Measurement of the cerebral saturation for assessment of safety of epidural anaesthesia during abdominal surgery

Background : Near Infrared Spectroscopy (NIRS) is considered a reliable assessment method of a balance between cerebral oxygen demand and supply. One of forms of anaesthesia applied during extensive abdominal surgical procedures is the epidural anaesthesia. Its application in addition to the general anaesthesia is a commonly accepted form of anaesthesia in patients undergoing abdominal surgery. The aim of this study was to verify the hypothesis that epidural blocks may have effects on cerebral saturation in patients undergoing abdominal surgery under general anaesthesia. Methods : Cerebral saturation was monitored intrasurgically. Reduction of cerebral oxymetry by over 25% in relation to the baseline, or cerebral oxymetry value below 50% was considered clinically significant. Results : One hundred and one (101) subsequent and non-randomised patients, age between 35 and 84 years (mean 64 ± 10) qualified for major abdominal surgeries were enrolled. In 14 (13.9%) patients of 101 enrolled a clinically significant reduction of cerebral saturation was observed. In 50 (49.5%) of the enrolled patients, the epidural anaesthesia was applied along the general anaesthesia. A clinically significant reduction of cerebral saturation was observed in 9 of them. No statistically significant association was found between the application of epidural anaesthesia and development of cerebral desaturation.Conclusion : The application of epidural anaesthesia caused no clinically significant reduction of cerebral saturation during the general anaesthesia in course of major abdominal surgical procedures

WHOQOL-BREF survey of quality of life among dialyzed end-stage renal disease patients

Introduction: Hemodialysis (HD) improves health and prolongs the life of end-stage renal disease patients, but simultaneously leads to emotional disturbances and impairs the quality of life (QOL). The study was conducted to evaluate the QOL of HD patients. The study was approved by the Regional Bioethical Committee (K.B.Cz.-0014/2017). Material and methods: The World Health Organization Questionnaire of QOL (WHOQOL-BREF) was used in this study with the formal agreement of the WHO. The associations between each patient-related and dialysis-related factor and WHOQOL-BREF domains and questions were computed. The variables were compared by the Student t-test. Results: Data were collected in August 2017 in a single access center. Sixty-nine patients, including 23 (33.3%) women, were evaluated. The factors lowering the scores for particular questions and domains of WHOQOL-BREF were senility, marriage, wrist and arm AVF, not-tunneled CVCs (vs. tunneled), and unwillingness to have a kidney graft. The factors that increased scores for particular questions and domains of WHOQOL-BREF were short dialysis, tunneled CVCs (vs. not-tunneled), and higher URR. The relations between domains and questions of WHOQOL-BREF and sex, education, months on dialysis, kidney graft in the past, fulfillment of medical recommendations, Kt/V and UF were not significant. Conclusions: Although a kidney graft is the best kidney replacement therapy, there is a large group of patients who do not want to receive this treatment. This group should be given special attention. The medical professionals in HD units should remember that patients may not feel comfortable with their disease and satisfied with their body image affected by therapy

Prevalence of the persistent median artery in patients undergoing surgical open carpal tunnel release : a case series

Background: Carpal tunnel syndrome is a common condition in adults with an estimated prevalence of up to 5% in the general population. The presence of a persistent median artery is an important consideration for plastic and orthopedic surgeons who frequently perform carpal tunnel release. This artery may persist into adulthood and constitute a significant supply of blood to the hand, sometimes compressing the median nerve. Purpose: In this case series, we describe the prevalence of the persistent median artery identified intraoperatively in Polish subjects undergoing surgical open carpal tunnel release. Methods: The data regarding the prevalence of persistent median artery were retroactively collected postoperatively from the standard surgical protocols. Results: Persistent median artery was identified in 36 out of 1285 operated hands (2.8%). The observed PMAs were identified in 15 (2.0%) cases out of 750 right upper limbs and in 21 (3.9%) cases out of the 535 left upper limbs. Conclusions: Persistent median artery can be present in the operating field of any surgeon that performs carpal tunnel release and any other surgical procedures in the wrist region. Therefore awareness of its presence is crucial to minimize intraoperative complications such as bleeding or digital ischemia

Coeliac trunk and its anatomic variations : a cadaveric study

Background: Coeliac trunk (CT) is the first major visceral branch of the abdominal aorta. The aim of this work was to present the CT division pattern and its anatomical variants in a sample of Polish population. Materials and methods: Coeliac trunk dissection was performed in 50 adult cadavers in the Department of Anatomy, Jagiellonian University Medical College. Cadavers of Polish subjects were included. Cadavers with previous upper abdominal surgery, abdominal trauma, disease process that distorted arterial anatomy or signs of putrefaction were excluded. CT variations, accessory vessels, and vertebral level of origin were described. CT patterns were reported according to the Adachi classification. This study was reviewed and approved by the local Ethics Committee. Results: Coeliac trunk consisting of the left gastric, common hepatic and splenic artery (type 1 according to the Adachi classification) was found in 82% of cadavers. The true tripod was found in 20% and the false one in 80%. Additional vessels were also found: greater pancreatic from the splenic artery and left inferior phrenic from the left gastric artery, which accounted for 2% sections. Type 2 according to the Adachi classification (i.e. the hepatosplenic trunk) was found in 16% of the sections. Other types of CT were not observed. The level of origin was found to be at the inter-vertebral disc between T12 and L1 in all of the cases. Conclusions: Based on the analysis of the sectional material of the Department of Anatomy, it was found that the typical visceral segmental division is approximate to that observed by Adachi in its classification, whereas the second type of CT was twice as frequent and no other, less frequent types were found

Two-stage optical system for colorectal polyp assessments

BACKGROUND AND AIMS: Macroscopic real-time evaluations of the histopathology and degree of invasion of colorectal polyps help to select the most suitable endoscopic treatment method. Dual-focus (DF) narrow-band imaging (NBI) is a new imaging enhancement system that uses digital and optical methods to enhance the view of blood vessels on mucosal surfaces. However, the superiority of this technique over standard imaging techniques has not been previously reported. The aim of this study was to determine whether the two-stage optical systems in a new generation of endoscopes will increase the diagnostic accuracy of colorectal polyp recognition. METHODS: The study included 270 patients, and 386 colorectal polyps were diagnosed and removed. The polyps were assessed with white light and NBI using one- and two-stage optical systems, respectively. After being classified according to the Kudo pit pattern schemes, the polyps were removed and histopathologically verified. RESULTS: Regarding non-neoplastic lesions (Kudo I and II), no difference was observed in the recognition of polyps when using the NBI-DF function. We observed improved accuracy in the preliminary diagnoses of Kudo III(L) lesions (from 87.16 to 90.09 %, p < 0.05) and Kudo III(S) lesions (from 87.29 to 92.79 %, p < 0.01). NBI-DF also increased the accuracy of preliminary diagnoses of Kudo IV lesions (from 88.24 to 94.12 %, p < 0.01). The Kudo V pit patterns were also more distinct with NBI-DF imaging, increasing the diagnostic accuracy from 91.67 to 100 %. CONCLUSIONS: Using a two-stage optical system with electronic colorization of the mucosa increased diagnostic accuracy for differentiating colorectal polyps with neoplastic potential