Promjene intra-abdominalnog, ilijačno venskog i centralnog venskog tlaka u bolesnika podvrgnutih abdominalnom kirurškom zahvatu zbog velikih tumora debelog crijeva – probno ispitivanje

Changes in intra-abdominal pressure during bowel tumor surgery have not been documented. The purpose of the present study was to analyze changes in intra-abdominal pressure (IAP), central venous pressure (CVP) and iliac venous pressure (IVP) in patients undergoing laparotomy due to large tumor of the bowel. Twenty-one adult patients undergoing elective abdominal surgery were examined. Intra-abdominal pressure, CVP and IVP were measured during anesthesia, surgery and early postoperative period. The mean IAP before anesthesia was 12.76±1.09 mm Hg and mean bowel tumor volume 1550±227.48 mL. Anesthesia induction decreased IAP to 10.52±1.32 mm Hg and excision of intra-peritoneal tumors to 5.24±1.51 mm Hg (49.7%). Ten minutes after anesthesia, IAP increased to 7.47±1.2 mm Hg and one hour after surgery decreased to 6.19±1.43 mm Hg. There was a strong overall correlation between IAP and CVP (P=0.0000; r=0.7779), as well as between IAP and IVP (P=0.0000; r=0.8635). Moreover, IAP correlated with IVP immediately after anesthesia and one hour after anesthesia. In conclusion, induction of anesthesia decreased IAP; excision of large bowel tumors decreased IAP; and IAP strongly correlated with CVP and IVP.Promjene intra-abdominalnog tlaka tijekom operacijskog zahvata zbog crijevnog tumora nisu dokumentirane. Svrha ovoga ispitivanja bila je ispitati promjene intra-abdominalnog tlaka (IAT), centralnog venskog tlaka (CVT) i ilijačno venskog tlaka (IVT) u bolesnika podvrgnutih laparotomiji zbog velikog crijevnog tumora. Ispitan je 21 odrasli bolesnik podvrgnut elektivnoj abdominalnoj kirurgiji. IAT, CVT i IVT mjereni su tijekom anestezije, operacije i ranog poslijeoperacijskog razdoblja. Srednji IAT prije anestezije bio je 12,76±1,09 mm Hg, a srednji volumen crijevnog tumora 1550±227,48 mL. Indukcija anestezije snizila je IAT na 10,52±1,32 mm Hg, a ekscizija intraperitonejskog tumora na 5,24±1,51 mm Hg (49,7%). Deset minuta nakon anestezije IAT se povisio na 7,47±1,2 mm Hg, a jedan sat nakon operacije snizio na 6,19±1,43 mm Hg. Zabilježena je visoka sveukupna korelacija između IAT i CVT (P=0,0000; r=0,7779) te između IAT i IVT (P=0,0000; r=0,8635). Štoviše, IAT je korelirao s IVT odmah nakon anestezije i jedan sat nakon anestezije. U zaključku, indukcijom anestezije snizio se IAT, uklanjanje velikog crijevnog tumora dovelo je do sniženja IAT, te je utvrđena visoka korelacija IAT s CVT i IVT

Additional secure circular suture during sphincteroplasty — preliminary results on the efficacy of fecal incontinence surgery in urogynecological patients

Objectives: The paper is a ten case series study presenting women with complex pelvic floor disorders involving fecal incontinence (FI) with stress urinary incontinence or pelvic organ prolapse.  Our study aimed at ascertaining whether FI-induced sphincteroplasty with an additional secure circular suture around the external anal sphincter muscle (EAS) may improve long term success rates.  Materials and methods: Twelve patients had scheduled urogynecological surgery and overlapping sphincteroplasty with the placement of an additional circular suture around the EAS. Of these, the status of ten women was established by way of the Cleveland Clinic Fecal Incontinence Score/Wexner Score before and about 70 months after surgery.  Results: Statistical analysis of fecal incontinence score showed that patients were not completely cured from FI, but were significantly better (p = 0.011).  Conclusions: A circular secure suture around the external anal sphincter in FI patients may help to improve anal sphincter function. 

Plasma magnesium concentration in patients undergoing coronary artery bypass grafting

Introduction Magnesium (Mg) plays a crucial role in cell physiology and its deficiency may cause many disorders which often require intensive treatment. The aim of this study was to analyse some factors affecting preoperative plasma Mg concentration in patients undergoing coronary artery bypass grafting (CABG). Material and Methods Adult patients scheduled for elective CABG with cardio-pulmonary bypass (CPB) under general anaesthesia were studied. Plasma Mg concentration was analysed before surgery in accordance with age, domicile, profession, tobacco smoking and preoperative Mg supplementation. Blood samples were obtained from the radial artery just before the administration of anaesthesia. Results 150 patients were studied. Mean preoperative plasma Mg concentration was 0.93 ± 0.17 mmol/L; mean concentration in patients – 1.02 ± 0.16; preoperative Mg supplementation was significantly higher than in patients without such supplementation. Moreover, intellectual workers supplemented Mg more frequently and had higher plasma Mg concentration than physical workers. Plasma Mg concentration decreases in elderly patients. Patients living in cities, on average, had the highest plasma Mg concentration. Smokers had significantly lower plasma Mg concentration than non-smokers. Conclusions 1. Preoperative magnesium supplementation increases its plasma concentration. 2. Intellectual workers frequently supplement magnesium. 3. Smoking cigarettes decreases plasma magnesium concentration

Good practices in motivation of secondary educators for further education in the STEM area

Od kilkunastu lat mówi się o potrzebie reindustrializacji Europy. Wobec znacznej różnicy w kosztach pracy, warunkiem realizacji tej koncepcji jest wykorzystywanie w przemyśle najnowszych rozwiązań technologii wytwarzania, w tym automatyzacji i robotyzacji. Aby to było możliwe potrzebna jest wykształcona, kompetentna kadra. W Europie jest znaczny potencjał edukacyjny. Jednak od wielu lat nie jest on wykorzystywany w pełni przez Europejczyków. Powodem jest nikłe zainteresowanie młodzieży naukami ścisłymi, a dalej technologicznymi i inżynierskimi. Dlatego konieczne jest podjęcie działań zachęcających młodych ludzi do dalszego kształcenia w obszarze STEM. Istnieją przykłady dobrych praktyk w tym zakresie. Ich wspólnym mianownikiem jest wykorzystanie w kształceniu nowoczesnych narzędzi ICT. W artykule przedstawiono problemy edukacji STEM oraz przegląd i analizę dobrych praktyk z krajów UE.At the end of the 20th century, a very intensive transfer of production activity from Europe to countries with lower labour costs was observed. Over time, it has been recognized that the negative effects of this phenomenon are more significant than benefits. This applies both to the dependence of Europe on external suppliers, including those from countries with unstable political systems, as well as the labour market. For a dozen or so years, we have been talking about the need to reindustrialize Europe. It's about building new production facilities, as well as the return of factories. These activities must have economic justification. In view of the still considerable difference in labour costs, the prerequisite for the advantage of production installations operating in Europe is the use of the latest manufacturing technology solutions, including automation and robotics. To make this possible, a team is needed. There is considerable educational potential in Europe. This applies to both vocational education at the secondary and university level. However, it has not been used by Europeans for many years. At our universities, specialists from outside the EU are trained. The reason is the low interest of young people in exact sciences, and then in technological and engineering. Therefore, it is necessary to take measures to encourage young people to continue their education in the area of STEM. The use of modern ICT tools will be helpful in these activities

Two-Point Left Ventricle Pacing and Cardiac Computed Tomography

Endocardial leads can potentially cause problems during coronary vessels visualization in multislice computed tomography (MSCT) due to a large number of artifacts. Based on presented case, we conclude that it is possible to perform MSCT of coronary arteries and leads visualization despite coexistence of four endocardial leads

Intra-abdominal pressure correlates with extracellular water content.

Secondary increase in intra-abdominal pressure (IAP) may result from extra-abdominal pathology, such as massive fluid resuscitation, capillary leak or sepsis. All these conditions increase the extravascular water content. The aim of this study was to analyze the relationship between IAP and body water volume.Adult patients treated for sepsis or septic shock with acute kidney injury (AKI) and patients undergoing elective pharyngolaryngeal or orthopedic surgery were enrolled. IAP was measured in the urinary bladder. Total body water (TBW), extracellular water content (ECW) and volume excess (VE) were measured by whole body bioimpedance. Among critically ill patients, all parameters were analyzed over three consecutive days, and parameters were evaluated perioperatively in surgical patients.One hundred twenty patients were studied. Taken together, the correlations between IAP and VE, TBW, and ECW were measured at 408 time points. In all participants, IAP strongly correlated with ECW and VE. In critically ill patients, IAP correlated with ECW and VE. In surgical patients, IAP correlated with ECW and TBW. IAP strongly correlated with ECW and VE in the mixed population. IAP also correlated with VE in critically ill patients. ROC curve analysis showed that ECW and VE might be discriminative parameters of risk for increased IAP.IAP strongly correlates with ECW

Echo-guided left ventricular assist device speed optimisation for exercise maximisation

OBJECTIVE: Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates the concept of physiological pump speed optimisation based on aortic valve opening (AVO) imaging during a cardiopulmonary exercise test (CPET). METHODS: This prospective crossover study (NCT05063006) enrolled patients with implanted third-generation LVADs with hydrodynamic bearing. After resting speed optimisation, patients were randomised to a fixed-modified speed or modified-fixed speed CPET sequence. Fixed speed CPET maintained baseline pump settings. During the modified speed CPET, the LVAD speed was continuously altered to preserve periodic AVO. RESULTS: We included 22 patients, the mean age was 58.4±7 years, 4.5% were women and 54.5% had ischaemic cardiomyopathy. Exertional AVO assessment was feasible in all subjects. Maintaining periodic AVO allowed to safely raise the pump speed from 2900 (IQR 2640–3000) to 3440 revolutions per minute (RPM) (IQR 3100–3700; p<0.001). As a result, peak oxygen consumption increased from 11.1±2.4 to 12.8±2.8 mL/kg/min (p<0.001) and maximum workload from 1.1 (IQR 0.9–1.5) to 1.2 W/kg (IQR 0.9–1.7; p=0.028). The Borg scale exertion level decreased from 15.2±1.5 to 13.5±1.2 (p=0.005). CONCLUSIONS: Transthoracic AVO imaging is possible during CPETs in patients with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance and augments peak oxygen consumption and maximum workload

ROC curve for extracellular water content (ECW) as a diagnostic test of intra-abdominal hypertension (IAH).

<p>Cut-off point of ECW for IAH = 23.9 L. Area under the curve (AUC) = 0.87.</p

Correlation between intra-abdominal pressure (IAP) and extracellular water content (ECW) in all participants (Spearman correlation—p < 0.001, r = 0.74).

<p>Correlation between intra-abdominal pressure (IAP) and extracellular water content (ECW) in all participants (Spearman correlation—p < 0.001, r = 0.74).</p