scholarly journals General Anaesthesia for Renal Transplantation in Latvia: A Critical Analysis Based on Clinical Experience

2013 ◽  
Vol 67 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Antoņina Sondore ◽  
Sanita Ūdre ◽  
Jānis Nemme ◽  
Laimdota Grašiņa ◽  
Ieva Kruževņaka ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
General Anaesthesia ◽  
Venous Pressure ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Haemodynamic Instability ◽  
Total Intravenous Anaesthesia ◽  
Intravenous Anaesthesia ◽  
Arterial Blood

Anaesthesia methods for surgical procedures, as well as for organ transplantation, have experienced remarkable changes over the past 40 years. Cadaveric renal transplant function may be impaired by haemodynamic instability induced by anaesthesia drugs. This study aimed to analyse the safety and effectiveness of the different anaesthesia methods used for renal transplantation in Latvia since 1973, with focus on its haemodynamic effects. In this retrospective study anaesthesia chart review was conducted for 607 patients (pts), aged 17-75 yrs, ASA III/IV, undergoing renal transplantation using general anaesthesia in the following periods: 1973-1990 (stage I - 282 pts); 1991-2000 (stage II - 145 pts); 2001-2011 (stage III - 180 pts). Haemodynamic data (systolic, diastolic, mean arterial blood pressure and central venous pressure) were measured prior to premedication and induction of anaesthesia, immediately afterwards, during the surgery and up to its completion with the special attention regarding the time of graft reperfusion. The main perioperative problems of the anaesthesia methods used during stage I (barbiturates, viadril, neuroleptanalgesics, sodium oxybutyrate, halothane, nitrous oxide) was haemodynamic instability in 60% of cases and apnea due to central depression and long-time peripheral neuromuscular blockade. Two patients died due to underlying comorbid conditions, including hyperhidration and oedema pulmonum. Substantial haemodynamic changes during total intravenous anaesthesia with propofol and combined anaesthesia propofol-isoflurane (stage II) were not observed. At the time of graft reperfusion, the incidence of hypotension was slightly higher in patients anaesthetised with isoflurane than in those who received sevoflurane (stage III), but this difference was not significant (P > 0.05). Kidney functioned immediately in 75% of cases and delayed function was observed in 25% of cases in sevoflurane and isoflurane groups. The modern anaesthetic agents provide a great margin of safety during renal transplantation. Total intravenous anaesthesia with midasolam-fentanyl-propofol and general anaesthesia with propofol-isoflurane, propofol-sevoflurane can be safely used. During renal transplantation, anaesthesiologists must optimise volume status, perfusion pressure and promote survival of the renal graft.

Correlation between venous stump pressure and brain damage after cortical vein occlusion: an experimental study

1997 ◽  
Vol 86 (4) ◽  
pp. 694-698 ◽  
Author(s):  
Yuhei Yoshimoto ◽  
Masaru Endo ◽  
Takashi Mori ◽  
Susumu Wakai
Keyword(s):  
Brain Damage ◽  
Venous Pressure ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Venous Obstruction ◽  
Venous Resection ◽  
Cortical Vein ◽  
Vein Occlusion ◽  
Stump Pressure

✓ A canine model of cortical vein occlusion was used to evaluate whether data obtained from monitoring venous stump pressure could help predict cerebral infarction after venous obstruction. Following bilateral parasagittal craniotomy, the cortical vein in each hemisphere was temporarily occluded and the increase in pressure was directly measured. Permanent venous obstruction was subsequently produced, and parenchymal brain damage 24 hours later was classified as: Stage 0, no parenchymal damage; Stage I, mild edema; Stage II, moderate parenchymal edema and/or ischemic changes in neurons; and Stage III, moderate-to-severe hemorrhage. The histological stages correlated closely with the rise in venous pressure: mean pressure increases (± standard deviation) were 5.5 ± 2.9 mm Hg in hemispheres graded as Stage 0 (12 hemispheres), 7.7 ± 3.2 mm Hg in those graded as Stage I (five), 11.2 ± 4.1 mm Hg in those classed as Stage II (five), and 16.4 ± 5 in those categorized as Stage III (seven). There were significant differences between Stages 0 and II (p < 0.01) and between Stages 0 and III (p < 0.001). Disruption of the blood-brain barrier as indicated by extravasation of Evans blue dye correlated well with the pressure increment. These results may indicate the threshold for injury after cortical venous occlusion. Venous stump pressure measurements obtained during a test occlusion may be a useful adjunct in predicting brain damage and may be helpful for intraoperative vessel selection for venous resection.

Identification of biomarkers and functional modules from genomic data in stage-wise breast cancer

2020 ◽  
Vol 15 ◽  
Author(s):  
Athira K ◽  
Vrinda C ◽  
Sunil Kumar P V ◽  
Gopakumar G
Keyword(s):  
Breast Cancer ◽  
Expression Patterns ◽  
Differential Expression Analysis ◽  
Predictive Biomarkers ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Functional Modules ◽  
Incidence And Mortality ◽  
Multiple Stages

Background: Breast cancer is the most common cancer in women across the world, with high incidence and mortality rates. Being a heterogeneous disease, gene expression profiling based analysis plays a significant role in understanding breast cancer. Since expression patterns of patients belonging to the same stage of breast cancer vary considerably, an integrated stage-wise analysis involving multiple samples is expected to give more comprehensive results and understanding of breast cancer. Objective: The objective of this study is to detect functionally significant modules from gene co-expression network of cancerous tissues and to extract prognostic genes related to multiple stages of breast cancer. Methods: To achieve this, a multiplex framework is modelled to map the multiple stages of breast cancer, which is followed by a modularity optimization method to identify functional modules from it. These functional modules are found to enrich many Gene Ontology terms significantly that are associated with cancer. Result and Discussion: predictive biomarkers are identified based on differential expression analysis of multiple stages of breast cancer. Conclusion: Our analysis identified 13 stage-I specific genes, 12 stage-II specific genes, and 42 stage-III specific genes that are significantly regulated and could be promising targets of breast cancer therapy. That apart, we could identify 29, 18 and 26 lncRNAs specific to stage I, stage II and stage III respectively.

Cardiac transthyretin wild-type amyloidosis (ATTRwt): a prospective study of 400 patients followed at the Italian referral center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Milani ◽  
L Obici ◽  
R Mussinelli ◽  
M Basset ◽  
G Manfrinato ◽  
...  
Keyword(s):  
Natural History ◽  
Median Survival ◽  
Troponin I ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Wild Type ◽  
Staging Systems ◽  
Significant Difference ◽  
History Of

Abstract Background Cardiac wild type transthyretin (ATTRwt) amyloidosis, formerly known as senile systemic amyloidosis, is an increasingly recognized, progressive, and fatal cardiomyopathy. Two biomarkers staging systems were proposed based on NT-proBNP (in both cases) and troponin or estimated glomerular filtration rate, that are able to predict survival in this population. The availability of novel effective treatments requires large studies to describe the natural history of the disease in different populations. Objective To describe the natural history of the disease in a large, prospective, national series. Methods Starting in 2007, we protocolized data collection in all the patients diagnosed at our center (n=400 up to 7/2019). Results The referrals to our center increased over time: 5 cases (1%) between 2007–2009, 33 (9%) in 2010–2012, 90 (22%) in 2013–2015 and 272 (68%) in 2016–2019. Median age was 76 years [interquartile range (IQR): 71–80 years] and 372 patients (93%) were males. One hundred and seventy-three (43%) had atrial fibrillation, 63 (15%) had a history of ischemic cardiomyopathy and 64 (15%) underwent pacemaker or ICD implantation. NYHA class was I in 58 subjects (16%), II in 225 (63%) and III in 74 (21%). Median NT-proBNP was 3064 ng/L (IQR: 1817–5579 ng/L), troponin I 0.096 ng/mL (IQR: 0.063–0.158 ng/mL), eGFR 62 mL/min (IQR: 50–78 mL/min). Median IVS was 17 mm (IQR: 15–19 mm), PW 16 mm (IQR: 14–18 mm) and EF 53% (IQR: 45–57%). One-hundred and forty-eight subjects (37%) had a concomitant monoclonal component in serum and/or urine and/or an abnormal free light chain ratio. In these patients, the diagnosis was confirmed by immunoelectron microscopy or mass spectrometry. In 252 (63%) the diagnosis was based on bone scintigraphy. DNA analysis for amyloidogenic mutations in transthyretin and apolipoprotein A-I genes was negative in all subjects. The median survival of the whole cohort was 59 months. The Mayo Clinic staging based on NT-proBNP (cutoff: 3000 ng/L) and troponin I (cutoff: 0.1 ng/mL) discriminated 3 different groups [stage I: 131 (35%), stage II: 123 (32%) and stage III: 127 (33%)] with different survival between stage I and II (median 86 vs. 81 months, P=0.04) and between stage II and III (median 81 vs. 62 months, P&lt;0.001). The UK staging system (NT-proBNP 3000 ng/L and eGFR 45 mL/min), discriminated three groups [stage I: 170 (45%), stage II: 165 (43%) and stage III: 45 (12%)] with a significant difference in survival: between stage I and stage II (86 vs. 52 months, P&lt;0.001) and between stage II and stage III (median survival 52 vs. 33 months, P=0.045). Conclusions This is one of the largest series of patients with cardiac ATTRwt reported so far. Referrals and diagnoses increased exponentially in recent years, One-third of patients has a concomitant monoclonal gammopathy and needed tissue typing. Both the current staging systems offered good discrimination of staging and were validated in our independent cohort. Funding Acknowledgement Type of funding source: None

Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

2019 ◽  
Vol 10 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Valdano Manuel ◽  
Humberto Morais ◽  
Aida L. R. Turquetto ◽  
Gade Miguel ◽  
Leonardo A. Miana ◽  
...  
Keyword(s):  
Confidence Interval ◽  
African Country ◽  
Single Ventricle ◽  
Hazard Ratio ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Lost To Follow Up ◽  
Single Ventricle Palliation

Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

scholarly journals Impact of the Number of Dissected Lymph Nodes on Survival for Gastric Cancer after Distal Subtotal Gastrectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Chang-Ming Huang ◽  
Jian-Xian Lin ◽  
Chao-Hui Zheng ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Distal Gastrectomy ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Prognostic Impact ◽  
Term Survival

Objectives. To investigate the prognostic impact of the number of dissected lymph nodes (LNs) in gastric cancer after curative distal gastrectomy.Methods. The survival of 634 patients who underwent curative distal gastrectomy from 1995 to 2004 was retrieved. Long-term surgical outcomes and associations between the number of dissected LNs and the 5-year survival rate were investigated.Results. The number of dissected LNs was one of the most important prognostic indicators. Among patients with comparable T category, the larger the number of dissected LNs was, the better the survival would be (). The linear regression showed that a significant survival improvement based on increasing retrieved LNs for stage II, III and IV (). A cut-point analysis yields the greatest variance of survival rate difference at the levels of 15 LNs (stage I), 25 LNs (stage II) and 30 LNs (stage III).Conclusion. The number of dissected LNs is an independent prognostic factor for gastric cancer. To improve the long-term survival of patients with gastric cancer, removing at least 15 LNs for stage I, 25 LNs for stage II, and 30 LNs for stage III patients during curative distal gastrectomy is recommended.

High Risk Status for Stage I Palliation Increases Mortality Following Stage II But Not Stage III

2021 ◽  
Author(s):  
Garrett N. Coyan ◽  
Carlos Diaz-Castrillon ◽  
Mario Castro-Medina ◽  
Luciana Da Fonseca Da Silva ◽  
Melita Viegas ◽  
...  
Keyword(s):  
High Risk ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Risk Status

Differing from diseased stage in melanoma, the olfactory receptor gene OR56A4 is expressed

2021 ◽  
Author(s):  
Bronte Morse ◽  
Kobi Decker
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Olfactory Receptor ◽  
Receptor Gene ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Olfactory Receptor Gene ◽  
Breast Cancer Patients ◽  
Receptor Family

We have compared the global profiles of 100 tumors in Stage I, II and III with two independently releasedmicroarray datasets in order to understand their transcriptional behaviors accompanying a progression in breastcancer (1, 2). The olfactive receptor, family 56, subfamily A, member 4 OR56A4, was discovered to have beenone of the genes with the most varied expression when comparing initial tumors in stage I, stage II, and stageIII of breast cancer patients. In the stage III tumors, OR56A4 expression in comparison to the stage I tumorswas lower.

scholarly journals Intravenous anaesthesia in goats: A review

2013 ◽  
Vol 84 (1) ◽  
Author(s):  
T. Brighton Dzikiti
Keyword(s):  
General Anaesthesia ◽  
Muscle Relaxation ◽  
Scientific Information ◽  
Working Environment ◽  
Total Intravenous Anaesthesia ◽  
Intravenous Anaesthesia ◽  
Anaesthetic Agents ◽  
Inhalation Anaesthetic ◽  
Intravenous Anaesthetic ◽  
Balanced Anaesthesia

Intravenous anaesthesia is gradually becoming popular in veterinary practice. Traditionally, general anaesthesia is induced with intravenous drugs and then maintained with inhalation agents. Inhalation anaesthetic agents cause more significant dose-dependent cardiorespiratory depression than intravenous anaesthetic drugs, creating a need to use less of the inhalation anaesthetic agents for maintenance of general anaesthesia by supplementing with intravenous anaesthesia drugs. Better still, if anaesthesia is maintained completely with intravenous anaesthetic drugs, autonomic functions remain more stable intra-operatively. Patient recovery from anaesthesia is smoother and there is less pollution of the working environment than happens with inhalation anaesthetic agents. Recently, a number of drugs with profiles (pharmacokinetic and pharmacodynamic) suitable for prolonged intravenous anaesthesia have been studied, mostly in humans and, to a certain extent, in dogs and horses. There is currently very little scientific information on total intravenous anaesthesia in goats, although, in the past few years, some scholarly scientific articles on drugs suitable for partial intravenous anaesthesia in goats have been published. This review article explored the information available on drugs that have been assessed for partial intravenous anaesthesia in goats, with the aim of promoting incorporation of these drugs into total intravenous anaesthesia protocols in clinical practice. That way, balanced anaesthesia, a technique in which drugs are included in anaesthetic protocols for specific desired effects (hypnosis, analgesia, muscle relaxation, autonomic stabilisation) may be utilised in improving the welfare of goats undergoing general anaesthesia.

scholarly journals PENGARUH REBUSAN DAUN SALAM TERHADAP PENURUNAN TEKANAN DARAH PADA LANSIA DENGAN HIPERTENSI

2018 ◽  
Vol 8 (2) ◽  
pp. 14-21
Author(s):  
Syaifurrahman Hidayat ◽  
Laylatul Hasanah ◽  
Dewi Herlina Susantin
Keyword(s):  
Stage Iv ◽  
T Test ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Test Design ◽  
Post Test

Daun salam (syzygiumpolyanthum) merupakan salah satu dari jenis terapi herbal yang digunakan untuk berbagai penyakit salah satunya yaitu untuk menangani penyakit hipertensi,untuk menurunkan hipertensi dibutuhkan 10 lembar daun salam dan 300 ml air lalu direbus hingga mendidih dan menyusut menjadi 200 ml dan dikonsumsi sebanyak 2 kali sehari pada pagi dan sore hari, masing-masing 100 ml. Penelitian ini bertujuan untuk mengetahui pengaruh air rebusan daun salam dalam menurunkan tekanan darah pada lansia di wilayah kerja UPT Puskesmas Guluk-Guluk. Penelitian ini menggunakan desain penelitian eksperimen Pre post test design, dimana pada rancangan ini berupaya mengungkapkan hubungan sebab akibat dengan cara melibatkan kelompok eksperimental, dengan sampel sebanyak 30 0rang Pengumpulan data menggunakan observasi tekanan darah langsung dan wawancara ke responden.  Hasil penelitian menunjukkan bahwa sebelum diberikan perlakuan pada responden sebagian besar berada pada stage III sebanyak 22 orang (73,3 %), lalu sebagian kecil berada pada stage IV dengan 2 orang (6,7 %). Setelah dilakukan penelitian menunujukkan sesudah diberikan perlakuan pada responden sebagian besar menempati stage II sebanyak 28 orang (93,3 %), sebagian kecil berada pada stage I hanya 2 orang (6,7 %). Hasil uji T test paried dan uji T test didapatkan nilai signifikan 0.000 yang nilainya lebih kecil dari taraf kesalahan α 0.05. sehingga H0 ditolak dan H1 diterima yang berarti ada pengaruh air rebusan daun salam terhadap penurunan tekanan darah pada lansia yang menderita hipertensi di wilayah kerja UPT Puskesmas Guluk-Guluk Kecamatan Guluk-Guluk. Daun salam mempunyai kandungan kimia seperti minyak atsiri, sitrat, euganol, tannin serta flavanoid yang dipercaya mampu untuk menurunkan tekanan darah, mekanisme kerja dari daun salam ini yaitu merangsang sekresi cairan empedu sehingga lemak akan keluar bersamaan dengan usus yang kemudian mengurangi gumpalan lemak yang mengendap dalam pembuluh darah sehingga aliran darah menjadi lancar dan tekanan darah akan normal.

Clinical Staging for Sleep-Disordered Breathing

2002 ◽  
Vol 127 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Michael Friedman ◽  
Hani Ibrahim ◽  
Lee Bass
Keyword(s):  
Body Mass Index ◽  
Success Rate ◽  
Body Mass ◽  
Sleep Disordered Breathing ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Clinical Staging ◽  
Disordered Breathing

OBJECTIVE: The purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep-disordered breathing (SDB) versus those destined to fail. STUDY DESIGN: We retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage. SETTING: Academically affiliated tertiary care referral center. RESULTS: Stage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%. CONCLUSION: A clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.

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