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Objective: An epiglottic abscess is considered a life-threatening medical situation that can cause death by obstruction the upper airways. We describe a 58-year-old man who presented to our hospital with sore throat, dysphagia and dysphonia., Materials and Methods: A fiberoptic laryngoscope (FOL) demonstrated beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. CT scan showed multiple air bubbles inside the swollen epiglottis, in keeping with the diagnosis of necrotizing epiglottic abscess., Results: Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis. He was dismissed 5days from his admission to the hospital after an improvement was noticed in his epiglottis., Conclusion: Treatment consists of airway management if needed under anesthesia and draining of the abscess. An IV antibiotics plus corticosteroids should be administrated the moment a suspicion of epiglottitis is present., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: Although non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) and opioids are effective treatments for acute renal colic, they are associated with adverse events (AEs). As cyclooxygenase-2 selective NSAIDs may provide a safer alternative, we compared the efficacy and safety of parecoxib versus an nsNSAID in subjects with acute renal colic., Materials and Methods: Phase IV., multicenter, double-blind, noninferiority, active-controlled study: 338 subjects with acute renal colic were randomized to parecoxib 40 mg i.v. plus placebo (n = 174) or ketoprofen 100 mg IV plus placebo (n = 164). 338 subjects with acute renal colic were randomized to parecoxib 40 mg IV (n = 174) or ketoprofen 100 mg IV(n = 164) plus placebo. Subjects were evaluated 15, 30, 45, 60, 90 and 120 minutes after treatment start and 24 hours after discharge. Primary endpoint was the mean pain intensity difference (PID) at 30 minutes by visual analog scale (VAS) (per-protocol population). An ANCOVA model was used with treatment group, country, and baseline score as covariates. Non-inferiority of parecoxib to ketoprofen was declared if the lower bound of the 95% confidence interval (CI) for the difference between the two groups excluded the pre-established margin of 10 mm for the primary endpoint., Results: Baseline demographics were similar. The mean (SD) mPID30 min was 33.84 (24.61) and 35.16 (26.01) for parecoxib and ketoprofen, respectively. For treatment difference (parecoxib-ketoprofen) the lower bound of the 95% CI was 6.53. The mean change from baseline in VAS 30 minutes after study medication was ~43 mm; AEs were comparable between treatments., Conclusions: Parecoxib is as effective as ketoprofen in the treatment of pain due to acute renal colic, is well tolerated, and has a comparable safety profile.

Acute urinary retention (AUR) is unusual in children. We report for the first time a case of recurrent urinary retention due to massive hematocolpos resulting from an imperforate hymen in a 14-year-old girl. In case of AUR in adolescent girls, clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically, but follow-up is still necessary to ensure that there is no recurrence., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Ultrasonography is useful in trauma patients to detect pleural effusions or peritoneal fluid., Aim: To assess the value of ultrasonography performed by surgeons in the assessment of trauma patients., Material and Methods: A retrospective review of ultrasonography reports and clinical history of 284 trauma patients., Results: One hundred fifty six patients had blunt trauma and 128 had penetrating trauma. Ultrasonography detected peritoneal fluid in 20%, pericardial effusion in 1% and pleural effusion in 1%. Eight percent had visceral damage or hematomas, without peritoneal fluid. None of the patients with a normal ultrasonography required surgery for hemoperitoneum; however, four patients had intestinal perforations and required surgery., Conclusions: Ultrasonography had a 100% sensitivity and specificity for the detection of clinically significant hemoperitoneum. Emergency ultrasonography performed by surgeons is useful and accurate.

Thyroid stimulating hormone (thyrotropin; TSH) in serum was assayed with the Immulite-TSH, a fully automated solid-phase third-generation immunoassay analyzer that has a chemiluminescent detection system. The intraassay CV ranged from 3.6% to 6.2% for TSH mean concentrations from 0.025 to 32.12 mIU/L and the interassay CV ranged from 7.9% to 10% for TSH mean concentrations between 0.023 and 31.93 mIU/L. The analytical and functional detection limits of the assay were 0.001 and 0.0068 respectively. No interference was observed by any of the compounds: bilirubin, triglycerides, and hemoglobin. To compare the accuracy of Immulite-TSH with that of a conventional immuno-radiometric assay (Orion Diagnostica Irma-TSH), we examined 153 patient samples with TSH concentrations ranging approximately 0.2 to 100 mIU/L. At TSH concentration approximately 0.15 the precision was greater for Immulite-TSH than for Irma TSH (3.8% vs 11.87%) intraassay CV and (8.6% vs 35.4%) interassay CV. We concluded that Immulite-TSH is a rapid and precise third-generation assay, totally automated and the results can be provided to the clinician within 1 to 2 h of receipt of the patient's sample.

To investigate the effect of pubertal development on serum levels of IGF binding protein-3 (IGFBP-3) and IGF-I, and the relationship between IGFBP-3 levels and height, weight, weight for height and age (WFHA), and IGF-I levels, a cross-sectional study was performed in a Spanish basic education school in Vigo (NW Spain). The study was made up of 181 girls with a mean chronologic age of 11.03 +/- 0.22 y and 173 boys with a mean chronologic age of 10.9 +/- 0.23 y. The pubertal development was graded into three groups according to estradiol and testosterone concentrations for girls and boys, respectively. All subjects were in good health and among the 5th and 95th percentile for height. Serum IGFBP-3 and plasma IGF-I concentration was determined by RIA. Pubertal development was significantly associated with IGFBP-3 and IGF-I concentrations in girls and boys, respectively (p < 0.0001, analysis of variance). Multivariate regression analyses between IGF-I or IGFBP-3 with age, sex, and estradiol or testosterone show significative correlation in prepubertal children for IGF-I (r = 0.545, p = 0.0001 and r = 0.574, p = 0.0001 for girls and boys, respectively) and only in prepubertal boys for IGFBP-3 (r = 0.336, p = 0.0012). The linear correlation between IGF-I and IGFBP-3 was significant in both prepubertal (r = 0.25, p < 0.0001) and pubertal (r = 0.40, p < 0.0001) girls, but only in prepubertal boys (r = 0.30, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Does coronary artery reoperation improve the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries? To examine this question, we retrospectively reviewed 1117 patients who had coronary bypass grafting and then underwent a postoperative coronary angiogram that showed a stenosis (> or = 20%) of at least one vein graft. Reoperation within 1 month of the postoperative angiogram was performed for 394 patients (REOP group) whereas 723 patients (MED group) received initial medical treatment (no reoperation or percutaneous transluminal coronary angioplasty within 1 year). Compared with the MED group, patients in the REOP group were older, more symptomatic, more likely to have left main stenosis, and had fewer patent bypass grafts (all p < 0.001). In-hospital mortality for the REOP group was 4.3%. Mean postangiogram follow-up of the entire group was 73 months. On the basis of the interval between the primary operation and the postoperative angiogram, patients were designated as having early (< 5 years) or late (> or = 5 years) saphenous vein graft stenosis. Univariate and multivariate analyses were used to identify factors influencing the survival of these subgroups. Reoperation was not identified as a variable improving the survival of patients with early vein graft stenoses. For patients with late vein graft stenoses, moderate or severe impairment of left ventricular function (p < 0.0001), advanced age (p < 0.0001), triple-vessel or left main stenosis (p = 0.0011), and stenosis in a vein graft to the left anterior descending artery (p = 0.0019) decreased survival, whereas reoperation improved survival (p = 0.0007). The improvement in survival with reoperation was particularly strong for patients with a stenotic vein graft to the left anterior descending artery. For that subset, survival was 84% and 74% for the REOP group versus 76% and 53% for the MED group at 2 and 4 years after catheterization, respectively (p = 0.004). For patients with stenotic vein grafts to the right coronary artery or circumflex coronary artery (or both), survival was 92% and 87% for the REOP group versus 89% and 78% for the MED group at 2 and 4 years after catheterization, respectively (p = 0.13). Even for patients with class I or II symptoms, reoperation prolonged survival (p = 0.002 with multivariate testing). Reoperation improves the survival of patients with late vein graft stenoses, particularly those with stenotic grafts to the left anterior descending coronary artery.

We tested the efficacy and safety of aprotinin in 169 patients undergoing isolated reoperative myocardial revascularization. Patients were randomly assigned to high-dose aprotinin, low-dose aprotinin, or placebo treatment groups in a double-blind, placebo-controlled study. Treatment groups did not differ significantly with respect to age, sex, red cell mass, number of grafts, use of internal thoracic artery, or incidence of preoperative aspirin therapy. Patients treated with aprotinin had a significant reduction in postoperative chest tube drainage (720 +/- 753, 866 +/- 1,636, and 1,121 +/- 683 mL, respectively, for high-dose aprotinin, low-dose aprotinin, and placebo; p < 0.001). Transfusion requirements were reduced in aprotinin-treated patients (2.1 +/- 4.2, 4.8 +/- 11.8, and 4.1 +/- 6.2 units for high-dose, low-dose, and placebo, respectively; p < 0.001). A similar reduction in chest tube drainage and transfusion requirements was seen in patients using aspirin preoperatively. Q-wave myocardial infarctions were increased in the aprotinin subgroups (17.5%, 14.3%, and 8.9% for high-dose, low-dose, and placebo groups; not significant). Acute vein graft thrombosis was found in six of 12 vein grafts studied at postmortem examination in patients receiving aprotinin but not in any of five grafts in patients receiving placebo. We conclude that aprotinin is extremely effective in reducing bleeding and transfusion requirements and may increase the risk of graft thrombosis.

From August 1979 through August 1991, 91 patients were supported with centrifugal mechanical ventricular assist. Major indications for its use were postcardiotomy ventricular failure (79) or as a bridge to cardiac transplantation (12). In postcardiotomy use (0.2% of all cardiac procedures), there were 54 male (68.4%) and 25 female patients (31.6%) with a mean age of 54.8 years and a mean duration of use of 3.56 days (range, 1 hour to 19 days). Forty-nine patients (62%) were successfully weaned, and 20 (25.3%) were hospital survivors. In 57 patients the device was inserted to wean from cardiopulmonary bypass, whereas in 22 it was employed later in the postoperative period because of low cardiac output or sudden arrest. Thirty-four (59.6%) of the 57 patients in the former group were weaned, and 15 (26.3%) were discharged, results similar to those in the latter group with 15 (68.2%) weaned and 5 (22.7%) discharged. Morbidity associated with use of centrifugal blood pumps included bleeding (87.3%; mean transfusion requirement, 53.2 units), renal failure (46.8%), cerebrovascular accident (12.7%), thromboembolism (12.7%), and hepatic insufficiency (12.7%). After a mean follow-up of 45.4 months (range, 2 to 142 months), 7 patients had died (35% late mortality), 1 patient is in functional class IV, and all others are in functional class I or II. Lower survival was associated with biventricular failure and renal failure but not with age or sex of the patient.

When systemic cooling and rewarming are performed during cardiopulmonary bypass (CPB), the pulmonary artery temperature typically decreases after CPB. This decrease may be rapid enough to cause substantial underestimation of cardiac output (CO) measured by thermodilution, due to changing baseline temperature during the thermodilution measurement. In 16 patients undergoing CPB for coronary artery grafts, digital recording of pulmonary artery temperature was done during room-temperature thermodilution CO (TDCO) injections. TDCO were computed with and without correction for baseline temperature decrease. Prior to CPB, the temperature change was -0.013 degrees C/min, producing no significant effect on CO measurements; the coefficient of variation of CO measurements was 5.1%. One minute after CPB the temperature change was -0.144 degrees C/min, producing a CO measurement error of -0.57 +/- 0.52 l/min (SD), or about 11% of the average CO; the range of the error was 0.05 to -2.0 l/min. Ten minutes after CPB the temperature change was -0.063 degrees C/min, and CO error was -0.31 +/- 0.36 (0.15 to -1.20) l/min. At 30 min the temperature change was -0.012 degrees C/min (not significant), and CO error was -0.13 +/- 0.14 l/min. Duration of CPB was 104 +/- 30 min, with rewarming for 44 +/- 13 min; the average minimum bladder temperature was 25.1 +/- 2.3 degrees C during cooling and 36.7 +/- 0.7 degrees C at the end of CPB. Under these conditions TDCO measurements within the first 10 min after CPB often underestimate the true CO.

Synchronous paced contractions of latissimus dorsi muscle pedicle (LDM) around the heart improve ventricular function in dynamic cardiomyoplasty. To optimize assistance and prolong pacemaker battery life, the LDM should be stimulated with the lowest energy pacing parameters (PP) that will produce maximal muscle contraction. Muscle fractional shortening (FS) and duration of contraction (CT) were studied in conditioned, fatigue-resistant LDM of six goats. Fractional shortening and CT were determined at increasing amplitude, (A, 1-6v); pulse width, (PW, 60-450 musec); and frequency, (F, 5-130 Hz). Maximal rate of contraction was determined by pacing at higher rates. Maximal FS plateaued after V, 2.4 +/- .6v; PW, 125 +/- 47 musec; and F, 36 +/- 9 Hz. Mean CT for all PP was significantly longer (p less than or equal to 0.001) than the burst length (185 msec). Increasing F resulted in CT, which peaked at 460 +/- 59 msec. Increasing rate of contraction demonstrated that over 87 beats per minute the muscle fails to achieve complete relaxation, and, therefore, maximal FS.

Quadricuspid aortic valve is a rare congenital anomaly that may be found unexpectedly at surgery or diagnosed preoperatively by means of echocardiography or aortography. The most common hemodynamic abnormality associated with this anomaly is aortic insufficiency. We describe a representative case involving a 62-year-old man with severe aortic insufficiency and mild aortic stenosis. At operation, the aortic valve was found to have 4 cusps. The valve was replaced with a mechanical prosthesis. The patient was released 7 days after operation and was clinically well at 6-month follow-up.

Four patients with Marfan syndrome developed severe aortic insufficiency requiring complete replacement of the ascending aorta with reimplantation of the coronary arteries by the technique of Cabrol. All patients have remained asymptomatic in NYHA class I.

The long range goal is the development of a clinically useful, implantable, skeletal muscle powered cardiac assist device (MCAD). To accomplish this goal, two criteria must be met: good anatomic fit, and antithrombogenicity. Because of the relative locations of the latissimus dorsi (LD) muscle and aorta, there are two possible port arrangements: "crisscrossed" (C design), in which the ports are crossed to anastomotic sites, and "prong" shaped (P design), in which no crossover takes place. The purpose of this paper is to determine which of these designs is best from a fluid dynamic perspective, and hence has the best possibility for low thrombogenicity. Flow visualization (FV) techniques were used during two pumping conditions in a mock loop: worst case (MCAD off) and best case (MCAD driven optimally). Results of the MCAD off tests showed that both designs required immediate actuation (for example, an IABP console). However, FV studies under optimal conditions indicated superiority of the C design, most likely due to kinetic energy-induced rotary motion combined with a minimal interport distance. It is concluded that the C design provides ideal flow dynamics, even in valveless pumps, and also has application to valved devices.

A diastolic counterpulsator that uses either skeletal muscle or pneumatic actuation was developed. The unit is positioned between the latissimus dorsi and the chest wall, without interference with collateral blood supply, and is connected in series with the descending aorta. The system was able to generate stroke volumes between 52 and 16 ccs against pressures of 60 and 140 mmHg, respectively. Stroke work at 200 msec stimulation averaged 2.8 X 10(6) ergs. Power output at an afterload of 100 mmHg, and at a rate of 60 bpm, was 0.51 W. Back-up pneumatic actuation provided by an intraaortic balloon pump resulted in a 46% increase in the endocardial viability ratio (EVR).