Recombinant factor VII (NovoSeven) in intraoperative blood saving during neurosurgical treatment of the brain arteriovenous malformation

BACKGROUND: Cerebral arteriovenous (AV) malformation causes, due to the increased blood flow through a malformation, a massive intraoperative bleeding complicating, so, surgical treatment. The use of intraoperative blood saving apparatus during surgery and a recombinant factor VII-a (NovoSeven) significantly reduce complications during surgical treatment. CASE REPORT: We reported a case of surgical treatment of the patient with AV malformation of IV stage according to the Spetzler-Martin scale, in the brain. Due to a possible heavy bleeding we used a apparatus for intrasurgical blood recovery, Cell Saver, Sequestra 1 000, Medtronic, U.S.A., and recombinant human factor VIIa (rFVIIa--NovoSeven, NovoNordisk, Denmark) to control bleeding and restore an adequate hemostasis. CONCLUSION: The use of an apparatus for intraoperative blood saving, as well as the NovoSeven preparation in the management of AV malformation of IV stage, showed to be successful.     

Effect of hypertonic-hyperoncotic solution infusion on tissue perfusion during surgical treatment of the abdominal aorta

BACKGROUND/AIM: Decreasing of arterial flow below the critical level leads to capillary endothelium edema and to further worsening of tissue perfusion. Hypertonic solution infusion provides mild and short plasma osmolality increasing, while colloidal solutions intensify that effect. The aim of this study was to investigate the effect of hypertonic-hyperoncotic solution (HH) on the organs perfusion during reconstructive surgical procedure on the abdominal aorta (AA). METHODS: The study included 40 patients submitted to AA reconstruction due to aneurysm or Leriche's syndrome. A clamp was put transversally to the aorta, under the outlets of the renal arterias. According to the solution received when a clamp was on the aorta, the patients were divided into two groups containing 20 patients each: the tested group (A) which received 4 ml/kg of the solution (7.2% NaCl/10% dextran), and the control group (B) which received 0.9% NaCl. The study excluded the patients with the preoperative creatinine level more than 139 micromol/l, and ejection heart fraction less than 40%. RESULTS: The mixed venous blood oxygen saturation increased from 73.3+/-7.33 to 74.95+/-6.19% in the group A, while it decreased from 65.35+/-10.39 to 62.65+/-10.42% in the group B (p = 0.001). The quantity of the provided oxygen in the group A increased significantly from 684.44+/-244.34 to 1362.45+/-2351.01 ml/min, while it decreased from 668.2+/-382.12 to 651.7+/-313.98 ml/min in the group B (p = 0.016). Alveolo-arterial difference in oxygen decreased from 23.12+/-14.74 to 21.1+/-10 mmHg in the group A, while it increased from 23.79+/-15.22 to 26.33+/-13.78 mmHg in the group B (p = 0.05). CONCLUSION: Satisfactory perfusion of organs during the AA surgery is obtained by using both HH and an isotonic solution. Due to maintaining the optimal values of the minute heart volume, saturation of vein blood blended with oxygen, and al-veolo-arterial difference in oxygen, it is recommended to use HH solution for reanimation of patients in declamping shock.     

A 5-year experience of a minimally invasive technique for correction of pectus excavatum in Croatia

The aim of this study was to assess the results of 5-year experience with minimally invasive operation without medial incision and resection cartilages for correction of pectum excavatum. From 2000 we made in our Hospital minimally invasive technique for the correction of pectus excavatum. 75 patients were treated by minimally invasive technique. A convex steel bar is inserted under the sternumtrough small bilateral Incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over. After 2 years the bar is removed when permanent remolding has occurred. Initial excelent results were maintained in 54 patients (normal chest), good results in 16 (mild residual pectus) and poor in 5 (severe recurrence requiring further treatment). The mean follow-up since surgery were 3 months to 3 years. Average blood loss was 25 ml. Average length of hospital stay was 8 days. Patients returned to full activity after 2 month. Complications were pneumothorax in 12 patients, pneumonia in 6 patients and displacement of the steel barr requiring revision in 2 patients. Poor results occurred because steel bar was too soft in 3 patients, and soft sternum in 2 patients with Marfan's syndrome. The minimally invesive technique is effective without cartilage incision and resection or sternal osteotomy.     

Age-related changes of the human fetal kidney size

Early prenatal diagnostics and the importance of genetic counseling are of great interest for echosonographic evaluation of normal fetus anatomy. Development of the human fetal kidney runs through a series of continual and mutually dependent changes during which the kidney obtains its morphological and functional maturity. This study was created to estimate the changes in kidney size during gestation in fetuses from the 4th to the 10th lunar month, to evaluate the dynamics of their growth, as well as to establish the validity of the volume calculated from these dimensions. Serial measurements of kidney dimensions (length, width, thickness) were performed in 110 fetuses. Photomicrographs of kidneys from the 4th, 6th, 8th and 10th lunar months are also presented. On the basis of the results obtained by our examination, we concluded that the period from the 14th to 16th week of intrauterine life is the fastest period of kidney growth during fetal development. Using the ellipsoid formula for calculating the fetal renal volume offers an underestimation of about 32-33% on average. The importance of this study lies in determining the average fetal kidney dimensions, which could be used as standard values in obstetrics.     

Multicriteria optimization methodology in development of HPLC separation of mycophenolic acid and mycophenolic acid glucuronide in human urine and plasma

Multicriteria optimization methodology was applied for development of isocratic reversed-phased HPLC method for simultaneous determination of mycophenolic acid (MPA) and mycophenolic acid glucuronide (MPAG) in human urine and plasma. In the first stage of method development, pH value of the water phase, percentage of acetonitrile, temperature of the column and flow rate of the mobile phase were investigated using fractional factorial design.Afterwards, the optimal conditions were found employing central composite design and Derringer's desirability function. Two goals were considered, the retention factor of the MPAG to be in the range, between 0.8 and 1.118 which allowed well separation of MPAG from the urine and plasma peaks, and the shortest possible total analysis run time. Then, the obtained sigmoid functions were used to transform the optimization criteria into the desirability values.The satisfactory chromatographic conditions were obtained with mobile phase consisted of acetonitrile–phosphate buffer (pH 2.4; 0.04 M KH₂PO₄) (28:72, v/v). The separation was performed on C₁₈ Chromolith column (100 mm × 4.6 mm) with flow rate of 5 mL/min, the temperature of the column was 25 °C and the chosen wavelength for simultaneous determination of MPA and MPAG was 215 nm. The MPAG eluted at 0.552 min and the duration of run was 3.092 min.Afterwards, the method was subjected to validation. Linearity was observed over the concentration range of 1–50 μg/mL for MPA and 1–500 μg/mL for MPAG in urine and 1–60 μg/mL for MPA and 1–70 μg/mL for MPAG in plasma matrix. The method showed intra-day and inter-day precision with relative standard deviation lower then 5% and accuracy as recovery (%) between 100 ± 5%.     

Antioxidant supplementation and serum lipids in patients with Graves' disease: effect on LDL-cholesterol

The effect of supplementation with a fixed combination of antioxidants (beta-carotene, selenium, vitamins C and E) on serum lipids was monitored in patients with newly detected Graves' disease. Measurements were made prior to the commencement of therapy and after 30 and 60 days. Patients were randomized into two groups. Test group comprised patients who received antioxidant supplementation in addition to methimazole, while patients treated with methimazole only were in the control group. The concentration of total and HDL-cholesterol increased significantly in test and control groups (p < 0.05) but these groups did not differ significantly. Concentration of LDL-cholesterol increased significantly in the test group only (p < 0.005) and was significantly different from the control group 60 days after the commencement of therapy (p < 0.005). Significant increase in the LDL-cholesterol concentration in the test group requires further investigations.