A Low-Volume Epidural Blood Patch for the Treatment of Spontaneous Intracranial Hypotension: A Case Report.

Spontaneous intracranial hypotension (SIH) is a rare neurological syndrome. We report the case of a 47-year-old woman with acute, severe orthostatic headache after surgery, chemotherapy, and radiotherapy for breast cancer. The brain and spine magnetic resonance imaging showed signs of intracranial hypotension. We describe the results of a non-targeted epidural blood patch with 10 mL of the patient's blood administered after unsuccessful conservative treatment. After the procedure, the patient reported gradual headache relief. This effect persisted over one year. The case shows that a single non-targeted low-volume epidural blood patch can be an effective treatment option for a patient with SIH when conservative treatment fails.

Foreign Body in the Airway Mimicking Tumour in an Adult: A Case Report.

Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol addiction, neuromuscular diseases, and mental health issues and illnesses are the main risk factors. The authors present an atypical clinical presentation of a 3-week-lasting foreign body aspiration mimicking a tumour that led to severe acute respiratory insufficiency and required aggressive artificial lung ventilation. Diagnosis of FB was based on the results of the chest computed tomography (CT) scans and flexible bronchoscopy, which, however, initially assumed a neoplastic disease in the right main bronchus. During FB extraction via flexible fiberoptic bronchoscopy inserted through an 8.5 mm endotracheal tube high-frequency ventilation through a catheter placed between the vocal cords was used to ensure adequate alveolar ventilation and maintain sufficient oxygenation. After extraction of the FB, thoracosurgical intervention was performed to resolve empyema as a septic complication of the FB aspiration. After this therapy, a complete resolution of pleural empyema and lung atelectasis was observed.

Occurrence of butyrylcholinesterase polymorphisms in patients undergoing surgery in Slovakia.

Background: Post-operative residual curarization is a persisting problem, characterized by muscle fatigue, exhaustion or paresis, caused by the use of neuromuscular blocking agents with prolonged postoperative effect. Genetically, determined changes in cholinesterase activity can be a major reason for persistent muscle blockade after administration of muscle relaxants. Methods: Regarding the subsistence of polymorphisms in the plasma cholinesterase gene causing change in enzyme activity and metabolism of applied drugs, we investigated the frequency of two polymorphisms known to reduce its activity significantly in patients undergoing surgery. Results: Primary results show a relatively high occurrence of plasma cholinesterase K risk allele (18.75%). Conclusion: Characterization of the lacking information about genetic background of changes in plasma cholinesterase activity within Slovakia may allow for easier decision-making in clinical practice when selecting alternative neuromuscular blocking and also reversal agents.

Effect of Polymeric Nanoparticles with Entrapped Fish Oil or Mupirocin on Skin Wound Healing Using a Porcine Model.

The utilization of poly(lactic-co-glycolic) acid (PLGA) nanoparticles (NPs) with entrapped fish oil (FO) loaded in collagen-based scaffolds for cutaneous wound healing using a porcine model is unique for the present study. Full-depth cutaneous excisions (5 × 5 cm) on the pig dorsa were treated with pure collagen scaffold (control, C), empty PLGA NPs (NP), FO, mupirocin (MUP), PLGA NPs with entrapped FO (NP/FO) and PLGA NPs with entrapped MUP (NP/MUP). The following markers were evaluated on days 0, 3, 7, 14 and 21 post-excision: collagen, hydroxyproline (HP), angiogenesis and expressions of the COX2, EGF, COL1A1, COL1A3, TGFB1, VEGFA, CCL5 and CCR5 genes. The hypothesis that NP/FO treatment is superior to FO alone and that it is comparable to NP/MUP was tested. NP/FO treatment increased HP in comparison with both FO alone and NP/MUP (day 14) but decreased (p < 0.05) angiogenesis in comparison with FO alone (day 3). NP/FO increased (p < 0.05) the expression of the CCR5 gene (day 3) and tended (p > 0.05) to increase the expressions of the EGF (day 7, day 14), TGFB1 (day 21) and CCL5 (day 7, day 21) genes as compared with NP/MUP. NP/FO can be suggested as a suitable alternative to NP/MUP in cutaneous wound treatment.

Effects of Different Processing Methods of Coffee Arabica on Colour, Acrylamide, Caffeine, Chlorogenic Acid, and Polyphenol Content.

An effect of a processing method (dry and wet) and a degree of roasting (light, medium, and dark) of 15 coffee (Coffea arabica) samples on the content of caffeine, chlorogenic acid (CQA), total polyphenols (TPP), acrylamide (AA), and on the colour parameters L*, a*, and b* was evaluated. Neither processing nor roasting affected caffeine content (p > 0.05). The degree of roasting accounted for 46% and 72% of explained variability of the CQA content and AA content, respectively (p < 0.05). AA content was in the range from 250 (wet-processed, light-roasted samples) to 305 µg·kg-1 (wet-processed, dark-roasted coffees), but the dark roasting only tended (p > 0.05) to increase AA content. Wet-processed, dry-roasted coffee had higher (p < 0.05) TPP content (48.5 mg·g-1) than its dry-processed, dry-roasted counterpart (42.5 mg·g-1); the method of processing accounted for 70% of explained variability of TPP. Both the method of processing and the degree of roasting affected the L*, a*, and b* values (p < 0.01), but the lower values (p < 0.05) of these parameters in the dark-roasted samples were found only within the wet processing. A negative correlation between the AA content and lightness (L*) was established (r = -0.39, p < 0.05). It was concluded that from the consumers' viewpoint, the results of the present study indicate relatively small differences in quality parameters of coffee irrespective of the method of processing or degree of roasting.

Improvement of mortality prediction accuracy in critically ill patients through combination of SOFA and APACHE II score with markers of stress haematopoiesis.

INTRODUCTION: In critically ill patients nucleated red blood cells (NRBC) and immature granulocytes (IG) appear in the peripheral blood as the consequence of stress haematopoesis. The aim of this retrospective study was to evaluate the diagnostic value of NRBC and IG and to propose a model of improved mortality prediction including these parameters in the assessment of critically ill patients. METHODS: The study included 338 critically ill adult patients hospitalized at Department of Anaesthesiology and Intensive Medicine, Louis Pasteur University Hospital in Kosice. As NRBC positive patients were considered patients with peripheral NRBC > 0.01 × 109 /L and IG positivity as >0.03 × 109 /L. Apache II index was calculated 24 hours after admission and Systemic Organ Failure Assessment (SOFA) on the day with the worst clinical condition. RESULTS: NRBC positivity was found in 27.6% of patients. The mortality of NRBC positive patients was 48.38%, significantly higher than 23.7% of NRBC negative patients. IG positivity was 79.0% and their mortality was also higher as compared with that of IG negative patients (69.3% vs 33.8%). Three regression models predicting mortality including stress haematopoiesis markers, APACHE II, SOFA scores and age had sufficient level of sensitivity and specificity. CONCLUSION: The presence of NRBC in the peripheral blood and the IG increase are available early risk predictors of mortality in critically ill patients. Regression models designed by combination of SOFA, APACHE II, and the new haematological parameters increase the accuracy and effectivity of diagnostic process in predicting prognosis and risk of mortality with high sensitivity and specificity.

EQ-5D-5L questionnaire as suitable assessment of quality of life after epiduroscopy : Multicenter randomized double-blind pilot study.

BACKGROUND: Epiduroscopy is a well-established diagnostic and to certain level therapeutic tool in complex situations, where conventional methods such as magnetic resonance imaging (MRI) lack power or resolution to detect pathological changes. Such a situation is primarily failed back surgery syndrome (FBSS) but also radicular pain without surgery. The aim of this study was to determine the effectiveness of epiduroscopic treatment in patients with FBSS. METHODS: A total of 79 patients with FBSS were randomized into 2 groups. The first group underwent epiduroscopy and received mechanical lysis of adhesions only, the second group received also medication into the epidural space (methylprednisolone and hyaluronidase). Patients were subsequently followed for 12 months, with evaluation also after 6 months post-epiduroscopy. Patients were checked in terms of mobility, self-care, usual activities, pain/discomfort and anxiety/depression as defined in the 5­dimensional EQ-5D-5L questionnaire and to asses suitability of this questionnaire in chronic pain states. Data were collected using EQ-5D-5L questionnaire and also quality of life (QoL) questionnaire. RESULTS: In the terms of ability to walk (dimension mobility) and also ability to do housework, study or leisure activities (dimension usual activity) patients improved in both groups after 6 and 12 months after epiduroscopy. In pain dimension there was improvement mainly after 6 months which correlated also with self-care dimension and quality of life self-assessment. Results in anxiety/depression dimension were mixed. CONCLUSION: Epiduroscopy appears to be a beneficial procedure for both patient groups, especially after 6 months, with some benefit remaining after 12 months. The EQ-5D-5L questionnaire seems to be a suitable and comprehensive way to assess patient health in chronic pain states.

Selenium adjuvant therapy in septic patients selected according to Carrico index.

OBJECTIVES: The objective of this paper is to highlight the selected group of patients in which adjuvant therapy seems to have a more pronounced positive effect. DESIGN AND METHODS: 65 septic patients from the prospective observational study Se-AOX (2008-2012) (ClinicalTrials.gov Identifier: NCT02026856) were divided into a Se group, receiving sodium selenite in a continual infusion of 750µg/24h for 6 days, and a placebo group. They were subsequently divided into subgroups according to the initial Carrico index (CI) on the day of admission: CI>200 and CI<200. Dynamical changes in glutathione peroxidase (GPx), glutathione reductase (GR) and superoxide dismutase activities were recorded at two day intervals. Clinical parameters and mortality were compared. RESULTS: The CI increased in subgroup Se-CI<200 with negative correlation against subgroup Placebo-CI<200 during the last measuring period (p<0.02). GPx activity increased in selenium subgroups with negative correlation against placebo subgroups (p<0.01). SOD activity was elevated in all subgroups in comparison with values of healthy subjects. CONCLUSIONS: Adjuvant selenium therapy seems to be beneficial for a selected group of patients with acute lung injury. However, as is clear from the results discussed, this is not the case with persistent renal failure, as this leads to an inability to maintain synthetic renal function and ensure GPx synthesis.

[Acute multiple organ failure after endoscopic polypectomy]. / Akútne multiorgánové zlyhanie po kolonoskopii s polypektómiou.

BACKGROUND: Serious intraabdominal infections belong among life treating diseases. They are based on spreading infections from focal sources of inflammation in abdomen or damaged intestinal wall. METHODS AND RESULTS: Treatment strategies are surgical intervention, antimicrobial therapy, distributional shock treatment and accurate nutritional support (1). Glutamine and selenium supplementation may improve intestinal functions and restore antioxidant defence (2). Septic shock with multiple organ failure accompanied by serious catabolism and decrease of albumin had developed in a patient after endoscopic polypectomy. Infection source was not discovered by medical imaging examinations non surgical laparotomy. After distributive shock treatment, wide spectral antibiotics and enteral and parenteral nutrition the patients health improved. As adjuvant therapy intravenous supplementation was administered: glutamine in daily dose 2g and sodium selenite in continual infusion in daily dose 750 µg over 6 days. During intensive therapy, inflammatory markers decreased: C-reactive protein, procalcitonin, leukocyte count and neutrophils. Albumin levels increased. CONCLUSIONS: The paper describes therapeutic options during septic shock treatment and reversion possibilities in the catabolic phase of disease.Key words: colonoscopy, septic shock, multiorgan failure, enteral nutrition, parenteral nutrition.