BACKGROUND: The effect of dexmedetomidine on regional splanchnic blood flow remain unclear. OBJECTIVES: We hypothesized, that there is no difference in regional rectal perianastomotic perfusion and oxygenation when using non-opioid dexmedetomidine-isoflurane anesthesia when compared to fentanyl-isoflurane anesthesia. METHODS: Ten female pigs were randomly divided into two groups (Dexmedetomidine, DEX, Fentanyl, FNT). Analgesia was provided by either dexmedetomidine (0.7-1.0 μg/kg/h) or fentanyl (6-10 μg/kg/h). The model of rectosigmoid resection in pigs was used. Two combined Laser Doppler flowmetry (LDF) and oxymetry probes were fixed on the antimesenterial site of the rectosigmoid, one orally and the second distally to resection zone. At the end of the experiment all animals were woken up and extubated. The healing of the anastomosis was controlled seven days after the operation. RESULTS: All experimental animals were hemodynamically stable throughout the experiment. No anastomotic leakage was detected. All animals survived until the seventh postoperative day. In the DEX group the median of the LDF signal on aboral site at the end of experiment was 35% (23-49%), in FNT group the median of the LDF signal was 19% (12-28%), which was statistically significantly lower (p < 0,05). CONCLUSIONS: This study has shown some protective effects of dexmedetomidine-isoflurane based anesthesia on perianastomotic microcirculation when compared to fentanyl-isoflurane based anesthesia.
- MeSH
- anastomóza chirurgická metody MeSH
- anestezie metody MeSH
- dexmedetomidin * farmakologie MeSH
- fentanyl * farmakologie MeSH
- kolorektální chirurgie metody MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Autoři prezentují případ 71leté pacientky, která byla operována pro 16 dní trvající bolesti břicha. Práce poukazuje na maligní melanom jako na vzácnou příčinu bolestí břicha a dále na nevyzpytatelnost maligního melanomu, důležitost multidisciplinárního přístupu k tomuto typu onemocnění vč. následné dispenzarizace onkologem. Nedílnou součástí je i důraz na prevenci tohoto onemocnění.
The authors present the case of a 71-year-old female patient who was operated on for 16 days of abdominal pain. The work points to malignant melanoma as a rare cause of abdominal pain and then shows the inscrutability of malignant melanoma and the importance of a multidisciplinary approach to this type of disease including subsequent dispensary by an oncologist. The emphasis on the prevention of this disease is an integral part of this approach.
- MeSH
- bolesti břicha chirurgie diagnostické zobrazování etiologie MeSH
- lidé MeSH
- melanom * komplikace sekundární terapie MeSH
- nádory neznámé primární lokalizace * chirurgie MeSH
- senioři MeSH
- tenké střevo chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
This systematic review aimed to summarize the available data on the treatment of pulmonary contusions with exogenous surfactants, determine whether this treatment benefits patients with severe pulmonary contusions, and evaluate the optimal type of surfactant, method of administration, and drug concentration. Three databases (MEDline, Scopus, and Web of Science) were searched using the following keywords: pulmonary surfactant, surface-active agents, exogenous surfactant, pulmonary contusion, and lung contusion for articles published between 1945 and February 2023, with no language restrictions. Four reviewers independently rated the studies for inclusion, and the other four reviewers resolved conflicts. Of the 100 articles screened, six articles were included in the review. Owing to the limited number of papers on this topic, various types of studies were included (two clinical studies, two experiments, and two case reports). In all the studies, surfactant administration improved the selected ventilation parameters. The most frequently used type of surfactant was Curosurf® in the concentration of 25 mg/kg of ideal body weight. In most studies, the administration of a surfactant by bronchoscopy into the segmental bronchi was the preferable way of administration. In both clinical studies, patients who received surfactants required shorter ventilation times. The administration of exogenous surfactants improved ventilatory parameters and, thus, reduced the need for less aggressive artificial lung ventilation and ventilation days. The animal-derived surfactant Curosurf® seems to be the most suitable substance; however, the ideal concentration remains unclear. The ideal route of administration involves a bronchoscope in the segmental bronchi.
- MeSH
- bronchoskopie metody MeSH
- lidé MeSH
- plicní surfaktanty * aplikace a dávkování terapeutické užití MeSH
- poškození plic * farmakoterapie etiologie MeSH
- syndrom dechové tísně * farmakoterapie etiologie MeSH
- umělé dýchání metody MeSH
- výsledek terapie MeSH
- zhmoždění * farmakoterapie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
OBJECTIVES: Although sarcopenia is recognized as one of the risk factors for increased morbidity after resection for colorectal cancer, the question of the most appropriate way to identify and quantify it is still unresolved. MATERIAL AND METHODS: This is a retrospective unicentric study following patients undergoing elective resection of the rectum for carcinoma with available staging computed tomography (CT) of the trunk. Psoas muscle density (PMD) and its area relative to patient height psoas muscle index (PMI) at the level of inferior vertebral end plate of third lumbar vertebra (L3) were assessed using an initial staging CT scan of the trunk. Post-operative complications, evaluated according to the Clavien-Dindo classification, and blood samples on post-operative days (POD) 3 and 5 were also recorded in the study population. Patients were divided into groups with complicated and uncomplicated post-operative course, and observed parameters were then statistically compared. RESULTS: The correlation of PMI values with the development of post-operative complications was not confirmed in a data set of 206 patients. PMD values were found to be borderline statistically significant in patients with complicated post-operative course, while in the group of patients with severe complications (Clavien-Dindo III-IV), there was no statistically significant difference in PMI or PMD values. The same results were obtained when comparing patients with anastomotic leak (AL). It was confirmed that operations on the lower rectum are riskier for the development of post-operative complications. The secondary objective of our study regarding serum C-reactive protein (CRP) levels of 3rd and 5th POD gave us the answer in the form of cutoff values of 115.7 mg/L (3rd POD) and 76 mg/L (5th POD). CONCLUSION: PMD appears to be a promising tool for predicting post-operative morbidity in patients after rectal resection, but a clear consensus on the method of measurement, interpretation of results and cutoff values is needed. Lower rectal resections are burdened with a higher risk of post-operative complications, especially AL. Monitoring of CRP levels remains an important marker in the prediction of AL due to its negative predictive value.
- Publikační typ
- časopisecké články MeSH
Trombóza ve splanchnické oblasti patří mezi trombózy v tzv. neobvyklé lokalizaci. Řadí se do ní trombóza portální žíly, lienální žíly a mezenterické žíly a dále i Budd-Chiariho syndrom. Příčiny jsou většinou multifaktoriální – jak lokální, tak celkové, nicméně ne vždy se podaří příčinu identifikovat. Tyto trombózy se vyskytují také po břišních operacích. Diagnostická ani terapeutická péče nejsou jednotné, a to i díky relativně vzácné incidenci a chybění cílených doporučení. V práci je retrospektivně analyzován soubor 40 nemocných (15 mužů, 25 žen, medián věku 38 let) se zaměřením na etiologii, léčbu a další sledování nemocných ze dvou krajů naší republiky. Etiologie trombózy byla identifikována u 23 nemocných s převahou nálezu JAK2 V617F mutace. U všech nemocných byla trombóza diagnostikována buď ultrazvukem, nebo angio-CT vyšetřením. Antikoagulační terapie nízkomolekulárním heparinem (LMWH) byla léčbou volby s převodem na warfarin či přímá perorální antikoagulancia (DOAC). Prognóza nemocných závisí na rozsahu a lokalizaci trombózy, její příčině a včasném zahájení léčby.
Splanchnic vein thrombosis is a thrombosis at a so-called unusual site. It includes portal vein thrombosis, mesenteric vein thrombosis, thrombosis of the splenic vein and Budd-Chiari syndrome. Aetiology of thrombosis is usually multifactorial; causes can be systemic or local. However, aetiology sometimes remains unclear. Thrombosis may also occur following abdominal surgery. The management of these patients is not unified, because of the low incidence and absence of specific guidelines. We retrospectively analysed a cohort of 40 patients from two regions of our republic (15 males, 25 females, mean age 38 years) focusing on aetiology, therapy and further management. Aetiology was identified in 21 patients with a predominance of JAK2 V617F mutation. In all cases, thrombosis was objectively detected by Doppler ultrasound or angio-CT. Anticoagulation therapy with low molecular weight heparin (LMWH) was the treatment of choice in all cases, switching to warfarin or direct oral anticoagulants (DOAC). The prognosis of splanchnic vein thrombosis depends on the severity and localisation, aetiology and timely treatment.
- MeSH
- antikoagulancia farmakologie klasifikace terapeutické užití MeSH
- časná diagnóza MeSH
- heparin nízkomolekulární aplikace a dávkování farmakologie terapeutické užití MeSH
- lidé MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- splanchnický oběh * MeSH
- žilní trombóza * diagnóza etiologie farmakoterapie klasifikace MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Klíčová slova
- abdominální katastrofa,
- MeSH
- adheze tkání komplikace MeSH
- břišní dutina * chirurgie MeSH
- drenáž metody MeSH
- laparotomie metody MeSH
- lidé MeSH
- nitrobřišní hypertenze MeSH
- nitrobřišní infekce chirurgie MeSH
- reoperace MeSH
- střevní píštěle MeSH
- syndrom krátkého střeva komplikace MeSH
- techniky open abdomen MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Bochdalek's hernia is the most common congenital malformation of the diaphragm with a defect in its posterolateral part. Its clinical manifestation in adulthood is rare. It is often an incidental finding, and its diagnosis may be challenging. A high index of suspicion is necessary, especially in cases presenting with cardiopulmonary or abdominal symptoms and an ambiguous finding on the initial chest X-ray. We present a case of an asymptomatic 50-year-old male patient with a bulky left-sided Bochdalek's hernia. Surgical treatment was indicated, and a direct suture of the defect after reduction of the herniated greater omentum, transverse colon, and tail of the pancreas was performed from the upper midline laparotomy. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. The management of adult patients with these kinds of hernias in both acute and chronic settings is discussed, and some recommendations are mentioned to minimize unnecessary pitfalls.
- Publikační typ
- kazuistiky MeSH
PURPOSE: We aimed to compare the effects of P-glycoprotein (ABCB1) on the intestinal uptake of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF), and metabolites, tenofovir isoproxil monoester (TEM) and tenofovir (TFV), and to study the molecular mechanism of drug-drug interaction (DDI) between sofosbuvir (SOF) and TDF/TAF. METHODS: Bidirectional transport experiments in Caco-2 cells and accumulation studies in precision-cut intestinal slices prepared from the ileal segment of rodent (rPCIS) and human (hPCIS) intestines were performed. RESULTS: TDF and TAF were extensively metabolised but TAF exhibited greater stability. ABCB1 significantly reduced the intestinal transepithelial transfer and uptake of the TFV(TDF) and TFV(TAF)-equivalents. However, TDF and TAF were absorbed more efficiently than TFV and TEM. SOF did not inhibit intestinal efflux of TDF and TAF or affect intestinal accumulation of TFV(TDF) and TFV(TAF)-equivalents but did significantly increase the proportion of absorbed TDF. CONCLUSIONS: TDF and TAF likely produce comparable concentrations of TFV-equivalents in the portal vein and the extent of permeation is reduced by the activity of ABCB1. DDI on ABCB1 can thus potentially affect TDF and TAF absorption. SOF does not inhibit ABCB1-mediated transport of TDF and TAF but does stabilise TDF, albeit without affecting the quantity of TFV(TDF)-equivalents crossing the intestinal barrier. Our data thus suggest that reported increases in the TFV plasma concentrations in patients treated with SOF and TDF result either from a DDI between SOF and TDF that does not involve ABCB1 or from a DDI involving another drug used in combination therapy.
- MeSH
- adenin metabolismus MeSH
- alanin MeSH
- Caco-2 buňky MeSH
- fumaráty MeSH
- HIV infekce * farmakoterapie MeSH
- látky proti HIV * MeSH
- lidé MeSH
- P-glykoprotein MeSH
- P-glykoproteiny MeSH
- sofosbuvir terapeutické užití MeSH
- tenofovir MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
