Evaluation of neuraxial analgesia on outcomes for patients undergoing robot assisted abdominal surgery.

STUDY OBJECTIVE: Following robot assisted abdominal surgery, the pain can be moderate in severity. Neuraxial analgesia may decrease the activity of the detrusor muscle, reduce the incidence of bladder spasm and provide effective somatic and visceral analgesia. In this systematic review, we assessed the role of neuraxial analgesia in robot assisted abdominal surgery. DESIGN: Systematic review. SETTINGS: Robot assisted abdominal surgery. PATIENTS: Adults. INTERVENTIONS: Subsequent to a search of the electronic databases, observational studies and randomized controlled trials that assessed the effect of neuraxial analgesia instituted at induction of anesthesia or intraoperatively in adult and robot assisted abdominal surgery were considered for inclusion. The outcomes of observational studies as well as randomized controlled trials which were not subjected to meta-analysis were presented in descriptive terms. Meta-analysis was conducted if an outcome of interest was reported by two or more randomized controlled trials. MAIN RESULTS: We included 19 and 11 studies that investigated spinal and epidural analgesia in adults, respectively. The coprimary outcomes were the pain score at rest at 24 h and the cumulative intravenous morphine consumption at 24 h. Spinal analgesia with long acting neuraxial opioid did not decrease the pain score at rest at 24 h although it reduced the cumulative intravenous morphine consumption at 24 h by a mean difference (95%CI) of 14.88 mg (-22.13--7.63; p < 0.0001, I2 = 50%) with a low and moderate quality of evidence, respectively, on meta-analysis of randomized controlled trials. Spinal analgesia with long acting neuraxial opioid had a beneficial effect on analgesic indices till the second postoperative day and a positive influence on opioid consumption up to and including the 72 h time point. The majority of studies demonstrated the use of spinal analgesia with long acting neuraxial opioid to lead to no difference in the incidence of postoperative nausea and vomiting, and the occurrence of pruritus was found to be increased with spinal analgesia with long acting neuraxial opioid in recovery but not at later time points. No difference was revealed in the incidence of urinary retention. The evidence in regard to the quality of recovery-15 score at 24 h and hospital length of stay was not fully consistent, although most studies indicated no difference between spinal analgesia and control for these outcomes. Epidural analgesia in robot assisted abdominal surgery was shown to decrease the pain on movement at 12 h but it had not been studied with respect to its influence on the pain score at rest at 24 h or the cumulative intravenous morphine consumption at 24 h. It did not reduce the pain on movement at later time points and the evidence related to the hospital length of stay was inconsistent. CONCLUSIONS: Spinal analgesia with long acting neuraxial opioid had a favourable effect on analgesic indices and opioid consumption, and is recommended by the authors, but the evidence for spinal analgesia with short acting neuraxial opioid and epidural analgesia was limited.

Correlation between activation of PPARγ and resistin downregulation in a mouse adipocyte cell line by a series of thiazolidinediones.

The present study shows significant correlations between the EC50 for PPARγ activation in a reporter gene cell line and resistin downregulation in mouse adipocytes, and between the IC50 for resistin downregulation and the already published minimum effective dose for antihyperglycemic activity in a mouse model. These correlations indicate that PPARγ mediated downregulation of resistin might promote insulin sensitivity and that downregulation of resistin in mouse adipocytes provides an adequate and possibly more direct bioassay for screening of newly developed antihyperglycemic compounds. Because of the higher throughput of the PPARγ the resistin downregulation assays seems most suitable to be used as a second tier in a tiered screening strategy.

Serological evidence of Mycoplasma pneumoniae infection in patients with acute exacerbation of COPD: analysis of 100 hospitalizations.

PURPOSE: A prospective study was conducted in order to investigate the serologic evidence of Mycoplasma pneumoniae infection in Greek hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Furthermore, we have assessed the frequency of a number of variables in the group of patients with a serological diagnosis of an acute M. pneumoniae infection compared to patients in whom M. pneumoniae infection was not documented. MATERIALS/METHODS: One hundred patients with AECOPD were enrolled in a 29- month study period. Serum IgG, IgA and IgM M. pneumoniae antibody titers were determined during the first day of their hospitalization and 30 days after enrolment, using a commercial ELISA. RESULTS: Nine patients (9%) had serological evidence of an acute M. pneumoniae infection. Acute infection was mainly documented by IgA antibody titer changes. It was mainly attributed to a reinfection rather than a primary infection. Patients with serological evidence of an acute M. pneumoniae infection had a higher heart rate (99±12 versus 88±14 beats/minute, p=0.02) and a higher hematocrit value (47±4.5% versus 40.4±6.2%, p=0.004) at admission than patients without a serological diagnosis for this pathogen. CONCLUSIONS: Serologic evidence of M. pneumoniae infection is rather common in Greek hospitalized patients with AECOPD. The determination of all three antibody classes was necessary in order to obtain an optimal level of serodiagnosis. No differences were found in the majority of characteristics of patients with and without serological evidence for this pathogen. The clinical utility of these results should be further clarified in future studies.

New results with 100 Excluder cases.

AIM: The purpose of this study was to report the outcome of EVAR using EXCLUDER endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz.) with low-porosity polytetrafluoroethylene (PTFE) in the medium term. We reviewed a 10-year-experience with this device to document the outcome of 100 consecutive elective EVARs with Excluder-Device performed at a single centre. METHODS: From 01.2006 to 01.2009 all elective abdominal aortic aneurysm (AAA) cases (N=100) with an abdominal aortic aneurysm (AAA; mean diameter 5.61 cm; range 4.2-7.3 cm) that were treated electively with the EXCLUDER Bifurcated Endoprosthesis were entered in an index. Anatomical and clinical evaluations and radiological results have been analyzed. Mean aortic neck length was 12.24 mm, mean proximal aortic diameter was 24.39 mm. Primary outcome that has been examined, include operative mortality, aneurysm rupture, aneurysm-related mortality, open surgical conversion, and late survival rates. The incidence of endoleak, migration, aneurysm enlargement, and graft patency have also been determined. Finally, the need for reinterventions and success of such secondary procedures were evaluated. Endoleaks were diagnosed from contrast-enhanced computed tomography, the rate of type II endoleaks was analyzed after 1, 3 and 12 months. RESULTS: Mean patient age was 74.1 years (range 44-91 years); 91% were male. Mean follow-up was 20 months; 78 % of the patients had 2 or more major comorbidities, and 32 % were categorized as inappropriate for open repair. On an intent-to-treat basis, device deployment was successful in 100%. Thirty-day mortality was 0%; freedom from AAA rupture was 100%. Type II endoleak appeared directly after the procedure in 24%, after 3 months in 15% and after 12 months in 7%. The initial technical success defined as endovascular aneurysm exclusion and absence of type I endoleak was 99%. Proximal type I early endoleak occurred (detected by intraoperative DSA) in 3 patients, in 2 cases intraoperative proximal aortic cuffs were needed to seal proximal type I endoleaks. In one case we performed a proximal bending via a retroperitoneal access and sealed the endoprosthesis. Postoperatively, the size of the AAA decreased or remained unchanged in 93% after 12 months. Freedom from reinterventions was 94% after 2 years. CONCLUSION: EVAR using the EXCLUDER-Device is a safe, effective, and durable method to prevent AAA rupture and aneurysm-related death. Assuming suitable AAA anatomy, these data justify a broad application within a wide spectrum of patients.

[Epithelioid hemangioma of the popliteal artery]. / Epitheloides Hämangiom der A. poplitea.

We report the case of a 37-year-old patient with an epithelioid haemangioma arising from the third segment of the popliteal artery and the tibio-peroneal trunk. As far as we know this is the first description of this tumour originating in an artery of this order. One year after excision of the tumour mass and vascular reconstruction the patient has recovered and shows no evidence of recurrence. Clinical manifestation and morphological characteristics of this rare lesion are described in this article.

Relative and population attributable risk of traffic injuries in relation to blood-alcohol levels in a Mediterranean country.

Blood samples were taken from, and interviews were conducted with, 76 persons injured in motor vehicle crashes, and from 126 controls with a home and leisure injury. The analysis was undertaken by modelling the data through conditional logistic regression, controlling for gender- and age-matched variables and other potentially confounding variables, including education and visual acuity. Detectable alcohol levels were associated with a 4.9 relative risk (95% confidence intervals 1.4 to 16.8). The population attributable fraction was about 10% with wide confidence intervals. There was no evidence for a safe threshold in these data. The increased injury risk associated with detectable blood-alcohol levels was disproportionally, albeit non-significantly, elevated among occasional drinkers in comparison to regular drinkers. We conclude that alcohol intake is an important cause of road traffic injuries even in the context of the Mediterranean countries where alcohol is taken in moderation and mainly in the form of wine during meals.