scholarly journals THE IMPORTANCE OF NON-INVASIVE REGIONAL BRAIN OXIMETRY IN PREVENTING POSTOPERATIVE COGNITIVE DYSFUNCTION DURING LAPAROSCOPIC CHOLECYSTECTOMY IN ELDERLY AND SENILE PATIENTS

2020 ◽  
Vol 4 ◽  
pp. 11-17
Author(s):  
Olena Bielykh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Gallstone Disease ◽  
Postoperative Cognitive Dysfunction ◽  
Test Group ◽  
Non Invasive ◽  
Regional Brain ◽  
Group I ◽  
Group Ii

The adverse effect of general anesthesia in elderly patients during surgery requires monitoring of functions and processes to identify their dangerous abnormalities to prevent complications. The aim of the study. To establish the effectiveness of non-invasive regional brain oximetry with rSO2 determination during anesthetic support in laparoscopic cholecystectomy (LCE) to prevent postoperative cognitive dysfunction in elderly and senile patients. Material and methods. 84 elderly and senile patients with diagnosed gallstone disease, acute cholecystitis, who underwent LCE with sevofluran inhalational anesthesia and total intravenous anesthesia with propofol were examined. rSO2 was monitored. Cognitive functions were assessed using neuropsychological scales and the MMSE mental state examination scale. Results. rSO2 was found to be significantly decreased during the carbon dioxide insufflation as compared to before premedication: in LH (left hemisphere) – by 7.0 %, in RH (right hemisphere) – by 6.9 % (Group I); in LH – by 7.4 %, in RH – by 7.5 % (Group II). rSO2 was significantly increased during the surgery, particularly in the middle of the operation, as compared to before premedication: in LH – by 14.66 %, in RH – by 13.94 % (Group I); in LH – by 11.60 %, in RH – by 11.53 % (Group II). The day following the surgery, cognitive functions significantly decreased by 8.7 % on the Luria's test, by 6.0 % on the MMSE test (Group I); in Group II – by 10.1 % and 6.3 %, respectively, as compared to before premedication. On Day 5 after the surgery, cognitive functions decreased by 2.7 % on the Luria's test, by 0.35 % on the MMSE test (Group I); in Group II – by 2.7 % and 0.35 %, respectively, as compared to before premedication. Conclusions. A decrease in rSO2 can occur during LCE in the Trendelenburg position, despite the fact that other intraoperative indicators remain stable, which allows it to remain unrecognized. rSO2 monitoring in the perioperative period contributes to alertness and timely measures to prevent postoperative cognitive dysfunction.

scholarly journals Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

2021 ◽  
pp. 34-39
Author(s):  
Olena Bielykh ◽  
Marine Georgiyants ◽  
Olena Vysotska ◽  
Anna Strashnenko
Keyword(s):  
Mechanical Ventilation ◽  
Laparoscopic Cholecystectomy ◽  
Elderly Patients ◽  
Cognitive Functions ◽  
Perioperative Period ◽  
The State ◽  
Stress Markers ◽  
Group I ◽  
Baseline Values ◽  
Group Ii

The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients. Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated. Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001). In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery. According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001). On the fifth postoperative day, no significant differences in baseline values ​​between the Luria test and the MMSE scale were detected. Conclusions.  The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient. According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period

scholarly journals IMPROVING THE RESULTS OF THE LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH COMPLICATED COURSE OF THE CALCULOUS CHOLECYSTITIS

2019 ◽  
Vol 72 (5) ◽  
pp. 790-794
Author(s):  
Oleg Y. Kanikovskyi ◽  
Yaroslav V. Karyi ◽  
Yura V. Babiichuk ◽  
Yevhen V. Shaprynskyi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gallstone Disease ◽  
Results Of Treatment ◽  
Bile Duct Injuries ◽  
Group I ◽  
Complicated Course ◽  
Duration Of Disease ◽  
Group Ii ◽  
Calculous Cholecystitis

Introduction: The laparoscopic cholecystectomy (LCE) has become “gold standard” in treatment of the gallstone disease (GSD). However, introduction of LCE is accompanied by increase in the frequency of the bile duct injuries by 2-5 times, and transfer to the conversion offsets main advantages of the laparoscopic access. The aim: Тo improve the results of treatment of the patients with complicated course of the calculous cholecystitis by developing new methods of the laparoscopic cholecystectomy. Materials and methods: The results of surgical treatment of 420 patients with complicated course of the calculous cholecystitis were analyzed. The patients were divided intwo groups: group I (n = 210) where the standard four-trocar LCE was used and the group II (n = 210) where the developed methods of LCE were used. The average age made up 62 ± 6.0 years. Duration of disease made up from 1 month to 35 years. Results: The patients in group I LCE with complicated course of the acute cholecystitis was performed in 108 (25.7%) cases, chronic – in 102 (24.3%) cases. The patients in group II surgical intervention with complicated course of the acute cholecystitis was performed in 112 (26.7%) cases, chronic – in 98 (23.3%) cases. The patients of group I intraoperative injuries were observed in 12 (5.7%) cases and patients of group II – in 4 (1.9%) cases. The conversion was applied in 13 (6.2%) and in 4 (1.9%) cases, respectively. 2 (0.9%) patients died. Conclusions: Introduction of the developed methods of LCE with complicated course of the calculous cholecystitis allows to reduce the frequency of intraoperative injuries by 3,8% and conversion rate – by 4,3% (p <0,001).

Stimulus Vividness and Anxiety Level in Intentional—Incidental Learning

1964 ◽  
Vol 14 (3) ◽  
pp. 819-825 ◽  
Author(s):  
Marilyn E. Miller ◽  
Joyce A. Dost
Keyword(s):  
Recognition Test ◽  
Incidental Learning ◽  
Test Group ◽  
Anxiety Level ◽  
Sorting Task ◽  
Group I ◽  
Group Ii

High (Ha) and low (La) scorers on the MAS were instructed to alphabetize a deck of 30 words, 10 each of which were high, medium, or low vivid. Group I had 3 trials with incidental instructions (told only to sort), a recognition test of the words, three more trials with instructions to learn the words, and a second recognition test. Group II had 6 incidental sorting trials followed by a recognition test. It was hypothesized that Ha Ss would sort more efficiently and recognize fewer words because of a greater tendency to focus on fewer available cues. Findings in support of the hypothesis were that Ha Ss sorted more rapidly and more accurately, recognized fewer words, and showed greater disruption in the sorting task when instructed to learn the words. In addition, Ha Ss evidenced a “sensitized” reaction to medium vivid words.

scholarly journals Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M Maher ◽  
H Abdelaziz ◽  
T yossif ◽  
M Ossama
Keyword(s):  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Disease Severity ◽  
P Value ◽  
Cytokeratin 18 ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Group I ◽  
Egyptian Patients ◽  
Group Ii

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is one of the types of fatty liver which occurs when exceeive fat is deposited in the liver due to causes other than excessive alcohol use, NAFLD is subdivided into non alcoholic fatty liver (NAFLD) and nonalcoholic steatohepatitis (NASH). In NAFLD, hepatic steatosis is present without evidence of significant inflammation, whereas in NASH, hepatic steatosis is associated with hepatic inflammation Aims To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients. Patients and Methods 60 subjects were divided into 2 groups: group I: including 30 patients with NAFLD, group II: including 30 matched healthy controls Diagnosis of NASH and its discrimination from NAFL was done by fibroscan. CK-18 level in plasma was measured for all subjects using ELISA. Results CK-18 was significantly elevated in patients of group I in comparison to group II, with mean ± SD: 460 ± 279, 167 ± 56 and 149 ± 57, respectively, and P value: 0.001. with mean ±SD: 59.6± 28, when compared with control group (with 23±8) P value &lt; 0.001. ROC curve between Cases and Control regard CK18 with Area Under the Curve (AUC): 0.925. Cutoff &gt; 30 ug/l With Sensitivity: 86.67% & Specificity: 83.33%. Ck-18 was found to correlate with steatosis and fibrosis assessed by fibroscan with P value&lt; 0.001. Conclusion Measurement of serum cytokeratin 18 fragment levels (CK18) correlate with the Fibroscan (Transient Elastograph) as a non invasive tests in diagnosis & prognosis of non alcoholic fatty liver diseases (NAFLD).

scholarly journals THE COMPARISON OF DEEP NECK FLEXOR STRENGTHENING EXERICISE WITH MCKENZIE NECK EXERCISE FOR NECK POSTURE CORRECTION ON STUDENTS WITH FORWARD HEAD POSTURE AT SMA N 1 SEMARAPURA

2018 ◽  
Vol 6 (1) ◽  
pp. 23
Author(s):  
Gede Eka Juli Prasana ◽  
I Nyoman Adiputra ◽  
I Made Krisna Dinata
Keyword(s):  
Exercise Intervention ◽  
Hypothesis Test ◽  
Test Group ◽  
Forward Head Posture ◽  
Head Posture ◽  
Group I ◽  
Strengthening Exercise ◽  
Significant Difference ◽  
Before And After ◽  
Group Ii

This study aims to compare deep neck flexor strengthening exercise intervention with mckenzie neck exercise to correct the neck posture of student with forward head posture. Using experimental design with Pre-Test and Post-Test Group Design involves a sample of 24 people divided into 2 groups. Group I was given deep neck flexor strengthening exercise intervention and Group II was given mckenzie neck exercise intervention. Hypothesis Test using paired sample t-test obtained result p = 0.592 with average difference in Group I 7.58 ± 4.39 whereas Group II got difference mean 8.5 ± 3.84. These results showed no significant difference in craniovertebral angle elevation before and after intervention in both groups. Keywords : forward head posture, craniovertebrae angle, deep neck flexor strengthening exercise, mckenzie neckexercise,

Physical Activity Effects in Elderly Female: Evaluation through Six-minute Walking Test

2011 ◽  
Vol 20 (5-6) ◽  
pp. 95-104 ◽  
Author(s):  
Matteo Merati ◽  
Alice Beretta ◽  
Luca Eid ◽  
Francesco Casolo ◽  
Nicola Lovecchio
Keyword(s):  
Physical Activity ◽  
Daily Living ◽  
Elderly Women ◽  
Training Session ◽  
Test Group ◽  
Walking Test ◽  
Elderly Female ◽  
Group I ◽  
Group Ii ◽  
Experimental Group

Physical Activity Effects in Elderly Female: Evaluation through Six-minute Walking Test Study aim. Aerobic capacity is very important for elderly. Daily living activities, such as walking, doing housework and shopping, require a good strength, but also a good aerobic endurance. The aim of this study was to verify the effects of regular training activity on a typical daily action, such as deambulation. Material and methods. Twenty-six volunteer elderly women randomly divided into two groups, group II (age = 64,5 ± 3,58 years, weight = 61,67 ± 4,25 kg, height = 1,62 ± 0,04 m; BMI = 23,67 ± 1,79 kg m-2), group I (age = 65,21 ± 4,59 years, weight = 63,36 ± 7,59 kg, height = 1,62 ± 0,06 m; BMI = 24,1 ± 1,98 kg m-2) participated in this study. Groups performed endurance training for eight weeks (2 days per week, 1 hour each, for experimental group II; 1 day per week, 1 hour each, for experimental group I). Exercises involved in many possibilities of physical expression to keeping all body in motion for at least 30 min. During the second 30 min exercises for abdominal and lower limb muscles were proposed. The physical efficacy was tested through 6 min walking test. Results. After the training all people increased the distance in the test. Group II participants significantly improved their distance (pre-training = 636.25 m, post-training = 673.75 m). Group I reported also improvements (pre = 568.21 m; post = 600 m), but with a minor level of significance. Conclusions. Specific regular physical activity provides significant benefits adopting two sessions per week but it is also important do not underestimate the possibility, where people can not, of a one training session per week. Regular and adequate levels of physical activity allow improving daily living activity helping the elderly to keep their autonomy as long as possible.

Liver Fibrosis in Adult Thalassemia Patients Assessed by Transient Elastography.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3820-3820
Author(s):  
Elena Cassinerio ◽  
Mirella Fraquelli ◽  
Elisabetta Volpato ◽  
Cristina Rigamonti ◽  
Massimo Colombo ◽  
...  
Keyword(s):  
Iron Overload ◽  
Transient Elastography ◽  
Thalassemia Major ◽  
Hcv Rna ◽  
Liver Iron ◽  
Non Invasive ◽  
Group I ◽  
Group Ii ◽  
T2 Mri ◽  
Severe Fibrosis

Abstract Background and aim. Transient elastography (TE) is a new, non-invasive and reproducible technique that measures liver stiffness (LSM). It has been demonstrated to be a reliable tool for assessing hepatic fibrosis and cirrhosis in patients with chronic liver disease (CLD). However, its role in patients with b- thalassemia has not been extensively investigated. The aim of the present study was to assess LSM and its possible correlation with iron overload in HCV positive patients with b- thalassemia major and intermedia. Methods. During a six-month period (from January to June 2007) 46 consecutive adults patients with b- thalassemia afferring to a single Italian Thalassemia Care Center in Milan, Italy, were enrolled in the study. Twenty-nine patients (Group I: 7 M and 23 F; mean age 31±SD 7.1 yrs; mean BMI 23.4±SD 3 Kg/m2) had b- thalassemia major and 17 intermedia (Group II: 10 M and 7 F; mean age 43±SD12.4 yrs; BMI 22 ±SD 3 Kg/m2). Sixteen patients (55%) in group I and two (12%) in group II were HCV RNA positive. All patients were examined by TE (FibroScan®; Echosens, Paris, France) and only the examinations with at least 10 validated measurements and a success rate of at least 60% were considered adequate. According to a previous study in CLD patients the considered TE cut off to diagnosing different stages of hepatic fibrosis were: &gt;7.9 kPa for F≥2; &gt;10.3 for ≥F3 and &gt;11.9 for F=4. Twelve patients (all in group I) also had undergone liver biopsy. Necroinflammation and fibrosis were scored by METAVIR classification; liver iron concentration (LIC, mg/gr of liver dry weight) was measured on fresh tissue cores by atomic absorption spectrometry. Twenty-five patients underwent liver iron determination by T2* Magnetic Resonance Imaging (MRI) assessment. Results. In patients who underwent liver biopsy, LSM increased proportionally to the METAVIR stage and a significant positive correlation was observed between LSM and fibrosis stage (r=0.57, p= 0.039). Patients in group I had significantly higher values of mean LSM values (10.6± SD 9.3 kPa) and serum ferritin (SF) (1367±SD 1169 ng/mL) than those in group II (6.0± SD 3.3 kPa and 716±SD 472 ng/mL, respectively) (p&lt;0.05). In both groups LSM did not significantly correlate with age, BMI, platelets count, serum iron and iron overload measured by T2* MRI. In group I a significant positive correlation was observed betweeen LSM and SF (r=0.47, p=0.008), ALT (r=0.87, p=0.0001) and GGT levels (r=0.80, p=0.0001). Among patients with b- thalassemia major LSM values did not differ significantly between HCV RNA positive (13.0±SD 12.5 kPa) and negative patients (7.7±SD 3.3 kPa) (p=NS) as well as the proportion of patients with significant (F&gt;=2) or severe fibrosis (F&gt;=3) did not differ significantly according to HCV viremic status. Conclusion TE is a reliable non invasive technique to stage liver fibrosis in patients with b- thalassemia major. In these patients with concomitant HCV infection a significant or severe fibrosis was observed in about one third of the cases. Apart from fibrosis also serum necroinflammatory activity, GGT levels and SF levels may influence LSM values. The reliability of liver iron overload by T2* MRI evaluation remains still to be validated.

scholarly journals Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

2018 ◽  
Vol 9 (4) ◽  
pp. 485-490
Author(s):  
М. А. Georgiynts ◽  
V. А. Коrsunov ◽  
О. М. Оlkhovska ◽  
К. E. Stoliarov
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Output ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Flow Index ◽  
Non Invasive ◽  
Group I ◽  
Group Ii

The study of intracranial pressure (eICP), cerebral perfusion pressure (eCPP), cerebral blood flow index (CFI), zero flow pressure (ZFP) in 49 children hospitalized in the intensive care unit with severe course of neuroinfections was carried out. The level of consciousness was determined by the Glasgow pediatric scale. Monitoring of central and peripheral hemodynamics (ECG, heart rate, systolic, diastolic and mean blood pressure, and cardiac output), pulse oximetry, capnography, hemoglobin, hematocrit, total protein, urea, creatinine, lactate, glucose and serum electrolytes was done. An ultrasound scanner was used to perform ultrasound duplex scanning of blood flow in the left and middle cerebral artery (MCA), measuring maximum, minimum and average blood flow velocities, pulsation index (PI), and resistance index (RI). Based on the formulae of Edouard et al. indicators of eCPP, ZFP, CFI, eICP were calculated. The eSCP was also determined by the formulae of Kligenchöfer et al. and Bellner et al. All patients were divided into group I with RI > 1.3 and group II with RI < 1.3. It was found that eCPP in the group I was significantly less (29.5 ± 1.3 mm Hg) than in the II group (41.6 ± 1.7 mm Hg). Despite the lack of a reliable difference in blood pressure between groups I and II, the difference in eCPP was found due to a significant difference in eICP 34.6 ± 1.4 and 27.6 ± 0.89 mm Hg in I and II groups respectively. ZFP in group I was significantly higher than in group II. The indexes of the Glasgow coma scale was significantly lower in group I and 7.8 ± 0.6 points. There were observed direct moderate correlations between systolic blood pressure, cardiac output and eSRP and CFI, presumably associated with a loss of autoregulation. CFI in the group I was lower than in the group II. Thus, non-invasive examination of cerebral flow in MCA by duplex sonography revealed that PI > 1.3 is an informative marker of intracranial hypertension and reduction of cerebral perfusion, which is common in children with neuroinfections. To determine the eSRP and CFI it is advisable to use the formula of Edouard et al. and to determine the eICP the formula of Kligenchöfer et al. The obtained data can be useful for objectifying the severity of the condition, predicting the outcomes of neuroinfections, choosing the directions of intensive care and evaluating its effectiveness.

scholarly journals The effect of low dose midazolam in addition to ondansetron on post-operative nausea and vomiting in laparoscopic cholecystectomy – a comparative study

2014 ◽  
Vol 24 (1) ◽  
pp. 8-12
Author(s):  
MM Masum-Ul Haque ◽  
Montosh K Mondal ◽  
S Afroz ◽  
SS Akhter ◽  
Abdul Hye ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Low Dose ◽  
Postoperative Nausea And Vomiting ◽  
Group Iv ◽  
Nausea And Vomiting ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Post Operative Nausea

Background Nausea, retching and vomiting are among the most common postoperative complaints. Premedication with low dose midazolam in addition to ondansetron is more effective in controlling postoperative nausea and vomiting. Objectives This study was designed to observe the effect of low dose midazolam 7.5mg in addition to ondansetron 4mg on postoperative nausea and vomiting in laparoscopic cholecystectomy. Methods 100 patients of ASA grade I and II, age range 30-50 years and weight 50-70 kg were randomly selected by a blind envelop method. They were equally divided into four groups of 25 patients in group each. Group I received vitamin, Group II ondansetron 8mg, Group III ondansetron 8mg and midazolam 7.5mg and Group IV ondansetron 4mg and midazolam 7.5 mg orally one hour before operation. In the recovery room occurrence of nausea and vomiting was assessed for 24 hours. Results The incidence of nausea was in vitamin Group I 64%, in ond8 group II 32%, in ond8+mid7.5 group III 24% and in ond4+mid7.5 group IV 24%. The incidence among the groups was highly significant (p=0.008). The incidence of vomiting was in vitamin Group I 16%, in ond8 group II 16%, in ond8+mid7.5 group III 8% and in ond4+mid7.5 group IV 8%. The difference among the groups were not significant (p=0.808). Conclusion Low dose midazolam 7.5mg in addition to ondansetron 4mg is more effective in controlling postoperative nausea and vomiting in laparoscopic cholecystectomy. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19793 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 8-12

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