Purpose
Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous ...conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-β1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS.
Methods
In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patient-administered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points.
Results
Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10.
Conclusion
The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery.
Level of evidence
Therapeutic study, Randomized controlled trial (significant differences and narrow confidence intervals), Level I.
We present a case of a 50-year-old man with advanced liver cirrhosis and native valve infective endocarditis caused by methicillin-resistant Staphylococcus epidermidis. Bacterial infections are one ...of the most common complications of liver cirrhosis, but reports of infective endocarditis in patients with liver cirrhosis are relatively rare. Because of vulnerability of patients with advanced cirrhosis for developing infections, it is necessary to pay attention to the pathogens that are sometimes considered contamination and actively seek for the seat of infection, even in less expected areas (e.g., native heart valves without a history of heart disease).
Križobolja i lumboishijalgija su značajni zdravstveni problemi današnjice. Bolesnici s navedenim tegobama često izostaju s posla, a troškovi operacijskog liječenja iznimno su visoki. Adekvatna ...dijagnostika križobolje i lumboishijalgije podrazumijeva detaljno poznavanje anatomije kralježnice i živčanih struktura, kao i rukovanje pomičnim RTG uređajem. Svrha je ovih procedura primjenom kratkodjelujućeg lokalnog anestetika anestezirati pojedine živčane završetke, a u slučaju provokativne diskografije provocirati bol, kako bi se sa sigurnošću potvrdilo koje su anatomske strukture uzrok bolova. To je potrebno stoga što križobolju mogu uzrokovati različite bolesti kralježnice. Najčešće su degenerativne promjene u intervertebralnom disku, promjene malih zglobova, oštećeni sakroilijakalni zglob ili hernijacija diska. Shodno ovome, a ovisno o različitim anatomskim strukturama koje mogu biti izvor bolova, postoji više dijagnostičkih minimalno invazivnih procedura. Svaka dijagnostička procedura, s kojom se egzaktno utvrdi uzrok križobolje ili lumboishijalgije, bolesnika posljedično potvrđuje kao dobrog kandidata za minimalno invazivni terapijski zahvat.
Križobolja i lumboishijalgija značajni su javnozdravstveni problemi modernoga doba. Troškovi operacijskog liječenja često su iznimno visoki, a radno sposobni ljudi s ovim bolestima često izostaju s ...radnoga mjesta. Minimalno invazivno liječenje križobolje i lumboishijalgije podrazumijeva detaljno poznavanje anatomije kralježnice i živčanih struktura, kao i rukovanje pokretnim RTG uređajem. Križobolju i lumboishijalgiju mogu uzrokovati degenerativne promjene u intervertebralnom disku, promjene zigapofizealnih (fasetnih) zglobova, oštećeni sakroilijakalni (SI) zglob ili hernijacija diska, kao najčešći uzrok stenoze spinalnog kanala. Svaka minimalno invazivna dijagnostička procedura, s kojom se egzaktno potvrdi uzrok križobolje ili lumboishijalgije, bolesnika posljedično predodređuje za specifični minimalno invazivni terapijski zahvat. Kod bolova u slabinskoj kralježnici uzrokovanih degenerativnim promjenama u intervertebralnom disku bolesniku se preporučuje jedna od metoda anuloplastike. Ako je križobolja uzrokovana degenerativnim promjenama fasetnih zglobova ili promjenama u SI zglobu, tada se primjenjuju procedure radiofrekventne neuroablacije. U slučajevima kada su križobolja i lumboishijalgija uzrokovane stenozom spinalnog kanala, bolesniku se preporučuju epiduralne steroidne injekcije ili perkutana laserska dekompresija diska. Svrha je ovih procedura, primjenom dugodjelujućih kortikosteroida i kratkodjelujućeg lokalnog anestetika, te primjenom radiofrekventne struje ili primjenom energije lasera, bolesnika na duže vrijeme osloboditi bolova i tako mu poboljšati kvalitetu života, a istovremeno prevenirati ili barem odgoditi velik operacijski zahvat.
Goiter or thyromegaly is one of the most common causes of mid tracheal obstruction (external compression or stenosis), which may be associated with difficult larynx visualization and/or difficult ...airway management, depending on the goiter size, type and ingrowth into the surrounding tissue. Iodine deficiency disorders are still one of the most common causes of goiter in the population of the African continent. These patients with goiter generally present for medical examination at an advanced stage of the disease. Mallampati test, thyromental distance and inter-incisor gap appear to provide the optimal combination for prediction of difficult visualization of the larynx. Video laryngoscopy examination of the subglottic region and inspection of tracheal deviation in the presence of tracheal compression without detected stenosis of the trachea is a standard and preferred technique in comparison with direct laryngoscopy. Intubation can be performed when vocal cords are visualized. The major difficulty on intubation is encountered in only 5.3% of patients with goiter. Large goiter need not always be associated with a higher incidence of difficult endotracheal intubation. Only two predicting factors for difficult airway assessment were identified in these patients: cancerous goiter (especially if compressive signs are present) and Cormack and Lehane grade III/IV. The indication for fiberoptic intubation is tracheal compression or initial tracheal stenosis. Conventional tracheostomy has to be performed in goiter patients with identified tracheomalacia and/or high degree or tracheal stenosis.
Multinodularna eutiroidna tiromegalija jedan je od najčešćih uzroka kompresije traheje i otežanoga pristupa dišnome putu. U 90% slučajeva etiološki je vezana uz nedostatan peroralni unos joda i/ili ...selena, a jednim dijelom i tireostatskim učinkom tvari poput tiocijanata. Tipične kliničke slike uznapredovale gušavosti susreću se i u endemskim područjima afričkog kontinenta (Zair, Južnoafrička Republika, Uganda, Sudan, Etiopija, Tanzanija, Nigerija). Većina ovih bolesnika dolazi s uznapredovalom bolešću kada je uslijed proširenosti strume već otežana vizualizacija larinksa i/ili teško dostupan dišni put. Pojedini bolesnici mogu izražavati simptome stenoze (kompresije) traheje uz disfagiju, promuklost i različit stupanj respiracijske insuficijencije, osobito uz medijastinalni prodor uvećane žlijezde. Specifičnost endotrahealne intubacije tada podliježe visokom proceduralnom pobolu i smrtnosti. Neovisno o veličini strume incidencija otežanog pristupa dišnome putu kod ovih bolesnika je 5,3%. Prediktorni testovi (Mallampati, Cormack-Lehane, tiromentalna udaljenost, pokretljivost vrata i sl.) uz prepoznavanje kliničkih simptoma doprinose optimalnom odabiru tehnike endotrahealne intubacije. Standardno pravilo uključuje video-laringoskopsku eksploraciju supra- i infraglotične regije te fiberoptičku endotrahealnu intubaciju otežanog dišnog puta.
In this report, we presented a case of a patient with a rupturedabdominal aortic aneurysm (AAA) accompanied by pulmonaryembolism but without an aortocaval fistula, which has not beenreported so far.
Resistant hypertension (RH) is a condition that confers a high cardiovascular risk to the patient due to both persistent blood pressure elevation and the high prevalence of comorbidities and organ ...damage. Hypertension is defined as resistant (RH) to treatment when a therapeutic strategy that includes appropriate lifestyle measures plus a diuretic and two other antihypertensive drugs belonging to different classes at adequate doses fails to lower blood pressure (BP) values to < 140 and 90 mm Hg, respectively. Prior to diagnosing a patient as having RH, it is important to document adherence and exclude white-coat hypertension, inaccurate measurement of BP, and secondary causes. Ambulatory BP monitoring (ABPM) has become an important tool in the diagnosis and follow-up of hypertensive patient, and it is even more important in the evaluation of those with resistant RH. Among patients with RH, it is very important to select patients with standardized stepwise screening: ABPM of resistant hypertensives has a circadian profile with a high proportion of nondipping. The possible reasons for the absence of dipping are sleep disturbance, obstructive sleep apnea, obesity, high salt intake in salt-sensitive subjects, orthostatic hypotension, autonomic dysfunction, chronic kidney disease, diabetic neuropathy, and old age. It seems reasonable to routinely use ABPM in the initial evaluation of all resistant hypertensive patients. In a significant number of these patients, ABPM will also be an essential tool in follow-up, especially regarding the possible effects of all therapeutic maneuvers that are devoted to bringing BP into the target ranges. The potential success of other therapeutic options such as renal denervation depends on the ability to select patients most likely to benefit.
Summary
Objectives: Mivacurium, rocuronium, and vecuronium are neuromuscular blocking agents (NMB) commonly used in pediatric day‐case anesthesia. Mivacurium is the most appropriate NMB for short ...surgical procedures where NMB drugs were required but is not available in all countries.
Aim: We evaluated the operating room time minimization after reduced‐dose rocuronium (0.45 mg·kg−1) during elective day‐case tonsillectomy in children.
Methods/Materials: One hundred and five children (6–9 years, ASA I/II status) scheduled for day‐case tonsillectomy were included in prospective, double blind clinical study. Children were randomly divided in three equal groups. All children were premedicated (midazolam 0.25 mg·kg−1 orally, EMLA). Anesthesia was induced (2.5 mg·kg−1) and maintained (0.1 mg·kg−1·min−2) by propofol and alfentanil (0.0015 mg·kg−1·min−1) and supplemented by inhalation mixture of 50% of O2/Air. Neuromuscular block was achieved by vecuronium (0.1 mg·kg−1) (V) or rocuronium in standard (0.6 mg·kg−1) (R) or reduced dose (0.45 mg·kg−1) (LD). Neuromuscular transmission was monitored by acceleromyography. Time analysis of NMB drugs action was performed.
Results: Time difference from the end of tonsillectomy to T90 neuromuscular block recovery was significantly shorter in LD Group (7.3 ± 0.41 min), (V = 15.9 ± 1.06, R = 16.0 ± 1.7 min) (P = 0.0011). The onset time of neuromuscular block was prolonged in LD Group (LD=3.1 ± 0.4, R = 1.3 ± 0.4, V = 2.2 ± 0.2 min) (P = 0.0039) without changing the intubating conditions. The maximum operation room time saving per each tonsillectomy was 37% in LD Group (Group V 21%, Group R 17%) (P = 0.0001). Low incidence of postoperative nausea and vomiting (PONV) 3–6% (0.4577) and good visual analog scale (VAS) score (≤2) (0.5969) were found in all study groups 12 h after surgery.
Conclusions: Reduced‐dose rocuronium in addition with propofol and alfentanil in children where volatile anesthetics are not used effectively saves the operating room time during short elective surgical procedures, avoids delays in patient recovery, allows high level of acceptable intubating conditions, and improves the optimal surgical work. Low incidences of PONV as VAS score may achieved successfully.
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