Risk Factors for Intraoperative Hypertension during Surgery for Primary Hyperparathyroidism.

OBJECTIVE: To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT). SUBJECTS AND METHODS: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure ≥20% compared to baseline values which lasted for 15 min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH. RESULTS: Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR = 2.080, 95% CI: 1.102-3.925, p = 0.024) and age (OR = 0.569, 95% CI: 0.360-0.901, p = 0.016). CONCLUSION: In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH.

Comparative spectroscopic studies on liposomes containing chlorophyll a and chlorophyllide a.

Chlorophyll a (Chla) and chlorophyllyde a (Chlida) - a derivative of Chla, have been incorporated in the lipid bilayers of two types of liposomes, small unilamellar vesicles (SUV) and multilamelar vesicles (MLV). The objective of the present work was to compare the spectral behaviour of Chla and Chlida incorporated in the lipid bilayers and their sensing behaviour at molecular level. The VIS absorption and fluorescence emission presented differences depending on the type of liposomes and inserted pigment, reflecting the different localization of porphyrin macrocycle in the lipid moieties. The temperature dependence of emission anisotropy and fluorescence intensity, for both Chla and Chlida incorporated in DPPC SUV, revealed the presence of different lipid phases. The degree of incorporation of quercetin (QCT) in liposome membrane was studied by using Chla and Chlida as molecular sensors. The fluorescence polarisation data and the fluorescence quenching process provided arguments for the insertion of the QCT at the interface lipid/water, in the vicinity of lipid polar heads and porphyrin macrocycle. The phytyl chain of Chla penetrating in the hydrophobic core of the lipid bilayers is responsible for the observed differences among Chla and Chlida in sensing the lipid phase transition and the fluorescence quenching process induced by QCT.

[Aspirin withdrawal in high risk cardiac patients before the operation of total colectomy with resection of ileum--case report].

Coronary artery disease is one of the risk factors for myocardial infarction and it is present in 40% of patients who are undergoing noncardiac surgery. Despite evidence of the benefit of the antiplatelet therapy in patients at risk of cardiac complications, aspirin treatment is often discontinued before surgery due to the risk of perioperative bleeding. In many studies and meta-analysis it is shown that aspirin withdrawal in perioperative period was associated with three-fold higher risk of major adverse cardiac events. Perioperative continuation of aspirin increase the rate of bleeding by 1.5, but it doesn't increase the level of the severity of bleeding complications. In perioperative periode aspirin is discontinued only if it is estimated that the bleeding risk is higher than the risk of thrombosis. In the paper authors present a case report of patient who developed a perioperative myocardial in-farction as a consequence of aspirin withdrawal before total colectomy.

The addition of fentanyl to local anesthetics affects the quality and duration of cervical plexus block: a randomized, controlled trial.

BACKGROUND: Cervical plexus block is frequently associated with unsatisfactory sensory blockade. In this randomized, double-blind, placebo-controlled trial, we examined whether the addition of fentanyl to local anesthetics improves the quality of cervical plexus block in patients undergoing carotid endarterectomy (CEA). METHODS: Seventy-seven consecutive adult patients scheduled for elective CEA were randomized to receive either fentanyl 1 mL (50 microg) or saline placebo 1 mL in a mixture of 10 mL bupivacaine 0.5% and 4 mL lidocaine 2% for deep cervical plexus block. Superficial cervical plexus block was performed using a mixture of 10 mL bupivacaine 0.5% and 5 mL lidocaine 2%. Pain was assessed using the verbal rating scale (0-10; 0 = no pain, 10 = worst pain imaginable), and propofol in 20-mg IV bolus doses was given to patients reporting verbal rating scale >3 during the procedure. Rescue medication consumption during surgery and analgesia requirements over the next 24 hours, as well as onset of sensory blockade, were recorded. A P value <0.05 was regarded as statistically significant. RESULTS: Fewer patients in the fentanyl group (4 of 38, 10.5%) required propofol compared with the placebo group (26 of 39, 66.7%; P < 0.001). In comparison with the placebo group, the fentanyl group consumed less propofol (median 0 [0-60] vs 60 [0-160] mg, respectively; P < 0.001), required postoperative analgesia less frequently (22 of 38 patients, 57.9% vs 35 of 39 patients, 89.7%, respectively; P = 0.002), and requested the first analgesic after surgery later (median 5.8 [1.9-15.6] vs 3.1 [1.0-11.7] hours, respectively; P < 0.001), whereas the onset time of sensory blockade was similar in both groups (median 12 [9-18] vs 15 [9-18] minutes, respectively; P = 0.18). CONCLUSIONS: The addition of fentanyl to local anesthetics improved the quality and prolonged the duration of cervical plexus block in patients undergoing CEA.

Liquid-liquid systems for acid hydrolysis of glycoalkaloids from Solanum tuberosum L. tuber sprouts and solanidine extraction.

BACKGROUND: Potato sprouts (Solanum tuberosum L.) contain steroidal glycoalkaloids containing solanidine, an important precursor for hormone synthesis. Glycoalkaloids are reported to inactivate the Herpes simplex, Herpes zoster and Herpes genitalis viruses in humans, while Aglyones, including solasodine, may protect against skin cancer. Extracts of glycoalkaloids or solanidine can be used to obtain a potential skin cancer preparation for clinical research. MATERIAL/METHODS: Dried potato sprouts were used to obtain glycoalkaloids and solanidine. The hydrolysis of glycoalkaloids in a liquid-liquid system was performed using a reflux condenser, obtaining extracts of glycolakaloids from dried and milled potato tuber sprouts. Hydrochloric acid was then added to the extract to form the first (aqueous) phase, and chloroform, trichloroethylene or carbon tetrachloride to form the second (organic) phase of the liquid-liquid system. In this way, glycoalkaloid hydrolysis to solanidine and solanidine extraction in the organic liquid phase were combined into a single step. IR and GC/MS analysis of solanidine was also conducted. RESULTS: Based on the results we obtained, the optimal liquid-liquid system was found to be 2% w/v hydrochloric acid in a 50% (volume) methanolic extract of glycoalkaloids from tuber sprouts, as the first phase, and chloroform as the second phase. Using this system, a yield of 1.46 g solanidine per 100 g of dried potato sprouts can be achieved. CONCLUSIONS: Glycoalkaloid hydrolysis in a liquid-liquid system yields the aglycone solanidine can be obtained from dried potato sprouts. The yield of solanidine is higher than that obtained using solid-liquid-liquid systems for glycoalkaloid hydrolysis from potato vines.