The significance of clinical markers in the prediction of hemodynamic and cardiac complications of capnoperitoneum in patients at risk.

OBJECTIVES: The aim of this prospective study was to find out the predictive value of concomitant diseases of cardiovascular system (CVS), lungs and kidneys as well as metabolic diseases to be able to anticipate the potential origin of hemodynamic and cardiopulmonary complications as a result of insufflated CO2 peritoneum. METHODS: The study investigated eleven patients at the anaesthetic risk of ASA III-IV and cardiac risk of NYHA II-III in whom elective laparoscopic surgical intervention had been indicated. RESULTS: We have found out that the significance of the increase in biologic ANP markers, catecholamines and PRA was not sufficient to signal the deepening of cardiac dysfunction, latent cardiac failure or hemodynamic disorder (p > 0.01). The courses of regression lines have shown the dependence on the increased IAP (intra-abdominal pressure) of capnoperitoneum in PRA and adrenaline. The reactions of biologic markers correlated with reactions of clinical hemodynamic markers of BP and HR. We have proved that the increased level of IAP causes a significant increase in CVP (p < 0.01) being one of the factors determining the preload of right ventricle (RV) and in coincidence with intact transpulmonary circulation also the optimal function of left ventricle (LV). CONCLUSION: Our investigation of peroperative clinical and biologic markers of hemodynamics and neuroendocrine response to operative stress and development of CO2 peritoneum has proved that the course of laparoscopic operations in patients in the risk group of ASA III-IV and NYHA III does not necessarily have to be deteriorated by complications. It can be assumed that increased values of biologic markers regulate the neurohumoral response in the physiologic range and do not predict a severe CVS dysfunction within its course. (Tab. 2, Fig. 3, Ref. 22.)

[Pulmonary embolism, prolonged diagnosis in young man]. / Pl'úcna embólia, zdlhavá diagnóza u mladého muza.

Despite progress in early detection and treatment, the rates of mortality and recurrences of pulmonary embolism remain high. Cardiovascular specialists must keep pulmonary embolism in mind when they evaluate patients with unexplained substernal or pleuritic chest pain, dyspnea and syncope because these symptoms constitute the cardinal clinical presentation of pulmonary embolism. Authors are presenting a case report of a patient with repeating pleuritic chest pain with pleural effusion. The patient was treated as suspected tuberculous pleuritis. Authors diagnosed pulmonary embolism as a cause of pleural effusion by elevated plasmatic D-dimer and perfusion lung scan. Thrombosis in left subclavian vein established by angiography was source of embolus. Patient was evaluated regarding primary risk factors for venous thromboembolism and Prothrombin 20210A mutation was detected. Subsequent adequate medical treatment led to significant clinical upturn in this patient.

[Acute cholecystitis in diabetics]. / Akútne cholecystitídy u diabetikov.

UNLABELLED: Diabetes modifies by its consequences the course of different diseases. OBJECTIVE: In the submitted work the authors compare the course of acute cholecystitis in diabetic and non-diabetic subjects. METHOD: The authors evaluated in a retrospective study a group of 246 patients whom they operated on account of acute cholecystitis. The group comprised 44 (18%) diabetics and 202 (82%) non-diabetic subjects. They compared the two groups in some selected parameters. The significance of differences was evaluated by statistical methods. RESULTS: Significant differences between the groups were found in the pathomorphological finding on the gallbladder, in the incidence of acute cholangitis, comorbidity and early infection to the disadvantage of diabetics. CONCLUSION: The clinical course of acute cholecystitis in diabetics may be masked which is often the reason of inadequate therapeutic radical measures and of subsequent risks of the development of serious perioperative complications. Despite the higher comorbidity in the diabetic-group the perioperative course in the two groups was comparable if early surgery and adequate preoperative preparation were provided.