Combination of chronic kidney disease (CKD) and heart failure (HF) results in extremely high morbidity and mortality. The current guideline-directed medical therapy is rarely effective and new therapeutic approaches are urgently needed. The study was designed to examine if renal denervation (RDN) will exhibit long-standing beneficial effects on the HF- and CKD-related morbidity and mortality. Fawn-hooded hypertensive rats (FHH) served as a genetic model of CKD and fawn-hooded low-pressure rats (FHL) without CKD served as controls. HF was induced by creation of aorto-caval fistula (ACF). RDN was performed 28 days after creation of ACF and the follow-up period was 70 days. ACF FHH subjected to sham-RDN had survival rate of 34 % i.e. significantly lower than 79 % observed in sham-denervated ACF FHL. RDN did not improve the condition and the final survival rate, both in ACF FHL and in ACF FHH. In FHH basal albuminuria was markedly higher than in FHL, and further increased throughout the study. RDN did not lower albuminuria and did not reduce renal glomerular damage in FHH. In these rats creation of ACF resulted in marked bilateral cardiac hypertrophy and alterations of cardiac connexin-43, however, RDN did not modify any of the cardiac parameters. Our present results further support the notion that kidney damage aggravates the HF-related morbidity and mortality. Moreover, it is clear that in the ACF FHH model of combined CKD and HF, RDN does not exhibit any important renoprotective or cardioprotective effects and does not reduce mortality. Key words Chronic kidney disease, Heart failure, Renal denervation, Fawn-hooded hypertensive rats.
- MeSH
- denervace MeSH
- hypertenze * chirurgie MeSH
- kardiorenální syndrom * etiologie patofyziologie MeSH
- krysa rodu rattus MeSH
- ledviny * inervace MeSH
- modely nemocí na zvířatech MeSH
- srdeční selhání MeSH
- sympatektomie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure. METHODS: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group. RESULTS: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years. CONCLUSION: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.
- MeSH
- dávka záření MeSH
- dospělí MeSH
- fluoroskopie metody MeSH
- ganglion trigeminale chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- neuralgie trigeminu * chirurgie diagnostické zobrazování radioterapie MeSH
- počítačová rentgenová tomografie * metody MeSH
- radiační expozice * prevence a kontrola MeSH
- retrospektivní studie MeSH
- rizotomie * metody MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. PATIENTS/METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. GOV IDENTIFIER: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.
- MeSH
- lidé MeSH
- nervová blokáda * metody MeSH
- novorozenec MeSH
- opioidní analgetika * terapeutické užití MeSH
- pooperační bolest farmakoterapie prevence a kontrola MeSH
- retrospektivní studie MeSH
- rozštěp patra * chirurgie MeSH
- rozštěp rtu * chirurgie MeSH
- svodná anestezie * metody MeSH
- zákroky plastické chirurgie metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions and can be refractory to conventional drug and device interventions. Stellate ganglion blockade (SGB) has been described as an adjunct, temporizing intervention in patients with refractory ventricular arrhythmia. We examined the association of SGB with VT/VF in a multicenter registry. OBJECTIVES: This study examined the efficacy of SGB for treatment/temporization of refractory VT/VF. METHODS: The authors present the first analysis from a multicenter registry of patients treated for refractory ventricular arrhythmia at a clinical site in the Czech Republic and the United States. Data were collected between 2016 and 2022. SGB was performed at the bedside by anesthesiologists and/or cardiologists. Outcomes of interest were VT/VF burden and defibrillations at 24 hours before and after SGB. RESULTS: In total, there were 117 patients with refractory ventricular arrhythmias treated with SGB at Duke (n = 49) and the Institute for Clinical and Experimental Medicine (n = 68). The majority of patients were male (94.0%), were White (87.2%), and had an implantable cardioverter-defibrillator (70.1%). The most common etiology of heart disease was ischemic cardiomyopathy (52.1%), and monomorphic VT was the most common morphology (70.1%). Within 24 hours before SGB (0-24 hours), the median episodes of VT/VF were 7.5 (Q1-Q3: 3.0-27.0), and 24 hours after SGB, the median decreased to 1.0 (Q1-Q3: 0.0-4.5; P < 0.001). At 24 hours before SGB, the median defibrillation events were 2.0 (Q1-Q3: 0.0-8.0), and 24 hours after SGB, the median decreased to 0.0 (Q1-Q3: 0.0-1.0; P < 0.001). CONCLUSIONS: In the largest cohort of patients with treatment-refractory ventricular arrhythmia, we demonstrate that SGB use was associated with a reduction in the ventricular arrhythmia burden and need for defibrillation therapy.
- MeSH
- blokáda autonomních nervů * metody MeSH
- defibrilátory implantabilní MeSH
- dospělí MeSH
- fibrilace komor * terapie MeSH
- ganglion stellatum * MeSH
- komorová tachykardie * terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- registrace MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Spojené státy americké MeSH
The aim was to evaluate the effects of renal denervation (RDN) on autoregulation of renal hemodynamics and the pressure-natriuresis relationship in Ren-2 transgenic rats (TGR) with aorto-caval fistula (ACF)-induced heart failure (HF). RDN was performed one week after creation of ACF or sham-operation. Animals were prepared for evaluation of autoregulatory capacity of renal blood flow (RBF) and glomerular filtration rate (GFR), and of the pressure-natriuresis characteristics after stepwise changes in renal arterial pressure (RAP) induced by aortic clamping. Their basal values of blood pressure and renal function were significantly lower than with innervated sham-operated TGR (p < 0.05 in all cases): mean arterial pressure (MAP) (115 ± 2 vs. 160 ± 3 mmHg), RBF (6.91 ± 0.33 vs. 10.87 ± 0.38 ml.min-1.g-1), urine flow (UF) (11.3 ± 1.79 vs. 43.17 ± 3.24 μl.min-1.g-1) and absolute sodium excretion (UNaV) (1.08 ± 0.27 vs, 6.38 ± 0.76 μmol.min-1.g-1). After denervation ACF TGR showed improved autoregulation of RBF: at lowest RAP level (80 mmHg) the value was higher than in innervated ACF TGR (6.92 ± 0.26 vs. 4.54 ± 0.22 ml.min-1.g-1, p < 0.05). Also, the pressure-natriuresis relationship was markedly improved after RDN: at the RAP of 80 mmHg UF equaled 4.31 ± 0.99 vs. 0.26 ± 0.09 μl.min-1.g-1 recorded in innervated ACF TGR, UNaV was 0.31 ± 0.05 vs. 0.04 ± 0.01 μmol min-1.g-1 (p < 0.05 in all cases). In conclusion, in our model of hypertensive rat with ACF-induced HF, RDN improved autoregulatory capacity of RBF and the pressure-natriuresis relationship when measured at the stage of HF decompensation.
- MeSH
- hodnoty glomerulární filtrace MeSH
- hypertenze * MeSH
- kardiorenální syndrom * MeSH
- krevní tlak MeSH
- krysa rodu rattus MeSH
- ledviny MeSH
- natriuréza MeSH
- píštěle * MeSH
- potkani transgenní MeSH
- renální oběh MeSH
- srdeční selhání * MeSH
- sympatektomie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Renal nerves play a critical role in cardiorenal interactions. Renal denervation (RDN) improved survival in some experimental heart failure (HF) models. It is not known whether these favorable effects are indirect, explainable by a decrease in vascular afterload, or diminished neurohumoral response in the kidneys, or whether RDN procedure per se has direct myocardial effects in the failing heart. To elucidate mechanisms how RDN affects failing heart, we studied load-independent indexes of ventricular function, gene markers of myocardial remodeling, and cardiac sympathetic signaling in HF, induced by chronic volume overload (aorto-caval fistula, ACF) of Ren2 transgenic rats. Volume overload by ACF led to left ventricular (LV) hypertrophy and dysfunction, myocardial remodeling (upregulated Nppa, MYH 7/6 genes), increased renal and circulating norepinephrine (NE), reduced myocardial NE content, increased monoaminoxidase A (MAO-A), ROS production and decreased tyrosine hydroxylase (+) nerve staining. RDN in HF animals decreased congestion in the lungs and the liver, improved load-independent cardiac function (Ees, PRSW, Ees/Ea ratio), without affecting arterial elastance or LV pressure, reduced adverse myocardial remodeling (Myh 7/6, collagen I/III ratio), decreased myocardial MAO-A and inhibited renal neprilysin activity. RDN increased myocardial expression of acetylcholinesterase (Ache) and muscarinic receptors (Chrm2), decreased circulating and renal NE, but increased myocardial NE content, restoring so autonomic control of the heart. These changes likely explain improvements in survival after RDN in this model. The results suggest that RDN has remote, load-independent and favorable intrinsic myocardial effects in the failing heart. RDN therefore could be a useful therapeutic strategy in HF.
- MeSH
- krysa rodu rattus MeSH
- ledviny * inervace metabolismus MeSH
- modely nemocí na zvířatech * MeSH
- myokard * metabolismus MeSH
- noradrenalin * krev metabolismus MeSH
- potkani transgenní * MeSH
- remodelace komor fyziologie MeSH
- srdce inervace patofyziologie MeSH
- srdeční selhání * patofyziologie metabolismus MeSH
- sympatektomie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Cieľ štúdie: Zistiť výhody supraklavikulárnej blokády brachiálneho plexu pri vytváraní artériovenóznych fistúl pre hemodialyzačnú liečbu, porovnanie periférnej nervovej blokády, celkovej anestézie a lokálnej infiltračnej anestézie pri tvorbe artériovenóznych fistúl. Typ štúdie: Prospektívna nerandomizovaná štúdia. Schválená etickou komisiou JLF UK v Martine. Typ pracoviska: Klinické pracovisko univerzitnej nemocnice. Materiál a metóda: Súbor pacientov, ktorým bola vytvorená artériovenózna fistula, bol rozdelený do 3 skupín. Skupina 20 pacientov bola operovaná v periférnej nervovej blokáde, skupina 20 pacientov bola operovaná v lokálnej infiltračnej anestézii a skupina 5 pacientov bola operovaná v celkovej anestézii. Hlavným sledovaným parametrom bola zachovaná funkcia fistuly 24 hodín a 6 týždňov po operácii. Inklúzne kritériá pacientov boli: vek 19–75 rokov, ASA 3–4, hmotnosť 40–120 kg, BMI do 40. Použili sa štatistické metódy: Mannov-Whitneyov U test a exaktný obojstranný test, Shapirov-Wilkov test, Fisherov obojstranný exaktný test, párový Wilcoxonov exaktný obojstranný test. Výsledky: Po 24 hodinách boli funkčné všetky fistuly vytvorené v periférnej nervovej blokáde, 90 % v lokálnej infiltračnej anestézii a 80 % v celkovej anestézii. Nepreukázala sa štatisticky významná závislosť medzi funkčnosťou fistuly a niektorým typom anestézie. Po 6 týždňoch bolo funkčných 80 % fistúl vytvorených v celkovej anestézii alebo periférnej nervovej blokáde a iba 50 % fistúl v lokálnej infiltračnej anestézii. Štatisticky významný rozdiel bol zistený medzi skupinou pacientov operovaných v periférnej nervovej blokáde a lokálnej infiltračnej anestézii, a to v prospech periférnej nervovej blokády (p < 0,05). Záver: Periférna nervová blokáda sa v našej štúdii spájala s lepším prežívaním fistuly oproti lokálnej infiltračnej anestézii. Pri celkovej anestézii bolo prežívanie fistuly porovnateľné ako pri periférnej nervovej blokáde, bola však spojená s vyšším výskytom komplikácií.
Objective: To determine the advantages of supraclavicular blockade of the brachial plexus in the formation of arteriovenous fistulas for hemodialysis treatment. Comparison of peripheral nerve block, general and local infiltration anesthesia in the formation of fistulas. Design: Prospective non-randomized study. Approved by the ethics committee of JLF UK in Martin. Setting: University hospital. Material and methods: Three groups of patients who were created arteriovenous fistula. A group of 20 patients were operated under peripheral nerve block anesthesia, 20 patients were operated under local infiltration anesthesia and 5 patients were operated under general anesthesia. The main monitored parameter was the preserved function of the fistula 24 hours and 6 weeks after the operation. Inclusion criteria: age 19–75 years, ASA 3–4, weight 40–120 kg, BMI up to 40. Statistical methods: Mann-Whitney U test and exact two-tailed test, Shapiro-Wilk test, Fisher's two-tailed exact test, paired Wilcoxon's exact two-tailed test. Results: After 24 hours, all fistulas created under peripheral nerve block anesthesia were functional, 90 % under local infiltration anesthesia and 80 % under general anesthesia. There was no statistically significant dependence between the functionality of the fistula and any type of anesthesia. After 6 weeks, 80 % of fistulas created under general or peripheral nerve block anesthesia and only 50 % of fistulas under local infiltration anesthesia were functional. For peripheral nerve block anesthesia and local infiltration anesthesia, a statistically significant difference was found in favor of peripheral nerve block anesthesia (p < 0.05). Conclusion: Peripheral nerve block anesthesia was associated with better fistula survival compared to local infiltration anesthesia in our study. General anesthesia had fistula survival comparable to peripheral nerve block anesthesia, but was associated with a higher incidence of complications.
- MeSH
- arteriovenózní píštěl * chirurgie MeSH
- blokáda brachiálního plexu * metody MeSH
- celková anestezie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální anestezie MeSH
- nerandomizované kontrolované studie jako téma MeSH
- nervová blokáda metody MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- amiodaron terapeutické užití MeSH
- beta blokátory terapeutické užití MeSH
- biologické markery analýza MeSH
- blokáda autonomních nervů metody MeSH
- defibrilátory implantabilní normy MeSH
- ganglion stellatum účinky léků MeSH
- katetrizační ablace MeSH
- lidé MeSH
- náhlá srdeční smrt * etiologie prevence a kontrola MeSH
- srdeční arytmie etiologie komplikace terapie MeSH
- srdeční selhání * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
AIM: To evaluate the feasibility of ultrasound (US) in identification of nerve lesions after breast cancer surgery in patients with neuropathic pain and assess the effect of a targeted US-guided therapy. MATERIAL AND METHODS: Patients with neuropathic pain after breast cancer surgery underwent US examination. Nerve lesions identified by US were treated by a US-guided application of a mixture of local anesthetics and corticoids. The patients reported pain relief on a 100-point scale (0% = no effect, 100% = complete relief) and its duration in the next 18 months. RESULTS: We performed 17 interventions in 11 women. A neuroma was observed in 2 patients, edema of the nerve in 5 patients, and scarring across the nerve in 4 patients. The affected nerves were the intercostobrachial nerve (5 patients), the long thoracic nerve (4), cutaneous branch of the pectoral nerve (1), and both the intercostobrachial and the long thoracic nerve (1). After 15 (88%) interventions, the patients reported relief (55±32%) with a median duration of 3 months (0.5-18 months). CONCLUSION: In patients after breast cancer surgery, ultrasound can reliably identify small painful neural lesions which can be efficiently treated by ultrasound-guided intervention.
- MeSH
- hrudní stěna * diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- mastektomie škodlivé účinky MeSH
- nádory prsu * diagnostické zobrazování chirurgie MeSH
- nervová blokáda * MeSH
- neuralgie * diagnostické zobrazování farmakoterapie etiologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
