significant difference was noticed in the smoothness of postoperative recovery or complication rate. CONCLUSION: Telescopic-assisted radiofrequency-curette adenoidectomy allows removal of huge adenoids completely in a precise, easy, and cost-effective procedure, with minimal blood loss and short operating time. The use of transoral telescopes provides a clear visualization that helps complete removal of the adenoids, reduction of unnecessary trauma, and effective control of bleeding.     

Deep lamellar endothelial keratoplasty: surgery in complex cases with severe preoperative visual loss

PURPOSE: This study was designed to report the use of deep lamellar endothelial keratoplasty (DLEK) in combination with other intraocular surgeries in the treatment of eyes with severe bullous keratopathy and visual loss. METHODS: DLEK surgery was performed in six patients with severe bullous keratopathy and preoperative vision with a range of between count fingers and light perception only. DLEK was combined with vitrectomy and placement of a ciliary sulcus sutured intraocular lens in four patients and with cataract surgery in one patient. Two patients with vitreoretinal disease underwent pars plana vitrectomy within only 4 months after the DLEK donor tissue had been placed. Graft clarity, Snellen visual acuities, refractive astigmatism, endothelial cell counts, and corneal topography were prospectively measured at 6 and 12 months postoperatively. RESULTS: At 6 months after DLEK surgery, all grafts were clear and vision improved in all patients. Best spectacle-corrected visual acuity improved from count fingers level (or worse) before surgery to a range of 20/40 to 20/200 after surgery. Average refractive astigmatism at 6 months was 2.0 diopters (range, 0.50-4.00 diopters). The average postoperative endothelial cell count was 1,679 +/- 380 (range, 1,200-2,298) cells/mm at 6 months and 1,449 +/- 365 (range, 1,105-2,043) cells/mm at 12 months. Vitreoretinal surgery subsequent to graft placement did not affect corneal clarity or dislodge the grafted tissue. CONCLUSIONS: DLEK surgery can be used in cases with severe visual loss caused by bullous keratopathy with transfer of healthy donor endothelium, clearing of the central cornea, and restoration of useful vision. DLEK also can be successfully combined with other intraocular surgeries such as vitrectomy, intraocular lens exchange, and sutured intraocular lens surgery. The DLEK graft can tolerate subsequent intraocular surgery performed as early as 3 months after placement of the donor tissue.     

Medication safety and transfusion errors in the ICU and beyond

The modern day intensive care unit (ICU) is a place in which patients can receive continuous monitoring of physiologic variables with concentrated patient observation and care. Despite the "intensive care," errors do occur. This article reviews medication and transfusion errors, including the different types, causes, and possible solutions to prevent these errors from occurring in ICUs and the hospital at large.