When hematochezia becomes a red herring

An 81-year-old male patient presented on the emergency ward for hematochezia, without any other complaints. Rectosigmoidoscopy showed a predominant patchy inflammation of the mucosa with several bluish blebs (submucosal hemorrhage) and small ulcerations. (Figure 1A). Subsequent elective colonoscopy (1) revealed multiple submucosal hematomas and mucosal lacerations throughout the entire colon in between normal mucosa. During the procedure spontaneous mucosal tears occurred. (Figure 1B). Multiple biopsies were taken.

Challenging Diagnosis of Addison’s Disease Presenting with Adrenal Crisis

Primary adrenal insufficiency, also known as Addison’s disease, is a rare but potentially fatal condition resulting from the failure of the adrenal cortex to produce glucocorticoid and/or mineralocorticoid hormones. Unfortunately, the clinical manifestation of primary adrenal insufficiency is not specific and often progresses insidiously, resulting in late diagnosis, or in severe cases, life-threatening circulatory collapse. Adrenal insufficiency should be considered in patients with unexplained vascular collapse. We report the case of a woman who presented to the emergency ward with unexplainable shock that was later diagnosed as adrenal crisis due to Addison’s disease. The presence of hyperpigmentation in patients with rapid progression of adrenal insufficiency suggests the diagnosis of Addison’s disease presenting with adrenal crisis.

First Russian experience in liver and kidney transplantation from donors with out-of-hospital cardiac arrest: 3 years’ results

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Management of Closed Tibal Shaft Fractures with Reamed Interlocking Nail

Objective: The aim of this study is to determine the effectiveness of reamed interlocking nail in the management of closed tibal shaft fractures. Study Design: Descriptive/ Observational study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan for nine months duration from January 2019 to September 2019. Methods: Total 80 patients of both genders were presented in this study. Age ranges of enrolled cases were 20-70 years. Demographically details of enrolled cases were recorded after taking written consent. Patients who had tibial shaft fractures were admitted in emergency ward and underwent for reamed interlocking nail. Postoperatively union time and rate of complications were assessed. Complete follow up of the patients were take place in duration of 14-months. Data was analyzed by SPSS 20.0 version. Results: Mean age of the patients was 28.65±8.77 years with mean BMI 24.16±6.23 kg/m2. Out of 80 patients, 47 (58.6%) were males and 33 (41.4%) were females. Traffic accident was the most common cause of fracture found in 60 (75%) cases, followed by fall from the height 15 (18.75%) and the rest were others 5 (6.25%). Mean united time of simple fractures were 13.14±4.14 weeks while among segmental fractures union time observed 18.13±6.17 weeks. Frequency of union fractures was 62 (77.5%), delayed unions were 13 (16.25%) and non-unions were 5 (6.25%). Satisfaction rate was 72 (90%) among all cases. Conclusion: We concluded in this study that reamed interlocking nail was an effective and safest method for the management of closed tibal shaft fractures. Overall union rate in this study was 93.75% and showed less morbidity among cases. Keywords: Interlocking nail, Tibial shaft fractures, Union