Patient-controlled epidural analgesia versus conventional epidural analgesia after total hip replacement - a randomized trial.

AIMS: Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR). METHODS: This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery. RESULTS: The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P<0.001).There was greater patient satisfaction (P<0.001) in the PCEA group. The mean pain intensity over 24 hours postoperatively was similar for both groups (P=0.14). There was no significant difference in rate of analgesia-related complications between the groups (hypotension, P=0.14; bradypnea, P=0.11). CONCLUSION: Compared to conventional epidural analgesia based on physician prescription, PCEA led to less total analgesic consumption and greater patient satisfaction after THR.

The Role of von Willebrand Factor, ADAMTS13, and Cerebral Artery Thrombus Composition in Patient Outcome Following Mechanical Thrombectomy for Acute Ischemic Stroke.

BACKGROUND The aim of the study was to investigate the role of von Willebrand factor (vWF), the vWF-cleaving protease, ADAMTS13, the composition of thrombus, and patient outcome following mechanical cerebral artery thrombectomy in patients with acute ischemic stroke. MATERIAL AND METHODS A prospective cohort study included 131 patients with ischemic stroke (<6 hours) with or without intravenous thrombolysis. Interventional procedure parameters, hemocoagulation markers, vWF, ADAMTS13, and histological examination of the extracted thrombi were performed. The National Institutes of Health Stroke Scale (NIHSS) score was used on hospital admission, after 24 hours, at day 7; the three-month modified Rankin Scale score was used. RESULTS Mechanical thrombectomy resulted in a Treatment in Cerebral Ischemia (TICI) score of 2-3, with recanalization in 89% of patients. Intravenous thrombolysis was used in 101 (78%). Patients with and without intravenous thrombolysis therapy had a good clinical outcome (score 0-2) in 47% of cases (P=0.459) using the three-month modified Rankin Scale. Patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥15 had significantly increased vWF levels (P=0.003), and a significantly increased vWF: ADAMTS13 ratio (P=0.038) on hospital admission. Significant correlation coefficients were found for plasma vWF and thrombo-embolus vWF (r=0.32), platelet (r=0.24), and fibrin (r=0.26) levels. In the removed thrombus, vWF levels were significantly correlated with platelet count (r=0.53), CD31-positive cells (r=0.38), and fibrin (r=0.48). CONCLUSIONS In patients with acute ischemic stroke, mechanical cerebral artery thrombectomy resulted in a good clinical outcome in 47% of cases, with and without intravenous thrombolysis therapy.

[Is obesity an adverse prognostic factor for pulmonary manifestations of influenza? Lesson from complicated disease course H1N1]. / Je závazná obezita nepríznivým prognostickým faktorem u chripkového zánetu plic? Poucení z komplikujícího prubehu onemocnení H1N1.

Influenza viruses cause annual epidemics that occur at different times in both the northern and southern hemisphere. In cases of seasonal influenza these are usually mild forms of the disease, which rarely lead to death of the patient. Vulnerable groups include the elderly, the young or those with comorbidities, where the virus affects tens of thousands of victims around the world. Occasionally, however, large epidemics appear caused by a dangerous variant of a new virus, which is usually characterized by high contagiousness and pathogenicity (virulence). Consequently, it is often accompanied by a complicated disease course and associated with high mortality. In 2009, a viral pandemic disease marked pH1N1 2009 Influenza A appeared. Even though the initial predictions were far worse, the course of influenza caused by this virus was often complicated by acute respiratory failure in the form of acute respiratory distress syndrome (ARDS). This formed part of the wider multiple organ failure syndrome (MODS). This type of virus often infects younger age groups and is more contagious compared to the seasonal flu. In order to illustrate the complicated forms of viral infections pH1N1 2009 Influenza A we present three case studies which demonstrate complicated pulmonary manifestation, which take the primary form of ARDS.