Estimation of usefulness of monitoring tissue polypeptide antigen - TPA-M concentrations in the effectiveness surgical treatment of urinary bladder cancer

BACKGROUND: Of all cancer tumours, urinary bladder cancer is the fourth must common in men and the seventh in women. The aim of this work was to answer the question whether tissue polypeptide antigen (TPA-M) determination in patients after electroresection of urinary bladder cancer can be used to establish the probability of tumour recurrence. MATERIAL AND METHODS: The research included 98 patients, all of whom had undertaken electroresection of urinary bladder tumour (TURT), which enabled its removal, and then estimation of malignancy and progression stage according to the international TNM scale. The mean age was 62.7 years. All patients had blood samples taken to determine TPA-M and then underwent routine cystoscopy examination. RESULTS: The patients with tumour recurrence (60, mean age 64 ± 10) had TPA 30.2 ± 4.3 U/l, the patients without recurrence (38, mean age 61.3 ± 11) had TPA-M 26.2 ± 3.18 U/l (p > 0.1). Taking the TPA-M threshold point 85 U/l as normal, true-positive results were 16.3%, true-negative were 31.6%, falsepositive results were 7.1% and false-negative were 44.9%. The ROC curves with the calculated area under them are the measurement of the diagnostic estimation of TPA-M concentrations in specificity and sensitivity categories. CONCLUSIONS: For the examined group the calculated P was 0.45. If P value is under 0.5 it is considered that the test should not be used in diagnosing recurrence of urinary bladder cancer

Quelques remarques touchant la procedure d’obtenir le consentement des patients prepares a la therapie de l’electrochoc

Electroconvulsive therapy (ЕСТ) as a medical procedure of higher risk as well as a therapy evoking certain controversies requires strict obedience to the conditions of acquiring the patient’s informed consent to the offered method of treatment. To acquire the patient’s consent it is necessary to inform him/her about the different aspects of electroconvulsive therapy. The paper stresses that in the case of ECT therapy, the spoken information given to the patient seems insufficient. It is necessary to work out a Polish questionnaire for acquiring the patient’s consent to electroconvulsive therapy and to apply it in all psychiatric institutions that carry out ECT procedures

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications