Rationalizing blood management in orthopedics and traumatology

In recent years there has been growing interest in blood conservation and avoidance of transfusion in patients undergoing orthopedic surgery. The benefits of blood transfusion must be considered and evaluated in terms of risk factors relating to the adverse effects of transfusion. A number of strategies are available to reduce the need for blood transfusion. These strategies are maximally effective if combined to span the pre-operative, intra-operative and post-operative periods. Surgical, anesthetic and pharmacological techniques can reduce blood loss during operation and the use of allogenic blood. This article presents current opinions, on the base of contemporary literature, regarding risks of transfusion and several simple techniques that will reduce the need for transfusion in orthopedic procedures.     

A single weekly dose of imatinib is sufficient to induce and maintain remission of chronic eosinophilic leukaemia in FIP1L1-PDGFRA-expressing patients

Hypereosinophilic syndrome (HES) is defined as chronic, unexplained hypereosinophilia with organ involvement. A subset of HES patients presents an interstitial deletion in chromosome 4q12, which leads to the expression of an imatinib-responsive fusion gene, FIP1L1-PDGFRA. These patients are diagnosed as chronic eosinophilic leukaemia (CEL). We treated seven CEL and HES patients, six of which expressed FIP1L1-PDGFRA , with imatinib using initial daily doses ranging from 100 to 400 mg. In a remission maintenance phase, the patients were treated with imatinib once weekly. All imatinib-treated patients achieved a complete haematological remission (CHR), and five of the six patients with FIP1L1-PDGFRA expression exhibited molecular remission. The decreased imatinib doses were as follows: 200 mg/week in three patients, 100 mg/week in two patients and 100 mg/d in the remaining two patients. For remission maintenance, imatinib doses were set at 100 mg/week in five patients and 200 mg/week in two patients. At a median follow-up of 30 months all patients remained in CHR and FIP1L1-PDGFRA expression was undetectable in five of the six FIP1L1-PDGFRA -expressing patients. These data suggest that a single weekly dose of imatinib is sufficient to maintain remission in FIP1L1-PDGFRA - positive CEL patients.     

Morphometric study of the suprascapular notch: proposal of classification

Introduction  

The size and shape of the suprascapular notch (SSN) may be a factor in suprascapular nerve entrapment. The aim of the study was to determine the variation of the SSN of 86 scapulae in the Polish people.     

The effectiveness of deep brain stimulation with intraoperative spatial mapping of subthalamic nucleus using intraoperative microrecording. Report of two cases

The aims of the study were to present the surgical technique of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) and to analyze our experience with the MedtronicStealthStation Treon neuronavigation system and Framelink 4.1 software in targeting STN using single-unit extracellular action potentials (microrecording). The prospective study included 2 patients with bilateral STN DBS. The STN boundaries were mapped using microrecording, without microstimulation and recording of kinesthetic cells. For macrostimulation the longest trajectory with neuronal activity characteristic of STN was chosen. The patients were assessed using Unified Parkinson's Disease Rating Scale UPDRS version 3 and Schwab and England Scale. Postoperatively we did not notice intracerebral haemorrhage. Also there were no transient or permanent side effects. The mean number of microelectrode tracts was 4 per STN. Framelink 4.1 software is reliable to plan individual microelectrode trajectories and help avoid the intraparenchymal vessels.     

Large, asymptomatic left atrial myxoma--a case report

We report a patient with a large, asymptomatic left atrial myxoma detected by transoesophageal echocardiography. The tumour filled the great part of the left atrium cave and led to mitral valve obstruction. Surgical management gave an excellent result.     

Clinical significance of muscle bridge narrowing coronary artery lumen--description of three cases

The muscle bridge is an anomaly which is found in 0.5-2.5% of coronary angiography examinations and may lead to impairment of coronary blood flow. The clinical course of the disease may be heterogeneous--from completely asymptomatic to the development of myocardial infarction or severe ventricular arrhythmia. We present three patients with muscle bridge in the left anterior descending artery. The clinical course of the disease was different in each patient--from mild symptoms to cardiac arrest during exercise test.     

Synergistic interaction of gabapentin with tiagabine in the hot-plate test in mice: an isobolographic analysis

This study was aimed at determining the analgesic effect of gabapentin and tiagabine, two antiepileptic drugs that were administered alone and in combination at a fixed ratio of 1:1, in the acute thermal pain model (hot-plate test) in mice.Linear regression analysis was used to evaluate the dose-response relationships between logarithms of antiepileptic drug doses and their resultant maximum possible antinociceptive effects in the mouse hot-plate test. From linear equations, we calculated doses that increased the antinociceptive effect by 50% (ED₅₀ values) for gabapentin, tiagabine and their combination. The type of interaction between gabapentin and tiagabine was assessed using the isobolographic analysis.Results indicated that both antiepileptic drugs produced the definite antinociceptive effect, and the experimentally derived ED₅₀ values for gabapentin and tiagabine, when applied alone, were 504.4 mg/kg and 5.67 mg/kg, respectively.With isobolography, the experimentally derived ED_{50 mix} value for the fixed ratio combination of 1:1 was 139.31 mg/kg and significantly differed from the theoretically calculated ED_{50 add} value, which was 255.04 mg/kg (p < 0.05), indicating the synergistic interaction between gabapentin and tiagabine in the hot-plate test in mice.In conclusion, the combination of tiagabine with gabapentin at a fixed ratio of 1:1 exerted a synergistic interaction in the mouse model of nociceptive pain. If the results from this study could be extrapolated to clinical settings, the combination of tiagabine with gabapentin might be beneficial for pain relief in humans.     

Influence of orphenadrine upon the protective activity of various antiepileptics in the maximal electroshock-induced convulsions in mice

Orphenadrine is an anticholinergic drug used in the treatment of Parkinson’s disease, and is also known to exert nonspecific antagonistic activity at the phencyclidine binding site of the N-methyl-D-aspartate (NMDA) receptor. The aim of this study was to assess the anticonvulsant properties of orphenadrine and to evaluate its effect on the anticonvulsant activity of antiepileptic drugs against maximal electroshock-induced seizures in mice. Orphenadrine given at a dose of 5.65 mg/kg elevated the electrical seizure threshold from 5.7 (5.4 – 6.1) to 6.8 (6.3–7.3) mA, while a dose of 2.8 mg/kg was ineffective. The ED₅₀ values of orphenadrine administered 10,30 and 120 min before maximal electroshock-induced convulsions were 16.8 (11.3–25.1), 17.8 (15.7–20.0) and 25.6 (23.3–28.3) mg/kg, respectively. Orphenadrine at a sub-threshold dose of 2.8 mg/kg significantly enhanced the anticonvulsant activity of valproate by reducing its ED₅₀ value from 315.8 (270.0–369.4) to 245.9 (207.1–292.0) mg/kg without affecting the free plasma levels of valproate. However, orphenadrine failed to enhance the protective activity of carbamazepine, phenytoin, phenobarbital, lamotrigine, topiramate, or oxcarbazepine against maximal electroshock-induced seizures.