Subinvolution of placental bed vessels: case report and review of the literature

Subinvolution of placental bed vessels, a well-recognized cause of postpartum and postabortal hemorrhage, is defined with prolonged or excessive uterine hemorrhage beginning after the delivery or abortion. Although physiological changes in uteroplacental parts of spiral arteries are well known, the sequence of events in involution of these vessels is not yet clearly understood. In this article we present two cases of subinvolution of placental bed vessels in which we were able to demonstrate the presence of extravillous trophoblast in and around the placental bed vessels. The disease is supposed to be the result of abnormal interaction between maternal uterine cells and fetal trophoblast.     

Infective endocarditis due to Abiotrophia defectiva: a report of two cases

BACKGROUND AND AIM OF THE STUDY: Endocarditis due to Abiotrophia sp. is rare and often associated with negative blood cultures. The rates of treatment failure, infection relapse and mortality are higher than in endocarditis caused by other viridans streptococci. METHODS: A retrospective review of A. defectiva endocarditis in a patient with prosthetic aortic valve and in a patient with Marfan syndrome was performed. RESULTS: A. defectiva, susceptible to penicillin (MIC 0.064 mg/l and 0.016 mg/l, respectively) was isolated from blood cultures of both patients. Treatment with penicillin and gentamicin was started in both patients. Since the first patient developed a macular rash and leukopenia, penicillin was substituted with ceftriaxone. Both patients responded well to antibiotic treatment, did not need prosthetic valve insertion or reinsertion, and were without any sequelae at one year follow up. CONCLUSION: Standard treatment of bacterial endocarditis with penicillin and gentamicin was effective in both patients. In contrast to previous reports, the present patients had a favorable outcome on completion of treatment and at one-year follow up.     

Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor type-1 (PAI-1) in breast cancer - correlation with traditional prognostic factors

Background

Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor type-1 (PAI-1) play a key role in tumour invasion and metastasis. High levels of both proteolytic enzymes are associated with poor prognosis in breast cancer patients. The purpose of this study was to evaluate the correlation between traditional prognostic factors and uPA and PAI-1 expression in primary tumour of breast cancer patients.

Patients and methods.

606 primary breast cancer patients were enrolled in the prospective study in the Department of gynaecological oncology and breast oncology at the University Medical Centre Maribor between the years 2004 and 2010. We evaluated the traditional prognostic factors (age, menopausal status, tumour size, pathohistological type, histologic grade, lymph node status, lymphovascular invasion and hormone receptor status), together with uPA and PAI-1. We used Spearman’s rank correlation, Mann Whitney U test and χ² test for statistical analysis.

Results

Our findings indicate a positive correlation between uPA and tumour size (p < 0.001), grade (p < 0.001), histological type (p < 0.001), lymphovascular invasion (p = 0.01) and a negative correlation between uPA and hormone receptor status (p < 0.001). They also indicate a positive correlation between PAI-1 and tumour size (p = 0.004), grade (p < 0.001), pathohistological type (p < 0.001) and negative correlation between PAI-1 and hormone receptor status (p = 0.002).

Conclusions

Our study showed a relationship between uPA and PAI-1 and traditional prognostic factors. Their role as prognostic and predictive factors remains to be further evaluated.     

Endodontic Management of the Three-Rooted Mandibular First Permanent Molar: a Case Report

The distal root of the mandibular first permanent molar (MFPM) contains one or two canals. More rarely, the second/third distal canal is found in a separate root in a distolingual (DL) position – a radix entomolaris (RE). In Caucasians, this occurs in less than 4% of cases, but it is equally important to be aware of this possibility. Careful examination of the preoperative periapical radiographs (orthoradial and mesially angled) and inspection of the pulp chamber floor during endodontic management may indicate that this radicular variant is present. RE’s lingual inclination and buccolingual curvature must be taken into account during cleaning and shaping of the canal within this root to avoid procedural errors, such as straightening and ledging of the root canal, perforation or instrument fracture. The aim of the present paper was to discuss a case report of a young patient, referred to an endodontic office after a ledge was created by inappropriate instrumentation of a buccolingually curved RE canal.Key words: mandibular first permanent molar, root canal therapy, radix entomolaris, supernumerary root, anatomical variants     

Knee anterior laxity: a risk factor for traumatic knee injury among sportswomen?

The purpose of this study was to investigate if knee anterior laxity, measured with an arthrometer, is a risk factor for traumatic knee injury in sportswomen. To allow a more complete analysis, other, easily measured variables such as anthropometry, lower leg characteristics, sport exposure and menstrual cycle characteristics were also evaluated as possible risk factors. Subjects were Slovenian sportswomen aged between 11 and 41 years participating in basketball, team handball and volleyball (N = 540). Sportswomen were tested in the pre-season and followed for one season. The data collection included: written informed consent, background questionnaire, anthropometric tests, leg dominance assessment, navicular drop test (measurement of foot pronation), passive knee extension assessment and measurement of knee anterior laxity with a KT arthrometer. Several sets of data analysis were performed including logistic regression analysis in order to build a model for predicting traumatic knee injury among sportswomen. Height and average hours of training per week were found to differ significantly (P < 0.05) between injured and uninjured sportswomen. More sportswomen injured their non-dominant leg. Traumatic knee injuries among Slovenian sportswomen participating in basketball, team handball and volleyball are associated with higher amounts of training, greater body height and greater knee anterior laxity. Only 1% of the variability in traumatic knee injuries among sportswomen were explained with those variables suggesting that there are many other variables associated with traumatic knee injuries among sportswomen than were tested in this study.     

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

AimTo evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery.MethodsPatients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n = 21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n = 19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis.ResultsThe level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon''s, anesthesiologist''s, and patients'' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range.ConclusionsFor patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone.Clinical trial number{"type":"clinical-trial","attrs":{"text":"NCT 03251222","term_id":"NCT03251222"}}NCT 03251222

Conscious sedation is an established anesthetic method of choice in patients undergoing short ophthalmic procedures and has been used successfully for many years. In Slovenia, there is also a published protocol in use for such cases (1).Intravenous (i.v.) remifentanil is used for analgesic and sedative purposes. It is a short-acting opioid analgesic with partial anxiolytic action that has been thoroughly studied in obstetric analgesia (2).The fine intra-ocular endoscopic technique is implemented in vitrectomies. Surgical instruments are inserted into the vitreous humor through the sclera by a surgeon. Patient cooperation is crucial during the procedure, meaning the level of sedation should not be too deep. Otherwise, sudden eye movements could potentially result in eye injury (3). For many ophthalmic surgeons, local anesthesia (LA) has become preferred over general anesthesia (GA) because of quicker patient rehabilitation and avoidance of possible complications from GA (4). Several methods of LA have been described for vitreoretinal cases, including retrobulbar, peribulbar, sub-Tenon’s, and even topical anesthesia (5). Many drugs have been used for sedation during eye surgery, such as propofol, benzodiazepines, and opioids, and there is a relative risk of oversedation, disorientation, and confusion, in addition to an increased risk of respiratory depression and oxygen desaturation (5,6). All of these adverse effects can hamper patient cooperation during surgery and make these agents less than ideal for intraoperative management of sedation. As a result, sedatives and anxiolytics with unpredictable dose requirements, such as propofol and midazolam, are not optimal for such procedures.In contrast, dexmedetomidine is a highly selective alpha-2-adrenoreceptor agonist with both sedative and analgesic properties and is not associated with respiratory depressant effects. Dexmedetomidine has been studied for its sedation- and analgesia-sparing properties in intensive care and surgical settings (eg, neurosurgery, maxillofacial surgery, ENT surgery) but not in vitreoretinal surgery (7-9).Dexmedetomidine is mainly administered intravenously. Although intranasal (i.n.) dexmedetomidine is still used off-label, recently an increasing consensus has emerged for its different uses, namely, in non-painful diagnostic procedures, in painful procedures, and in surgical premedication. Some studies have been published regarding this form of use in the pediatric population (10-12). However, at present, there is no consensus regarding indications, dosage, and timing for administration. Available pediatric evidence confirms the efficacy and safety of dexmedetomidine for i.n. administration. The reported dose for pediatric procedures performed under sedation ranges from 2.5 to 4 μg/kg i.n. Onset of action is expected to be slower (25-30-minute) with low doses (1-2 μg/kg) and faster (16.7-28-minute) with higher doses (2.5-3 μg/kg), while offset time is similar in both – 85-minute in average; range 55-100 minutes (13).The aim of our study was to evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon''s and patients'' satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery. We conducted an applied research study that produced objective indicators, showing which type of sedation was more comfortable for patients and more effective in terms of achieving the desired sedation and reducing pain during vitreoretinal procedures with fewer side effects.     

The role of genital pathogens in morbidity following diathermy loop excision of the transformation zone of the uterine cervix

ObjectiveTo evaluate the role of genital pathogens in postoperative morbidity following diathermy loop excision of the transformation zone (LETZ) of the uterine cervix.MethodsPatients with cervical intraepithelial neoplasia (CIN) who underwent diathermy LETZ were included in a prospective study. Cervical swabs for genital pathogens were collected before the diathermy procedure. After surgery, women were followed-up regarding the occurrence and severity of postoperative pain, bleeding, and discharge.ResultsGenital pathogens were present in 463 of 788 (58.8%) cases. The most frequently isolated groups of microorganisms were group B β-hemolytic Streptococcus, α-hemolytic Streptococcus, Enterococcus species, and coliforms. In patients with genital pathogens, postoperative pain was present in 298 (37.8%), discharge in 262 (33.2%), and bleeding in 236 (29.9%) cases. In patients without genital pathogens, 199 (25.3%) experienced pain, 181 (23.0%) discharge, and 143 (18.1%) bleeding. The differences between the 2 groups were not statistically significant (χ² for pain = 0.675; χ² for discharge = 0.031; χ² for bleeding = 3.444; P > 0.05).ConclusionGenital pathogens are very common among patients with CIN and do not affect the occurrence or severity of pain, discharge, or postoperative bleeding after diathermy LETZ.