Mini-laparotomy radical cystectomy with limited bowel externalization during ileal conduit urinary diversion reduces the rate of postoperative complications: a match-paired, single centered analysis

OBJECTIVE

To assess the feasibility and functional outcomes of mini-laparotomy radical cystectomy (RC) in association with limited bowel externalization during ileal conduit urinary diversion.

METHODS

Between January 2018 and March 2020, 53 patients underwent RC plus pelvic lymph node dissection (PLND) for invasive carcinoma of the urinary bladder. This group of patients was intentionally treated utilizing the mini-laparotomy approach, with the addition of limited bowel externalization during conduit preparation and match-paired with 46 examinees from a historical series of patients who underwent conventional open RC plus PLND and ileal conduit diversion. Clinicopathological features and perioperative outcomes were examined from medical records, while postoperative pain was evaluated through the Visual Analog Scale for Pain (VAS). Mean pain scores were evaluated on postoperative days (POD) 1-3.

RESULTS

There was no difference in specific intraoperative complications between groups, with a median (range) incision length of 8 (5-10) cm within the first group and 16.3 (12-22.6) cm within the second group. The first group had less postoperative pain compared with patients in the second group, with mean pain scores significantly lower across POD 1-3, 3.8 (IQR: 0-6) versus 6.7 (IQR: 3.8-8.1) and 2.5 (IQR: 1-3.7) versus 4.6 (IQR: 3-6), respectively (p = .012 and .002).

CONCLUSIONS

By using this technique, we were able to significantly reduce patients' postoperative pain, time to bowel restitution, and hospital stay, which are major issues in minimizing short-term postoperative complications of conventional open surgery.

Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate

OBJECTIVE

We aimed to establish the reliability of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder.

MATERIALS AND METHODS

A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were compared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system.

RESULTS

Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leakage rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03).

CONCLUSION

Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower incidence of postoperative complications in Wallace group.

Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients

OBJECTIVE

To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy.

MATERIALS AND METHODS

Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency.

RESULTS

Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery.

CONCLUSIONS

The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.

Modelling youth entrepreneurship intentions: A ten-year research

Entrepreneurship can have a crucial role in economic development. Youth entrepreneurship has even a greater role in economic growth. The underlying issues are the high youth unemployment rates in developing but also in developed countries as well. Improving the entrepreneurial climate and providing a “fertile” ground for venture creation is almost an imperative for increasing the number of young entrepreneurs and the number of entrepreneurs overall. In this paper, the results of an extensive, cross-sectional study conducted over ten-years, are presented. The study includes 5670 respondents - high school and university students from Serbia. The goal was to determine the predictors of youth entrepreneurship intentions in the domain of venture creation.

AB1130 LOCALIZATION OF MRI INFLAMMATORY LESIONS OF THE HAND IN SCLERODERMA AND RHEUMATOID ARTHRITIS - COMPARATIVE STUDY

Background:

Inflammatory lesions of hand are frquent clinical feature in rheumatoid artritis (RA), with lower frequency in pts with systemic sclerosis (SSc), also. MR is useful method for detecting and quantification of inflammatory lesion of the hand (bone oedema, erosions, synovitis) in RA and SSc.

Objectives:

The aim of the study was to compare MR hand feature in SSc (experimental) and RA (control group) and to detect the localisation of the highest OMERACT RAMRISinflammatory score on the hand in pts with SSc and RA

Methods:

110 pts with SSc and 60 with RA were investigated (mean age 53y). All the pts underwenr clinical examination, X ray and MR on the dominant hand and wrist. Contrast enhanced low field MRI of the wrist and MCP2-5 joints was performend to all the pts. MRI inflammatory changes (bone oedema,erosions, synovitis)were assessed and scored by OMERACT RAMRIS scoring system.

Results:

Clinical examination confirmed synovitis in 17.1%, and 78% of patients with SSc using MR I (p <0.001). In the SSc group, erosions (by MR method) was confirmed in 52 (63.4%), by radiography in 22 pts (27.5%), which is a significantly lower percentage (p <0.001). In the control RA group, erosion was confirmed in 34 (97.1%) by MR method, and by radiography in 6 (17.1%), which is a statistically significant difference (p <0.001). Mean values of total MR score of synovitis (2.69 ± 2.29: 4.37 ± 1.31), oedema (6.58 ± 10.89: 20.57 ± 10.23) and erosion (6.84 ± 7, 43: 18.60 ± 5.01) on the wrist of the dominant hand were significantly higher in subjects with control RA than in those in the experimental SSc (p < 0.001). Mean values of total MR score of synovitis (3.15 ± 2.95: 5.26 ± 2.09), oedema (3.99 ± 9.82: 10, 51 ± 7.90) and erosion (4, 04 ± 4.76: 9.69 ± 4.27) on the MCP joints of the dominant hand were significantly higher in the control RA subjects (p <0.001).The highest OMERACR RAMRIS synovitis score was on distal radioulnar (DRU joint) of hand in SSc and also In RA pts. The highest erosion score was found on capitate bone in SSc, but in lunate bone in RA pts. The highest bone oedema score was also found on capitate bone in SSc, but in lunate bone in RA pts. According to the MCP joints, the highest synovitis score was found on the second finger in SSc and RA, highest erosion score also on the second finger in SSc, but on the third finger in RA; The highest bone oedema score was found on the third finger in SSc, and olso on the third and fifth finger in RA pts

Conclusion:

MR inflammatory lesions in SSc are less frequent compared to that in RA but still in significant percentage, confirming the need for early detection and aggressive treatment of both, RA and SSc patients with joint involvement

References:

[1]Avouac J, Walker UA, Hachulla E, Riemekasten G, Cuomo G, Carreira PE, et al. Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. Annals of the rheumatic diseases. 2016;75(1):103–9.

[2]Abdel-Magied RA, Lotfi A, AbdelGawad EA. Magnetic resonance imaging versus musculoskeletal ultrasonography in detecting inflammatory arthropathy in systemic sclerosis patients with hand arthralgia. Rheumatology international. 2013;33(8):1961–6.doi:10.1007/s00296-013-2665-8.

Disclosure of Interests:

None declared

Double-blind, randomised, placebo-controlled trial on the effect of L-carnitine and L-acetylcarnitine on sperm parameters in men with idiopathic oligoasthenozoospermia

Carnitine is essential for energy metabolism and spermatozoa maturation. Combining L-carnitine and L-acetylcarnitine with micronutrients has been investigated as a treatment for infertility in men. We evaluated the effects of a therapeutic formulation, Proxeed Plus, on sperm parameters in oligoasthenozoospermic men. This prospective, randomised, double-blind, placebo-controlled clinical trial involved 175 males (19-44 years) with idiopathic oligoasthenozoospermia who failed to impregnate their partners (12 months). Males received Proxeed Plus or placebo for 3 and 6 months. Sperm volume, progressive motility and vitality significantly (p < 0.001) improved after 6 months compared to baseline. Sperm DNA fragmentation index significantly decreased compared to baseline (p < 0.001) and the 3-month therapy (p = 0.014) in treated men. Increased seminal carnitine and α-glucosidase concentration also positively correlated with improved progressive motility. Decreased DNA fragmentation index was the good predictor of progressive sperm motility >10%, and simultaneous measurement of changes in sperm vitality and DNA fragmentation index gave the highest probability of sperm motility 10% (AUC = 0.924; 95% CI = 0.852-0.996; p < 0.001). Logistic regression analyses revealed DNA fragmentation index decrease as the only independent predictor of sperm motility 10% (OR = 1.106; p = 0.034). We have demonstrated the beneficial effects of carnitine derivatives on progressive motility, vitality and sperm DNA fragmentation. Combining metabolic and micronutritive factors is beneficial for male infertility.

Double-blind, randomised, placebo-controlled trial on the effect of L-carnitine and L-acetylcarnitine on sperm parameters in men with idiopathic oligoasthenozoospermia

Carnitine is essential for energy metabolism and spermatozoa maturation. Combining L-carnitine and L-acetylcarnitine with micronutrients has been investigated as a treatment for infertility in men. We evaluated the effects of a therapeutic formulation, Proxeed Plus, on sperm parameters in oligoasthenozoospermic men. This prospective, randomised, double-blind, placebo-controlled clinical trial involved 175 males (19-44 years) with idiopathic oligoasthenozoospermia who failed to impregnate their partners (12 months). Males received Proxeed Plus or placebo for 3 and 6 months. Sperm volume, progressive motility and vitality significantly (p < 0.001) improved after 6 months compared to baseline. Sperm DNA fragmentation index significantly decreased compared to baseline (p < 0.001) and the 3-month therapy (p = 0.014) in treated men. Increased seminal carnitine and α-glucosidase concentration also positively correlated with improved progressive motility. Decreased DNA fragmentation index was the good predictor of progressive sperm motility >10%, and simultaneous measurement of changes in sperm vitality and DNA fragmentation index gave the highest probability of sperm motility 10% (AUC = 0.924; 95% CI = 0.852-0.996; p < 0.001). Logistic regression analyses revealed DNA fragmentation index decrease as the only independent predictor of sperm motility 10% (OR = 1.106; p = 0.034). We have demonstrated the beneficial effects of carnitine derivatives on progressive motility, vitality and sperm DNA fragmentation. Combining metabolic and micronutritive factors is beneficial for male infertility.

Predictive value of [-2]propsa (p2psa) and its derivatives for the prostate cancer detection in the 2.0 to 10.0ng/mL PSA range

Introduction

To assess predictive value of new tumor markers, precursor of prostate specific antigen (p2PSA) and its derivates-%p2PSA and prostate health index (PHI) in detection of patients with indolent and aggressive prostate cancer (PC) in a subcohort of man whose total PSA ranged from 2 to 10ng/mL.

Materials and Methods

This cross-sectional study included 129 consecutive male patients aged over 50 years, with no previous history of PC and with normal digital rectal examination findings, but with serum PSA in interval between 2 and 10ng/mL. All patients underwent standard transrectal ultrasonography guided prostate biopsy for the first time. For all patients, serum PSA, free PSA (fPSA) and p2PSA were measured and PHI and %p2PSA were calculated.

Results

PHI and %p2PSA levels were significanlty higher in patients with PC compared to those without this malignancy. The same findings have been observed in group of patients with Gleason score ≥7 compared to those with Gleason score <7. ROC analysis reveled the highest area under the curve with these two markers. Multivariate logistic regression showed significant improvement in PC detection and its agressive form (assumed as Gleason score ≥7).

Conclusions

New markers, derivates of p2PSA (especially %p2PSA and PHI), represente potentially very important clinical tool for predicting presence of PC, and even more important, to discriminate patients with Gleason score <7 from those with Gleason score ≥7 with total PSA in range from 2 to 10ng/mL.

Overtraining does not induce oxidative stress and inflammation in blood and heart of rats

The aim of our research was to evaluate the changes in levels of cytokines and redox state parameters in blood and isolated heart of rats subjected to different swimming protocols. Rats were divided into 3 groups: 1) controls, 2) moderately trained rats that during all 12 weeks swam 1 h/day, 5 days/week, and 3) overtrained rats that in 10(th) week swam twice, 11(th) week 3 times, and in 12(th) week 4 times a day for 1 h. After sacrificing, blood from jugular vein was collected, and the heart excised and perfused on a Langendorff apparatus. Samples of the coronary effluent were collected during coronary autoregulation. Levels of superoxide anion radical (O(2)(-)), hydrogen peroxide (H(2)O(2)), nitric oxide (NO) and thiobarbituric acid reactive substances (TBARS) were measured in plasma and coronary effluent, while reduced glutathione (GSH), activities of superoxide dismutase (SOD) and catalase (CAT) were measured in erythrocytes. Venous blood was also used for interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) determination. Moderate training protocol induced the decrease of TBARS in plasma, while both training protocols induced the decrease of O(2)(-) and H(2)O(2) in coronary effluent. There was no significant difference in levels of cytokines between groups. The results of study add evidence about beneficial effects of moderate-intensity training on blood and cardiac redox state of rats, and furthermore, shows that exercising frequently, if the intensity stays within moderate range, may not have detrimental effects.

Erectile dysfunction as a predictor of advanced vascular age

Vascular age (VA) represents chronological age (CA) adjusted for individual's atherosclerotic burden. The presence of erectile dysfunction (ED) has been considered as a clinical sentinel of premature atherosclerosis. The objective of this study was to explore the predictive value of ED in assessing the discrepancy between VA and CA. In the period from 1 January 2014 to 1 January 2015, all consecutive men referring to the outpatient departments of the Clinics of Urology and Cardiology in Belgrade (Serbia) were considered for enrolment in this cross-sectional study. General exclusion criteria were: age below 18, heart failure, history of myocardial infarction, impaired renal and liver function, acute infection, history of endocrine disease other than type 2 diabetes, pelvic surgery or trauma, and acute coronary syndrome within the last 6 months. According to the presence of ED, hypertension, type 2 diabetes and history of coronary artery disease participants were assigned into five study groups. Hierarchical multiple regression analysis was conducted to identify the predictive value of ED in detection of advanced VA. The mean age of males enrolled in the study was 52.9 ± 7.7 years. The predominance of VA over CA was statistically significantly higher in the group of participants with coexistence of ED and hypertension compared to the group of patients with ED and type 2 diabetes (p = 0.027) and the group of patients with ED (p = 0.014) and control group (p < 0.01). Regression analysis highlighted that ED represented a highly important marker (p < 0.01) of advanced VA, which independently accounted for 6.1% of the variance in the discrepancy between VA and CA. Our study suggests that assessment of ED could be a part of a more comprehensive prediction of patients' advanced VA. Screening among such a highly selected population may help identify those that would most benefit from drug treatments and life style changes.

A simple method of supplementation of omega-3 polyunsaturated fatty acids: use of fortified yogurt in healthy volunteers

BACKGROUND

A relative dietary ω-3 fatty acid deficiency exists in Western diets, and this deficiency may be associated with some chronic diseases. The aim of the present study was to supplement yogurt with docosahexaenoic acid and assess whether this fatty acid could be incorporated into plasma lipids.

METHODS

We developed a stable emulsion of docosahexaenoic acid that was incorporated into yogurt. Twelve healthy volunteers agreed to consume 1 serving daily that contained 600 mg of docosahexaenoic acid.

RESULTS

After 3 weeks of supplementation, plasma phospholipid docosahexaenoic acid content increased significantly, by 32%, in parallel with a 16% rise in total ω-3 fatty acids. This result was associated with a significant 7% decline in phospholipid arachidonic acid.

CONCLUSIONS

Fortification of ordinary foods with docosahexaenoic acid is a potentially attractive method of increasing ω-3 fatty acid content of plasma lipids, and might even lower arachidonic acid concentrations.

Chemical and physical stability of protein and gum arabic-stabilized oil-in-water emulsions containing limonene

An important flavor component of citrus oils is limonene. Since limonene is lipid soluble, it is often added to foods as an oil-in-water emulsion. However, limonene-containing oil-in-water emulsions are susceptible to both physical instability and oxidative degradation, leading to loss of aroma and formation of off-flavors. Proteins have been found to produce both oxidatively and physically stable emulsions containing triacylglycerols. The objective of this research was to determine if whey protein isolate (WPI) could protect limonene in oil-in-water emulsion droplets more effectively than gum arabic (GA). Limonene degradation and formation of the limonene oxidation products, limonene oxide and carvone, were less in the WPI- than GA-stabilized emulsions at both pHs 3.0 and 7.0. These data suggest that WPI was able to inhibit the oxidative deterioration of limonene in oil-in-water emulsions. The ability of WPI to decrease oxidative reactions could be due to the formation of a cationic emulsion droplet interface at pH 3.0, which can repel prooxidative metals, and/or the ability of amino acids in WPI to scavenge free radical and chelate prooxidative metals.

Dermatoglyphic studies in eastern and south-eastern Europe

In nine population samples from Bulgaria, Croatia, Greece, Hungary, Republic of Macedonia (Skopje and Aromuns from Stip region), Romania, Serbia and Slovakia 12 dermatoglyphic variables have been studied. There are distinct differences between the populations and between males and females. The Macedonian Aromuns are clearly separated from the other populations.

Effect of antioxidants on stabilization of meat products fortified with n-3 fatty acids

The effects of an n-3 oil emulsion, with and without added antioxidants, on lipid oxidation in n-3 polyunsaturated fatty acid (PUFA)-fortified meat products were studied. An emulsion of n-3 PUFAs was prepared (25% algal oil, 2.5% whey protein isolates, 10mM sodium citrate, 0.2% potassium sorbate, 500ppm of 70% mixed tocopherols, 100μM EDTA, pH 3, pasteurized at 75°C for 30min) and incorporated into fresh ground turkey, and fresh pork sausage (20% fat) to achieve a concentration of 500mg n-3 PUFA/110g meat. An antioxidant combination containing rosemary (0.2% w/w; radical quencher), citrate (0.5% w/w; sequestrant) and erythorbate (1g/kg product; reductant) was prepared and incorporated into ground turkey patties (5cm dia, 1.5cm thick) or fresh pork sausages (5cm dia, 1.5cm thick). Meat products were stored at 4°C or -18°C and analyzed for color (L*, a*, b* values), lipid oxidation (TBARS and lipid hydroperoxides) and n-3 PUFA profile. a* Values of refrigerated ground turkey patties decreased with storage, and an antioxidant combination effect was observed after 4 days (P<0.05). For fresh pork sausages at 4°C, control+antioxidant (CON+ANTI), and n-3+antioxidant (n-3+ANTI) groups showed greater a* values than controls (CON) indicating that the antioxidant combination stabilized meat color. TBARS and lipid hydroperoxides of both n-3 PUFA-enhanced meat products increased with storage (P<0.05); there were no significant changes in TBARS or lipid hydroperoxides for treatments containing the antioxidant combination (P<0.05). The actual level of n-3 PUFA incorporation in both meat products was greater than 87%; n-3 PUFA concentrations did not change within any treatment during storage (P>0.05). These results provide support for including antioxidant protection in n-3 PUFA fortified meat products.

Microtiter plate assay for assessment of Listeria monocytogenes biofilm formation

Listeria monocytogenes has the ability to form biofilms on food-processing surfaces, potentially leading to food product contamination. The objective of this research was to standardize a polyvinyl chloride (PVC) microtiter plate assay to compare the ability of L. monocytogenes strains to form biofilms. A total of 31 coded L. monocytogenes strains were grown in defined medium (modified Welshimer's broth) at 32 degrees C for 20 and 40 h in PVC microtiter plate wells. Biofilm formation was indirectly assessed by staining with 1% crystal violet and measuring crystal violet absorbance, using destaining solution. Cellular growth rates and final cell densities did not correlate with biofilm formation, indicating that differences in biofilm formation under the same environmental conditions were not due to growth rate differences. The mean biofilm production of lineage I strains was significantly greater than that observed for lineage II and lineage III strains. The results from the standardized microtiter plate biofilm assay were also compared to biofilm formation on PVC and stainless steel as assayed by quantitative epifluorescence microscopy. Results showed similar trends for the microscopic and microtiter plate assays, indicating that the PVC microtiter plate assay can be used as a rapid, simple method to screen for differences in biofilm production between strains or growth conditions prior to performing labor-intensive microscopic analyses.

[Work capacity evaluation in workers with arterial hypertension]

The aim of this study was to show the results of working ability estimation of the workers with arterial hypertension. The estimation included 313 workers with arterial hypertension estimated by Disability Commission during 1999. Arterial hypertension was a leading diagnosis in 30.9% cause of working ability estimation. The majority of workers belonged to the 41-60 years age group and were with arterial hypertension with complications on the fundus and on the heart. In the examined group the majority of workers was declared as first category invalid (35.8%), while 32.3% of hypertensive workers had to change the working place. The majority of the first category invalids were among the hypertensive workers from textile and chemical industry, as well as among the professional drivers. The changing of the working place was more frequently suggested to the workers in textile and metal industry and in printing firms. These results could be explained by the influence of professional noxious agents on the onset and development of arterial hypertension.

[The closed head injury syndrome--frequency and character of brain parenchyma lesions]

The aim of this investigation was to determine the frequency and character of the brain parenchyma lesions using CT scan and MR in patients with closed head injury, and afterwards to establish the connection of those changes with clinical parameters (neurological deficit and the degree of consciousness disorder), evaluating the sensitivity and specificity of neuroradiological procedures. The investigation comprised 40 patients with closed head injury. Grade of neurological deficit (Canadian Neurological Scale) and the degree of consciousness disorder (Glasgow Coma Scale) were determined in all patients by the same neurologist. The results revealed significantly higher specificity and sensitivity of brain examination using MR in patients with closed head injury, particularly in the detection of small ischemic and contusion lesions. Likewise, the correlation of positive findings using MR was more significant concerning the grade of neurological deficit and the degree of consciousness disorder compared to the brain examination using CT scan.

Trace and major element pollution originating from coal ash suspension and transport processes

Coal ash obtained by coal combustion in the "Nikola Tesla A" power plant in Obrenovac, near Belgrade, Yugoslavia, is mixed with water of the Sava river and transported to the dump. In order to assess pollution caused by leaching of some minor and major elements during ash transport through the pipeline, two sets of samples (six samples each) were subjected to a modified sequential extraction. The first set consisted of coal ash samples taken immediately after combustion, while the second set was obtained by extraction with river water, imitating the processes that occur in the pipeline. Samples were extracted consecutively with distilled water and a 1 M solution of KCl, pH 7, and the differences in extractability were compared in order to predict potential pollution. Considering concentrations of seven trace elements as well as five major elements in extracts from a total of 12 samples, it can be concluded that lead and cadmium do not present an environmental threat during and immediately after ash transport to the dump. Portions of zinc, nickel and chromium are released during the ash transport, and arsenic and manganese are released continuously. Copper and iron do not present an environmental threat due to element leaching during and immediately after the coal ash suspension and transport. On the contrary, these elements, as well as chromium, become concentrated during coal ash transport. Adsorbed portions of calcium, magnesium and potassium are also leached during coal ash transport.

[Neurologic manifestations after surgical interventions]

Administration of general anesthesia is rarely accompanied with newly developed postoperative neurological complications. We analyzed postoperative complications after general anesthesia where an urgent neurologic assistance was necessary. The investigation included 120 patients. The same neurologist performed neurologic examination and electroencephalography, and computerized tomography (CT) was performed if necessary. In 96 (80%) patients focal stimulative or destructive phenomena such as epi-seizures or neurologic deficit were not detected by neurologic examination. In 9 (7.5%) patients were detected consciousness crisis. In 6 patients (5%) were registered right extremities weakness with motor dysphasia, which was withdrawn in first 24 hours. In these cases EEG revealed weak activity in theta frequency, above frontoparietal regions, bilaterally. In 6 (5%) patients was registered neurologic deficit of hemiparesis or semi-severe degree with development of ischemic lesion confirmed by CT. In 6 (5%) patients, CT scan revealed the presence of mild brain edema. Also, positive correlation between duration of anesthesia, age and metabolic disorders, specially diabetes mellitus, was found. We concluded that age, type of surgical intervention and duration of general anesthesia had the greatest influence on the development of neurologic disorders during and after general anesthesia, and the presence of metabolic disorders and previous brain damage increase the risk for the onset of these complications.

Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial

BACKGROUND AND STUDY AIMS

A number of trials have been reported in which a combination of ligation and sclerotherapy was compared with ligation alone, or with sclerotherapy alone. The present trial was carried out to assess whether the combined therapy might achieve more rapid eradication of bleeding esophageal varices.

PATIENTS AND METHODS

One hundred and three patients with either active bleeding or stigma of recent bleeding from esophageal varices were randomly assigned to receive ligation plus sclerotherapy, or ligation alone. Ligation was performed with the technique introduced by Stiegmann. Sclerotherapy was carried out using low-volume (1 ml) 1% aethoxysclerol, which was injected into varices proximal to each ligature. Further treatment sessions were held seven days later, and then at two-week intervals, until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at three-month intervals, or immediately if there was any recurrent bleeding. The mean follow-up period was 14 months.

RESULTS

There were no significant differences between the groups of patients compared with regard to the number of sessions required to eradicate the varices (2.4 +/- 0.7 in the combined group, and 2.3 +/- 0.7 in the ligation group; p>0.05). No significant differences were found between the groups with regard to recurrent bleeding (Fp = 2.882; p > 0.05). Three cases of recurrent bleeding (6%) from treatment-induced ulcers and two cases of recurrent bleeding (4%) from duodenal ulcers were observed with the combined therapy and ligation, respectively. No significant differences in the mortality were found between the groups (Fp = 1.145; p>0.05). Two percent of patients in the ligation group died due to bacterial peritonitis.

CONCLUSION

Since ligation combined with low-volume sclerotherapy did not reduce the time required for variceal eradication, it can be concluded that the combined therapy is not superior to ligation alone. This mode of endoscopic therapy for the treatment of bleeding esophageal varices is therefore not recommended.