Duration and Variability of Speech Segments in Fluent Speech of Children with and without Stuttering

The purpose of this study was to compare the duration and variability of speech segments of children who stutter with those of children who do not stutter and to identify changes in duration and variability of speech segments due to the effect of utterance length. Eighteen children participated (ranging from 6.3 to 7.9 years of age). The experimental task required the children to repeat a single word in isolation and the same word embedded in a sentence. Durations of speech segments and Coefficients of variation (Cv) were defined to assess temporal parameters of speech. Significant differences were found in the variability of speech segments on the sentence level, but not in duration. The findings supported the assumption that linguistic factors pose direct demands on the speech motor system and that the extra duration of speech segments observed in the speech of stuttering adults may be a kind of compensation strategy

LIVER TRANSPLANTATION AND ALLERGY: TRANSPLANT-ACQUIRED FOOD ALLERGY

Transplant-acquired food allergy is a well known phenomenon especially linked to liver transplants. Risk factors lie both in transplant recipient and transplant donor - age of recipient and the maturity of immune regulatory mechanisms, family history of atopy in recipient, young age of the donor and atopic history in donor. The exact mechanism has not yet been established and there are many different explanations of this pathophysiologic process. Transplanted liver is a large and well perfused organ, rich in pluripotent hematopoietic stem cells and donor\u27s IgE antibodies that can alter immunological response in the host. Some studies suggest that post-transplant immunosuppression with tacrolimus is linked to an increased occurrence of IgE-mediated sensitization and manifestation of allergic disease. Research in the field of transplant-acquired food allergy is not important only for transplant patients and physicians involved but also for understanding the mechanism of food allergy development in general population and potentially reducing this global health concerning issue

LIVER TRANSPLANTATION AND ALLERGY: TRANSPLANT-ACQUIRED FOOD ALLERGY

Transplant-acquired food allergy is a well known phenomenon especially linked to liver transplants. Risk factors lie both in transplant recipient and transplant donor - age of recipient and the maturity of immune regulatory mechanisms, family history of atopy in recipient, young age of the donor and atopic history in donor. The exact mechanism has not yet been established and there are many different explanations of this pathophysiologic process. Transplanted liver is a large and well perfused organ, rich in pluripotent hematopoietic stem cells and donor\u27s IgE antibodies that can alter immunological response in the host. Some studies suggest that post-transplant immunosuppression with tacrolimus is linked to an increased occurrence of IgE-mediated sensitization and manifestation of allergic disease. Research in the field of transplant-acquired food allergy is not important only for transplant patients and physicians involved but also for understanding the mechanism of food allergy development in general population and potentially reducing this global health concerning issue

Effects of age on onset time and duration of sensory blockade in ultrasound guided supraclavicular block Abstract

Background and purpose: Involutive changes of brachial plexus occur with aging. The aim of this study was to determine if these changes would effect onset time and duration of sensory blockade in all four distal nerves of brachial plexus in middle aged (65 years). Materials and methods: Middle aged (N=22) and elderly patients (N=22) undergoing upper limb surgery received an ultrasound guided supraclavicular block with a mixture of local anesthetics (50 : 50, 0.5% levobupivacaine, 2% lidocaine). The prospective, observer-blinded study method is a previously validated step-up/step-down sequential model where the local anesthetic volume for each following patient is determined by the outcome of the previous block. The starting volume was 30 ml. Only the blocks with complete sensory blockade in all four regions of distal nerves were analyzed for the onset time and duration of sensory blockade. Results and conclusions: The mean (SD) block onset time was 25.8±0.6 min and the mean (SD) block duration was 151.5±8.9 min in the entire middle aged group. In the entire elderly group, the mean (SD) block onset time was 21±0.82 min and the mean (SD) block duration was 195.75±14.99 min. The difference in both, onset time and duration was significant (P=0.0002, 95%CI 3.352–6.248; P=0.0023, 95% CI 65.63–22.95, respectively). In conclusion, local anesthetics have a faster onset time and longer duration of sensory blockade in elderly due to alterations of peripheral nerves and increased sensitivity to local anesthetics

ACUTE RESPIRATORY DISTRESS SYNDROME AND OTHER RESPIRATORY DISORDERS IN SEPSIS

Akutni respiracijski distresni sindrom (ARDS) se uobičajeno razvija u bolesnika s prisutnim rizičnim čimbenicima (npr. sepsa, pneumonija, akutni pankreatitis, politrauma, višestruke transfuzije krvi i krvnih pripravaka i sl.) koji aktiviraju sustavni upalni odgovor. Sepsa je jedan od najčešćih čimbenika koji može dovesti do razvoja ARDS-a. ARDS povezan sa sepsom pokazuje sporiji oporavak plućne funkcije uz manju uspješnost odvajanja bolesnika od strojne ventilacije. Vrlo je važno uz sve ostale mjere liječenja sepse obratiti posebnu pozornost optimalizaciji strojne respiracijske potpore u skladu s trenutnim stanjem pluća. Svake je godine dostupno sve više podataka o mogućnostima liječenja bolesnika s ARDS-om uz pomoć posebno prilagođenih načina strojne ventilacije pri čemu važnu ulogu imaju: izbor optimalnog poštednog modaliteta, primjena potpomognute ventilacije i adekvatno podešavanje pozitivnog tlaka na kraju izdaha (engl. positive end-expiratory pressure - PEEP). Međutim, što iz ovih eksperimentalnih i kliničkih podataka možemo prenijeti u svakodnevnu kliničku praksu? U ovom članku izneseni su načini adekvatne prilagodbe poštedne ventilacije kao mjere s dokazanim učinkom na smanjenje mortaliteta ove skupine bolesnika ako se sustavno i dosljedno primjenjuje.Acute respiratory distress syndrome (ARDS) develops in patients with predisposing conditions that induce systemic infl ammatory response such as sepsis, pneumonia, acute pancreatitis, major trauma, or multiple transfusions. Sepsis is the most common cause of ARDS. Sepsis-related ARDS patients have signifi cantly lower PaO2 /FiO2 ratios than patients with non-sepsis-related ARDS. Furthermore, their recovery from lung injury is prolonged, weaning from mechanical ventilation less successful, and extubation rate slower. Clinical outcomes in patients with sepsis-related ARDS are also worse, associated with signifi cantly higher 28-day and 60-day mortality rates (31.1% vs. 16.3% and 38.2% vs. 22.6%, respectively). It is extremely important to optimally adjust ventilator setting to current condition of lungs, while providing all other therapeutic measures in the treatment of sepsis, severe sepsis and septic shock. The pool of data on treatment possibilities for patients with ARDS grows every year, with specifi cally designed mechanical ventilation strategies. Ventilator modes and adequate positive end-expiratory pressure (PEEP) settings play a major role in these strategies. However, how can we best apply these experimental and clinical data to everyday clinical practice? This article emphasizes protective ventilation as a measure that is proven to reduce mortality in this group of patients, when systematically and consistently applied

Comparison of minimum effective volume of local anesthetic for ultrasound guided supraclavicular block (MEAV95) in elderly and middle aged patients

Backgrund and purpose: The aim of this study was to determine the minimum effective volume of local anesthetic (LA) required to produce an efficient supraclavicular block in 95% of patients (MEAV95) using an ultrasound (US)-guided technique in an elderly (>65 y) and a middle aged group (<45 y) of patients. Furthermore, we aimed to calculate potency ratio of LA between the groups. We assumed a reduced MEAV95 in elderly group. Matherials and Methods: Fourty-four patients (N=22 per group) undergoing upper limb surgery received a US-guided supraclavicular block. The study method is a previously validated step-up/step-down sequential model where the volume of LA for each following patient is determined according to the outcome of the previous block. The starting volume was 30 mL; in the case of block failure, the volume was increased by 5 ml. After successful block, the volume was reduced by 5 mL. MEAV95 was calculated using probit transformation and logistic regression. Potency ratio of LA is calculated using Fieller’s method. Results and Conclusions: The calculated minimum effective anesthetic volume in 95% of patients was 16.49 mL (95% CI, 12.23–20.75 mL) in elderly and 44.52 mL (95% CI, 19.05–69.99 mL) in middle aged group (95% CI, 0.7–55.3 mL, P=0.044). A potency ratio of LA between middle aged and elderly is 2.69 (95% CI 2.13 to 3.44). The minimum volume requirement for effective US-guided supraclavicular block in 95% of elderly patients was significantly reduced. A potency ratio of 2.69 indicates almost three times stronger LA potency in the elderly

Spinal Anesthesia at the L2–3 and L3–4 Levels: Comparison of Analgesia and Hemodynamic Response

Aim of this study was to evaluate level of analgesia and hemodynamic response to spinal anesthesia obtained by administering 15 mg 0.5% isobaric bupivacaine at L2–3 vs. L3–4 interspace for inguinal herniorrhaphy, since studies comparing analgesia and hemodynamic response at the L2–3 vs. L3–4 interspaces are lacking. In a prospective, randomized clinical study that encountered 72 patients undergoing elective inguinal herniorrhaphy randomly allocated in to two equal groups L2–3 (N=36) and L3–4 (N=36) according to lumbar interspace where intrathecal injection of bupivacaine was administered. Analgesia was evaluated by intraoperative »rescue« fentanyl requirements, the absence of pain and the maximal visual analogue scale (VAS) scores reached per patient during the operation. The severity of intraoperative pain was quantified by a 10 cm VAS scale (VAS 0: no pain to 10: worst pain imaginable) every 5 minutes after skin incision until the end of the operation. VAS>3 was treated with intravenous fentanyl 25 μg. Hemodynamic response was monitored and evaluated, heart rate was continuously monitored as well as, baseline systolic, diastolic and mean arterial pressure prior to induction and every 5 minute after applying spinal anesthesia until surgical completion. Intraoperative fentanyl requirements were significantly higher in group L3–4 (L2–3 0%, 97.5% confidence interval [CI] 0.0–0.11 vs. L3–4 17%, 95% CI 0.07–0.32, p=0.025). Absence of pain was significantly higher in L2–3 group at the beginning of the operation (L2–3 89%, 95% CI 0.74–0.96 vs. L3–4 67%, 95% CI 0.50–0.79, p=0.047). The maximal VAS scores reached per patient during the operation in L2–3 group were lower then in L3–4 group (L2–3 median [M] 0, range [R] 0–3, L3–4 M 0, R 0–8, p=0.014). There were no significant differences (p>0.05) in the incidence of hypotension (L2–3 19%, 95% CI 0.09–0.35 vs. L3–4 17%, 95% CI 0.07–0.32) and bradycardia (L2–3 19%, 95% CI 0.09–0.35 vs. L3–4 8%, 95% CI 0.02–0.23). Spinal anesthesia with isobaric bupivacaine administered in L2–3 interspace for inguinal herniorrhaphy provides superior analgesia and equal hemodynamic stability as compared to neuroaxial anesthesia administered in the L3–4 interspace

Perioperative volume replacement therapy for orthopic liver transplantation-observational, retrospective study

Cilj: Tijekom transplantacije jetre očekuju se značajni gubitci tjelesnih tekućina koje je potrebno nadoknaditi kristaloidnim i koloidnim otopinama te transfuzijom krvlju i krvnim derivatima. U studiji smo analizirali je li u petogodišnjem razdoblju promijenjen pristup intraoperacijskoj nadoknadi tekućina i krvnih derivata tijekom transplantacije jetre. Materijali i metode: U opservacijskoj retrospektivnoj studiji analizirali smo podatke ukupno 155 pacijenata kojima je transplantirana jetra u Kliničkoj bolnici Merkur, 79 tijekom 2015. godine i 76 tijekom 2010. godine. Analizirali smo ukupni gubitak krvi, ukupni uneseni volumen tekućina tijekom transplantacijskog postupka te volumen pojedinih vrsta tekućina (kristaloidi, koloidi, koncentrati eritrocita, svježe smrznuta plazma, trombociti). Statistička analiza rađena je Studentovim t-testom. Rezultati: Pacijenti su bili međusobno usporedivi po tjelesnoj masi i visini, MELD ljestvici. Ukupni gubitci krvi (ml) tijekom transplantacije jetre u 2015. i 2010. godini iznosili su: 6526± 4194 i 11122± 6685, P<0,001. Volumeni unesenih tekućina (ml) tijekom transplantacije jetre u 2015. i 2010. godini iznosili su: ukupni volumen tekućina 9640± 6017 i 18433 ± 7282, P< 0,001; kristaloidi 5077± 1443 i 5674± 2326, P=0,055; koloidi 1853± 814 i 2244± 1188, P=0,018; autologna krv 1097± 1160 i 1927± 2608, P=0,011; homologna krv 1293± 1247 i 2979± 2196, P<0,001; svježe smrznuta plazma 2244± 1523 i 5429± 1954, P<0,001; trombociti 349± 387 i 426± 313, P=0,176. Zaključci: Ovom studijom uočeno je značajno smanjenje ukupnog volumnog unosa, unosa koloidnih otopina, koncentrata eritrocita i svježe smrznute plazme tijekom transplantacije jetre u razdoblju od pet godina. Razlozi navedenog su ograničavanje perioperacijske volumne nadoknade u svrhu smanjivanja nepovoljnih učinaka volumnog preopterećenja. Ipak, najvažniji je faktor anestezijsko i kirurško iskustvo prikupljeno tijekom niza uspješnih godina u transplantacijskoj medicini.Aim: Significant fluid losses occur during liver transplantation, which need to be replaced. In this study, we analyzed whether fluid replacement strategies during liver transplantation have changed over a five-year period. Materials and Methods: In this observational, retrospective study, we collected data on 155 patients who underwent liver transplantation at the University Hospital «Merkur», 79 in 2015 and 76 in 2010. We analyzed total blood loss, total volume of replaced fluids and the volume of crystalloids, colloids, erythrocyte concentrates, fresh frozen plasma and platelets applied. We employed the Student t-test for statistical analysis. Results: Total blood losses (ml) in 2015 and 2010 were: 6526± 4194 and 11122± 6685, respectively, P<0,001. Volumes of replaced fluids (ml) in 2015 and 2010 were following: total fluid volume 9640± 6017 and 18433± 7282, P< 0,001; crystalline 5077± 1443 and 5674± 2326, P=0,055; colloids 1853± 814 and 2244± 1188, P=0,018 ; autologous blood 1097± 1160 and1927± 2608, P=0,011; homologous blood 1293± 1247 and 2979± 2196, P<0,001; fresh frozen plasma 2244± 1523 and 5429± 1954, P<0,001; platelets 349± 387 and 426± 313, P=0,176. Conclusions: This study showed a significant reduction in total fluid replacement, as well as in replacement of colloids, blood transfusion and fresh frozen plasma during liver transplantation over a period of five years. A possible explanation is a more restrictive perioperative fluid replacement strategy employed with the aim of reducing adverse effects of volume overload as well as a growing experience acquired over a number of successful years in transplantation medicine

Comparison of minimum effective volume of local anesthetic for ultrasound guided supraclavicular block (MEAV95) in elderly and middle aged patients

Backgrund and purpose: The aim of this study was to determine the minimum effective volume of local anesthetic (LA) required to produce an efficient supraclavicular block in 95% of patients (MEAV95) using an ultrasound (US)-guided technique in an elderly (>65 y) and a middle aged group (<45 y) of patients. Furthermore, we aimed to calculate potency ratio of LA between the groups. We assumed a reduced MEAV95 in elderly group. Matherials and Methods: Fourty-four patients (N=22 per group) undergoing upper limb surgery received a US-guided supraclavicular block. The study method is a previously validated step-up/step-down sequential model where the volume of LA for each following patient is determined according to the outcome of the previous block. The starting volume was 30 mL; in the case of block failure, the volume was increased by 5 ml. After successful block, the volume was reduced by 5 mL. MEAV95 was calculated using probit transformation and logistic regression. Potency ratio of LA is calculated using Fieller’s method. Results and Conclusions: The calculated minimum effective anesthetic volume in 95% of patients was 16.49 mL (95% CI, 12.23–20.75 mL) in elderly and 44.52 mL (95% CI, 19.05–69.99 mL) in middle aged group (95% CI, 0.7–55.3 mL, P=0.044). A potency ratio of LA between middle aged and elderly is 2.69 (95% CI 2.13 to 3.44). The minimum volume requirement for effective US-guided supraclavicular block in 95% of elderly patients was significantly reduced. A potency ratio of 2.69 indicates almost three times stronger LA potency in the elderly