Volume 5 Number 2

NHE-1 Inhibitors and Erythropoietin for Maintaining Myocardial Function during Cardiopulmonary Resuscitation (Views : 3344 times)


Efforts to successfully restore life in cardiac arrest victims are formidably challenging. They require not only that cardiac activity be initially reestablished but that injury to vital organs be prevented or minimized. In this article, we discuss the effects that cardiac arrest and resuscitation have on the myocardium, describing first the functional myocardial abnormalities that occur during cardiac resuscitation, which may limit the ability to reestablish cardiac activity. We then discuss strategies for minimizing myocardial injury and examine novel therapies aimed at minimizing ischemia and reperfusion injury. Finally, we discuss sodium-hydrogen exchanger isoform-1(NHE-1) inhibitors and erythropoietin for maintaining myocardial function during cardiopulmonary resuscitation.

Keywords: myocardial ischemic injury, reperfusion myocardial injury, cardiopulmonary resuscitation, NHE-1 inhibitors, erythropoietin


Acute mesenteric ischemia caused by isolated dissection of the superior mesenteric artery and thrombotic occlusion of its major branches: treatment by systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) (Views : 4288 times)


Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dissection, is relatively uncommon. Therefore, there are insufficient data to support a particular therapeutic option in the specific setting of isolated SMA dissection associated with thrombotic complications.
Case report. In this article we describe the diagnosis and treatment of a patient who presented to the Emergency Department with the clinical picture of an acute abdomen and signs suggestive of acute occlusion of the SMA. Diagnostic studies showed an isolated SMA dissection with acute thrombotic occlusion of its main branches. The patient was successfully treated with systemic recombinant tissue plasminogen activator (rtPA) thrombolysis. To the best of our knowledge, this is the first description of a case of isolated SMA dissection associated with thrombotic occlusion of its main branches.
Conclusion. In patients presenting with persistent abdominal pain and unspecific clinical findings, rare causes should be considered because of their life threatening complications. Systemic thrombolysis is a feasible technique for the treatment of isolated SMA dissection associated with thrombotic complications in the absence of bowel necrosis.

Keywords: acute intestinal ischemia, superior mesenteric artery, dissection, thrombosis, systemic lysis, recombinant tissue plasminogen activator (rtPA)


Anaesthesiological problems in children with congenital laryngeal stenosis (Views : 3763 times)


Congenital laryngeal stenosis is a rare condition, which can be diagnosed in the early neonatal period. Manifest stenosis can be life threatening. Severe ("critical") types of stenosis require securing an adequate airway just after the birth, as well as early tracheotomy as a life-saving procedure.
This paper presents a case report of a preterm newborn with severe laryngeal stenosis diagnosed at birth. It was not possible to secure the airway even with endotracheal tubes of the smallest diameter, thus a laryngeal mask (LMA) was placed to provide adequate ventilation and oxygenation. Anaesthesia was administered in the same way during the tracheotomy procedure, which was performed in the earliest hours of the baby's life.

Key words: laryngeal stenosis, laryngeal mask, newborn, airway


Misdiagnosed acute aortic dissection type A (Views : 5160 times)


In the absence of diagnostic imaging, chest pain can represent a diagnostic dilemma, especially, if the patient's condition requires immediate action. We present a case of a patient with signs of obstructive shock that turned out to result from an acute aortic dissection (AAD) and consequent cardiac tamponade. Before the correct diagnosis was made, myocardial infarction and/or pulmonary embolism were suspected and the patient was treated with antithrombotic and anticoagulant drugs, which are contraindicated in AAD. We discuss the correct procedures and treatment in suspected AAD.

Key words: acute aortic dissection, Stanford type A, misdiagnosis


Emergency Open Cardiac Massage via Subxyphoid Approach in Ruptured Type A Aortic Dissection (Views : 5641 times)


Patient sustained cardiac tamponade caused by rupture of type A aortic dissection may result in sudden death. Pericardiocentesis is a lifesaving procedure; nevertheless, blood may occlude the catheter and fail to relieve the pressure. However, open-chest cardiac massage in resuscitation has been studied in animal models by some medical centers and laboratories with inspiring results. We report a 58-year-old woman who was transferred from a local hospital with the diagnosis of cardiac tamponade caused by ruptured type A aortic dissection. Pulseless electrical activity followed by cardiac arrest occurred thereafter. Successful resuscitation in the emergency department was achieved using open cardiac massage through the sub-xyphoid region by opening a pericardial window. Therefore, in unstable patients with cardiac tamponade due to aortic dissection, this resuscitative procedure is feasible, safe and efficient.

Keywords: direct cardiac compression, resuscitation, sub-xyphoid approach, cardiac tamponade, aortic dissection




Most Accessed Articles

Original Articles


Abstract Introduction. The contribution of tracheotomy in comparison to intubation in patients on the resuscitation ward ...

Clinical s

Abstract Elevated intraabdominal pressure (IAP) has been claimed to play a role in abdominal compartment syndrome. ...


Abstract Objectives. We examined the relationship between partial end-tidal CO2 (pet) and mean arterial pressure in ...

Case Reports

Severe barium sulphate aspiration: a report of two cases and review of the literature

Abstract Aspiration of barium sulphate is a well-recognized complication, occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Rarely, large amounts of barium sulphate are inadvertently aspirated into ...

Pulmonary hypertension leading to right heart failure in a patient with IgA gammapathy

Abstract Amyloidosis is a rare disorder characterized by the deposition of amorphous, extracellular, insoluble fibrillar protein in various tissues of the body. Pulmonary hypertension usually occurs in the last stages of ...

Myotubular myopathy associated with hypoxic-ischemic encephalopathy as a cause of prolonged ventilat

Keywords: myotubular myopathy, muscle biopsy, genetic analysis hypoxic-ischemic ...

Review Articles

Venous oximetry

Abstract Tissue hypoxia is the central pathophysiological process in shock and an important co-factor in the development of organ dysfunction. Hemodynamic parameters, usually used to assess the perfusion of organs and ...

Pediatric Shock

Abstract Millions of children die of shock due to various etiologies each year. Shock is a state of circulatory dysfunction where the metabolic demands of the tissue cannot be met by ...

Inpatient management of alcohol withdrawal: a practical approach

Abstract Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will ...

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