Our experience with the use of dexmedetomidine in the postoperative period in surgical patients.

Introduction The problem of treatment of postoperative pain syndrome remains very relevant, despite the large selection of analgesics of various types, as well as the development of various methods of pain relief. Providing complete pain relief after surgery remains a desirable but not always achievable goal. According to the literature, from 50 to 80% of patients who underwent surgery suffer from severe pain in the postoperative period. Purpose of the study: To study the efficacy and safety of pain relief technique using intravenous prolonged in- fusion of dexmedetomidine in combination with NSAIDs and opioids in the early postoperative period in surgical patients. Material and methods The study was conducted in the surgical clinic of the AMU. The clinical study included 156 patients aged 10 to 35 years after elective abdominal surgery (cholecystectomy, hemicolectomy, etc.). To assess the adequacy of analgesia and the need for the introduction of narcotic analgesics, we used a visual analogue scale (VAS) of pain intensity. Results The criterion for the effectiveness of analgesia performed in the postoperative period was the reduction of painaccording to VAS to 3 and below. The criterion for the introduction of opioids was considered to be an increase in the intensity of pain according to the VAS up to 6-7 points. Mean pain scores between groups at various stages are presented. Conclusion The use of prolonged intravenous infusion of dexmedetomidine in combination with non-narcotic analgesics in the early postoperative period in patients undergoing elective abdominal surgery can significantly reduce the need for repeated injections of both non- narcotic and narcotic analgesics, improves patient comfort and safety

SWISSspine: a nationwide registry for health technology assessment of lumbar disc prostheses

SWISSspine is a so-called pragmatic trial for assessment of safety and efficiency of total disc arthroplasty (TDA). It follows the new health technology assessment (HTA) principle of "coverage with evidence development”. It is the first mandatory HTA registry of its kind in the history of Swiss orthopaedic surgery. Its goal is the generation of evidence for a decision by the Swiss federal office of health about reimbursement of the concerned technologies and treatments by the basic health insurance of Switzerland. During the time between March 2005 and 2008, 427 interventions with implantation of 497 lumbar total disc arthroplasties have been documented. Data was collected in a prospective, observational multicenter mode. The preliminary timeframe for the registry was 3years and has already been extended. Data collection happens pre- and perioperatively, at the 3months and 1-year follow-up and annually thereafter. Surgery, implant and follow-up case report forms are administered by spinal surgeons. Comorbidity questionnaires, NASS and EQ-5D forms are completed by the patients. Significant and clinically relevant reduction of low back pain VAS (70.3-29.4 points preop to 1-year postop, p<0.0001) leg pain VAS (55.5-19.1 points preop to 1-year postop, p<0.001), improvement of quality of life (EQ-5D, 0.32-0.73 points preop to 1-year postop, p<0.001) and reduction of pain killer consumption was revealed at the 1-year follow-up. There were 14 (3.9%) complications and 7 (2.0%) revisions within the same hospitalization reported for monosegmental TDA; there were 6 (8.6%) complications and 8 (11.4%) revisions for bisegmental surgery. There were 35 patients (9.8%) with complications during followup in monosegmental and 9 (12.9%) in bisegmental surgery and 11 (3.1%) revisions with new hospitalization in monosegmental and 1 (1.4%) in bisegmental surgery. Regression analysis suggested a preoperative VAS "threshold value” of about 44 points for increased likelihood of a minimum clinically relevant back pain improvement. In a short-term perspective, lumbar TDA appears as a relatively safe and efficient procedure concerning pain reduction and improvement of quality of life. Nevertheless, no prediction about the long-term goals of TDA can be made yet. The SWISSspine registry proofs to be an excellent tool for collection of observational data in a nationwide framework whereby advantages and deficits of its design must be considered. It can act as a model for similar projects in other health-care domain

Maximum intensity projection of cranial computed tomography data for dental identification

Dental radiographs play the major role in the identification of victims in mass casualties besides DNA. Under circumstances such as those caused by the recent tsunami in Asia, it is nearly impossible to document the entire dentition using conventional x-rays as it would be too time consuming. Multislice computed tomography can be used to scan the dentition of a deceased within minutes, and the postprocessing software allows visualization of the data adapted to every possible antemortem x-ray for identification. We introduce the maximum intensity projection of cranial computed tomography data for the purpose of dental identification exemplarily in a case of a burned corpse. As transportable CT scanners already exist, these could be used to support the disaster victim identification teams in the fiel

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new ‘Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With ‘Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tang

Оценка эффективности комбинированного применения способов профилактики несостоятельности швов кишечных анастомозов

Цель. Изучение эффективности комбинации различных способов профилактики несостоятельности швов кишечных анастомозов (НШКА) у больных после плановой, экстренной и неотложной резекции различных сегментов кишечника. Материалы и методы. Изучено результаты лечения 642 больных, которым выполнена резекция различных сегментов тонкой и толстой кишок с наложением первичных анастомозов. Из 642 больных 357 (55,6%) оперированы в плановом порядке, 285 (44,4%) - по неотложным и экстренным показаниям. У 467 (72,7%) больных наложены анастомозы по типу бок в бок, у 150 (23,4%) - по типу конец в конец, у 25 (3,8%) - по типу конец в бок. С целью профилактики НШКА выполняли перманентную внутрибрыжеечную блокаду, проводили лимфотропную терапию, местную лазеромагнитотерапию, интубационную декомпрессию, санацию и гастроэнтеросорбцию с полифепаном, а также внутримышечно вводили человеческий плацентарный гидролизат «Laennec». Результаты. НШКА наблюдали у 10 (1,6%) больных: у 6 (4,0%) - с анастомозами конец в конец и у 4 (0,86%) - с анастомозами бок в бок. Несостоятельными были 1 (10%) тонко-толстокишечный анастомоз, 2 (20%) тонко-тонкокишечных и 7 (70%) толсто-толстокишечных анастомозов. Выводы. С целью профилактики НШКА у больных, оперированных в неотложном, экстренном и плановом порядке, рекомендуется использовать по показаниям перманентную внутрибрыжеечную (забрюшинную) блокаду с лимфотропной терапией, местную лазеромагнитотерапию, интубационную декомпрессию, санацию и гастроэнтеросорбцию с полифепаном, а также препарат «Laennec

Postmortem imaging of blood and its characteristics using MSCT and MRI

The rapid development of computed tomography (CT) and magnetic resonance imaging (MRI) led to the introduction and establishment in postmortem investigations. The objectives of this preliminary study were to describe the imaging appearances of the early postmortem changes of blood after cessation of the circulation, such as sedimentation, postmortem clotting, and internal livores, and to give a few first suggestions on how to differentiate them from other forensic findings. In the Virtopsy project, 95 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy and therefore 44 cases have been investigated in this study. Postmortem alterations as well as the forensic relevant findings of the blood, such as internal or subcutaneous bleedings, are presented on the basis of their imaging appearances in multislice CT and MR

Efficacy of application of a human placenta hydrolysate in prophylaxis of the intestinal anastomoses sutures insufficiency

Objective. Studying of impact of a human placenta hydrolysate on regeneration of intestinal anastomosis and prophylaxis of their sutures insufficiency. Materials and methods. Experimental investigations were conducted on two groups of rabbits. In every group a simulation model of an acute strangulation ileus was created. In a one day a relaparotomy, resection of necrotized intestinal segments with anastomosing in a “side-to-side” fashion were done in rabbits of both groups. After the operation the control group rabbits have obtained a standard treatment, while in the main group the rabbits together with a standard treatment have obtained a human placenta hydrolysate preparation «Laennec». On the days 3, 5, 7 and 15th the according intestinal segments were probed for morpho-histochemical investigations. Clinical investigations were conducted in 122 patients, consisting of resection of intestinal segments with formation of anastomoses. The control group consisted of 60 patients, and the main one – in 62. The data of the control group were studied retrospectively. In the main group the patients, together with a standard treatment, a human placenta hydrolysate in a form of preparation “Laennec” was applied for prophylaxis of insufficiency of the intestinal anastomoses sutures. Results. Basing on experimental results it may be stressed, that application of preparation «Laennec» strengthens regeneration and angiogenesis in zone of anastomosis, because in animals of the main group, comparing with a control one, high mitotic index, good angiogenesis and the motor-evacuation function integrity were noted. In clinical practice the anastomotic sutures insufficiency in the control group have occurred in 13.3% of observations, and in the main group – in 1.6% of observations. Conclusion. Application of the human placenta hydrolysate for prophylaxis of the sutures insufficiency in intestinal anastomoses is affordable due to successive clinical and experimental data obtained

The Current Testing Protocols for Biomechanical Evaluation of Lumbar Spinal Implants in Laboratory Setting: A Review of the Literature

In vitro biomechanical investigations have become a routinely employed technique to explore new lumbar instrumentation. One of the most important advantages of such investigations is the low risk present when compared to clinical trials. However, the best use of any experimental data can be made when standard testing protocols are adopted by investigators, thus allowing comparisons among studies. Experimental variables, such as the length of the specimen, operative level, type of loading (e.g., dynamic versus quasistatic), magnitude, and rate of load applied, are among the most common variables controlled during spinal biomechanical testing. Although important efforts have been made to standardize these protocols, high variability can be found in the current literature. The aim of this investigation was to conduct a systematic review of the literature to identify the current trends in the protocols reported for the evaluation of new lumbar spinal implants under laboratory setting

Role of cytokines in hepatocellular carcinoma

Liver cancer ranks No. 5 in the world among all types of cancer and takes 3rd position among cancer-related deaths. Hepatocellular carcinoma (HCC) is a primary malignancy which does not include liver metastases from other sites. It is the most common form of liver cancers, and one of the leading causes of cancer-related deaths worldwide. HCC includes genetically and morphologically heterogeneous group of malignant tumors. HCC is characterized by a gender predisposition, namely, it occurs in men 1.5-fold more often, than in women. Viral infections such as hepatitis B and C are major risk factors for HCC. Moreover, non-alcoholic steatohepatitis (NASH) associated with metabolic syndrome and type 2 diabetes also becomes an increasingly common risk factor in developed countries. The mechanisms underlying the development of HCC are based on genetic changes in tumor cells and their microenvironment. Recently, the role of changes in the tumor microenvironment has drawn more attention, thus becoming the key characteristic in the HCC pathogenesis at all stages of the malignant process. Hepatocytes have a close relationship with immune cells, since in the liver, in addition to hepatocytes, there are Kupffer cells, myeloid cells (dendritic cells, monocytes and neutrophils) and other types of immune cells (T and B lymphocytes, NK and NKT, etc.). Cytokines released by various immune cells in the liver may influence liver processes, e.g., inflammation and carcinogenesis. Chronic inflammation results from persistent stimulation, or deficiencies of anti-inflammatory mechanisms. Its key features include immune cell infiltration, presence of inflammatory mediators, and imbalance of pro- and antiinflammatory cytokines leading to aggressive angiogenesis and tissue remodeling which, in turn, promotes the malignant process. Currently, there are several approaches to the HCC treatment which depend on the stage of the disease. Immunotherapy and its combinations have shown positive advances, and further research in this area will provide therapeutic options at the terminal stages of HCC. A variety of cytokines and their functions in HCC development are discussed in the present review article