Is CO2 cystometry a reliable test in estimating detrusor contractile function in patients with acute urinary retention?

ObjectivesCO₂ cystometry is very convenient for patients who already received indwelling urethral catheterization. This study aims to evaluate the reliability of CO₂ cystometry in estimating the detrusor contractile function in patients with acute urinary retention.MethodsPatients with acute urinary retention were enrolled between December 2011 and January 2015. All patients underwent CO₂ cystometry and H₂O cystometry in the same session to evaluate detrusor contractility. The results obtained with H₂O cystometry and CO₂ cystometry were compared.ResultsWe recruited a total of 32 patients (11 females and 21 males). The mean ± standard deviation age was 77.43 ± 10.48 years (range 21–102 years). Analyses of the parameters of cystometry, including volume at first desire to void, volume at strong desire to void, cystometric capacity, and compliance revealed a strong linear correlation between the comparative parameters of H₂O and CO₂ cystometry (Pearson's correlation coefficients: 0.75, first desire; 0.83, strong desire; 0.71, cystometric capacity; and compliance, 0.96). Using H₂O cystometry as the gold standard, the sensitivity and specificity of CO₂ cystometry for diagnosis of detrusor contractile function were calculated as 1 and 0.72, respectively.ConclusionCO₂ cystometry gives as valid information as H₂O cystometry in estimating detrusor contractile function in patients with acute urinary retention.     

N-acetylcysteine protects against star fruit-induced acute kidney injury

Background: Star fruit (SF) is a popular fruit, commonly cultivated in many tropical countries, that contains large amount of oxalate. Acute oxalate nephropathy and direct renal tubular damage through release of free radicals are the main mechanisms involved in SF-induced acute kidney injury (AKI). The aim of this study was to evaluate the protective effect of N-acetylcysteine (NAC) on SF-induced nephrotoxicity due to its potent antioxidant effect.

Materials and methods: Male Wistar rats received SF juice (4?mL/100?g body weight) by gavage after a 12?h fasting and water deprivation. Fasting and water deprivation continued for 6?h thereafter to warrant juice absorption. Thereafter, animals were allocated to three experimental groups: SF (n?=?6): received tap water; SF?+?NAC (n?=?6): received NAC (4.8?g/L) in drinking water for 48?h after gavage; and Sham (n?=?6): no interventions. After 48?h, inulin clearance studies were performed to determine glomerular filtration rate. In a second series of experiment, rats were housed in metabolic cages for additional assessments.

Results: SF rats showed markedly reduced inulin clearance associated with hyperoxaluria, renal tubular damage, increased oxidative stress and inflammation. NAC treatment ameliorated all these alterations. Under polarized light microscopy, SF rats exhibited intense calcium oxalate birefringence crystals deposition, dilation of renal tubules and tubular epithelial degeneration, which were attenuate by NAC therapy.

Conclusions: Our data show that therapeutic NAC attenuates renal dysfunction in a model of acute oxalate nephropathy following SF ingestion by reducing oxidative stress, oxaluria, and inflammation. This might represent a novel indication of NAC for the treatment of SF-induced AKI.     

Torsion of a mesenchymal hamartoma of the liver in a 1-year-old boy

We report a case of a one-year-old boy who was referred to our clinic suspected of having acute abdomen. On physical examination, the abdomen was soft, diffusely tender with weak peristalsis. Ultrasonography and MRI of the right hemiabdomen demonstrated a well-defined, solid, expansive formation with slightly lobulated contours and an interspersed inhomogeneous structure with overall dimensions of 59?×?45?×?50?mm. After midline laparotomy was performed, a cystic tumor was found, twisted around a pedicle which was arising from the falciform ligament and it measured 5–6?cm in diameter. The tumor appeared to be necrotic. The mass was ligated and extirpated on the pedicle and sent for histopathological analysis. After the surgery, the boy was hemodynamically stable, without respiratory complications and all laboratory findings were within normal limits. Histopathological analysis showed that the tumor was composed of mesenchymal stroma with sparse glimpses of hepatocytes and bile ducts with partly cystic changes lined by orderly epithelium. Given the clinical data, histology and immunohistochemistry analysis (alpha-fetoprotein, CK8/18, hepatocyte, desmin and CD31) a diagnosis of a twisted mesenchymal hamartoma of the liver was made.     

Review of non‐invasive ventilation in the emergency department: clinical considerations and management priorities

Aims and objectives. We aimed to synthesise evidence from published literature on non‐invasive ventilation to inform nurses involved in the clinical management of non‐invasive ventilation in the emergency department. Background. Non‐invasive ventilation is a form of ventilatory support that does not require endotracheal intubation and is used in the early management of acute respiratory failure in emergency departments. Safe delivery of this intervention requires a skilled team, educated and experienced in appropriate patient selection, available devices and monitoring priorities. Design. Systematic review. Method. A multi‐database search was performed to identify works published in the English language between 1998–2008. Search terms included: non‐invasive ventilation, continuous positive airway pressure and emergency department. Inclusion and exclusion criteria for the review were identified and systematically applied. Results. Terminology used to describe aspects of non‐invasive ventilation is ambiguous. Two international guidelines inform the delivery of this intervention, however, much research has been undertaken since these publications. Strong evidence exists for non‐invasive ventilation for patients with acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. Non‐invasive ventilation may be delivered with various interfaces and modes; little evidence is available for the superiority of individual interfaces or modes. Conclusions. Early use of non‐invasive ventilation for the management of acute respiratory failure may reduce mortality and morbidity. Though international guidelines exist, specific recommendations to guide the selection of modes, settings or interfaces for various aetiologies are lacking due to the absence of empirical evidence. Relevance to clinical practice. Monitoring of non‐invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask‐fit and high air flows; serious complications are few and occur infrequently. The use of non‐invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department.     

A Child with Benign Acute Childhood Myositis After Influenza

Background: Benign acute childhood myositis (BACM) is a rare transient muscle syndrome classically occurring in children after a viral upper respiratory infection (URI). BACM causes difficulty walking due to severe bilateral calf pain. The incidence of this well-described phenomenon is uncertain but infrequent, and it is typically appreciated during times of large influenza outbreaks and epidemics. The URI symptoms that precede BACM are consistent with an uncomplicated viral influenza infection and include fever, malaise, cough, sore throat, headache, and rhinitis. Objectives: Little is written in the Emergency Medicine literature regarding this clinical entity. In this report, a brief review of BACM from the current literature is provided, as well as tools to aid in differentiating it from more severe but similar disorders such as rhabdomyolysis and Guillain-Barré syndrome. Case Report: We present a case of BACM in a 7-year-old boy who presented to the emergency department after a resolving URI with the acute onset of calf pain causing alarming difficulty in his ability to walk. His presentation was typical for BACM and his condition improved with supportive treatment. Conclusions: Although quite alarming and potentially puzzling to the physician who is not familiar with BACM, this syndrome is self limited and spontaneously resolves with no specific intervention. Recognition of this rare but distinct clinical entity by the emergency physician can spare a patient from potentially unneeded invasive testing and hospital admission.