Biomedical subjects

Peter Mikhail

Publications and source records attributed to Peter Mikhail.

3 recordsLinked to original sources

PubMed2003

Appendicitis in children: a ten-year update of therapeutic recommendations.

BACKGROUND/PURPOSE: In 1990, the authors reported excellent outcomes using a standard protocol to treat pediatric appendicitis. This protocol has been simplified further and a large retrospective review was conducted to assess current outcomes. METHODS: All patients treated for presumed appendicitis between April 1997 and December 1999 were reviewed. All patients received preoperative gentamicin and clindamycin. Patients with complicated appendicitis received postoperative ampicillin, gentamicin, and clindamycin or metronidazole. All wounds were closed primarily without drains. Patients with complicated appendicitis were discharged when their ileus resolved, they remained afebrile for 24 hours, and had a normal leukocyte count. RESULTS: A total of 648 patients were reviewed. A total of 9.4% of appendices were pathologically normal, 55.6% were simple acute, 15.7% were gangrenous, and 19.3% were perforated. Hospital stay was 2.21 +/- 2.04 days for normal, 1.39 +/-.89 for simple acute, 2.97 +/- 1.25 for gangrenous, and 6.31 +/- 3.51 days for perforated appendices. There were no wound infections in patients with normal or simple acute appendices. Two minor intraabdominal infections (0.56%) occurred in patients with simple appendicitis. Patients with complicated appendicitis (gangrenous or perforated) had wound infection and intraabdominal infection rates of 2.6% and 4.4%, respectively. CONCLUSIONS: The authors' current protocol results in reasonable hospital stays and good outcomes. It serves as an evidence-based standard of care for the treatment of pediatric appendicitis.

Abdominal Abscess↗

PubMed2003

Does ischemic preconditioning afford clinically relevant cardioprotection?

This paper reviews significant work which has been done on ischemic preconditioning since its introduction by Murry et al. in 1986. This is a phenomenon where myocardial cells gain protection against long periods of ischemia by initially being exposed to brief episodes of ischemia followed by reperfusion. The molecular basis of ischemic preconditioning where adenosine, bradykinin and opioids are released, and eventually lead to the opening of mitochondrial ATP-sensitive potassium channels, is discussed in detail. There have been over 33 clinical studies to assess the clinical relevance of ischemic preconditioning. Many of these studies have looked at its benefit in patients undergoing percutaneous transluminal coronary angioplasty; others have looked at its use in open-heart surgery. There is no doubt that many of these studies support the clinical relevance of ischemic preconditioning, however, most of these studies have looked at surrogate markers, such as cardiac enzyme release, and left ventricular ejection fraction, but very few looked at the original endpoint, described by Murry et al., which is cell death. Larger trials, with morbidity and mortality being with the primary endpoints, are needed to confirm the clinical relevance of ischemic preconditioning.

Angina, Unstable↗

PubMed2003

An incidental calcified right atrial mass.

A 58-year-old man presented to his family physician with a mild cough. A routine chest x-ray revealed a 4 cm 'ring opacity' in the right atrium. A transthoracic echocardiogram revealed a 41 mm x 33 mm mass in the right atrium. The patient underwent urgent cardiac surgery, where a firm to hard 4 cm x 3 cm mass was excised. Pathology revealed an old, largely infarcted and calcified right atrial myxoma. A review of the published literature shows that this case is the first to demonstrate an almost completely infarcted atrial myxoma with only a few clusters of viable cells identified histologically.

Calcinosis↗