Subclinical hyperthyroidism and biatrial function and mechanics: a two- and three-dimensional echocardiographic study.

BACKGROUND: We sought to evaluate left atrial (LA) and right atrial (RA) phasic function and deformation in the subclinical hyperthyroidism (SCH) using two- and three-echocardiographic (2DE and 3DE) methods. METHODS: We included 45 untreated women with SCH and 45 healthy women who underwent comprehensive 2DE and 3DE examination. RESULTS: Total and passive LA emptying fractions (EF) were decreased, whereas active EF was increased among the SCH participants. RA total EFs were similar between the controls and the SCH subjects; passive EF was reduced; and active EF was amplified in the SCH group. TSH correlated with 2DE LA passive and active EFs, 3DE LA total, passive and active EFs, as well as 2DE LA positive longitudinal strain. Additionally, TSH correlated with 2DE RA passive and active EFs, 3DE LA and RA passive EF, 2DE LA and RA positive longitudinal strain. However, after adjustment for the parameters of left and right ventricular diastolic function and structure, the TSH level remained associated only with LA conduit and booster pump functions, as well as RA pump function. CONCLUSION: Biatrial phasic function evaluated by 2DE and 3DE is significantly impaired in the SCH subjects. TSH level correlates with LA and RA conduit and pump functions.

Scoring Systems in Assessing Survival of Critically Ill ICU Patients.

BACKGROUND: The aim of this study was to determine which of the most commonly used scoring systems for evaluation of critically ill patients in the ICU is the best and simplest to use in our hospital. MATERIAL AND METHODS: This prospective study included 60 critically ill patients. After admittance to the ICU, APACHE II, SAPS II, and MPM II0 were calculated. During further treatment in the ICU, SOFA and MPM II were calculated at 24 h, 48 h, and 72 h and 7 days after admittance using laboratory and radiological measures. RESULTS: In comparison with survivors, non-survivors were older (p<0.01) and spent significantly more days on mechanical ventilation (p<0.01). ARDS was significantly more common in patients who survived compared to those who did not (chi-square=7.02, p<0.01), which is not the case with sepsis (chi-square=0.388, p=0.53). AUROC SAPS II was 0.690, and is only slightly higher than the other 2 AUROC incipient scoring systems, MPM II and APACHE II (0.654 and 0.623). The APACHE II has the highest specificity (81.8%) and MPM II the highest sensitivity (85.2%). MPM II(7day) AUROC (1.0) shows the best discrimination between patients who survived and those who did not. MPM II(48) (0.836), SOFA(72) (0.821) and MPM II(72) (0.817) also had good discrimination scores. CONCLUSIONS: APACHE II and SAPS II measured on admission to the ICU were significant predictors of complications. MPM II(7day) has the best discriminatory power, followed by SOFA(7day) and MPM II(48). MPM II(7day) has the best calibration followed by SOFA(7day) and APACHE II.

Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients.

BACKGROUND: The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia. MATERIAL AND METHODS: The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO2). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4). RESULTS: Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO2 values did not differ significantly between the groups (p=0.081). CONCLUSIONS: Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.

[Outcome among patients suffering from in-hospital cardiac arrest].

INTRODUCTION: In relation to pre-hospital treatment of patients with cardiac arrest (CA) in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. OBJECTIVE: The aim was to define the factors associated with an improved outcome among patients suffering from the in-hospital CA (IHCA). METHODS: The prospective study included a total of 100 patients in the Emergency Center over two-year period.The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC). RESULTS: Most patients (61%) had cardiac etiology. Return of spontaneous circulation (ROSC) was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69 +/- 11.37), (p < 0.05), non-surgical patients (76.1%), (p < 0.01) and in patients who were in continuous monitoring (66.7%) (p < 0.05). The outcome of CPR was significantly better in patients who received advanced life support (ALS) (76.6%) (p < 0.01). Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67 +/- 1.13 min), (p < 0.01). A total of 5% of IHCA patients survived to hospital discharge. CONCLUSION: In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

[Recombinant activated factor VII in haemostasis after radical nephrectomy].

INTRODUCTION: The paper presents important facts in the application of recombinant human factor VIIa (rFVIIa) and in the treatment of renal cell carcer. CASE REPORT: A 69-year old male with infiltrative renal cell carcer underwent radical nephrectomy using Hasagawa's approach. The extirpated tumor was 35 cm in diameter. During surgery, the patient suffered cardiac arrest with 3500 ml blood loss. Twenty-four hours after operation, he lost additional 2100 ml of blood. Despite adequate blood substitution with intensive surgical attempts to treat haemostasis, bleeding did not stop until the application of rFVIIa (300 IU). The patient survived and fully recovered. CONCLUSION: To control massive non-surgical bleeding additionally complicated by paraneoplastic syndrome, extensive surgical intervention, haemodilution and massive blood substitution, the application of rFVIIa has proved to be most successful.