Long-term outcome and cancer incidence after abdominal aortic aneurysm repair.

PURPOSE: The influence of cancer development on long-term outcome after elective endovascular (EVAR) vs. open repair (OAR) of non-ruptured abdominal aortic aneurysms (AAA) was investigated. METHODS: Patient survival and cancer incidence were recorded for 18,802 patients registered with the AOK health insurance company in Germany who underwent EVAR (n = 14,218) and OAR (n = 4584) in the years 2010 to 2016 (men n = 16,086, women n = 2716). All patients were preoperatively and in their history cancer-free. RESULTS: 30.1% of EVAR and 27.6% of OAR patients (p ≤ .001) developed cancer after a follow-up period of up to 9 years (Kaplan-Meier estimated). Patients with cancer had a significantly less favorable outcome compared to patients with no cancer (HR 1.68; 95% CI 1.59-1.78, p < .001). After 9 years, the estimated survival of patients with and without cancer was 27.0% and 55.4%, respectively (p < .001). Survival of men and women did not differ significantly (HR 0.94; 95% CI 0.88-1.00, p = .061). In the Cox regression analysis (adjusted outcomes by operative approach, gender, age, and comorbidities), the postoperative cancer incidence was not significantly different between EVAR and OAR (HR 1.09; 95% CI 1.00-1.18, p = .051). However, EVAR showed an increased risk of postoperative development of abdominal cancer (HR 1.20; 95% CI 1.07-1.35, p = .002). 48.0% of all EVAR patients and 53.4% of all OAR patients survived in the follow-up period of up to 9 years. This difference was not significant (HR 0.96; 95% CI 0.91-1.02, p = .219). CONCLUSION: Cancer significantly worsened the long-term outcome after EVAR and OAR, without significant differences between the two repair methods in the overall cancer incidence. However, the higher abdominal cancer incidence with EVAR can affect quality of life including oncological therapy and therefore should be considered when determining the indication for surgery, and the patient should be informed about it.

Nerve blocks in stereotactic neurosurgery.

The advantage of performing preoperative nerve blocks of the supraorbital and occipital nerves facilitates frame fixation and the perioperative management of patients in stereotactic neurosurgery, resulting in better patient handling with reduced intraoperative medication and less monitoring by anesthesia personnel.

Psychomotor recovery in very old patients after total intravenous or balanced anaesthesia for cataract surgery.

We compared psychomotor recovery after total intravenous anaesthesia (TIVA) with remifentanil/propofol and balanced anaesthesia (BAL) with etomidate/fentanyl/isoflurane in 40 patients, ASA I-III, aged > or =80 yr undergoing elective cataract surgery. Recovery times were recorded and psychomotor recovery was assessed according to simple reaction time, critical flicker fusion frequency (CFF) and short-term memory 30 min, 2 h and 1 day after surgery. Physical characteristics of patients in the two groups (19 in the TIVA group and 21 in the BAL group) were comparable. The TIVA group recovered significantly more quickly. Both groups showed a poorer psychomotor performance 30 min after surgery than at baseline assessment, but simple reaction time and short-term memory were close to baseline values 2 h after surgery. Only performance in the CFF test remained below baseline at this point. No deficits in psychomotor performance were noted on the first day after surgery. We conclude that there is only a minor deficit in psychomotor function in elderly patients 2 h after cataract surgery under general anaesthesia and that psychomotor function recovers completely by 24 h after surgery.

Comparative analysis of costs of total intravenous anaesthesia with propofol and remifentanil vs. balanced anaesthesia with isoflurane and fentanyl.

BACKGROUND AND AIM: We evaluated the costs and benefits of total intravenous anaesthesia compared with a balanced anaesthesia regimen. METHODS: One-hundred and twenty-four patients undergoing cataract surgery were randomized to either a propofol/remifentanil or an isoflurane/fentanyl group. In the propofol/remifentanil group, both drugs were used for induction and maintenance of anaesthesia; in the isoflurane/fentanyl group, anaesthesia was induced with etomidate and fentanyl and maintained with isoflurane and fentanyl. All patients received mivacurium for muscle relaxation and the lungs were ventilated mechanically. The use of propofol and remifentanil resulted in a faster emergence and an overall savings per case of [symbol: see text] 12.25 due to a reduction in personnel costs which outweighs the higher drug acquisition costs. RESULTS: In the propofol and remifentanil group, more patients were satisfied and would accept the same anaesthetic again. CONCLUSION: We conclude that propofol and remifentanil is more cost-effective than isoflurane/fentanyl due to its better recovery profile, reduced total direct costs and higher patient satisfaction.

[Computer simulation and pharmacoeconomics. Computer simulation as an aid for the analysis of operating room efficiency: an example]. / Computersimulation und Pharmakoökonomie. Computersimulation als Hilfsmittel zur Analyse von Effizienzsteigerungspotenzialen im OP-Bereich: ein Beispiel.

In this study we compared operating room (OR) efficiency of total intravenous anaesthesia (TIVA) with remifentanil and propofol and balanced anaesthesia (BAL) with fentanyl and isoflurane in cataract surgery using computersimulation. We simulated patient flow for one OR and for three ORs. Time intervals of patient flow were randomly generated from the results of a prospective, randomized trial. Both for one and for three ORs, the postanaesthesia care unit (PACU) finished earlier and one additional case per OR and per day could be performed when TIVA was used for the procedures. Overtime in the PACU was less after TIVA. With a workload of 13 or 15 operations per day in three ORs, monitoring equipment for an additional patient in the PACU was required when BAL was used. TIVA with remifentanil and propofol was associated with more OR efficiency than balanced anaesthesia with fentanyl and isoflurane when given for cataract surgery.

Long-term supplementation with melatonin delays reproductive senescence in rats, without an effect on number of primordial follicles.

The primary objective of the present experiment was to determine if lifelong supplementation with melatonin delayed reproductive senescence through decreased loss of ovarian primordial follicles. Holtzman rats were divided into three treatments on Day 10 after pupping (Day 0 = day of pupping). Treatment 1 pups had access to water, whereas Treatment 2 and 3 pups had access to water containing 10 microg/ml melatonin only at night (Treatment 2) or continuously (Treatment 3). Estrous cycles and weights of pups were monitored at selected times during the experiment; ovaries were removed for histology at 75 and 380 days of age. Vaginal opening in Treatment 2 was delayed (P <.01) compared with Treatments 1 and 3, but there was no difference (P > 0.05) among treatments in percentage of normal length estrous cycles from vaginal opening to 75 days of age. There were fewer (P < 0.001) abnormal-length estrous cycles from 180 to 380 days of age in Treatment 2 as compared with Treatments 1 or 3. There was no effect of treatment (P > 0.05) on number of primordial follicles. In conclusion, nighttime, but not continuous supplementation with melatonin, delayed puberty and reproductive senescence without any effect on number of primordial follicles.

[Desflurane versus isoflurane in geriatric patients. A comparison of psychomotor and postoperative well-being following abdominal surgical procedures]. / Desfluran versus Isofluran bei geriatrischen Patienten. Ein Vergleich von Aufwachverhalten und postoperativer Befindlichkeit nach abdominalchirurgischen Eingriffen.

PURPOSE: The new volatile anaesthetic agent desflurane has a significantly lower blood-gas partition coefficient (0.42) than isoflurane (1.4), suggesting excellent intraoperative control of anaesthesia and rapid emergence and recovery from anaesthesia. However, only limited experience is available in geriatric patients undergoing major abdominal surgery. METHODS: After approval by the local ethics committee and with written informed consent, 52 patients (> or = 65 years old, ASA class II or III) scheduled for major abdominal surgery were randomised to receive either desflurane (DES) or isoflurane (ISO) for maintenance of anaesthesia. After oral premedication with midazolam 3.75-7.5 mg, anaesthesia was induced with etomidate 0.2-0.3 mg/kg and fentanyl 3 micrograms/kg. Vecuronium 0.1 mg/kg provided muscle relaxation for endotracheal intubation. All patients were mechanically ventilated to maintain normocapnia. For maintenance of anaesthesia, DES or ISO was administered in 60% N2O and additional boluses of fentanyl and vecuronium were given as required. At the end of surgery, the neuromuscular blockade was reversed with neostigmine 0.02 mg/kg and DES or ISO was discontinued at the end of skin closure. Episodes of bradycardia and tachycardia and hypo- and hypertension, the time from the end of anaesthesia to extubation, opening eyes, squeezing hand, stating name and birthdate and to discharge from the recovery room were recorded. Until 360 minutes after the end of anaesthesia, the recovery of psychomotor functions was measured by means of simple reaction time tests, critical flicker fusion test, labyrinth test, ball bearing test, short and long-term memory test and digit symbol substitution test. The patient's well-being was documented with scores for pain, sedation and postoperative nausea and vomiting. RESULTS: Demographic data in both groups was similar (Tab. 1). Anaesthesia was significantly prolonged in the ISO group. No significant differences between groups were found for MAC hours and the total dose of fentanyl and vecuronium administered (Tab. 3). Intraoperative haemodynamics were comparable between both groups (Tab. 4). No episodes of increases in heart rate or blood pressure associated with rapid increases in DES concentration were seen. Early emergence parameters were faster in the DES group (Tab. 5). When compared to ISO, the overall test performance and testing ability was superior following DES. Psychomotor tests showed significantly better results up to 240 minutes after the end of DES anaesthesia (Tab. 7, Fig. 4). Comparing the postoperative well-being, there were mild advantages for DES (Tab. 6, Fig. 1, 2, 3). However, time to discharge of geriatric patients from the recovery room was significantly shorter in the DES group (median 171 vs. 215 min., p < 0.05). CONCLUSION: Using a balanced anaesthesia technique, we found desflurane as suitable as isoflurane for geriatric patients. Additionally, due to the fast emergence from anaesthesia, an improved cooperativity was found. In the DES group overall better postoperative psychomotor performance resulted in a shortening of discharge times from the recovery room. Hence, desflurane anaesthesia may be advantageous in geriatric patients.

Selective and synchronous activation of early-S-phase replicons of Ehrlich ascites cells.

Twelve-hour exposure of G1 Ehrlich ascites cells to controlled hypoxia (200 ppm of O2 at 1 bar) suppressed replicon initiation. Synchronous cycling, beginning with a normal S phase, was released by reoxygenation immediately. The addition of cycloheximide at reoxygenation largely resuppressed, after a short initial burst, succeeding replicon initiations. Alkaline sedimentation analysis of growing daughter strand DNA, DNA fiber autoradiography, and analysis of the newly formed DNA demonstrated that normal chain growth and DNA maturation (replicon termination) in the initially activated replicons continued in the presence of cycloheximide. After 2 to 3 h, a low level of cycloheximide-insensitive background replication emerged out of the then-ebbing single surge of activity of the initially released replicons.

On evolutionarily conserved simple repetitive DNA sequences: do "sex-specific" satellite components serve any sequence dependent function?

The nuclear genomes of eukaryotes contain DNA of varying degrees of repetition. Highly repetitious DNA and simple repetitive sequences as a fraction thereof appear to be distributed in a non-random fashion in the genome. There are arguments for and against functional roles of simple repetitive sequences, and the reasons for their evolutionary conservation are not at all clear. In order to learn more about the biologic role of simple repetitive sequences in the context of their evolutionary history, we report here the following results from studies of sex-specific snake satellite DNA: 1) The snake simple repeat sequence is 5'-GATAGACA-3' and it is strictly conserved throughout vertebrate evolution. 2) The simple repeat sequence is intimately interspersed with single-copy DNA throughout the mouse genome. 3) The simple repeat is transcribed into RNA in several animal systems and it is translatable in bacterial test systems. 4) The simple repeat sequence is sex-specifically arranged in vertebrates. 5) In snake DNA, the simple repeat is adjacent to a single-copy sequence which singles out a male-specific putative mRNA in mouse polysomal poly (A)+ RNA. Thus even if this snake simple repetitive sequence is not involved in a basic cellular function such as sex-determination, it is nevertheless a valuable tool to approach those problems.