Gastric intramucosal pH-guided therapy in patients after elective repair of infrarenal abdominal aneurysms: is it beneficial?

Objective: To determine if gastric intramucosal pH (pHi)-guided therapy reduces the number of complications and length of stay in the intensive care unit (ICU) or the hospital after elective repair of infrarenal abdominal aortic aneurysms. Design: Prospective, randomized study. Setting: Surgical intensive care unit (SICU) of a University Hospital. Patients: Fifty-five consecutive patients randomized to group 1 (pHi-guided therapy) or to group 2 (control). Interventions: Patients of group 1 with a pHi of lower than 7.32 were treated by means of a prospective protocol in order to increase their pHi to 7.32 or more. Measurements and results: pHi was determined in both groups on admission to the SICU and thereafter at 6-h intervals. In group 2, the treating physicians were blinded for the pHi values. Complications, APACHE II scores, duration of endotracheal intubation, fluid and vasoactive drug treatment, treatment with vasoactive drugs, length of stay in the SICU and in the hospital and hospital mortality were recorded. There were no differences between groups in terms of the incidence of complications. We found no differences in APACHE II scores on admission, the duration of intubation, SICU or hospital stay, or hospital mortality. In the two groups the incidence of pHi values lower than 7.32 on admission to the SICU was comparable (41 % and 42 % in groups 1 and 2, respectively). Patients with pHi lower than 7.32 had more major complications during SICU stay (p<0.05), and periods more than 10 h of persistently low pHi values (< 7.32) were associated with a higher incidence of SICU complications (p<0.01). Conclusions: Low pHi values (<7.32) and their persistence are predictors of major complications. Treatment to elevate low pHi values does not improve postoperative outcome. Based on these data, we cannot recommend the routine use of gastric tonometers for pHi-guided therapy in these patients. Further studies are warranted to determine adequate treatment of low pHi values that results in beneficial effects on the patient's postoperative course and outcom

Иммуногистохимическая детекция каппа-опиоидных рецепторов в коже человека

The imbalance of p- and kappa-opioid receptors in the skin or central nervous system is currently deemed to be one of the reasons of chronic pruritus. A number of studies demonstrated a positive effect of system agonists of kappa-opioid receptors in the treatment of uremic pruritus, nodular pruritus, paraneoplastic and cholestatic pruritus. This research demonstrates an expression of kappa-opioid receptors in human skin (basal keratinocytes, dendritic cells, epidermal melanocytes and fibroblasts of the upper dermis) detected with the use of different immunochemistry methods.В качестве одной из причин хронического зуда в настоящее время предполагается дисбаланс системы мю- и каппа-опиоидных рецепторов в коже или в центральной нервной системе. В нескольких исследованиях продемонстрирован положительный эффект системных агонистов каппа-опиоидных рецепторов в лечении уремического зуда, узловатой почесухи, паранеопластического и холестатического зуда. В настоящей работе демонстрируется экспрессия каппа-опиоидных рецепторов в коже человека (базальных кератиноцитах, дендритных клетках, меланоцитах эпидермиса и фибробластах сосочкового слоя дермы), определенная с помощью различных иммуногистохимических методик

National critical incident reporting systems relevant to anaesthesia: a European survey

Background Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European leve

UVA/UVA1 phototherapy and PUVA photochemotherapy in connective tissue diseases and related disorders: a research based review

BACKGROUND: Broad-band UVA, long-wave UVA1 and PUVA treatment have been described as an alternative/adjunct therapeutic option in a number of inflammatory and malignant skin diseases. Nevertheless, controlled studies investigating the efficacy of UVA irradiation in connective tissue diseases and related disorders are rare. METHODS: Searching the PubMed database the current article systematically reviews established and innovative therapeutic approaches of broad-band UVA irradiation, UVA1 phototherapy and PUVA photochemotherapy in a variety of different connective tissue disorders. RESULTS: Potential pathways include immunomodulation of inflammation, induction of collagenases and initiation of apoptosis. Even though holding the risk of carcinogenesis, photoaging or UV-induced exacerbation, UVA phototherapy seems to exhibit a tolerable risk/benefit ratio at least in systemic sclerosis, localized scleroderma, extragenital lichen sclerosus et atrophicus, sclerodermoid graft-versus-host disease, lupus erythematosus and a number of sclerotic rarities. CONCLUSIONS: Based on the data retrieved from the literature, therapeutic UVA exposure seems to be effective in connective tissue diseases and related disorders. However, more controlled investigations are needed in order to establish a clear-cut catalogue of indications