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Scalise E, Costa D, Bolboacă SD, Ielapi N, Bevacqua E, Cristodoro L, Faga T, Michael A, Andreucci M, Bracale UM, Serra R. The role of inflammation biomarkers in carotid artery stenosis procedures. Ann Vasc Surg 2024:S0890-5096(24)00583-1. [PMID: 39343368 DOI: 10.1016/j.avsg.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Carotid revascularization procedures, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can lead to restenosis. Monitoring restenosis onset through biomarkers is crucial in clinical practice. This study aimed to evaluate inflammation biomarkers in CEA and CAS to determine their predictive value for restenosis risk post-procedure. METHODS A retrospective analysis was conducted on the clinical records of patients with carotid stenosis who underwent CEA or CAS over one year at the Vascular Surgery departments of an interuniversity center. Eligible asymptomatic patients with carotid stenosis (70-99%) underwent revascularization. Differences between pre- and early post-procedural inflammation indices were assessed, and restenosis risk was evaluated using Receiver Operating Curve analysis and logistic regression. RESULTS The cohort comprised 100 patients, 68 undergoing CEA and 32 undergoing CAS. Significant values were observed for inflammation ratios post-CEA: neutrophils to lymphocytes ratio (NLR) (p=0.036), platelets to lymphocytes ratio (PLR) (p=0.009), monocytes to lymphocytes ratio (MLR) (p<0.001), systemic inflammation index (SII) (p=0.024), systemic immune response index (SIRI) (p=0.003), and aggregate inflammation response index (AISI) (p<0.001). At 12-month follow-up, 12% of patients experienced restenosis; 50% were men and 50% women. Women showed a higher restenosis rate (26.1% vs 7.8%). Pre-intervention NLR (OR [95% CI] = 13.38 [1.88 to 95.44], p=0.010) and SIRI (OR [95% CI] = 10.22 [2.65 to 39.43], p=0.001) remained significantly associated with restenosis after adjusting for sex and smoking. CONCLUSION The study provided a predictive model for restenosis, identifying pre-intervention NLR and SIRI as independent predictors of restenosis at 12-month follow-up.
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Affiliation(s)
- Enrica Scalise
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Davide Costa
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania. ;.
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Egidio Bevacqua
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Lucia Cristodoro
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Teresa Faga
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Ashour Michael
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | | | - Raffaele Serra
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
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Abdelgawad E, Kadry AM, Abdelhalim KM, Abdelwahab HA. Optimization of the outcome of percutaneous nephrolithotomy regarding urinary leakage, what should we do? Urolithiasis 2022; 51:8. [PMID: 36459230 PMCID: PMC9718711 DOI: 10.1007/s00240-022-01375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
To evaluate the factors affecting urinary leakage post percutaneous nephrolithotomy. To define those at high risk in whom a double J stent for 4 weeks or external ureteral catheter fixation for at least 3 days is indicated at the end of procedure. A total of 140 patients who underwent single-stage Percutaneous Nephrolithotomy (PCNL) with single or multiple accesses were included between February 2014 and March 2019. A detailed history, laboratory and radiological investigations were performed on all patients. All patients were classified according to postoperative urinary leakage into three groups. We defined leakage as a leakage from percutaneous puncture site. Group 1 (90 patients), No leakage was defined as leakage < 12 hours. In group 2 (32 patients), short-term leakage was defined as leakage 12-48 hours, and in Group 3 (18 patients), prolonged urinary leakage > 48 hours. Patients with short-term and prolonged urinary leakage had a significantly shorter access tract. Most patients (93.8%) with short-term leakage had an access tract of 71-90 mm, while > 50% of patients (55.6) with prolonged leakage had an access tract of 51-70 mm (p <0.001). Multivariate ordinal regression revealed that Operative time, length of the access tract and parenchymal thicknesses significantly predict short-term and prolonged leakage. For predicting the prolonged urinary leakage, the length of access tract and parenchymalthickness showed significant areas under the curve (AUC); 78% (95% CI: 69 - 85, p = 0.002) and 94% (95% CI: 87 - 97, p <0.001), respectively. Operative time, length of the access tract and parenchymal thickness significantly predict short-term and prolonged leakage.
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Affiliation(s)
- Esam Abdelgawad
- Urology Department, Faculty of Medicine, Suez Canal University Hospital, Round Rood, Ismailia, 41111, Egypt.
| | - Ahmed M Kadry
- Urology Department, Faculty of Medicine, Suez Canal University Hospital, Round Rood, Ismailia, 41111, Egypt
| | - Khaled M Abdelhalim
- Urology Department, Faculty of Medicine, Suez Canal University Hospital, Round Rood, Ismailia, 41111, Egypt
| | - Hassan A Abdelwahab
- Urology Department, Faculty of Medicine, Suez Canal University Hospital, Round Rood, Ismailia, 41111, Egypt
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Zhang K, Mao T, He Z, Wu X, Peng Y, Chen Y, Dong Y, Ruan Z, Wang Z. WITHDRAWN: Diagnostic performance of MASP-2 in the diagnosis of colorectal carcinoma. Pathol Res Pract 2020:153278. [PMID: 33549364 DOI: 10.1016/j.prp.2020.153278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The publisher regrets that an error occurred which led to the premature publication of this paper. The publisher apologizes to the authors and the readers for this unfortunate error.
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Affiliation(s)
- Keqian Zhang
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Tianqi Mao
- Department of Radiology Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Zhicheng He
- Department of Pathology, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Xiaojiao Wu
- Quality Management Section, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yu Peng
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yanrong Chen
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yan Dong
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Zhihua Ruan
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Zhe Wang
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
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El-Deeb A, El-Morsy GZ, Ghanem AAA, Elsharkawy AA, Elmetwally AS. The effects of intravenous lidocaine infusion on hospital stay after major abdominal pediatric surgery. A randomized double-blinded study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alaa El-Deeb
- Department of Anesthesiology, Faculty of Medicine , Mansoura University , Egypt
| | - Gamal Z. El-Morsy
- Department of Anesthesiology, Faculty of Medicine , Mansoura University , Egypt
| | - Abdel Aziz A. Ghanem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine , Mansoura University , Egypt
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Sichani MM, Babaeian M, Haghdani S, Alizadeh F, Mazdak H, Hadi M, Khorrami M. Is it Necessary to Perform Nephrostography before Tube Removal after Percutaneous Nephrolithotomy. Adv Biomed Res 2017; 6:35. [PMID: 28516069 PMCID: PMC5385698 DOI: 10.4103/2277-9175.203160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of this study is the caparison of the complications rate among the patients which underwent nephrostomy removal with and without performing nephrostography. MATERIALS AND METHODS Between October 2010 and November 2011, 200 patients who underwent standard percutaneous nephrolithotomy (PCNL) procedures were included in this study. The patients were randomly assigned into two groups, Group A (n = 100) did not undergo the antegrade nephrostography on postoperative day 2 and the patients were discharged keeping the nephrostomy until postoperative day 3, while in Group B (n = 100) the nephrostomy tube was removed on postoperative day 3 after antegrade nephrostography demonstrating ureteral drainage down to the bladder. Postoperative complications in both groups were recorded and compared between two groups. RESULTS A total of 200 patients were treated with standard PCNL. The persistent leakage of urine after removal of the nephrostomy tube was encountered in 5 (5.0%) and 3 (3%) of patients in Groups 1 and 2, respectively. Urinary leakage was resolved with conservative management in 3 and 2 patients of Groups 1 and 2, respectively, but a double-J stent was inserted in 2 and 1 patients in each group because of persistent leakage of urine more than 1-week. The two groups show comparable complications such as prolonged urinary leakage which managed in a similar manner, however, postoperative hospital stay was lesser in Group 1. CONCLUSION Our results revealed postoperative performing nephrostogramy before tube removal changed the planning of complications such as prolonged urinary leakage and could be omitted in cases.
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Affiliation(s)
- Mehrdad Mohammadi Sichani
- Department of Urology, Isfahan Kidney Transplantaion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masih Babaeian
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Haghdani
- Department of Urology, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Alizadeh
- Department of Urology, Isfahan Kidney Transplantaion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Mazdak
- Department of Urology, Isfahan Kidney Transplantaion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mazaher Hadi
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadhatef Khorrami
- Department of Urology, Isfahan Kidney Transplantaion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Lee U, Choi YJ, Choi GJ, Kang H. Intravenous lidocaine for effective pain relief after bimaxillary surgery. Clin Oral Investig 2017; 21:2645-2652. [PMID: 28168381 DOI: 10.1007/s00784-017-2066-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the analgesic effect of intravenous lidocaine on postoperative pain in bimaxillary surgery. MATERIALS AND METHODS Between July 2015 and November 2015, 52 consecutive patients that underwent bimaxillary surgery were recruited to the present study. The patients were randomly divided into two groups: group L (1.5 mg/kg bolus and 2 mg/kg/h continuous infusion during the operation) and group C (normal saline). To measure pain intensity, a visual analog scale (VAS) was used at 2, 4, 8, 12, 24, and 48 h after surgery. Rescue ketorolac use was measured in the first 4, 4-8, 8-24, and 24-48 h after surgery. Total ketorolac consumption (the sum of rescue and eight-hourly fixed schedule ketorolac injection), WBC count, neutrophil count, and postoperative swelling were recorded. RESULTS There were no significant differences between the two groups with respect to demographics. VAS pain scores were significantly lower in group L compared with group C up to 8 h after surgery. Rescue ketorolac use up to 8 h after surgery and total ketorolac consumption were significantly lower in group L than in group C. Postoperative WBC and neutrophil counts were significantly decreased in group L. Compared with group C, the amount of calibrated postoperative swelling was lower in group L. CONCLUSIONS Systemic lidocaine infusion during bimaxillary surgery reduces postoperative pain, analgesic consumption, and facial swelling. CLINICAL RELEVANCE Systemic lidocaine is simple, economic, and a safe procedure reducing pain and soft tissue swelling after bimaxillary surgery.
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Affiliation(s)
- Uilyong Lee
- Department of Oral and Maxillofacial Surgery, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06911, Republic of Korea
| | - Young-Jun Choi
- Department of Oral and Maxillofacial Surgery, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06911, Republic of Korea
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06911, Republic of Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06911, Republic of Korea.
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Kim TH, Kang H, Choi YS, Park JM, Chi KC, Shin HY, Hong JH. Pre- and Intraoperative Lidocaine Injection for Preemptive Analgesics in Laparoscopic Gastrectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. J Laparoendosc Adv Surg Tech A 2013; 23:663-8. [DOI: 10.1089/lap.2012.0542] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tae Han Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joong Min Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyong Choun Chi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hwa Yong Shin
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joon Hwa Hong
- Thoracic and Cardiovascular Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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STAR VaS--Short Term Atorvastatin Regime for Vasculopathic Subjects: a randomized placebo-controlled trial evaluating perioperative atorvastatin therapy in noncardiac surgery. Can J Anaesth 2012; 59:527-37. [PMID: 22528165 DOI: 10.1007/s12630-012-9702-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Evidence suggests that statins reduce cardiovascular complications in patients undergoing noncardiac surgery, although questions remain regarding the mechanism of benefit and the preferred dosing strategy. In this trial, we evaluated the perioperative effects on C-reactive protein (CRP) that resulted from starting atorvastatin within seven days of noncardiac surgery. The objective was to identify anti-inflammatory effects of atorvastatin prior to conducting a large randomized trial with clinical end points. METHODS In a single centre, parallel group, placebo-controlled trial, sixty high cardiac risk participants over age 45 yr undergoing noncardiac surgery were assigned randomly to one of three groups to receive atorvastatin 80 mg (A) and/or placebo (P). Group AA (n = 26) received atorvastatin seven days before surgery, the day of surgery, and for seven days post surgery. Group PA (n = 17) received placebo seven days before surgery, atorvastatin on the day of surgery, and atorvastatin for seven days post surgery. Group PP (n = 17) received placebo at all times. All participants, health care professionals, research assistants, and outcome adjudicators were masked to treatment allocation. Analyses were by intention to treat. The primary outcome was the C-reactive protein level at 48 hr. RESULTS Fifty-six participants completed the 30-day follow-up. The mean (standard deviation) changes in CRP levels from baseline at 48 hr in Groups AA, PA, and PP were 141.0 (72.4), 153.5 (42.2), and 111.2 (84.6), respectively. The mean differences (95% confidence interval) at 48 hr for AA vs PA, AA vs PP, and PA vs PP were: -20.1 (-81.2 to 41.1), 22.7 (-31.7 to 77.2), and 42.8 (-20.0 to 105.7), respectively, adjusting for baseline CRP, type of procedure, presence of coronary artery disease, use of medications, and for multiple comparisons using Tukey's method. CONCLUSIONS Administration of atorvastatin, initiated within seven days preoperatively, was not associated with clinically significant reductions in CRP levels.
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Binbay M, Sari E, Tepeler A, Erbin A, Savas O, Muslumanoglu AY, Tefekli A. Characteristics of patients requiring Double-J placement because of urine leakage after percutaneous nephrolithotomy. J Endourol 2010; 23:1945-9. [PMID: 19821693 DOI: 10.1089/end.2009.0154] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Prolonged urine leakage (PUL) from the percutaneous tract after percutaneous nephrolithotomy is a major complication that necessitates the placement of a urethral Double-J stent. We analyzed the characteristics of patients who had this complication to find out its risk factors. PATIENTS AND METHODS During a 6-year period, 1407 standard percutaneous nephrolithotomy procedures were performed at our institution. Medical charts were reviewed focusing on the patients who required Double-J placement because of PUL from the percutaneous tract for more than 24 hours after removal of the nephrostomy tube. A total of 81 patients in whom a Double-J stent was placed because of ureteropelvic injury or pelvicaliceal extravasation or as a part of percutaneous endopyelotomy were excluded from the study. Factors that are considered to have an impact on this untoward event were analyzed and compared. RESULTS Double-J stent was placed in a total of 57 (4.3%) patients who were found to have PUL. Stone size was significantly larger in the stented group (10.0 +/- 5.6 cm(2) vs. 7.8 +/- 5.3 cm(2)). The stones were classified as complex in 68.4% of patients in the stented group and in 53.4% of patients in the nonstented group, and this difference was also statistically significant. Stone-free rate was significantly higher in the nonstented group (p < 0.05). Residual stone and additional treatment rates were statistically higher in the stented group (p < 0.05). Access number and location as well as per-operative bleeding were not predictive factors for PUL development. CONCLUSION The necessity for Double-J placement due to PUL from the percutaneous tract, diminishes with increase in stone-free rates. Stone size and stone complexity are other predictive factors for PUL development.
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Affiliation(s)
- Murat Binbay
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
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Editorial Comment. J Endourol 2009:110306124715065. [PMID: 19899958 DOI: 10.1089/end.2009.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aghamir SMK, Mojtahedzadeh M, Meysamie A, Atharikia D, Izadpanah F, Sheikhvatan M. Comparison of Systemic Stress Responses Between Percutaneous Nephrolithotomy (PCNL) and Open Nephrolithotomy. J Endourol 2008; 22:2495-500. [PMID: 19046089 DOI: 10.1089/end.2008.0319] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mojtaba Mojtahedzadeh
- Department of Anesthesiology and Pharmacotherapy, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alipasha Meysamie
- Department of Epidemiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Atharikia
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Izadpanah
- Department of Anesthesiology and Pharmacotherapy, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Wang X, Zhang XF. Enflurane requirement for blocking adrenergic responses to incision in infants and children. World J Pediatr 2008; 4:49-52. [PMID: 18402253 DOI: 10.1007/s12519-008-0010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Enflurane is one of the most commonly used inhaled anesthetics in China, but its requirement to block adrenergic responses after skin incision in pediatric patients is still unknown. This study was to determine the minimum alveolar anesthetic concentration (MAC) of potent inhaled anesthetics required to blunt the adrenergic response to skin incision of enflurane (MACBAR) in infants and children. METHODS Twenty-eight patients, 10 infants (6-12 months) and 18 young children (1-6 years), were studied. The 18 children were randomly assigned into two groups, with or without fentanyl. Anesthesia was induced with 3 mg/kg propofol and 0.15 mg/kg vecuronium, and maintained with enflurane in 100% oxygen. Fentanyl (3 microg/kg) was given intravenously 5 minutes before incision for the patients of fentanyl group. The "up and down" method (with 0.3 MAC as a step size and 1 MAC as the start dose) was applied to determine MACBAR. The response was considered positive if the mean arterial pressure (MAP) or heart rate (HR) increased > or =15% after incision. The MACBAR was calculated as the mean of four independent cross-over responses in each group. RESULTS MACBAR of enflurane in children of 1-6 years old was 3.2% (95% CI, 2.8%-3.6%) and was reduced to 2.2% (95% CI, 1.8%-2.5%) by 3 microg/kg fentanyl. In infants of 6-12 months old, the MACBAR of enflurane was 3.4% (95% CI, 3.0%-3.8%). CONCLUSIONS MACBAR of enflurane in infants older than 6 months is similar to that in young children. The MACBAR of enflurane decreases with co-administration of fentanyl in the pediatric population.
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Affiliation(s)
- Xuan Wang
- Department ofAnesthesiology, Children's Hospital of Fudan University, 183 Fenglin Road, Shanghai 200032, China.
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Herroeder S, Pecher S, Schönherr ME, Kaulitz G, Hahnenkamp K, Friess H, Böttiger BW, Bauer H, Dijkgraaf MGW, Dijkgraaf OGW, Durieux ME, Hollmann MW. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 2007; 246:192-200. [PMID: 17667496 PMCID: PMC1933564 DOI: 10.1097/sla.0b013e31805dac11] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To characterize the beneficial effects of perioperative systemic lidocaine on length of hospital stay, gastrointestinal motility, and the inflammatory response after colorectal surgery. SUMMARY BACKGROUND DATA Surgery-induced stimulation of the inflammatory response plays a major role in the development of several postoperative disorders. Local anesthetics possess anti-inflammatory activity and are thought to positively affect patients' outcome after surgery. This double-blinded, randomized, and placebo-controlled trial aimed to evaluate beneficial effects of systemic lidocaine and to provide insights into underlying mechanisms. METHODS Sixty patients undergoing colorectal surgery, not willing or unable to receive an epidural catheter, were randomly assigned to lidocaine or placebo treatment. Before induction of general anesthesia, an intravenous lidocaine bolus (1.5 mg/kg) was administered followed by a continuous lidocaine infusion (2 mg/min) until 4 hours postoperatively. Length of hospital stay, gastrointestinal motility, and pain scores were recorded and plasma levels or expression of pro- and anti-inflammatory mediators determined. RESULTS Lidocaine significantly accelerated return of bowel function and shortened length of hospital stay by one day. No difference could be observed in daily pain ratings. Elevated plasma levels of IL-6, IL-8, complement C3a, and IL-1ra as well as expression of CD11b, L- and P-selectin, and platelet-leukocyte aggregates were significantly attenuated by systemic lidocaine. CONCLUSIONS Perioperative intravenous lidocaine not only improved gastrointestinal motility but also shortened length of hospital stay significantly. Anti-inflammatory activity modulating the surgery-induced stress response may be one potential mechanism. Systemic lidocaine may thus provide a convenient and inexpensive approach to improve outcome for patients not suitable for epidural anesthesia.
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Affiliation(s)
- Susanne Herroeder
- Laboratory of Experimental Intensive Care & Anesthesiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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Ytting H, Christensen IJ, Basse L, Lykke J, Thiel S, Jensenius JC, Nielsen HJ. Influence of major surgery on the mannan-binding lectin pathway of innate immunity. Clin Exp Immunol 2006; 144:239-46. [PMID: 16634797 PMCID: PMC1809648 DOI: 10.1111/j.1365-2249.2006.03068.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The mannan-binding lectin (MBL) pathway of complement activation is important in host defence against pathogens and possibly against cancer. We investigated the effect of major surgery on two central components of the MBL pathway; MBL and the MBL-associated serine protease MASP-2, and for comparison also measured the interleukin (IL)-6 and C-reactive protein (CRP) levels. Serial blood samples were obtained from patients belonging to two different cohorts. Cohort 1 comprised 60 patients undergoing open or laparoscopic colectomy for benign disease (n = 12) or colon cancer (n = 48). Cohort 2 comprised 27 patients undergoing elective, open surgery for colorectal cancer, and was included in order to cover blood sampling between days 2 and 6. As expected, the surgical stress induced a marked acute phase response, as evidenced by a large increase in IL-6 (18-fold) and CRP (13-fold) levels with maximum at 12 h and 2 days, respectively. However, in both cohorts the levels of MBL and MBL-associated serine protease 2 (MASP-2) were largely unaffected, except for a minor but significant increase around day 8 in cohort 1. The preoperative levels of IL-6 and CRP were correlated significantly in both cohorts (r = 0.71, P < 0.0001 and r = 0.65, P = 0.005, respectively). Preoperative MASP-2 correlated with preoperative CRP (r = 0.59, P = 0.001) and IL-6 (r = 0.55, P = 0.02) in cohort 2 only. In contrast to the marked effects on the levels of IL-6 and CRP, the surgery influenced only marginally the two proteins of the MBL pathway.
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Affiliation(s)
- H Ytting
- Department of Surgical Gastroenterology 435, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
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Ytting H, Christensen IJ, Thiel S, Jensenius JC, Nielsen HJ. Serum mannan-binding lectin-associated serine protease 2 levels in colorectal cancer: relation to recurrence and mortality. Clin Cancer Res 2005; 11:1441-6. [PMID: 15746044 DOI: 10.1158/1078-0432.ccr-04-1272] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Mannan-binding lectin-associated serine protease 2 (MASP-2) is a plasma protein involved in inflammatory processes. MASP-2 circulates in complex with the protein mannan-binding lectin (MBL) or ficolins, and is activated to recruit the complement system when MBL binds to its targets. The level of MASP-2 is genetically determined, and the aim of the present study was to evaluate the effect of MASP-2 levels on postoperative infection, recurrence and survival. EXPERIMENTAL DESIGN MASP-2 concentrations were determined in serum from 605 patients collected before elective resection for primary colorectal cancer. The primary end points were postoperative infection, time to any recurrence, and time to death. The median time of follow-up was 7.9 years. RESULTS MASP-2 levels were not correlated to postoperative infections (P = 0.49). High MASP-2 levels significantly correlated with recurrent cancer disease [P = 0.03; hazard ratio (HR) = 1.4; 95% confidence interval (CI), 1.0-2.0] and with poor survival (P = 0.0005; HR = 1.4; 95% CI, 1.2-1.7). Multivariate statistical analysis, including age, gender, Dukes' stage of disease, tumor localization, and postoperative pneumonia, showed that the MASP-2 level had an independent prognostic value in the patients (P = 0.0001; HR = 1.5; 95% CI, 1.2-1.8). CONCLUSION In the cohort of patients with colorectal cancer investigated, MASP-2 concentration in serum proved to be an independent prognostic marker with high MASP-2 levels predicting recurrence and poor survival. Postoperative infection could not be shown to be associated with MASP-2 levels.
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Affiliation(s)
- Henriette Ytting
- Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
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Ytting H, Christensen IJ, Jensenius JC, Thiel S, Nielsen HJ. Preoperative mannan-binding lectin pathway and prognosis in colorectal cancer. Cancer Immunol Immunother 2005; 54:265-72. [PMID: 15449036 PMCID: PMC11034352 DOI: 10.1007/s00262-004-0594-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Accepted: 07/09/2004] [Indexed: 12/24/2022]
Abstract
PURPOSE Deficiency of the mannan-binding lectin (MBL) pathway of innate immunity is associated with increased susceptibility to infections. In patients with colorectal cancer (CRC), postoperative infection is associated with poor prognosis. The aim of the present study was to evaluate (1) the relation between the MBL pathway and postoperative infectious complications and survival of patients resected for CRC, and (2) the role of MBL in acute phase response compared to C-reactive protein (CRP). METHODS Preoperative MBL concentration, MBL-associated serine protease (MBL/MASP) activity and CRP were determined in serum from 611 patients and 150 healthy controls. The patients were observed for 8 years. Postoperative infections, recurrence and survival were recorded. RESULTS The MBL pathway components were increased in the patients compared with the healthy controls (p < 0.0001). Low MBL levels were predictive of pneumonia (p = 0.01), and pneumonia (n = 87) was associated with poor survival (p = 0.003; HR = 1.5; 95% CI, 1.1 to 1.9). MBL and MBL/MASP activity showed no correlation with CRP (Spearman's rho = 0.02; 95% CI, -0.06 to 0.10). CONCLUSION Low preoperative MBL levels are predictive of pneumonia, which is associated with poorer survival. MBL concentration and MBL/MASP activity was not predictive of other postoperative infections or long-term prognosis, and showed no correlation with CRP.
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Affiliation(s)
- Henriette Ytting
- Department of Surgical Gastroenterology 435, Hvidovre University Hospital, Kettegard Allé 30, 2650 Hvidovre, Denmark.
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Abstract
The following article summarizes different aspects of local anesthetic effects that cannot be explained purely by a sodium channel blockade. Particularly remarkable is hereby their antiinflammatory activity, e.g. the inhibition of pathological changes such as excessive stimulation of the inflammatory system, without compromising the host defense system. In contrast to other immunosuppressive drugs commonly used for treating such conditions, local anesthetics look promising for the future as a new therapeutic option. Besides general anesthetic activity, local anesthetics exert cerebroprotective effects and are furthermore, in consideration of their cardiovascular stability, of interest during neuroanesthetic procedures. In addition, local anesthetics are known for their potency to minimize bronchial hyperreactivity, although details of the underlying mechanisms are not yet elucidated. These effects of local anesthetics may represent interesting prospects for which their relevance has to be determined.
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Affiliation(s)
- S Pecher
- Universitätsklinik für Anaesthesiologie, Universität Heidelberg
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