Effect of preoperative chemotherapy, mediastinal lymph node dissection and stump cover on bronchial regeneration following experimental pneumonectomy

The dynamics of morphological changes occurring in the bronchial stump depending on the extent of mediastinal lymph dissection, preoperative chemotherapy and the stump cover method are discussed. Stump healing after right-side pneumonectomy was assessed in 32 non-inbred dogs. Typical procedure was tested in group 1 while complete systematic mediastinal lymph dissection (CSMLD)--in groups 2-4. In groups 3-4, pneumonectomy was performed after two courses of chemotherapy (cisplatin 80 mg/m2 per day + etoposide 120 mg/m2, days 1,3,5). In groups 1-3, the stump was covered with a parietal strap; in group 4, a m. latissimus dorsi strap was fixed on a vascular "pedicle". Experiment was suspended on days 3, 7, 14, 21 and 30. One animal in group 2 died of ischemic necrosis of the esophagus terminating in mediastinitis. None of the animals developed bronchial fistula. Angiography detected reduced blood flow in the right-side third of the trachea and medial surface of the left main bronchus in the CSMLD groups. Microscopically, all the groups revealed a similar pattern of stump healing. CSMLD did not influence bronchial stump regeneration significantly. Nor was it hampered in any way by preoperative chemotherapy. The latter was followed by expansion of necrotic and edematous area thus slightly affecting regeneration. Primary bronchoplasty failed to speed up regeneration, yet it might diminish the risk of bronchial fistula.     

Protocol biopsies in kidney transplant recipients: histologic findings as prognostic markers for graft function and outcome

The aim of the present study was to identify subclinical and borderline rejections as well as histological markers of chronic allograft nephropathy (CAN) among protocol biopsies performed at 1 and 6 months after living related kidney transplantation to assess their possible implications for graft function. Twenty paired allograft biopsies performed at 1 and 6 months were reviewed according to the Banff scoring scheme. The mean ages of donors and recipients were 59.6 +/- 13.8 and 34.4 +/- 8.7 years, respectively. Among all biopsies only 10% (4/40) showed no histopathological lesions. At the first month borderline rejection was shown in 35% and subclinical rejection in 10% of patients. At 6 months the proportion of findings was even higher, namely, 40% and 30%, respectively. When divided according to donor age, donors above 55 years showed a mean CAN score of 2.33 +/- 1.56 which increased to 5.0 +/- 2.26 on the 6 month biopsy (214.3%). Unexpectedly, the proportion of these changes in the younger donor group also increased by 173.3%, which might have been explained by the greater number of borderline and subclinical rejections in the younger donor group at the 1 month biopsy. In conclusion, 1 month biopsy may be valuable to determine borderline and subclinical rejection and to prognosticate the outcome of renal allograft function. Our findings suggest a greater susceptibility of histological deterioration among the older donor population. However, the presence of an untreated rejection in the younger donor pool leads to a rapid impairment of the graft function accelerating the process of chronic allograft nephropathy.     

Radiotherapy in prostate cancer treatment

Prostate cancer is a complex disease, with many controversial aspects of management in almost all stages of disease. The natural history of this tumor is variable and is influenced by multiple prognostic factors. Radical prostatectomy and radiotherapy are standard treatment options for disease limited to the prostate. The data in literature does not provide clear- cut evidence for the superiority of any treatment. Neo- adjuvant or adjuvant hormonal therapy improves local control and survival in locally advanced disease. The patients treated with radiotherapy would have a relatively long life expectancy, not great risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a significant potential for cure, it is well tolerated in the majority of men especially when the modern techniques of conformal radiotherapy and intensity modulated therapy are used and it is non-invasive therapeutic options with no anesthesia risk. Expected complications like radiation cystitis, impotence and proctitis are registered in about 1% of patients.     

Power spectral analysis of heart rate variability during helium pneumoperitoneum: The mechanism of increased cardiac sympathetic activity and its clinical significance

Background Carbon dioxide pneumoperitoneum (PP) is known to induce increased cardiac sympathetic expression. The role of the insufflated gas involved in this mechanism should be elucidated in an attempt to eliminate its possible serious consequences.Methods Twenty-five patients undergoing elective laparoscopic cholecystectomy were prospectively analyzed for cardiac autonomic nervous activity by spectral heart rate variability. In 15 patients, helium was used as CO₂ substitution for abdominal insufflation (study group). Four frequency bands of interest were obtained from the power spectrum of R-R intervals, as well as the ratio between the low and high frequency (LF/HF), using the fast Fourier transformation algorithm to characterize the synergy of both autonomic branches during PP.Results Significantly increased values of the power spectrum related to the LF and VLF bands (from 130 to 377 msec²/Hz and from 145 to 516 msec²/Hz, respectively) were inspected during CO₂ PP, as well as increased LF/LH ratio (2.1). Using helium as CO₂ substitution has eliminated the significant changes in the power spectrum that reflect increased cardiac sympathetic activity.Conclusions The elimination of sympathetic predominance by helium PP indicates the central role of CO₂ in establishing this phenomena. Considering this information and its other known advantages, helium should be considered for use during prolonged laparoscopic procedures for high-risk patients.     

Use of continuous epidural infusion of ropivacaine as a component of an anesthesiological appliance and postoperative analgesia in elderly patients in cancer surgery

The study was undertaken to evaluate the effectiveness and safety of ropivacaine used via long-term epidural infusion and to define the optimum doses of the agent in the intra- and postoperative period. The parameters of hemodynamics, the adequacy of anesthesia, and the consumption of the agent were explored in 53 patients (ASA III-IV) aged 68 +/- 1.4 years operated on for abdominal cancer. Following 15 and 25 min of the injection of a bolus dose of ropivacaine, the occurrence of sensory block II was observed in 60 and 95% of the patients, respectively. After injection of ropivacaine in a bolus dose (56 +/- 3.4 mg), there was a 20% lowering of mean blood pressure and a 17% reduction in heart rate as compared with the baseline values. Maintenance infusion was made at a rate of 15-25 (20 +/- 1.9) mg/h. The total consumption was 126 +/- 13 mg. Bradycardia was noted in 4 (7.5%) cases; 7 (13%) patients required additional administration of phentanyl. The latter was used in a dose of 100 microg in 87% of the patients only prior to tracheal intubation. For postoperative analgesia, 0.2% ropivacaine was infused at a rate of 6-10 ml/h. Increasing its dose up to 12-14 ml/h resulted in hypotension and the occurrence of the signs of motor block. Postoperative analgesia was effective in 89% of cases when the agent was infused at rate of 8.8 +/- 0.9 ml/h and the hemodynamic parameters were stable. Postoperative intestinal paresis was abolished in 85.8% of patients after an average of 52 +/- 2.7 hours. Long-term epidural infusion of ropivacaine may be regarded as an effective component of anesthesia at abdominal surgery in elderly patients with severe comorbidity. The method allows one to completely refuse the use of narcotic analgesics in most cases both during a surgical intervention and in the postoperative period, which creates good conditions for an early activation of patients and for a reduction of postoperative complications.     

The cytokine profile in patients with chronic type C hepatitis

The purpose of the study was to perform complex evaluation of cytokine status in patients with type C chronic hepatitis (CCH), taking into account its system and local parameters and their correlation with peculiarities of clinical and morphological parameters. The study revealed a significant increase of concentrations of cytokines Th-2, interleukins (IL-4, IL-10), and proinflammatory cytokines (IL -1alpha, IL -12p40, IL -12p70), as well as a significant decrease of Th1-cytokine (IL-2 and interferon-gamma) levels, both in blood and in the supernatant of hepatic tissue samples. The study also found an increase of serum and local tumor necrosis factor (TNF) -alpha and established a correlation between the levels of the system and local cytokines under study, on the one part, and clinical, laboratory and morphological parameters, on the other, which evidences their significant role in CCH immunopathogenesis. The most significant from the clinical point of view are serum and local levels of TNF-alpha, IL-4, IL-12p40; the most important parameters for determination of inflammatory activity of the pathologic process and fibrosis stage are concentrations of IL-4, IL-10, and IL-12p70 in serum and the supernatant of hepatic tissue samples.     

Lisinopril-induced changes in antioxidant defense in patients with acute coronary syndrome and concomitant diabetes mellitus type 2

AIM: To examine antioxidant defense (AOD) in patients with acute coronary syndrome (ACS) and concominant diabetes mellitus type 2 (DM2) as well as AOD changes related to lisinopril administration. MATERIAL AND METHODS: AOD was studied for a year (by activity of glutathion reductase and myeloperoxidase of neutrophils, catalase and superoxide dismutase of blood) in 94 patients with ACS (35 of them had DM2). RESULTS: The number of recurrent coronary events for a year was significantly more in patients with ACS and DM. Such patients had initially lower activity of catalase, higher blood glucose, circulating immune complexes, creatinine, urinary protein. The lowest catalase activity was in DM patients who had recurrent infarction or died. Low catalse activity was accompanied with the highest blood creatinine and protein, more severe systolic dysfunction of the left ventricle. Compared to captopril, administration of lisinopril in hospital increased catalase activity, lowered blood creatinine, eliminated protein in the urine. These changes were associated with a significantfall in the number of cases with progressive chronic cardiac failure and lethal outcomes.