Correlation between increased maternal body mass index and pregnancy complications.

OBJECTIVE: Obesity in pregnancy carries significant maternal and fetal risk. The aim of this study was to investigate the effect of maternal body mass index on pregnancy outcomes. PATIENTS AND METHODS: The study retrospectively reviewed the clinical outcome of 485 pregnant women who delivered at the Department of Obstetrics and Gynecology, Clinical Centre of Vojvodina, Novi Sad, during the period of three years (2018-2020) and compared them against the body mass index (BMI). Correlation coefficient was calculated for BMI and seven pregnancy complications (hypertensive syndrome, preeclampsia, gestational diabetes mellitus, intrauterine growth restriction, premature rupture of membranes, mode of delivery and postpartum hemorrhage). The collected data were presented in the form of median values and relative numbers (the measure of variability). The implementation of the simulation model and its verification were carried out using a specialized programming language, Python. Statistical models were created where the Chi-square and p-value were as determined for every observed outcome. RESULTS: The average age of the subjects was 35.79 years and average BMI 29.28 kg/m2. A statistically significant correlation was found between the BMI and arterial hypertension, gestational diabetes mellitus, preeclampsia and cesarean section. The correlations between the body mass index and postpartum hemorrhage, intrauterine growth restriction and premature rupture of membranes were not statistically significant. CONCLUSIONS: As high BMI correlates with a number of negative outcomes in pregnancy, weight control before and during pregnancy and proper antenatal and intranatal care are necessary to achieve a favorable pregnancy outcome.

Pharmacodynamic study of Hypericum perforatum L.

The effects of Hypericum perforatum L. (Hypericaceae) crude ethanol extract (A), ethyl acetate extract (B), aqueous extract (C) and infusion (I), on pentobarbital induced sleeping time, intestinal motility, and their analgesic activity, have been investigated. Extracts A and B exhibited significant stimulatory and antidepressant effects on the CNS. Both extracts prolonged sleep, increasing time up to more than 25 min. The antidepressive activity of extract A was also achieved by significant reduction of the myorelaxant activity of diazepam. Extract B exhibited strong analgesic activity reducing abdominal stretching induced by acetic acid by nearly 50 %. Extracts A, B and C exhibited spasmolytic activity, significantly reducing intestine motility.

Effect of neuroleptics on ethanol-treated rats.

The subject of the present study is the effect of neuroleptic anaesthetics on sleeping time and some biochemical parameters of ethanol-treated and untreated rats. In one set of experiments involving four groups of animals, we studied how ethanol (12%, v/v) consumption for 10, 20 and 30 days influenced the sleeping time of animals after administration of a single dose of the investigated anaesthetics. In the other set of experiments, we studied the combined effect of 30 day ethanol consumption and each of the anaesthetics administered to the animals in multiple doses for 3 h, by determining the contents of cytochrome P450 and glutathione and the activities of glutathione peroxidase and lipid peroxidation. The results show that statistically significant changes of measured parameters are due to the action of ethanol and not of the neuroleptic anaesthetics.

[Early aggressive treatment in severe craniocerebral injuries]. / Rani agresivni tretman teske kraniocerebralne povrede.

A series of 33 severely head injured patients, Glasgow Coma Scala score 8 or less, was studied prospectively. All patients were treated by the same protocols and by the physician. Intracranial pressure was monitored in all patients by ventricular puncture. Some degree of increased intracranial pressure (more than 10mmHg) was present at admission to the intensive care unit in 52% of cases. Increases in over 20mmHg during the monitoring period were seen in 15 patients (45%). In 5 patients (15%) he was over 20mmHg, but controlled in intensive care unit with combination of dexamethasone, hyperventilation, normothermia, furosemide and mannitol. In this group mortality rate was 80%. In 10 patients (30%) intracranial hypertension was uncontrollable despite intensive measures, in this group all patients died. The mortality rate in patients with intracranial pressure less than 20mmHg during the monitoring period was significantly lower, 25%. Uncontrollable intracranial hypertension is a serious prognostic sign; all affected patients in our series died. Even intracranial pressure more than 20mmHg, which could be controlled, was associated with high mortality rate (80%). By early aggressive treatment based on intracranial pressure monitoring we can diminish the incidence of intracranial hypertension and reduce overall mortality rate in patients with severe head injury.

Effect of fentanyl, ketamine and thalamonal on some biochemical parameters in ethanol-treated and untreated dogs.

The effects of fentanyl, ketamine and thalamonal on some biochemical parameters of ethanol-treated and untreated dogs, were studied. The study was carried out on mongrel dogs. The animals were divided into two main groups: one which had free access to food and to 12% (v/v) ethanol, instead of water, and a control group which had food and water ad libitum. The animals in both groups were exposed to the action of anaesthetics for 3 h. The results show that, under the given experimental conditions, the anaesthetics did not significantly change the investigated parameters of blood and liver, either in ethanol-treated or untreated dogs. However, the action of ethanol caused remarkable changes in almost all the investigated parameters. An increased content of cytochrome P450 caused by the action of ethanol suggests possible changes in the metabolism of anaesthetics, which should be of concern to anaesthetists when dealing with patients potentially intoxicated with ethanol.

[Postspinal headache--incidence and prognosis]. / Postspinalna glavobolja--incidenca i prognoza.

Spinal anaesthesia was performed in 776 adult patients with 22 G and 25 G spinal needle. The incidence of postdural puncture headache was 3.5%. Its association to age, sex, needle size, duration of postoperative recumbency was analyzed. Our results show that the age was a significant predictor of postlumbar puncture headache. Postspinal headache was more often found in younger patients (p < 0.001).

[Postspinal headache as an anesthesiology problem]. / Postspinalna glavobolja kao anestezioloski problem.

Spinal anaesthesia, is nowadays one of the safest anaesthetic techniques with low complication rates. Postspinal headache is a complication of spinal anaesthesia. This paper presents several factors associated with the development of postspinal headache and discusses the reduction, prediction and treatment of postspinal headache.

[Therapy of resistant ascites using the peritoneojugular (Leveen shunt)]. / Terapija rezistentnog ascita peritoneojugularnim (Le Veen) santom.

Since 1984 the peritoneovenous shunt has been installed in 33 patients (10 females - 30.3%; 23 males - 69.7%) of the average age of 54 +/- 8, all in the phase of therapeutically resistant ascites (alcoholic cirrhosis 28 - 84.85%; 4 - 12.12% posthepatitic cirrhosis; and 1 - 3.03% hepatic amyloidosis). The control group consisted of 39 patients (11 females - 28.2% and 28 males - 71.8%) treated in an identical time span with the strict conduction of medicament-diet therapy. The aim of this study was to check the value of this method on our own clinical-patient material, and therefore establish the incidence of complications. By the use of a unique protocol we followed mortality, morbidity, body weight, belly circumference, diuresis, the ultrasonographic finding of the abdominal cavity and the complications which appeared. Out of the group operated on 19 (57%) of the patients died, and so did all the control group patients as well. The average life duration was 275 +/- 810 days in the group operated on, and 44 +/- 29 (p less than 0.005) in the control group. All those alive (14.33-42.42%) lived longer than six months. Six patients lived longer than one year (42.85%), 4 (28.47%) longer than two years, and one (7.14%) longer than three years. There is a statistically significant decrease in body weight, belly circumference, diuresis increase and the consequent ascites withdrawal. DIC occurred in 2 patients, shunt malposition in 2, saccular dilatation in 1, plastic peritonitis in 6, and ileus in 1 patient. Not one of the listed complications resulted by death.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia in peritoneovenous shunt placement]. / Anestezija za ugradnju peritoneojugularnog santa.

Since 1984 the peritoneovenous shunt has been installed in 33 patients because of resistant ascites. The aim of this study was to find the optimal type of anesthesia in our conditions on our own clinical-patient material. All patients were classified by the ASA, Goldman, Child and Child-Puigh score. The patient, surgeon and anesthesiologist were polled about the quality of anesthesia, and all observed complications were followed, like after different premedications as well as in the course and after different types of neuroleptic anesthesia. General neuroleptic anesthesia was applied in 23 patients (69.7%), one was operated on in ketamine anesthesia (3.0%) and 9 (27.3%) in local anesthesia with 2% Xylocaine. After premedication with Thalamonal in all patients there came to a fall in arterial pressure for more than 20% of initial values and the feeling of uneasiness and fear was present. All patients with local anesthesia absolutely needed additional application of sedation or analgesia, especially during the formation of the subcutaneous tunnel, and neither patient nor surgeon were satisfied with the achieved comfort. During the course of neuroleptic anesthesia with Thalamonal hypotension developed, in 17/20 patients an in 2/20 the presence of prolonged apnea demanded additional artificial ventilation. In the patient operated on in ketamine anesthesia, an acute psychotic reaction developed, followed by visual and acustic hallucinations without signs of metabolic encephalopathy. On the basis of our own experience, we conclude that general neuroleptic anesthesia with the use of Flormidal as an anesthetic and Fentanil as an analgetic, is the method of choice, and that local anesthesia can be recommended only on one operative site (except the subcutaneous tunnel).

[Acute gastrointestinal hemorrhage after placement of a peritoneojugular shunt]. / Akutna gastrointestinalna krvarenja nakon ugradnje peritoneojugularnog santa.

Since 1984 the peritoneovenous (LeVeen) shunt has been installed in 33 patients (10 females 30.3%, and 23 males 69.7%), with the average age of 54 +/- 8 years all in the oedema--ascitic decompensation phase of their primary illness. The control group consisted of 39 patients with identical etiology and primary illness stadium, sex and age structure and duration of primary illness, all treated with medicament - diet therapy. All the operated patients and those treated with medicament--diet regime died. Their autopsy findings were confronted. The aim of this study was to indicate the type and frequency of digestive hemorrhage in this population on our own clinical--patient material. Gastrointestinal hemorrhage was the cause of death in 8 (24.24%) patients out of the group operated on, and 6 (15.3%) from the control group. The isolated rupture of esophageal varices was the cause of death in one (3.03%) patient out of the group operated on, and in 5 (12.12%) patients from the control group, the rupture of esophageal varices with toxic vasculitis in 3 (0.09%) patients from the group operated on, and not in one out of the control group; rupture of esophageal varices associated with toxic vasculitis and disorders of the hemostatic mechanism appeared in 4 (12.12%) of patients from the group operated on, and in 1 (2.56%) of the control group. On the basis of the presented it can be concluded that gastrointestinal hemorrhage is a significantly more frequent cause of death in the group operated on than in the control group, and that hemorrhages are of an all the more complex etiology when the flow-in of ascites into circulation is greater. Hemodilution and endotoxins are to blame for their occurrence and it is necessary to preoperatively conduct, beside the control of the hemostatic mechanism, also the test of ones own ascitic burdening and to determine the level of endotoxin in the ascites.