Perspectives of Electroacupuncture as a New Option for the Treatment of Denervated Muscles.

Introduction: Conservative treatment of peripheral nerve injuries is based on physical therapy approaches, including electrostimulation of denervated muscle. Electrostimulation retards denervation atrophy and prolongs the time window for axon reinnervation. Aim: This article focuses on the potential of electroacupuncture, which combines electrostimulation with acupuncture, in the context of the latest knowledge on the mechanisms of axonal regeneration. Results and conclusions: The possibilities of influencing the growth rate of the axon itself through neurotrophic factors have primarily been previously proven in rodent models. Electroacupuncture as mini-invasive electrostimulation using acupuncture needles appears to be a promising option for the treatment of peripheral nerve paresis. However, this therapy needs to be evaluated in the context of human medicine.

Re-operations for bleeding in cardiac surgery: treatment strategy.

AIMS: Cardiac surgery patients are prone to bleeding postoperatively owing to the extensive sternotomy wound, multiple vessel and heart sutures, and disorders of hemostasis. In this study we retrospectively analyzed the outcomes for all patients in our department who were re-operated for bleeding, over a 5 year period. METHODS: A total of 4297 patients underwent heart surgery between February 2002 and January 2007, of which 98 (2.3 %) were emergency reoperations for bleeding. We analyzed the process of indication for repeat surgery, possible source of bleeding, and postoperative complications. RESULTS: Most (85.7 %) of the reoperated patients had undergone their first operation as an elective cardiac procedure. The mean blood loss before the reoperation was 1557 ml. The studied group was characterized by increased mortality (11.2 %), longer ventilation period (35.1 hours) and ICU (4.5 days) and hospital (13.3 days) stays. The postoperative outcomes did not differ significantly between patients with TEG-detected coagulation disorder and the rest of the patients, or between patients treated with antilysin and those who did not receive antifibrinolytics. CONCLUSIONS: It is vital for the indication process leading to reoperation of the bleeding patient to be as short as possible so as to minimize the delay to repeat surgery. Echocardiography including ultrasound of both pleural spaces, and TEG could shorten that time delay, and should always be included when evaluating patients. Platelets should be administered more often, with the use of antifibrinolytics reserved for cases with confirmed fibrinolysis.