Acta medica Iranica
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Acta medica Iranica · Jan 2014
Serum inflammatory markers in the elderly: are they useful in differentiating sepsis from SIRS?
Differentiating sepsis from other noninfectious causes of systemic inflammation is often difficult in the elderly. The aim of this study was to evaluate the ability of C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), procalcitonin (PCT), and Interleukin-6 (IL-6) to identify elderly patients with sepsis. In this single center prospective observational study, we included all consecutive elderly patients admitted with suspected sepsis and systemic inflammatory response syndrome (SIRS) in an emergency department. ⋯ CRP exhibited the greatest sensitivity (98%) and negative predictive value (98.6%) and performed best in differentiating patients with sepsis from those with SIRS. In a receiver operating characteristic curve analysis, IL-6 performed best in distinguishing between SIRS and the control group (AUC 0.75, 95% CI). On the other hand, both CRP and ESR appeared to be a more accurate diagnostic parameter for differentiating sepsis from SIRS among elderly patients.
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Acta medica Iranica · Jan 2014
Randomized Controlled TrialThe effect of low-dose remifentanil on the hemodynamic responses of endotracheal extubation.
Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. We have examined the effect of remifentanil on the hemodynamic response to the emergence from anesthesia and tracheal extubation. ⋯ Remifentanil attenuated the increase in both systolic and diastolic arterial pressure and heart rate after extubation compared to the control group. No differences in SpO2, cough and laryngospasm were observed between two groups. Use of a low-dose remifentanil has clinically acceptable effect in blunting the cardiovascular changes induced by tracheal extubation.
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Acta medica Iranica · Jan 2014
Randomized Controlled TrialVertical infraclavicular block with local anesthetic injections at different currents.
Injecting local anesthetic at the seeking current would be appealing. It would save time and avoid potentially dangerous manipulations of the needle. This study aimed to test the hypotheses that in vertical infraclavicular block, injecting local anesthetic at a seeking current of 0.8 mA would produce the same quality of block as injecting at ≤0.5mA. ⋯ We had patients in both groups who developed complete anesthesia of the hand within 25 minutes. We conclude that the injection at 0.8 mA would result in a similar quality of block to one injected at ≤0.5 mA. The difference between two groups was not statistically significant.
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Acta medica Iranica · Jan 2014
Temporary abdominal closure in the critically ill patients with an open abdomen.
The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag). ⋯ Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogotá bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage.
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Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been reported in the literature. These fractures are due to high energy trauma and conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and decreases the incidence of complications. The purpose of the study was to prospectively analyse the clinico-radiological and functional outcome following open surgical treatment. ⋯ Complications were stiffness and pain in one patient, collateral laxity in one patient and progression of arthritis in one patient. The results were excellent in 90.90% and good in 9.09% patients. Finally, we conclude that the early anatomical reduction and rigid fixation with screws provide best results and minimal complications.