Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients

Background

There is no well-recognized guideline for intraoperative fluid management in bariatric surgery. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management which was shown to improve patients’ prognoses. Dynamic indicators may better predict fluid response compared to static indicators. In this study, we aimed to assess effects of administering GDFT protocol via Pleth Variability Index (PVI) in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery.

Methods

The study included 60 patients who underwent elective laparoscopic RYGB surgery. Subjects were randomized to two groups as being managed with either standard fluid regimen (control group) or PVI (PVI group) during intraoperative period. After induction of general anesthesia, control group received 500 ml crystalloid bolus followed by 4–8 ml/kg/h infusion. Fluid management of the control group was guided by central venous pressure and mean arterial pressure. PVI group received 500 ml crystalloid bolus followed by 2 ml/kg/h infusion. If PVI had been > 14%, 250 ml colloid was administered. Norepinephrine was given by infusion to keep mean arterial pressure > 65 mmHg, if needed. Perioperative lactate levels, hemodynamic parameters, and renal functions were recorded.

Results

In PVI group, volume of crystalloid and total fluid infusion during intraoperative period was significantly lower than the control group (p < 0.05). The groups did not significantly differ in terms of lactate or creatinine levels before or after the surgery (p > 0.05).

Conclusions

There is no need to administer extra volume of fluid to obese patients undergoing laparoscopic bariatric surgery. Use of dynamic indicators like PVI helps to decrease intraoperative volume of infused fluids with no effects on either intraoperative or postoperative lactate levels in laparoscopic bariatric interventions.

     

Predictors of fertility quality of life (FertiQoL) in infertile women: analysis of confounding factors

Objective

Infertility may adversely influence quality of life (QoL). The aim of this study was to compare QoL in women with primary and secondary infertility, and identify factors associated with poor and good QoL.

Study design

Quality of life was measured using the FertiQoL tool in 273 patients attending an infertility clinic, and demographic and clinical characteristics of the patients were recorded. Patients with primary and secondary infertility were compared for QoL subscales, and other confounding factors were investigated using multiple regression analysis.

Results

Women with secondary infertility obtained higher scores in emotional, mind/body, and social domains of the core subscale, tolerability domain of the treatment subscale, and total QoL (p < 0.05). Women desiring psychological support showed lower scores in all domains except environment. Prolonged duration of infertility was associated with lower scores of mind/body, social, tolerability domains and total QoL score (p < 0.05). Multiple regression analysis showed that the status of education and secondary infertility had a positive impact, whereas prolonged duration of infertility and desire for psychological support had a negative impact on total QoL scores.

Conclusion

QoL scores were better in patients with secondary infertility and higher educational status, whereas scores were negatively affected by prolonged duration of infertility and desire for psychological support.     

Hematoma progressivo na região anterior do pescoço após tratamento endovascular de aneurisma da artéria cerebral média

Background

Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm.

Percutaneous Treatment of Simple Hepatic Cysts: The Long-Term Results of PAIR and Catheterization Techniques as Single-Session Procedures

Purpose

The purpose of our study is to evaluate results of percutaneous aspiration with alcohol sclerotherapy in symptomatic patients with simple hepatic cysts by employing single-session techniques either by a needle or a catheter.

Materials and Methods

We retrospectively included 39 simple hepatic cysts in 35 patients treated via percutaneous aspiration and single-session alcohol sclerotherapy between years 1993 and 2012. Indications were pain (n = 28) or ruling out cystic echinococcus (CE) disease (n = 7). 29 cysts in 26 patients were treated by needle technique (Group A) and ten cysts in nine patients were treated by single-session catheter technique (Group B). Patients were followed for 4–173 months (median: 38 months).

Results

All patients were successfully treated. Before procedure, cyst volumes were 21–676 cc (median: 94 cc). Post-procedure cyst volumes at last follow-up were 0-40 cc (median: 1 cc). The mean decrease in cyst volume was 95.92 ± 2.86 % in all patients (95.96 ± 3.26 % in Group A and 95.80 ± 6.20 % in Group B). There was no statistically significant difference between the volume reduction rates of Group A and Group B. Only one patient, in Group B, developed a major complication, an abscess. Hospitalization period was 1 day for all patients.

Conclusions

For patients with symptomatic simple hepatic cysts smaller than 500 cc in volume by using puncture, aspiration, injection, and reaspiration (PAIR) technique with only needle, single-session alcohol sclerotherapy of 10 min is a safe and effective procedure with high success rate.

     

Do sodium channel blockers have neuroprotective effect after onset of ischemic insult?

OBJECTIVE: Cerebral ischemia causes a series of pathophysiologic events that may result in cerebral infarct. Some neurons are more vulnerable to ischemia, particularly pyramidal neurons in the hippocampal CA1 region. Pharmacologic intervention for treatment of cerebral ischemia aims to counteract secondary neurotoxic events or to interrupt the progression of this process. In the present study, we compare the neuroprotective effects of sodium channel blockers (mexiletine, riluzole and phenytoin) and investigate whether they have neuroprotective effect when given after ischemic insult. METHODS: A transient global cerebral ischemia model was performed in this study by clipping bilateral common carotid arteries during 45 minutes. Riluzole (8 mg/kg), mexiletine (80 mg/kg) and phenytoin (200 mg/kg) were injected into the rats intraperitoneally 30 minutes before or after reperfusion. Lipid peroxidation levels and cerebral water contents were evaluated 24 hours after ischemia. Histopathologic assessment of hippocampal region was determined 7 days after ischemia. RESULTS: Riluzole, mexiletine and phenytoin treatment after global ischemia significantly decreased water content of the ischemic brain (p<0.05 for each). No significant difference was observed in cerebral edema among the drug treatment groups (p>0.05). When pre-treatment and post-treatment groups were compared with each other, only riluzole pre-treatment group revealed better result for cerebral edema (p<0.05). Pre-treatment with these drugs revealed significantly better results for the malonyldialdehyde (MDA) level and the number of survival neuron on the hippocampal region than the post-treatment groups. CONCLUSION: It is demonstrated that riluzole, mexiletine and phenytoin are potent neuroprotective agents in the rat model of transient global cerebral ischemia, but they are more effective when given before onset of the ischemia.     

Acute and chronic effects of electroconvulsive treatment on oxidative parameters in schizophrenia patients

Electroconvulsive therapy (ECT) is an effective treatment alternative for schizophrenia. Previous studies have already indicated the possible effects of oxidative stress in this disorder. However, there have been no previous studies evaluating the effects of ECT on the oxidative stress in these patients. We therefore aimed to investigate the acute and chronic effects of ECT on serum levels of oxidant and antioxidant molecules in schizophrenia patients (n = 28). The serum MDA and CAT levels of the patients with schizophrenia were higher than that of the controls before ECT (n = 20) but there was no significant difference in the serum NO and GSH levels of the patient groups compared to the controls. We found that the NO levels of the patients were higher than the controls in the group experiencing their first episode but not in the chronic group. There was a significant clinical improvement in the patients in terms of BPRS, SANS and SAPS reduction after the 9th ECT, but not the 1st ECT. Serum MDA levels were significantly reduced compared to the baseline after the 9th ECT session although there was no significant difference after the 1st session. Separate evaluation of the patient groups revealed that the significant MDA decrease following ECT was in the patients experiencing their first episode and not in the chronic group. No significant difference was noted in the serum levels of other oxidant and antioxidant molecules after either the 1st or 9th ECT session. These results suggest that ECT does not produce any negative effect on oxidative stress in patients with schizophrenia.