A Prospective Observational Study of High-Dose Intrathecal Diamorphine in Laparoscopic Bariatric Surgery: a Single-Centre Experience.

BACKGROUND: Post-operative pain management following laparoscopic bariatric surgery can be challenging. There are concerns regarding the use of opioids. The rate of cardiorespiratory problems following neuraxial opioids is unclear. There is little published data on their use in bariatric surgery. This study aimed to assess technique feasibility, pain outcomes, patient acceptability, and the side effects and complications of a 'high-dose' (1.0 mg) intrathecal diamorphine technique for patients undergoing primary laparoscopic bariatric surgery. MATERIALS AND METHODS: Fifty patients were included. Eleven patients (22%) had a diagnosis of OSA. All patients had a spinal anaesthetic with 2.0 mL of 0.25% isobaric bupivacaine containing 1.0 mg diamorphine. General anaesthesia followed together with multi-modal analgesia and anti-emesis. Post-operative pain scores, complications, and side effects in the first 24 h post-operative period were documented. Patients were followed up 6 to 8 weeks after discharge. RESULTS: All patients had a working spinal anaesthetic with thirty-nine insertions (78%) on the first attempt. Pain scores were similar to previously published data where they were found to be superior to a non-spinal analgesic regime. The median 24 h post-operative oral morphine equivalent consumption was 5 mg. Eight patients (16%) required urinary catheterisation. Four patients (8%) complained of pruritus. Eighteen patients (36%) had post-operative nausea or vomiting. Thirty-three patients (66%) responded to the follow-up request. Thirty of the thirty-three patients (91%) stated they would have the spinal anaesthetic again. CONCLUSION: We have demonstrated that neuraxial blockade is a simple, practical, and feasible technique to adopt. Our case series demonstrated a high level of patient acceptability.

Spontaneous clearance and treatment of acute hepatitis C infection in HIV-positive men with 48 weeks of interferon-alpha and ribavirin.

Acute hepatitis C infection in the context of HIV is an emerging problem in men who have sex with men (MSM). We conducted a retrospective cohort study of MSM diagnosed with and treated for acute hepatitis C infection over 10 years. Genotype 1 was the commonest type representing 69% of cases; the spontaneous clearance rate was 20%. The overall sustained virological response (SVR) rate on an intention-to-treat basis was 83%; SVR and was 92% for those completing 48 weeks of treatment. The presence of detectable RNA at week 12 had a 100% negative predictive value for SVR. This is the largest single cohort treated with 48 weeks of interferon and ribavirin and the treatment SVR is one of the highest reported. We propose that a 48-week treatment regimen may be superior to shorter (24-week) regimens though we acknowledge the need for a randomized controlled trial.

[Thrombotic thrombocytopenic purpura as a diagnostic and therapeutic problem]. / Zakrzepowa plamica maloplytkowa-jako problem diagnostyczno-terapeutyczny.

The authors describe patient with Thrombotic Thrombocytopenic Purpura (TTP). The diagnosis based on the clinical symptoms, laboratory tests and microscopic investigations. The unknown etiology and pathogenesis of TTP, lead to many diagnostic and therapeutic difficulties.

[Minitracheotomy as a method of the restoring of airways during occlusion of the larynx]. / Minitracheotomia jako metoda czasowego udroznienia dróg oddechowych w przypadkach niedroznosci krtani.

The authors presents use of the minitracheotomy as a method of the restoring of airways during occlusion of the larynx in emergency cases. Minitracheotomy is a simple method of the restoring of airways by small endotracheal tube.

[Premature tracheoesophageal fistula as a complication after short- term intubation of the patient after craniocerebral trauma]. / Wczesna przetoka tchawiczo-przelykowa powstala po krótkotrwalym przebywaniu rurki intubacyjnej w tchawicy u chorego po urazie czaszkowo-mózgowym.

We have described a rare case of early tracheo-esophageal fistula after short-term intubation. 18-year old male patient was admitted to ICU after craniocerebral trauma. After 6 days of intubation the tracheo-esophageal fistula appeared. We suggest that tracheoesophageal fistula was caused by compression of the trachea by tracheostomies tube cuff, shock and poor general condition.