Journal of Acute Disease

258-264

Authors: Georgios Geropapas, George Galyfos, Ioannis Stefanidis, Ioannis Stamatatos, Stavros Kerasidis, Sotirios Giannakakis, Georgios Kastrisios, Gerasimos Papacharalampous, Chrisostomos Maltezos

This study aims to collect and present all current literature data on the diagnostic and therapeutic management of acute type B aortic dissection. It includes a comprehensive literature search utilizing the following keywords: ‘acute aortic dissection’, ‘type B aortic dissection’, ‘conservative management’, ‘endovascular repair’, ‘open surgery’ and ‘diagnosis’. Uncomplicated acute type B aortic dissection can be effectively managed using conservative management, although open repair is indicated only for complicated cases. Endovascular repair shows promising results in selected patients with increased perioperative risk and without contraindications. Recent evidence supports endovascular repair even in uncomplicated cases, although more data on long-term outcomes are needed. Early risk stratification and evaluation of the patient is crucial fo r selection of optimal management.

272-276

Authors: Bhaskar Kumar Somani, Harun Gupta, Alastair Todd

Objective: To assess the outcomes of early percutaneous nephrostomy in obstructed hydronephrosis and hyperkalaemia from ureteric obstruction. Methods: Patients were diagnosed with hyperkalaemia with serum potassium >5.0 mmol/L and hyperkalaemia was graded as mild (5.0-6.0 mmol/L), moderate (6.1-7.0 mmol/L) or severe (>7.1 mmol/L). Data on age, sex, clinical presentation, presence of concurrent disease, creatinine, potassium, haemoglobin concentration, time interval in doing the nephrostomy since their first presentation, any prenephrostomy medical correction of hyperkalaemia and complications were collected. Results: A total of 61 patients (40 males and 21 females) with mean age of 69.7 years (ranged 35 to 94 years) underwent 69 procedures. Prior to the nephrostomy, the serum potassium was mildly elevated in 42 cases, moderately elevated in 17 cases and severely elevated in 10 cases. The overall mean level of potassium before intervention was 6.1 mmol/L (range: 5.1 mmol/L-9.3 mmol/ L). Forty (58%) had nephrostomy without prior medical treatment of the hyperkalaemia. The mean serum potassium in these patients was 5.6 mmol/L (range: 5.1 mmol/L-7.5 mmol/L). Twentynine (42%) had medical treatment of the hyperkalaemia prior to nephrostomy. The mean potassium level in these patients was reduced from 6.7 mmol/L (range 5.4 mmol/L-9.3 mmol/L) before medical treatment to 5.8 mmol/L (4.0 mmol/L-7.4 mmol/L). Five patients (7%) had complications fr om percutaneous nephrostomy including temporary atrial fibrillation in 3 patients and transient pyrexia in 2 patients. Conclusions: Percutaneous nephrostomy as the initial management for hyperkalaemia from ureteric obstruction is a safe procedure with acceptable complication rates.

284-289

Authors: Kamal Seyed-Forootan, Hamid Karimi, Ahmad-Reza Dayani

Objective: To evaluate effects of PRP injection in strengthening of repaired tendon. Methods: This study was conducted in animal lab of our hospital on 20 rats. The animals were divided into two groups randomly and distal third of left Achillis tendons were cut and then repaired with Vicryl 2/0. The first group was control group and in the second group 0.5 cc of PRP was injected into the repair site. After 4 weeks all of the rats were executed and 70% of tendons were sent randomly for tensilometry and the force that required to rupture the tendons were measured. In next stage the tendons were sent for pathological exam. Results: The force that was needed to rupture the tendon were not significantly different in the two groups. Neovascularization were more prevalent in PRP group but not statistically significant. There were two cases of Cartilage Metaplasia in PRP group. Conclusion: It seems that using PRP has no effect on strengthening the tendons repair and may have some adverse effects. It usage needs further studies to evaluate their probable adverse side effects.

296-299

Authors: Mohammad-Esmaiil Hassani, Hamid Karimi, Hosein Hassani, Ali Hassani

Objective: To determine the results of Bilateral Distraction Osteogenesis (DO) versus traditional methods in treatment of micrognathia. Methods: During 6 years we had 67 patients with micrognathia. In group A, randomly 35 were treated with traditional methods (Saggital osteotomy and/or bone grafts) and group B 32 cases were treated with Bilateral External Distraction Osteogenesis.Follow up was 36+/- 6 months.X-Ray , CT scan and cast modelling were done fo r all of the patients. SNA, SNB angles were measured in cephalograms. The patients were examined after one, two, three, six, 12 months for any complications and signs of bone resorption and relapse. Bony and soft tissue advancements were measured and compared with each other. Results: During 6 years we had 67 patients with class II malocclusion. Mean SNA angle in group A was 80.8 (80-81.5) and 80.9 (80-82) in group B. Mean SNB angle in group A was 77.6 (76.5- 78) and 77.4 (76.5-78.5).After treatment mean SNB in group A was 79.1 and the difference was significant comparing to pre-op measurement (P<0.005).Mean SNB in group B after treatment was 79.2 which was significantly different comparing with SNB angle before surgery. The mean SNA in both group were not statistically and significantly different. The mean SNB after surgery in both group were not statistically and significantly different. Mean Mandibular advancement in group A was 11.9 mm (7.5- 18 mm) and group B with DO treatment was12.1 mm (8-19 mm) which was not significantly different . The patient in group A evaluate the surgical results as excellent (60%) and good ( 28.5%). The patient in group B evaluate the results as excellent (78.1%) and good (15.6%). Conclusion: The Bilateral Distraction Oseogenesis method can bring forwards the retruded mandible effectively and its results has no difference with older methods. It is an effective and reliable procedure for hypoplasia of Mandible and the results are comparable with older methods.

303-313

Authors: Concepción Blasco-Ros, Joe Herbert, Manuela Martinez

Objectives: To analyse the individual differences in the impact that intimate male partner violence (IPV) has on a woman’s depressive and posttraumatic stress disorder (PTSD) symptomatology, and to determine the association of the different profiles of mental dysfunction with cortisol and dehydroepiandrosterone (DHEA) basal saliva levels as well as physical health symptoms. Methods: A cross-sectional study was carried out in which IPV victims (n=73) and control non-abused (n=31) women participated. Information was obtained through structured interviews and saliva samples were collected for hormonal assays under baseline conditions. Results: There were three profiles of mental symptoms in IPV subjects: no symptoms (n=19); with depressive symptoms (n=36), and depressive/PTSD symptom (n=18). None of the non-abused women had depressive or PTSD symptoms. The stress hormone response differed between groups. Only the IPV-depressive group had higher evening cortisol, and both morning and evening DHEA, but lower morning cortisol/DHEA ratio than non-abused women. Furthermore, there were differences between the IPV groups. The IPV-depressive group had lower morning cortisol and morning cortisol/DHEA ratio than the IPV-no symptoms and lower morning cortisol/DHEA ratio than the IPV-depressive/PTSD group. With respect to the physical symptoms there was an association between the mean of symptoms and the profile of mental health, the incidence being higher in the depressive/PTSD group than in the other groups. Conclusions: This study demonstrates that there are individual differences in the impact that IPV has on the stress response and health status in women victims.

320-323

Authors: C Tsompos, C Panoulis, K Toutouzas, G Zografos, A Papalois

Objective: To examine the effect of the antioxidant drug “U-74389G”, on rat model and particularly in a hypoxia reoxygenation (HR) protocol. The beneficial effect or non-effectiveness of that molecule was studied hematologically using mean red blood cells levels. Methods: 40 rats of mean weight 231.875 g were used in the study. Red blood cells levels were measured 60 min after reoxygenation (groups A and C) and 120 min after reoxygenation (groups B and D) with administration of the drug U-74389G only in groups C and D. Results: U-74389G administration non-significantly increased the red blood cells level by (0.64±0.32)% (P=0.810 6). Reoxygenation time also non-significantly increased the red blood cells level by (4.63±2.36)% (P=0.068 0). However, U-74389G administration and reoxygenation time together non-significantly increased the red blood cells level by (1.05±0.53)% (P=0.491 1). Conclusions: Results of this study show that U-74389G administration, reoxygenation time and their interaction non significantly increased the red blood cells levels within 2 hours’ time interval.

328-331

Authors: Predrag Grubor, Gabriele Falzarano, Antonio Medici, Luigi Meccariello, Milan Grubor

Laugier's fractures are rare because they are located deep in the elbow joint and are thus protected from any direct trauma. Laugier's fractures have been insufficiently described in the literature. Surgical treatment does not have an alternative, and timely diagnosis and surgical and physical therapy. We presented a case report of a 23 years' old man, sustained a Laugier’s fr acture in June 2012 after falling from motocycle (low energy trauma) and hit with his flexed elbow against the street.

335-336

Authors: Emmanouil Petrou, Vasiliki Karali, Emmanouil Papadakis

Toxic epidermal necrolysis comprises a severe immune-complex mediated hypersensitivity reaction that typically involves the skin and mucous membranes. Herein, we describe a 68-year -old man who presented with the condition after simvastatin administration.