Effects of positioning in laparoscopic adnexal surgery on QT dispersion and heart rate variability under sevoflurane anesthesia

PURPOSE: This study compared the intraoperative changes in the corrected QT dispersion and heart rate variability, predictors of autonomic cardiac function, in laparotomic and laparoscopic adnexal surgery. MATERIALS AND METHODS: The study was conducted on 46 American Society of Anaesthesiologists class I/II patients, aged 33-51 years, randomized to one of two groups, for elective gynecologic laparotomy or laparoscopy for a benign adnexal mass. Anesthesia was induced and maintained with sevoflurane. Corrected QT dispersion and spectral powers of heart rate variability were measured at baseline, before the induction of anesthesia, and intraoperatively during the adnexal surgery for 15 minutes. The lithotomy and Trendelenburg positions were set at 145 degrees and 30 degrees between thigh and body, respectively. Pneunoperitoneum was established at 12 mm Hg. Laparoscopic surgery was performed via one principal and two ancillary ports. Data were analyzed using the Wilcoxon and Mann-Whitney tests. RESULTS: A significant increase was observed in intraoperative standard deviation of RR interval values of heart rate variability in both groups compared to preoperative values (P < 0.05). The corrected QT dispersion and low and high frequency heart rate variability showed no significant changes between the two groups. CONCLUSION: Gynecologic laparoscopy with pneumoperitoneum in the lithotomy and Trendelenburg positions is as safe as laparatomy and seems not to deteriorate the autonomic cardiac function.     

Adult polysplenic syndrome accompanied by aberrant right subclavian artery and hemangioma in a cleft spleen: a case report

We present a case of adult polispleny syndrome accompanied by cleft spleen containing a cavernous hemangioma and an aberrant right subclavian artery. Patients with polysplenic syndrome are usually lost in childhood and rarely reach adulthood. The most frequently accompanying vascular abnormality is an interrupted inferior vena cava with azygous-hemiazygous continuation. Arterial vascular anomalies are rather rare, and there are several reports in the medical literature where cases of childhood polyspleny syndrome are accompanied by pulmonary arteriovenous fistulas or a main hepatic artery originating from the superior mesenteric artery. The case presented here seems to be the first report of adult polysplenic syndrome with an aberrant subclavian artery and a splenic cavernous hemangioma. The possible congenital vascular anomalies which eventually could accompany adult polysplenic syndrome cases are clinically important for the approach to the patient and planning of eventual vascular interventions.     

Prognostic significance of third ventricle dilation in spontaneous intracerebral hemorrhage: a preliminary clinical study

OBJECTIVE: Although numerous factors have been described that predict outcome after spontaneous intracerebral hemorrhage (ICH), very little is know about the role of hemorrhagic dilation of the third ventricle in development of hydrocephalus and prognosis. The objective of this study was to investigate whether the presence of hemorrhagic third ventricle dilation after ICH would predict development of hydrocephalus and outcome. METHODS: We identified the patients with spontaneous ICH treated with external ventricular drainage (EVD) in this retrospective study. Computerized tomography (CT) was performed at admission within 24 hours of onset and retrospectively analysed to determine lesion size and location, status of third and fourth ventricle and frontal horn index (FHI). Glasgow coma scale (GCS) score, mean arterial pressure (MAP), etiology and demographic data were obtained from medical records. Outcome was determined using modified Rankin score at month 3. Patients with and without third ventricle dilation were compared in terms of hydrocephalus (FHI > 0.38), initial GCS score, age and MAP, and analyses were performed to determine whether third ventricle dilation was a predictor of poor outcome. RESULTS: Of the 22 patients studied, all had thalamic or basal ganglia hemorrhage with intraventricular hemorrhage (IVH) and all are treated with external ventricular drainage (EVD). Of the 22 patients, 12 had third ventricle dilation (width > or = 10 mm) and ten patients had non-dilated third ventricle (width < 10 mm). Patients with third ventricle dilation had lower GCS scores (7.4 +/- 1.8 versus 9.7 +/- 2.1, p < 0.005) and had higher FHI (0.46 +/- 0.06 versus 0.38 +/- 0.02, p < 0.005) as compared to patients with non-dilated third ventricle. The differences in age (59.5 +/- 9.4 versus 59.2 +/- 11.2) and MAP (128.3 +/- 16.0 versus 130.5 +/- 13.6) of the patients were not significant statistically. Sixty-six percent of patients (8/12) with third ventricle dilation and 60% of patients (6/10) with normal third ventricle were dead 6 months post-operation and mortality rate did not differ significantly. DISCUSSION: Although the roles of various factors are well described in the prognosis of spontaneous ICH, little is known about the role of third ventricle dilation. Based on our results, we concluded that third ventricle dilation is a poor prognostic factor.