Effects of pleural opening on respiratory function tests in cardiac surgery: a prospective study.

PURPOSE: To show the effects on lung function of the opening pleura in patients undergoing cardiac surgery. SUBJECTS AND METHODS: 66 patients were included. Patients were allocated into two groups. In group 1 (n=21) pleura was intact, in group 2 (n=45) pleura was opened. Both groups were compared prospectively in terms of preoperative and on the post-operative 5th day pulmonary function tests (PFT), preoperative, postoperative first and fifth day arterial blood gas analysis, preoperative and postoperative first day mixt venous oxygen saturation, bleeding, operation periods, pulmonary complications, intensive care and hospital stay period and mortality. RESULTS: There was significant decrease in all PFT indicators on 5th post-operative day in group 2 (p < 0.01). Although there was a significant decrease in FEV1 on 5th post-operative day in group 1 (p < 0.001), other pulmonary functions parameters were not change significantly (p > 0.025). In group 2 much more decline in pulmonary function test parameters than group 1 were observed (p < 0.05). There was not statistically significant difference in blood gas analysis and mixed venous oxygen saturation values in group 1 (p > 0.05). But in group 2 except pH and PaCO2, other blood gas measurements were significantly decreased on the postoperative first and fifth day (p < 0.008). In group 2 except pH and PCO2, other parameters were less than the other Group (p < 0.01). The drained amount was still significantly higher in group 2 (p < 0.001). The frequency of the revision due to bleeding was observed much more in group 2. CONCLUSIONS: Protection of the integrity of pleura may have positive effects on pulmonary functions in cardiac surgery.

Nociceptive improvements and kynurenine pathway alterations with diclofenac treatment in a rat model of neuropathic pain created by partial sciatic nerve ligation.

OBJECTIVE: Neuropathic pain is regulated by several metabolites of the kynurenine pathway (KYNA-kynurenic acid, and QA-quinolinic acid). Diclofenac exerts analgesic and anti-hyperalgesic effects and also alters KYNA levels, indicating a potential for therapy. We aimed to assess the nociceptive effects of different doses of diclofenac treatment in a rat model of neuropathic pain and to determine potential relationships with KYNA and QA levels (Graphical Abstract). MATERIALS AND METHODS: Twenty-eight Sprague-Dawley rats were divided into four groups: 40 mg/kg/day diclofenac (high-dose), 20 mg/kg/day diclofenac (normal-dose), non-treatment, and sham. Except for the sham group, the others underwent partial sciatic nerve ligation (left). Baseline (day 0) and post-treatment (day 3) KYNA and QA levels were measured. Allodynia and pain detection were assessed with the von Frey and hot plate tests. RESULTS: Baseline findings were similar in all groups. Compared to baseline, the non-treatment group had significantly worse allodynia on day 3. Baseline and post-treatment von Frey results (left) remained similar in the normal-dose diclofenac group (p=0.336); however, this benefit was not observed in the high-dose group. Relative to baseline, normal-dose diclofenac recipients had significantly higher KYNA concentration (p=0.046) and KYNA-to-QA ratio (p=0.028) on day 3. CONCLUSIONS: Our results show that 3-day therapy with 20 mg/kg/day diclofenac can improve nociceptive findings in neuropathic pain, and that this effect may be associated with increased KYNA or KYNA-to-QA ratio. The lack of dose-dependent effects may be associated with potential adverse influences of exceedingly high diclofenac dosage.

Early and midterm results of the retrograde transpopliteal approach as the first-line treatment for total occlusions of iliofemoral arteries.

OBJECTIVE: This study aims to present our early and midterm results regarding the use of the retrograde popliteal artery approach as the first-line treatment for patients with total occlusions of the iliac or femoropopliteal arteries. PATIENTS AND METHODS: Between July 2017 and July 2019, 84 patients underwent transpopliteal retrograde subintimal recanalization for iliac and femoral artery occlusive disease. RESULTS: The procedure was technically successful in 92.9% of the patients and had a complication rate of 5.95%. Complications, including stent thrombosis, dissection, and rupture, were treated successfully. No hematomas were observed at the puncture site. The primary patency rates at 6, 12, and 18 months were 86.9%, 82.1%, and 77%, respectively. CONCLUSIONS: With respectable early and midterm results, the retrograde popliteal artery approach can be considered a primary treatment option for iliac or femoropopliteal arteries' recanalization in selected patients.

Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease.

BACKGROUND: In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. METHODS: A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. RESULTS: The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). CONCLUSION: Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.

Gold-on-glass microwave split-ring resonators with PDMS microchannels for differential measurement in microfluidic sensing.

This paper describes a microwave resonator incorporating microfluidic lab-on-chip sensor system capable of performing simultaneous differential measurement based sensing of liquid samples. The resonators are split-ring resonator shapes made of gold on glass substrates. Directly bonded on glass substrates are polydimethylsiloxane microchannels. Sensor system design incorporates a pair of identical resonators, one of which performs reference reading from the background. Tracking the difference of the responses of both resonators simultaneously, rather than a single one, is used to obtain a more linear and noise-free reading. The sensor system was produced with conventional fabrication techniques. It is compatible with low-cost, simple, easy to handle sensing applications. Results indicate that reliable differential measurement was possible owing to a well-matched pair of sensors with a response error as low as 0.1%. It was also demonstrated that differential measurement capability enables sensing with improved linearity. Measurements were performed with glucose solutions in the range of 3.2-16.1 mM, achieving a sensitivity of 0.16 MHz/mM.

Prevalence, presentation and occupational risk factors of chronic venous disease in nurses.

OBJECTIVE: In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored. METHODS: Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria. RESULTS: Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical-Etiology-Anatomy-Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left-right ankles and the mean duration of hospital stay. CONCLUSIONS: Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency.

Note: Tunable overlapping half-ring resonator.

A unique tunable microwave resonator with a pair of half-rings is introduced and validated by experimental data. The capacitive gap between the overlapping areas can be controlled accurately using a magnetic actuator for tunability. The design geometry is scalable to cover different bands of electromagnetic spectrum. Transmission characteristics of the resonators have been modeled using finite-element analysis and have been measured. The experimental results indicate the resonant frequency can be controlled with a resolution of a few MHz in a tuning range of 38%. The resonator exhibits sharp transmission dips within the tuning range with measured quality factors larger than 2500.

Intrathecal low-dose levobupivacaine and bupivacaine combined with fentanyl in a randomised controlled study for caesarean section: blockade characteristics, maternal and neonatal effects.

BACKGROUND: Intrathecal combination of local anaesthetics with opioids produces a synergistic effect without intensifying motor and sympathetic blockades. It also enables successful anaesthesia with use of a low dose of local anaesthetic, which also results in more stable haemodynamics. We compared the characteristics of blockade and maternal-neonatal effects of low-dose levobupivacaine and low-dose bupivacaine combined with fentanyl used in spinal anaesthesia for caesarean section. METHODS: Seventy-two patients undergoing caesarean section with spinal anaesthesia received low-dose 0.5% levobupivacaine (7 mg) plus fentanyl 25 µg (group L) or low-dose 0.5% bupivacaine (7 mg) plus fentanyl 25 µg (group B). The time to achieve sensory blockade of T6, the maximum spread of sensory blockade, time to S2 regression, sensorial blockade levels and motor blockade at the beginning and end of surgery were the parameters assessed. Haemodynamic parameters (systolic and diastolic blood pressures, heart rate), neonatal effects (APGAR scores at 1. and 5. min, umblical-cord gas analyses) were recorded, as were side-effects. RESULTS: The qualities of sensory blockade were similar and clinically effective in both groups. Significantly more patients had complete motor blockade in group B than in group L at the beginning and end of surgery. Haemodynamic and neonatal parameters were similar between the two groups. Pruritis was a common side-effect in both groups. CONCLUSION: In spinal anaesthesia for caesarean section, using low-dose levobupivacaine in combination with fentanyl elicits effective sensorial blockade and less motor blockade with similar haemodynamic and neonatal effects than usage of low-dose bupivacaine in combination with fentanyl.

Single-stage repair of adult aortic coarctation and concomitant coronary artery disease: an unusual surgical approach through median sternotomy.

Surgical repair of postductal aortic coarctation associated with severe coronary artery disease is in most cases a difficult decision to make. As staged procedures are associated with a higher rate of morbidity and mortality, simultaneous operative management of both pathologies is desirable. We describe a case of a 51-year-old man who was referred to our department for surgical treatment of postductal aortic coarctation and concomitant coronary artery disease, which we managed with single-stage surgery through median sternotomy.

Effects of erythropoietin and pentoxifylline on the oxidant and antioxidant systems in the experimental short bowel syndrome.

In this study, we investigated the effects of erythropoietin (Epo), and pentoxifylline (Ptx) on the oxidant and antioxidant systems in the experimental short bowel syndrome. Spraque-Dawley rats were divided into four groups and all animals underwent 75% small bowel resection. Group E was treated with 500 IU kg(- 1) Epo subcutaneously (s.c.), group P with 50 mg kg(- 1) day(- 1) s.c. Ptx and group E+P with 500 IU kg(- 1) s.c. Epo plus 50 mg kg(- 1) day(- 1) s.c. Ptx for a period of 28 days. In group C, which is the control group, no drug treatment was given. At the end of 28 days the experimented rats were killed and ileum samples excised for biochemical and histopathological testing. Malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were determined in ileum homogenates. When compared to group C, the MDA and GSH-Px levels were significantly decreased (p < 0.05), but SOD activity was not changed (p > 0.05) in groups P and E+P, whereas both MDA and SOD and also GSH-Px activities were not changed significantly in group E (p > 0.05). The average villous length, crypt depth, muscular thickness and mucosal length were measured in all groups. The average crypt depth and mucosal length were statistically higher in the group P than group C (p < 0.001, p < 0.01, respectively). In addition, the crypt depth was statistically higher in both E and E+P groups as compared to group C (p < 0.001, p < 0.01, respectively). Therefore, our study indicates that Ptx may be more effective than Epo in reducing lipid peroxidation. Moreover, we considered that Ptx may give this protective effect by inhibiting the free oxygen radicals to a greater extent than developing the antioxidant capacity.