The Advocate - March 14, 1963

Original title (1951-1987)--The Advocate: official publication of the Archdiocese of Newark (N.J.)

Znieczulenie do cięcia cesarskiego u rodzących z łożyskiem przodującym z/bez łożyska wrośniętego – badanie retrospektywne

Objectives: The aim of this retrospective study was to review placenta previa cases and determine the prognostic factors effective on morbidity and mortality and to evaluate the strategy of anesthetic management. Material and methods: 65 women with placenta previa scheduled for elective or emergency cesarean sections from 2004 to 2009 were examined. Patient demographic data, surgery and obstetric characteristics, anesthetic techniques, blood transfusions, the values of hemoglobin and complications were recorded. Results: Mostly, general anesthesia was preferred in the parturients with placenta previa (86.2%, 56/65). 9 patients (13.8%), 2 of whom were converted to general anesthesia due to bleeding and prolonged surgery, received regional anesthesia. 37 of 65 women (56.9%) with placenta previa had had cesarean sections previously. More than half of these patients (21/37, 56.7%) had abnormally invasive placentation and 16 of 21 cases underwent cesarean hysterectomy. The incidence of complications in women with previous cesarean section with abnormally invasive placentation was higher than in the other women (pCel pracy: Celem tego retrospektywnego badania była analiza przypadków łożyska przodującego pod kątem oceny czynników prognostycznych wpływających na zachorowalność i śmiertelność oraz ocena postępowania anestezjologicznego. Materiał: Przeanalizowano 65 przypadków kobiet z łożyskiem przodującym zakwalifikowanych do elektywnego lub pilnego cięcia cesarskiego w latach 2004-2009.Zebrano następujące dane: demograficzne, wywiad operacyjny i położniczy, techniki anestezjologiczne, transfuzje krwi, poziomy hemoglobiny i powikłania. Wyniki: Preferowaną metodą znieczulenia u rodzących z łożyskiem przodującym było znieczulenie ogólne (86,2%; 56/65). Przewodowe znieczulenie otrzymało 9 pacjentek (13,8%) ale u 2 z nich trzeba było przejść na znieczulenie ogólne z uwagi na krwawienie i przedłużony czas operacji. 37 z 65 kobiet (56,9%) z łożyskiem przodującym miało cięcie cesarskie w poprzedniej ciąży. Więcej niż połowa tych pacjentek (21/37, 56,7%) miała nieprawidłowo utworzone łożysko a 16 z 21 przeszło histerektomię położniczą. Częstość powikłań u kobiet po cięciu cesarskim w wywiadzie i z nieprawidłowo utworzonym łożyskiem w analizowanym materiale była wyższa niż u innych pacjentek (

The Inflammatory Kinase MAP4K4 Promotes Reactivation of Kaposi's Sarcoma Herpesvirus and Enhances the Invasiveness of Infected Endothelial Cells

Kaposi's sarcoma (KS) is a mesenchymal tumour, which is caused by Kaposi's sarcoma herpesvirus (KSHV) and develops under inflammatory conditions. KSHV-infected endothelial spindle cells, the neoplastic cells in KS, show increased invasiveness, attributed to the elevated expression of metalloproteinases (MMPs) and cyclooxygenase-2 (COX-2). The majority of these spindle cells harbour latent KSHV genomes, while a minority undergoes lytic reactivation with subsequent production of new virions and viral or cellular chemo- and cytokines, which may promote tumour invasion and dissemination. In order to better understand KSHV pathogenesis, we investigated cellular mechanisms underlying the lytic reactivation of KSHV. Using a combination of small molecule library screening and siRNA silencing we found a STE20 kinase family member, MAP4K4, to be involved in KSHV reactivation from latency and to contribute to the invasive phenotype of KSHV-infected endothelial cells by regulating COX-2, MMP-7, and MMP-13 expression. This kinase is also highly expressed in KS spindle cells in vivo. These findings suggest that MAP4K4, a known mediator of inflammation, is involved in KS aetiology by regulating KSHV lytic reactivation, expression of MMPs and COX-2, and, thereby modulating invasiveness of KSHV-infected endothelial cells. © 2013 Haas et al

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Jinekolojik olgularda postoperatif hasta kontrollü analjezide (HKA) intravenöz tramadolün intravenöz morfin ile etkinlik ve güvenilirlik yönünden karşılaştırılması

Objective: The aim in postoperative analgesia should be using the techniques and agent providing less side effects with longer analgesia time. In this study we investigated the analgesic efficacy and side effects of tramadole hydrochloride with PCA in which the patient can supply his analgesic agent by himself according to his requirements and anytime he needs. Materials and methods: Twenty patients undergoing abdominal hysterectomy with general anesthesia were involved in the study. They were randomly divided into 2 groups. Postoperatively the first group received tramadole and the second group received morphine by IV route. VAS values, sedation scores, respiratory depression and the other side effects and vital signs in the first 24 hours were compared between the 2 groups. Results: IV tramadole by PCA provided adequate analgesia and there were no significant statistical differences between tramadole and morphine groups with the respect to the quality of analgesia. Conclusion: It is concluded that postoperative use of tramadole in IV PCA method with an antiemetic, instead of morphine is an effective and safe alternative.Amaç: Postoperatif analjezide amaç; daha uzun analjezi süresini daha az yan etkiyle sağlayacak ajan ve tekniklerin kullanılmasıdır. Bu çalışmada tramadol hidroklorürün analjezik etkinliğini ve yan etkilerini; hastanın analjeziği kendi kendine, gerektiği zaman ve yeterli miktarda verebildiği HKA yöntemiyle ve morfinle karşılaştırarak araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya genel anestezi altında abdominal histerektomi uygulanan 20 hasta alındı. Onar kişilik 2 gruba ayrılan hastalardan postoperatif dönemde birinci gruba intravenöz yoldan tramadol ve ikinci gruba morfin başlandı. Grupların 24 saatlik süre içinde VAS değerleri, sedasyon skorları, solunum depresyonu ve diğer yan etkileri ile vital fonksiyon değerleri karşılaştırıldı. Bulgular: İntravenöz HKA tekniği ile Tramadolün uygulandığı grupla morfin uygulanan grup arasında ağrı skoru ve yan etki bakımından istatistiksel açıdan fark saptanmadı. Sonuç: Tramadolün intravenöz HKA yöntemi ile postoperatif uygulanmasının beraberinde bir antiemetik kullanılması koşulu ile morfine alternatif olarak kullanılabilecek etkili ve güvenli bir ajan olduğu kanısına varıldı

Did We Get Lost in Space A Step Away From 2020? Bibliometric Analysis of Turkish-Based Publications from 2008 to the Present in Science Citation Index and Citation Index-Expanded Indexed Journals in the Field of Anaesthesiology

WOS: 000538479400010PubMed: 32551452Objective: Despite the rapid increase in economy and general scientific activities, it is thought that the same increase may not be seen in publication quality. We aimed at evaluating the current scientific performance of our country in the field of anaesthesiology in international journals with a high impact value from 2008 to the present. Methods: the list of anaesthesiology journals in the Science Citation Index (SCI) and SCI-Expanded (SCI/SCI-E) index and the ISSN numbers were obtained. the studies published in these journals from Turkey and from 2007 to September 2018 were listed. the year of publication, subject, method and number of citations and the conducting institution of each study were recorded. Institutions with the highest publications and institutions with the highest number of citations were identified. Results: A total of 3,486 articles were found. of them, 583 (16.7%) publications were from Turkey. the highest number of publications was in 2018 (14.4%) and the lowest was in 2015 (5.3%). Conclusion: Although there seems to be a significant increase in the number of publications in recent years, the same increase is not reflected in the publication quality evaluation criteria and there is no increase in the number of prospective randomised controlled trials and citations

Epidural anestezide bilinçli sedasyon: Remifentanil ve propofol karşılaştırılması

Aim: The aim of our study was to compare the effects of the ultra-short acting opioid agent remifentanil and propofol for epidural anesthesia with conscious sedation. Materials and Methods: ASA class I or II, 50 patients, aged between 35-60 years were separeted into two groups in a randomized manner after epidural anaesthesia. Group R received 0.1 ;micro;g kg-1 remifentanil bolus and an infusion with the rate of 0.025-0.1 ;micro;g kg-1 min-1 was started. Group P received propofol of 0.5 mg kg-1 bolus and 1-4 mg kg-1 h-1 infusion. Mean arterial pressure (MAP), heart rate (HR), peripheric oxygen saturation (SpO2), respiratory rate (RR) and sedation scores were obtained before block and sedation, 1., 5., 10, 15. minutes after sedation, at the end of the operation and 15. and 30. minutes postoperatively. Results: There was no statistically difference between the MAP and HR values at the end of the operation and postoperatively but there was a statistically difference between before sedation and the 1., 5., 10., 15. minutes values (p ;lt; 0.05). When groups were compared; the 1., 5., 10., 15. minutes MAP values were statistically significantly lower in the propofol group (p;lt; 0.05) while there was no difference in the HR measurement. RR and SpO2 values were statistically lower in Group R at the 1., 5., 10. 15. minutes (p;lt; 0.05). When compared with Group P, sedation scores were also lower in Group R (p;lt; 0.05). Postoperative recovery times were 8.1;plusmn;4.3 min in Group R, 7.9;plusmn;5.1 min in Group P, there was no statistically difference. Conclusion: We found that propofol is more efficient and safe in producing sedation; while remifentanil causes more respiratory depression, nausea and vomiting, therefore, careful monitoring is necessary.Amaç: Çalışmamızda epidural anestezide bilinçli sedasyonda, çok kısa etkili opioid ajan olan remifentanil ile propofolün karşılaştırılması amaçlandı. Gereç ve Yöntem: ASA I-II grubu, 35-60 yaş arasında 50 olgu epidural anestezi uygulamasını takiben randomize olarak iki gruba ayrıldı. Grup R'ye: remifentanil 0.1 µg kg-1 bolus takiben 0.025-0.1 µg kg-1 dk-1 infüzyonu ve Grup P'ye, propofol 0.5 mg kg-1 bolus takiben 1-4 mg kg-1 sa-1 infüzyon uygulandı. Blok öncesi, sedasyon öncesi, sedasyon sonrası 1., 5., 10., 15. dk. ve operasyon sonu ve postoperatif 15., 30. dk.'larda kalp atım hızı (KAH), ortalama arter basıncı (OAB), periferik oksijen satürasyonu (SpO2), solunum sayısı (SS) ve sedasyon değerleri kaydedildi. Bulgular: İlk 15 dk.'daki ölçümlerde blok öncesine göre KAH ve OAB'de anlamlı düşmeler gözlenirken (p 0.05), operasyon sonu ve postoperatif dönemdeki değerler açısından anlamlı fark bulunmadı. Gruplar arası karşılaştırmada ise KAH değerleri açısından fark saptanmazken, OAB değerlerinin 1., 5., 10., 15. dk.'larda propofol grubunda anlamlı olarak daha düşük olduğu saptandı (p 0.05). Solunum depresyonu yönünden karşılaştırıldığında ilk 15 dk.'daki ölçümlerde Grup R'de Grup P'ye göre SS ve SpO2'de azalma saptandı (p 0.05). Gruplar sedasyon açısından değerlendirildiğinde Grup R'de sedasyon skorları Grup P'ye göre anlamlı olarak düşük bulundu (p 0.05). Postoperatif derlenme süreleri Grup R'de 8.1±4.3 dk., Grup P'de 7.9±5.1 dk. olarak bulundu ve gruplar arasında anlamlı bir fark saptanmadı. Sonuç: Sedasyon sağlamada propofolün daha etkili ve güvenli olduğu, remifentanilin daha fazla solunum depresyonuna neden olup, bulantı ve kusma oranını arttırdığı saptandı ve sedasyon amacıyla kullanımında dikkatli izlem gerektiği kanısına varıldı