Evaluation of changes in serum concentration of sodium in a transurethral resection of the prostate.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate changes in serum electrolytes during Transurethral resection of the prostate (TURP) and to evaluate the degree of correlation of hyponatremia and the factors that affect the incidence of TURP syndrome and to show the impact of the duration of the procedure on the severity of hyponatremia due to absorption of irrigation fluid in the systemic circulation. MATERIALS AND METHODS: This study examined 60 male patients planned for elective TURP. The level of serum electrolytes are determined by taking venous blood samples preoperatively and Postoperatively and when the duration of the operation was longer than 60 minutes, the level of serum electrolytes was determined intraoperative. The amount of used irrigation fluid, the weight of resection prostate, and duration of surgery, were also followed. Patients were divided in two groups according to the length of the surgical procedure: Group 1 (30-60 min) and Group 2 (> 60 min). RESULTS: Statistically significant reduction of serum sodium and the elevation of the potassium level in serum observed postoperatively and was directly proportional to the volume of of the used irrigation fluid, the duration of the procedure and volume of the resected prostate. CONCLUSIONS: To evaluate changes in serum electrolyte during TURP is simple and economical method for the indirect estimation of irrigation fluid absorption into the systemic circulation during TURP and opportunity for early identification of TURP syndrome.

The effect of a small dose of ketamine on postoperative analgesia and cytokine changes after laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: In this study we assesed the effect of a small dose of ketamine on the production of TNFα, IL-1ß and IL-6 and the postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients undergoing laparoscopic cholecystectomy were randomized in two equal groups. Patients in the ketamine group after induction in anesthesia received ketamine--025 mg/kg(-1). At the same time patients from the control group received sodium chloride. Postoperatively, the pain was assessed with VAS at periods of 30 min at 1, 2, 4, 8, 18, 24 and 48 hours. TNFα, IL-1ß and IL-6 were evaluated before surgery at 4, 18 and 24h after the operation. RESULTS: Differences of mean values of TNFα and IL-1ß between the two groups in the postoperative period were not significant. Mean values of IL-6 in the investigated group A were significantly lower than the mean values of IL-6 in the investigated group B after the 4th hour (p=0.00990), after the 18th hour (p=0.00133) and as after the 24th hour following surgery (p=000860). the difference in pain intensity according to the VAS scale was also statistically significantly smaller in group A after 30 min, 1,2,8 and 12 hours after surgery. CONCLUSIONS: The addition of a small-dose of ketamine in patiens undergoing laparoscopic cholecystectomy resulted in attenuation of secretion of TNFα, IL-1ß, IL-6 and reduction of postoperative pain.

Functional outcome and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis.

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically refractory ulcerative colitis, ulcerative colitis with dysplasia or cancer, or familial adenomatous polyposis (FAP). The aim of this study is to report our 6-year experience of restorative proctocolectomy and IPAA at a tertiary referral centre. Chart review was performed for 7 patients undergoing IPAA from 2006 to 2010. Preoperative histopathological diagnoses were ulcerative colitis (n=5), FAP (n=1) and other (n=1). We collected data regarding patient demographics, type and du-ration of the disease, previous operations and indications for surgery. We analysed the operative protocols and postoperative pathological diagnoses. Early (within 30 days after surgery) and late complications were noted. Follow-up was conducted upon annual function and a quality of life questionnaire, physical examination and endoscopic evaluation of the pouch. Postoperative histopathological diagnoses were: ulcerative colitis (n=3), indeterminate colitis (n=2), FAP (n=1) and colonic necrosis and gangrene (n=1). The average age of the operated patients was 48, with a female predomination of 71%. The mean duration of the follow-up was 4 years. We report 2 cases of steroid use prior to operation as well as 2 cases of extraintestinal manifestations. We report no septic complications and 3 cases of pouchitis. Functional results and quality of life were good to excellent in all 7 cases of IPAA. Restorative proctocolectomy with IPAA is a safe procedure with a low morbidity rate. Functional results are generally good and patient satisfaction is high.

Improvement of cerebral oxygenation during laparoscopy using intermittent sequential compression of legs.

The creation of CO2 pneumoperitoneum during laparoscopy causes a series of adverse effects. Impairment of brain oxygen saturation during laparoscopy is a result of increased intra-abdominal pressure, absorbed CO2 and increased intracranial pressure. The aim of this study is to investigate the possible effects of pneumatic inter-mittent sequential compression (ISC) of legs on oxygenation of the brain during laparoscopy. 100 patients, ASA groups 1 and 2, subjected to elective laparoscopic cholecystectomy, were included in this study. The patients were divided into two groups consisting of 50 patients each, group I, control group, and group II, where ISC was applied. Oxygen saturation of the mixed venous blood from the internal jugular vein (SjvO2) is an indirect assessment of cerebral oxygen use (oxygenation of the brain). Blood samples were obtained from the bulb of the right jugular vein, as the dominant side for venous drainage from the brain. Informed consent was obtained from each patient. Blood samples of 2 ml were obtained several times during the operation; the first sample immediately after anesthesia induction in order to establish the baseline values of SjvO2, the second sample immediately after the creation of the pneumoperitoneum, and then every 15 minutes respectively until the end of the pneumoperitoneum. The last sample was obtained before the extubation of the patients. The ISC in group II was terminated after obtaining the last blood sample. Results showed that the average values of oxygen saturation of the mixed venous blood from the internal jugular vein--SjvO2 levels were higher in group II where ISC was applied (82.3%→86.4%→85.3%→80.2%→82.8%→80.4%), compared to group I, without ISC (85.5%→77.8%→80.6%→83.8%→84.8%), statistically significant in the second and third measurement for p<0.05 for the second and the third measurement, i.e. after the creation of pneumoperitoneum, when the decreease in the brain oxygenation is most dramatic in the group without ISC. In conclusion, application of intermittent sequential compression of the legs is a simple and safe technique for preserving the brain oxygenation during laparoscopy by restoring the blood return from the legs.

Femoropopliteal bypass vs percutaneous transluminal angioplasty and stenting in treatment of peripheral artery diseases of infrainquinal segment - short-term results.

(Full text is available at http://www.manu.edu.mk/prilozi). Critical limb ischaemia is a result of occlusive arterial disease in the infrainquinal segment and is a major indication for arterial revascularization, which implies a femoropopliteal bypass procedure or an interventional procedure - stent graf notting of the occluded segment. Although indications for both techniques are clearly defined, there are still controversies. Thus, the aim of this study was to determine short-term results in patients treated with these two treatment modalities. In the period between 2002 and 2008 a total of 70 patients with occlusive arte notrial diseases of the low extremity were analysed. In 50 out of 70 patients a femo notro notpopliteal bypass was made. Of these, in 30 (60%) patients PTFE material was used and in 20 (40%) patients an autologous saphenous vein graft was used. The other group comprised 20 patients who underwent stenting. In patients treated with surgical revas notcularization, the major indication for surgery was occlusive arterial disease in: stage II - in 10 patients (20%), stage III - in 5 patients (10%), stage IV - in 25 patients (50%) and the remaining 10 patients (20%) had subacute ischaemia. Arteriography showed three crural patent tributaries in 18% of the patients, two patent crural tributaries in 40% of the patients and one crural patent tributary in 32% of the patients. There were no significant differences concerning indications and arteriographic findings between the two subgroups. The follow-up period lasted for 6 months and the patency rate was 85% (17) for venous bypass, 11 (64.6%) - short-segment lesions (< 4 cm) and 6 (35.3%) lon notger segment lesions (> 4 cm) versus 76.5% (23) for PTFE graft (p < 0.05), of which 13 (56.5%) were short-segment (<4 cm) and 10 (43.5%) longer segment lesions (> 4 cm). The following results were obtained for the second group of patients: initially successful stents in 85%; failure in 15% or 2 patients; technical failure in 1 patient or 5%. After 6 months the patency rate was 75% (15), of which 11 patients (73.2%) had short-segment occlusions (< 4 cm) whereas 4 patients (26,8%) had lesions > 4 cm. The baseline value of the lower limb index (ABI - ankle-brachial index) was significantly increased in both groups, from 0.41 to 0.91 in the group with surgical revascularization and from 0.47 to 0.88 in the second group treated with stenting. The same trend was observed after six months. This study demonstrated a small but significant difference (85% vs 75%, p < 0.05) in favour of the autologous saphenous vein, which should be a preferred graft material in all cases for reconstruction of the femoropopliteal segment. When compared to the overall patency rate of PTFE grafts after 6 months there was no significant difference in patency in the group treated with stent grafting (76.5% vs 75%). However, stenting is a method of choice in the treatment of short-segment occlusions - smaller than 4 cm with good early run off (73.2% vs 64.6%, p > 0.05 p = ns). It is obvious that the results are identical to those in treatment with an autologous great saphenous vein, but in comparison with PTFE the results imply stent usage (73.2% vs 56.5%, p < 0.005). Prosthesis (PTFE) is a graft material of choice when the great saphenous vein is used, damaged or calcified and when the occlusion is longer than 4 cm and is not suitable for stent grafting (43.5% vs 26.6%, p < 0.001). Key words: peripheral artery disease, femoropopliteal bypass, percutaneous translu notminal stent angioplasty.