The role of central serotonergic markers and estradiol changes in perinatal mental health.

OBJECTIVE: Women have an increased risk for mental distress and depressive symptoms in relation to pregnancy and birth. The serotonin transporter (SERT) may be involved in the emergence of depressive symptoms postpartum and during other sex-hormone transitions. It may be associated with cerebrospinal fluid (CSF) levels of the main serotonin metabolite 5-hydroxyindolacetic acid (5-HIAA). In 100 healthy pregnant women, who were scheduled to deliver by cesarean section (C-section), we evaluated 5-HIAA and estradiol contributions to mental distress 5 weeks postpartum. METHODS: Eighty-two women completed the study. CSF collected at C-section was analyzed for 5-HIAA, with high performance liquid chromatography. Serum estradiol concentrations were quantified by liquid chromatography tandem mass spectrometry before C-section and postpartum. Postpartum mental distress was evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Associations between EPDS, 5-HIAA, and Δestradiol were evaluated in linear regression models adjusted for age, parity and SERT genotype. RESULTS: Higher levels of postpartum mental distress symptoms were negatively associated with a large decrease in estradiol concentrations (ßΔE2  = 0.73, p = 0.007) and, on a trend level, positively associated with high antepartum 5-HIAA levels (ß5-HIAA  = 0.002, p = 0.06). CONCLUSION: In a cohort of healthy pregnant women, postpartum mental distress was higher in women with high antepartum 5-HIAA (trend) and lower in women with a large perinatal estradiol decrease. We speculate that high antepartum 5-HIAA is a proxy of SERT levels, that carry over to the postpartum period and convey susceptibility to mental distress. In healthy women, the postpartum return to lower estradiol concentrations may promote mental well-being.

Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management.

OBJECTIVE: The long-term survival of in-hospital cardiac arrest (IHCA) patients treated with targeted temperature management (TTM) is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA) patients treated with TTM. DESIGN SETTING AND PATIENTS: Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed. MEASUREMENTS: Primary endpoints were survival to hospital discharge and long-term survival. Secondary endpoint was neurological outcome assessed using the Pittsburgh cerebral performance category (CPC). RESULTS: A total of 282 patients were included in this study; 233 (83%) OHCA and 49 (17%) IHCA. The IHCA group presented more often with asystole, received bystander cardiopulmonary resuscitation (CPR) in all cases, and had shorter time to return of spontaneous circulation (ROSC). Survival to hospital discharge was 54% for OHCA and 53% for IHCA (adjusted odds ratio 0.98 [95% confidence interval {CI}; 0.43-2.24]). Age ≤60 years, bystander CPR, time to ROSC ≤10 min, and shockable rhythm at presentation were associated with survival to hospital discharge. Good neurologic outcome among survivors was achieved by 86% of OHCA and 92% of IHCA (P=0.83). After a median follow-up time of >5 years, 83% of OHCA and 77% of IHCA were alive (adjusted hazard ratio [HR] 1.51 [95% CI; 0.59-3.91]). Age ≤60 years was the only factor associated with long-term survival (adjusted HR 2.73 [95% CI; 1.36-5.52]). CONCLUSION: There was no difference in short- and long-term survival and no difference in neurologic outcome to hospital discharge between IHCA and OHCA patients treated with TTM despite higher frequency of asystole in IHCA.

[Oesophageal perforation of osteosynthesis material after anterior cervical surgery].

The rare, potentially life-threatening complication to anterior cervical surgery, oesophageal perforation, occurs after surgical trauma or due to erosion by migrating hardware. Symptoms are hoarseness, dysphagia, neck/throat pain, subcutaneous emphysema and fever. Imaging and endoscopic diagnosis can give false negative results. We present a case of a 74-year-old male, who was readmitted with sepsis and abscess in the operation area three weeks after anterior cervical surgery. Veillonella parvula was found in the abscess material and computed tomography confirmed the diagnosis of oesophageal perforation.

Effect of head rotation during surgery in the prone position on regional cerebral oxygen saturation: A prospective controlled study.

BACKGROUND: Near-infrared spectroscopy (NIRS) has been used to study regional cerebral blood oxygen saturation (rScO2) in patients in the prone position. OBJECTIVES: We aimed to test the hypothesis that head rotation more than 45° would affect the rScO2. DESIGN: A prospective, controlled, single cohort study. SETTING: University Hospital specialising in spinal surgery. PATIENTS: Fifty-two patients undergoing spinal surgery in prone position were enrolled and 48 completed the study. INTERVENTIONS: NIRS sensors were attached to each side of the forehead. Measurements were conducted during steady-state anaesthesia with the head in the neutral position, rotated left, rotated right and returned to the neutral position. Each series consisted of three measurements: resting on the head support, during head lift (to relieve pressure on the tissue at the sensors) and returned to rest on the head support. MAIN OUTCOME MEASURES: The differences in rScO2 between the neutral and the turned head positions. RESULTS: For both left and right sensors, the median differences in rScO2 between neutral and left or right positions were between 0 and -1 with the head up (P = 0.14 to 0.84). The median differences with the head down were between 3.8 and -0.8, with a significant difference for the left sensor when turned left (P < 0.01) and for the right sensor (P = 0.006) when turned right. Ten patients showed reductions of more than 10 in rScO2 in the rotated (and lifted) positions. When the head was lifted from the head support, the rScO2 was -0.5 to 3.75 units higher, but there was high variability between patients. CONCLUSION: We recommend the neutral head position for prone patients.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01760369.

One-week postoperative patency of lower extremity in situ bypass graft comparing epidural and general anesthesia: retrospective study of 822 patients.

BACKGROUND: The purpose of this study was to determine whether anesthesia affects graft patency after lower extremity arterial in situ bypass surgery. METHODS: This investigation was a retrospective study using a national database on vascular surgical patients at a single medical institution. We assessed a total of 822 patients exposed to infrainguinal in situ bypass vascular surgery over the period of January 2000 to September 2010. RESULTS: All patients included in the study (age [mean ± SD] 70.8 ± 9.7 years) underwent infrainguinal in situ bypass (n = 885) for lower extremity revascularization under epidural (n = 386) or general (n = 499) anesthesia. Thirty-day mortality (3.4% for epidural anesthesia versus 4.4% general anesthesia; P = 0.414) and comorbidity were comparable in the 2 groups. Graft occlusion within 7 days after surgery was reported in 93 patients, with a similar incidence in the epidural (10.1%) and general (10.8%) anesthesia groups (P = 0.730). When examining a subgroup of patients (n = 242) exposed to surgery on smaller vessels (femorodistal in situ bypass procedures, n = 253), the incidence of graft occlusion was also similar in the 2 groups at 14.0% and 9.4%, respectively (P = 0.262). CONCLUSION: This retrospective study has shown that when graft patency is evaluated 7 days after surgery, anesthetic choice (epidural or general anesthesia) does not influence outcome.