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

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

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

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

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

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry

Incremental value of extracellular volume assessment by cardiovascular magnetic resonance imaging in risk stratifying patients with suspected myocarditis

Cardiovascular magnetic resonance imaging (CMR) has become a key investigative tool in patients with suspected myocarditis. However, the prognostic implications of T1 mapping, including extracellular volume (ECV) calculation, is less clear. Patients with suspected myocarditis who underwent CMR evaluation, including T1 mapping at our institution were included. CMR findings including late gadolinium enhancement (LGE), left ventricular ejection fraction (LVEF), native T1 mapping, and ECV calculation were associated with first major adverse cardiac events (MACE). MACE included a composite of all-cause death, heart failure hospitalization, heart transplantation, documented sustained ventricular arrhythmia, and recurrent myocarditis. One hundred seventy-nine patients with a mean age of 49 ± 15 years were identified. Seventy nine individuals (44%) were female. Mean LVEF was 48 ± 16. At a median follow-up of 4.1 [interquartile-range (IQR) 2.2-6.1] years, 22 (12%) patients experienced a MACE. Mean ECV (per 10%) was significantly associated with MACE (HR 2.09, 95% CI 1.07-4.08, p = 0.031). Presence of ECV ≥ 35% demonstrated significant univariable association with MACE (HR 3.3, 95% CI 1.43-7.97, p = 0.005) and such association was maintained when adjusted to LVEF (HR 3.42, 95% CI 1.42-7.94, p = 0.006). ECV ≥ 35% portended a greater than threefold increased hazards to MACE adjusted to LGE presence (HR 3.14, 95% CI 1.29-7.36, p = 0.012). In patients without LGE, ECV ≥ 35% portended a greater than sixfold increased hazards (HR 6.6, p = 0.010). In the multivariable model including age, LVEF and LGE size, only ECV ≥ 35% maintained its significant association with outcome. ECV calculation by CMR is a useful tool in the risk stratification of patients with clinically suspected myocarditis, incremental to LGE and LVEF

The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review

The aim of this study was to assess the role of postmortem computed tomography (PMCT) as an alternative for autopsy in determining the cause of death and the identification of specific injuries in trauma victims. A systematic review was performed by searching the EMBASE and MEDLINE databases. Articles were eligible if they reported both PMCT as well as autopsy findings and included more than one trauma victim. Two reviewers independently assessed the eligibility and quality of the articles. The outcomes were described in terms of the percentage agreement on causes of death and amount of injuries detected. The data extraction and analysis were performed together. Fifteen studies were included describing 244 victims. The median sample size was 13 (range 5–52). The percentage agreement on the cause of death between PMCT and autopsy varied between 46 and 100%. The overall amount of injuries detected on CT ranged from 53 to 100% compared with autopsy. Several studies suggested that PMCT was capable of identifying injuries not detected during normal autopsy. This systematic review provides inconsistent evidence as to whether PMCT is a reliable alternative for autopsy in trauma victims. PMCT has promising features in postmortem examination suggesting PMCT is a good alternative for a refused autopsy or a good adjunct to autopsy because it detects extra injuries overseen during autopsies. To examine the value of PMCT in trauma victims there is a need for well-designed and larger prospective studies

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Background: Currently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR. Methods. Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D). Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling. Results: Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower. Conclusions: Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal candidates for the procedure. © 2011 Zweig et al; licensee BioMed Central Ltd