Anesthetic aspects of the resection of hormone-active carotid chemodectomas: a clinical case and literature review

The article describes a clinical case - the resection of the hormone- active tumor of the carotid glomus. The hormonal activity of the tumor was suspected based on data of the patient's history, (malignant arterial hypertension with sharp rises in arterial tension, episodes of the increased arterial tension during mechanical impact on the tumor) and hemodynamic parameters during surgery (heart rhythm disturbances after induction of anesthesia and pronounced hypertensive reactions when manipulating the tumor tissue). The article reviews publications on anesthetic support during the resection of hormone-active chemodectomas.Detection of typical clinical signs such as hypertension, tachycardia, fever, headaches, etc. in the history of patients with chemodectoma may suggest hormonal activity of the tumor. Biochemical tests that determine the level of catecholamines and their breakdown products can confirm the diagnosis. When planning surgery, the anesthesiologist should be prepared for the development of the relevant complications. Hypertension, as the most frequent complication, should be prevented by preoperative adrenergic blockers and treated intraoperatively with short-acting antihypertensive drugs. After exclusion of the tumor from the bloodstream, it is necessary to prepare for the development of hypotension.

Current advances in Diabetes Type 1 and type 2 treatment: an overview

Diabetes is undoubtedly one of the diseases that cause disastrous of human health and wellbeing, and unfortunately which is in constant increasing worldwide. Especially, when the connection with the current lifestyle and the interdependence with other varied health problems (obesity, arterial tension...etc.). Classical treatment methods unfortunately allow the treatment of symptoms and the alleviation of the disease state. The search for new alternatives is a promising strategy to reduce the cost of Diabetes cure and ameliorate the life of millions suffering people worldwide.

Intrapartum Procedures for Prevention of Infections and Complications in Mothers During Childbirth

Introduction: Multiple factors can cause infection and other pathological conditions in mothers during childbirth. These risk factors and diseases/complications can be prevented or timely detected through the implementation of special protocols/procedures. The aim of this paper is to identify the implementation of procedures/measures for the prevention and detection of infections and risk factors for morbidity and mortality in four hospitals in the Republic of Macedonia, before and during childbirth. Material and Methods: A retrospective study was conducted in four hospitals in R. Macedonia, in December 2016, on certain days according to the same principle of selection in all institutions. The questionnaire used contained relevant and specific questions related to the application of procedures and protocols at the maternity clinic at the time of admission to the birthplace and immediately prior to delivery. Results: The study analyzes the performed procedures from 137 obstetric histories. Cardiotocograph was taken after the admission in a hospital in 86% of the mothers; a temperature was measured at only 47.5%, and arterial tension at 89.8%. Immediately before delivery, the color and odor of the vaginal discharge in 98.5% of the mothers was checked, urine was analyzed only in 8% of the mothers, and the analysis of the time of rupture of the mammalian sheaths in 98.6% of the mothers. Conclusion: The study showed that part of the analyzed procedures was not sufficiently implemented, and the percentage distribution varied between hospitals. There is a need for introduction of organized programs with standard procedures in maternity wards in order to protect against infections and other pathological conditions during childbirth.

Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

Diabetic macular edema (DME) can cause blindness in diabetic patients suffering from diabetic retinopathy (DR). DM parameters controls (glycemia, arterial tension, and lipids) are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF) is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.

Nocturnal Hypertension and Special - Period Hypertension in Type 1 Diabetes Mellitus

Nocturnal Hypertension and Special - Period Hypertension in Type 1 Diabetes MellitusBackground: One of the unique aspects of continuous ambulatory arterial-tension monitoring is the ability of recording the diurnal variations. The patients suffering from Type 1 Diabetes Mellitus (T1DM) may present higher nocturnal values of arterial tension and this rise can be determined by hyperinsulinism. The first hours in the morning (6 a.m. - 9 a.m.), the so-called special period, is correlated with a rise in the incidence of cardiovascular events and a rise in plasmatic catecholamine and of platelet aggregability. The main goal of this study is to analyze the particularities of the tensional profile with regard to nocturnal behavior and behavior in the special period, reported to glycemic variations. Material and method: The study analysed 351 patients known with T1DM, who have been suffering from this disease for more than 10 years, who were in the records of the Center of Diabetes, Nutrition and Metabolic Diseases of Iaşi and Suceava. The patients were assesssed from a tensional and glycemic point of view, by continuous blood-tension (ABPM) and glycemia (CGMS) monitoring. Results: The occurrence of nocturnal hypertension in patients suffering T1DM is by 29.24 higher than in the case of hypertensive persons compared to the risk presented by the persons without blood hypertension. The continuous recording of blood hypertension during the asymptomatic hypoglycemia period showed increased values both for systolic blood tension and for diastolic one (p<0.05). The hypertension risk is by 3.24 higher during the hypoglycemia period compared to the normoglycemic one. Tension variations during the special period were noticed in 87 patients who have been suffering from diabetes mellitus for 19.75 ± 4.57 years. These tension values are higher than the nocturnal ones, but lower than the diurnal ones. Conclusions: Hypoglycemia duration and magnitude induces increased tension values which adds another hemodynamic stress factor to the patient suffering from T1DM. In T1DM, in the first morning hours, in particular conditions, we can notice increased tension values, higher in patients with blood hypertension, which induces a stressed cardiovascular risk. Tension value increase during the special period overlaps the morning hyperglycemias. Therefore, there appears an apparently invisible impact on the cardiovascular condition of diabetes mellitus.

Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report

Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT) supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients? Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.