Days Of Postoperative Period Research Articles

Influence of low molecular weight heparins on immune system of surgical patients

Venous thromboembolic complications are potentially dangerous complications to life in patients undergoing surgical intervention.
 The aim of the work is to study the safety of enoxaparin thromboprophylaxis by eliciting the effect of sodium enoxaparin (Flenox) on the immune system of patients undergoing laparoscopic cholecystectomy.
 Materials and methods. Study group: (n = 15)– patients who were treated with enoxaparin sodium (Flenox) for venous thromboembolic complications. Study of immunograms in patients with calculous cholecystitis was performed before surgery and after two days in post-operative period after appointment of enoxaparin.
 Results and discussion. In the study group (Flenox), the values of the studied rates did not go beyond the norm.
 Conclusions. It was established that sodium enoxaparin (Flenox) does not affect the immune system’s rates. In connection with the above mentioned, this medicine can be considered safe and effective for thromboprophylaxis in patients at risk of venous thromboembolism.

PROPOFOL-INDUCED METABOLIC DISTRESS SYNDROME

Introduction.The obtained experience of using propofol under clinical conditions and in experimental studies discover the mechanism of a negative drug effect at the level of mitochondrial enzymes which is currently treated as the propofol infusion syndrome.Purpose.To demonstrate the cases of creatine phosphokinase level variation during the intraoperative pediatric use of propofol in anesthesia.Materials and methods.Three cases of intraoperative use of propofol in 2–17‑years-old patients with different dosages and dose schedules.Results.The level of creatine phosphokinase was increased 9–44 times within 2–5 days of postoperative period without any significant disturbances or with insignificant changes in the levels of transaminase and lactic dehydrogenase (LDG).Conclusion.Propofol-based variation in the cellular metabolism proven today rather corresponds to the term ‘propofol-induced metabolic distress syndrome’. It can be manifested both at the level of clinical symptoms and subclinically, without any evident clinical signs with short-term transient variations of laboratory parameters only (acid-base balance (ABB), transaminase, LDG and CPK).

ДИНАМИКА КОЛИЧЕСТВА ТРОМБОЦИТОВ В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ДЕТЕЙ РАННЕГО ВОЗРАСТА С ВРОЖДЕННЫМИ ПОРОКАМИ СЕРДЦА

Цель исследования: выявить причины развития и определить влияние тромбоцитопении на течение послеоперационного периода у детей после хирургической коррекции врожденных пороков сердца в условиях искусственного кровообращения. Материалы и методы. Проведено сравнение течения раннего послеоперационного периода у детей с применением торакальной эпидуральной (ТЭА) анестезии (n = 68) и высокоопиоидной (ВВА) внутривенной анестезии (n = 84). Взаимосвязь между видом анестезии и результатами хирургического вмешательства оценивали по клинико-лабораторным характеристикам, в том числе по количеству тромбоцитов на 1, 2, 3 сутки и при выписке из стационара. Тромбоцитопенией считали количество тромбоцитов менее 150×109/л. Результаты. При использовании ТЭА уровень интраоперационной гликемии был ниже, а тромбоцитопения на 2 и 3 сутки после операции развивалась реже, чем при ВВА. При ишемии миокарда (ИМ) более 60 минут частота тромбоцитопении на 1 и 3 сутки после операции была выше, чем при ИМ менее 60 минут. Послеоперационная тромбоцитопения коррелировала с развитием дыхательной недостаточности и продленной ИВЛ. Количество тромбоцитов было достоверно ниже на 1 и 3 сутки после операций с выраженной интраоперационной сердечной недостаточностью. Заключение. Ранняя послеоперационная тромбоцитопения коррелирует с периоперационными осложнениями. Использование ТЭА коррелирует с меньшей выраженностью интраоперационной гипергликемии и ранним восстановлением количества тромбоцитов. The aim of study was to identify the reasons of thrombocytopenia development and to determine its effect on postoperative period in children after surgical correction of congenital heart diseases under cardiopulmonary bypass. Materials and methods. We compared 2 groups of children after surgery with thoracic epidural (TEA) anesthesia (n = 68) and high-opioid intravenous (HIA) anesthesia (n = 84) and assessed the relationship between the type of anesthesia and surgery results by clinical and laboratory characteristics, including the number of platelets on 1, 2, 3 days of postoperative period and at discharge from the hospital. Thrombocytopenia was the number of platelets less than 150×109/l. Results. With TEA usage the level of intraoperative glycemia was lower, and thrombocytopenia on 2 and 3 days after surgery developed less frequently than with HIA. Thrombocytopenia occurrence on days 1 and 3 after surgery was higher after myocardial ischemia (MI) for more than 60 minutes than with MI less than 60 minutes. Postoperative thrombocytopenia correlated with the development of respiratory failure and prolonged artificial lung ventilation. Platelets number was significantly lower on 1 and 3 days after operations with severe intraoperative heart failure. Conclusion. Early postoperative thrombocytopenia correlates with perioperative complications. TEA usage correlates with lesser severity of intraoperative hyperglycemia and early recovery of platelets count.

Intraoperative prevention of cognitive impairment in total intravenous anesthesia in school-age children: randomized clinical trial

Objective. To determine the possibility of prophylactic use of the domestic drug Cytoflavin to reduce the incidence of cognitive impairment after total intravenous anesthesia based on propofol and fentanyl in school-age children. Material and methods. A prospective randomized clinical trial involving 90 school-age children (ASA I–II) was conducted. Children operated under total intravenous anesthesia on the basis of propofol and fentanyl were randomized into two groups: intraoperative cerebroprotection with cytoflavine 0.25 mg/kg per minute by succinate was performed in group 1 (n = 30), and no cerebroprotection was performed in group 2 (n = 30). For the Z-assessment of cognitive potential, neuropsychological testing of children of the same age who were not subjected to anesthesia was performed (group 3, n = 30). Research results. There were no significant differences in hemodynamic and neurophysiological parameters in the groups using total intravenous anesthesia based on propofol and fentanyl. Analysis of these parameters showed the safety of the study drug. In the 1 group postoperative cognitive dysfunction (POCD) was detected on the first day of 6.67 % of children, and on the 7th day of postoperative period — at 3.33 %. In group 2, on the first day of the postoperative period, POCD was verified in 13.79 % of patients, on the 7th day — in 27.59 %. Conclusion. The obtained data showed the effectiveness and safety of the domestic drug Cytoflavin as a prophylactic agent of POCD in school-age children with total intravenous anesthesia based on propofol and fentanyl.

Incidence of post-operative hypocalcaemia after thyroidectomy - a retrospective study

Introduction Post-operative hypocalcaemia following thyroidectomy can lead to distressing symptoms and increase the period of hospitalization. Iatrogenic injury to parathyroid glands is the primary cause for hypocalcaemia. Aim This study aims to describe the incidence of postoperative hypocalcaemia and its demographic distribution. Method A retrospective analysis was made in 240 consecutive patients who had undergone total thyroidectomy in the professorial surgical unit, Teaching Hospital Jaffna. The post-operative calcium level, symptoms and signs of hypocalcaemia were considered and correlated with their demographic details and histology report of the specimen. Results The overall incidence of hypocalcaemia was 10.83% (n=26). Among them, 96.15% (n=25) had transient hypocalcaemia and 88.46% had symptomatic hypocalcaemia (n=23) with biochemical evidence of hypocalcaemia. The rate of inadvertent parathyroidectomy was 6.25%. Conclusion Hypocalcaemia is common in the first three days of postoperative period and most of the hypocalcaemic events are transient.

ВПЛИВ ЕНДОГЕННОЇ ІНТОКСИКАЦІЇ НА РОЗВИТОК УСКЛАДНЕНЬ ПІСЛЯ ОПЕРАТИВНОГО ЛІКУВАННЯ ХВОРИХ ЗІ СПАЙКОВОЮ КИШКОВОЮ НЕПРОХІДНІСТЮ

Проблема гострої спайкової кишкової непрохідності залишається однією з найбільш актуальних та складних у сучасній абдомінальній хірургії. Серед усіх видів непрохідності спайкова непрохідність кишечника зустрічається найчастіше і складає від 40,4 до 86 % випадків.Мета дослідження – оцінити рівень показників ендогенної інтоксикації у хворих із спайковою кишковою непрохідністю до та після оперативного втручання та встановити їх вплив на розвиток ускладнень в післяопераційному періоді.Матеріали і методи. У статі висвітлено результати обстеження 57 хворих із гострою спайковою кишковою непрохідністю. З них 26 пацієнтів прооперовано лапароскопічно, 31 – виконано лапаротомію із подальшою ліквідацією непрохідності. Проведено дослідження рівня маркерів ендогенної інтоксикації (середньомолекулярних пептидів та визначення еритроцитарного індексу інтоксикації) до операції та на 3 добу післяопераційного періоду.Результати досліджень та їх обговорення. Встановлено, що у хворих із гострою спайковою кишковою непрохідністю значно зростає рівень маркерів ендогенної інтоксикації до операції і ступінь зростання цих показників перш за все залежить від стадії перебігу кишкової непрохідності. На 3 добу після операції виявлено незначне зниження рівня ендогенної інтоксикації, що свідчить про додаткові механізми розвитку токсикозу після оперативного втручання.Висновки. Протягом дослідження ми не встановили значно достовірного взаємозв’язку між маркерами ендогенної інтоксикації та розвитком ускладнень у післяопераційний період. Виявлено тісний взаємозв’язок між часом відновлення моторної функції кишок та рівнем ендогенної інтоксикації, що свідчить про провідну роль кишечника у формуванні токсикозу в пацієнтів із спайковою кишковою непрохідністю.

Optimization of postoperative period after surgical interventions on the cervix

The article presents the results of research on optimizing postoperative period in patients who underwent surgical interventions on cervix.134 patients were examined who underwent radiowave conization of the cervix for histologically confirmed CIN-2. By simple randomization, they were divided into two groups: Group I (66 women) received 2.0 ceftriaxone intraoperatively, and also Tamistol® vaginally for 1 suppository once a day for 3 days before surgery and for 12 days in postoperative period; patients of Group II (68 women) underwent only intraoperative prophylactic administration of 2.0 ceftriaxone.The laboratory studies after the operative intervention, in particular, revealed a higher microbial load in Group II than in Group I after 21 days and 1.5 months after operation. In addition, when comparing subjective and objective clinical indices, it was noted that the course of the postoperative period in Group I was easier than in Group II.It is proved that the use of complex prophylaxis that included local application of myramistin enhanced decontamination of vagina and cervix with bacterial and viral flora, benign сourse of postoperative period, fewer complications as well as faster and more complete epithelization of cervix after intervention. Considering the high incidence of sexually transmitted diseases in population, increase of the number of multimicrobal associations and the growing resistance of microbes to antibiotics the rationality of local antiseptic therapy in the complex of purulent-septic complications prevention in case of planned surgical interventions on cervix is concluded.Local application of the drug Tamistol® showed its high effectiveness against such pathogens as Atopobium vag. and Mobiluncus mul., considered highly specific markers of bacterial vaginosis. Given the increasing resistance of these microorganisms to nitroimidazole drugs, the proven high efficacy of myramistin against these microorganisms allows us to draw conclusions about the preferred choice of the drug Tamistol® for the prevention of purulentseptic complications during surgical interventions.

PHAGOCYTIC ACTIVITY AND BLOOD NEUTROPHILS RESPIRATORY BURST STATE FEATURES AMONGST WIDESPREAD PURULENT PERITONITIS PATIENTS IN THE POSTOPERATIVE PERIOD DYNAMICS

The research aim was to study the phagocytic activity and the blood neutrophils respiratory burst state amongst the patients with widespread purulent peritonitis (WPP) in the dynamics of the postoperative period. The study was involved patients with acute surgical diseases and injuries of the abdominal organs complicated by WPP. Blood sampling was performed prior to surgery (pre-operative period) and at 7, 14 and 24 day post-operative period. The neutrophil phagocytosis level was determined by flow cytometry using FITC-labeled staphylococcal protein A. There was counted the percentage of fluorescent neutrophils (defined as the phagocytic index — PI) and average of the cell fluorescence (phagocytic number — PN). According to the fluorescence intensity divided phagocytic neutrophils in an active (high PN) and weakly phagocytic (low PN). Condition of the respiratory burst in the neutrophils was examined using a chemiluminescent assay. It was found that patients with WPP in the preoperative period had increased phagocytic activity of the blood neutrophils. The maximum phagocytic activity observed on day 7 of the postoperative period and by 24 days the number of phagocytic cells is reduced to control level whereas phagocytic activity of the cells remains at the preoperative level. In the preoperative period in patients with WPP the amount of active phagocytic blood neutrophils 3.3 times higher than the number of weakly phagocytic cells. By the end of the observation period the number of active and weakly phagocytic neutrophils returning to normal. In the study of the state of respiratory burst in the neutrophils by the WPP patients discovered that the primary synthesis levels of reactive oxygen species (ROS) increases only with 7 days of postoperative period and the induced activity of NADPH-oxidase remains elevated to the end of the observation period. At the same time, the synthesis of secondary ROS in the blood neutrophil of the WPP patients increased already in the preoperative period and remains high until the end of the survey. Using correlation analysis it was found that if healthy people had a competitive relationship between the level of synthesis of primary ROS and the activity of phagocytosis then all detected correlations in the WPP patients characterized by high level of coordination between the respiratory burst and the phagocytic activity of the neutrophils. These relationships are identified in the preoperative period, postoperatively do not exist. It can be assumed that the surgery and the subsequent treatment leads to complete incoordination in the neutrophils the mechanisms of phagocytosis and respiratory burst.

Сравнительный анализ отдаленных результатов хирургического лечения первичной регматогенной отслойки сетчатки с использованием экстра- и интраокулярных подходов

Purpose . Analysis of clinical efficacy of surgical treatment of primary rhegmatogenous retinal detachment (PRRD) using extra- and intra-scleral approaches, depending on the stage of proliferative vitreoretinopathy (PVR). Material and methods . The analysis of long-term results in surgical treatment of 116 eyes (112 patients) with PRRD was carried out. Duration of retinal detachment ranged from 7 days to 5 months (average 4.5 weeks). The structure of PVR stages: A – 31 eyes, B – 31 eye, C – 54 eyes. Macular detachment occurred in 47 eyes. Visual acuity preoperatively varied from 0.005 to 1.0 (average 0.25). Extra-scleral approaches were used in 49 eyes of 45 patients. Endovitreal 20G surgery was performed in 67 eyes of 67 patients. Evaluation of the clinical efficacy of treatment in all eyes was carried out in the follow-up period of 3-7 postoperative days and 3-4 years later. Results and discussion . After the extraocular surgery the retinal anatomic reattachment was achieved at 2-3 day of postoperative period in 45 eyes (91.8%). Partial retinal reattachment was revealed in 4 eyes. After reoperation a complete retinal reattachment was achieved in all eyes. After endovitreal surgery it was noted at 2-3 day that the retina attached in 64 eyes (95.5%), in 3 eyes the retinal attachment was failed (4.5%), where a repeated silicone tamponade was performed. Relapses of PRRD occurred in 11 eyes (12.2%), in their structure: 6 eyes after extra-scleral approach – in the period from 2.5 to 12 months; 5 eyes (7.4%) after the intraocular approach – in the period from 4 to 18.5 months. After a repeated endovitreal surgery the anatomic reattachment of retina was achieved in all cases. Conclusions . The main reason of PRRD relapses was the progression of vitreo-proliferative process. Intraocular surgery with the use of plugging fluids (silicone, gas, air) allows more reliably reduce the risk of postoperative complications, occurrence of PRRD relapses. Episcleral approaches in PRRD treatment continue to be the method of choice in the initial PVR stages.

Use of a locking plate “notched head T-plate®” for the fixation of an ilial body fracture in a dog

Several types of implants may be used to treat iliac fractures in dogs, of which osteosynthesis with plate is the most described and recommended in the literature. The type of plate and screw are major factors in osteosynthesis success. The use of locking plates has been advocated for this purpose, as they do not allow the plate-bone-screw unit to shift, providing angular stability and rigidity to the system. The present study aimed to describe the unprecedented use of a locking notched head T-plate in the treatment of a caudal body of ilium fracture. A two year old male mongrel dog was attended after falling from a third floor height, with two days of evolution. The animal was in standing position, and during orthopedic examination non-weight bearing lameness of the right hind limb, instability, and crepitus in the right body of ilium, with considerable swelling and pain. The radiographic examination allowed diagnosing a complete fracture of the caudal body of ilium with decrease of the pelvic canal diameter. The patient underwent surgery, and the fracture was stabilized with an LCP notched head T-plate. The patient evolved satisfactorily, with good weight-bearing of the affected limb within 24 hours of surgery, and complete recovery with medical discharge after 60 days of postoperative period, with consolidation of the fracture.

METHOD OF OPERATIVE TREATMENT OF POSTNECROTIC CYSTS OF THE PANCREAS

An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4–5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant». Postoperative period have passed without complications in all the patients. The drainage was removed on 30–40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

ANTITHROMBOTIC THERAPY IN PATIENTS WITH METABOLIC SYNDROME AFTER ABDOMINAL DELIVERY

Objective. To assess the effectiveness for complex antithrombotic therapy with low molecular weight heparins (LMWH) after cesarean section at women with metabolic syndrome (MS). Materials and Methods. The study included 115 patients with metabolic syndrome after cesarean section. Group 1 (64 patients) with metabolic syndrome who had a complicated pregnancy in history. Group 2 (51 patient) with metabolic syndrome and no pregnancies in anamnesis. Group 3 (50 patients) – somatically healthy mothers. С omprehensive clinical and laboratory examination was conducted, including a study of indicators of hemostasis in the preoperative period and at 1-th, 3-4-th, 9-10-th day of postoperative period. To prevent thromboembolic complications all patients with metabolic syndrome were injected enoxaparin sodium 12 hours after abdominal delivery in a dose of 40 mg daily, with further dose adjustment. Results. According to the results of studies in patients with MS from 1 day of the postoperative period there was an increased prothrombotic potential, violation of indicators of coagulation, platelet hemostasis and the system of natural anticoagulants. Due to the therapy with the use of LMWH the development of thromboembolic episodes was prevented at all patients with MC in the postoperative period. Other complications of the postoperative period were detected in 17 (14.78%) of patients with MS and 7 (14.00%) somatically healthy mothers. The incidence of postoperative complications 1st and 2nd groups were comparable with 3rd group. Analysis of laboratory parameters in patients with metabolic syndrome with complicated postoperative period, showed that the aggregation capacity of platelets with ADP, the levels of TAT and D-dimer on 9-10th day were comparable with those indices in the 1st and 3-4th day. The results show prothrombotic tendencies and violations of the hemostatic system continued to 9-10 days in these patients and also indicate a pathogenetic relationship of these tendencies in the development of postoperative complications. Conclusion. The development of thromboembolic complications in patients with MC was prevented due to the therapy of LMWH.

The Outcomes of Endovascular Aneurysm Repair with the Chimney Technique for Juxtarenal Aortic Aneurysms.

We collected our experience in the use of chimney technique with endovascular aneurysm repair (Ch-EVAR) for juxtarenal aortic aneurysms (JAAs), and reviewed the outcomes. The patients who were treated with Ch-EVAR between January 2012 and December 2015 were retrospectively reviewed. All of the patients underwent endovascular aneurysm repair (EVAR) under general anesthesia. Femoral arterial access was obtained to place the main body of the endograft; brachial or axillary access was obtained to perform the placement of the chimney stent. We treated 12 patients with 15 renal arteries using the Ch-EVAR procedure. Technical success was achieved in 11 of the 12 (91.6%) cases. Within the first 30 days of postoperative period, the target vessel patency rate was 93.3% (14 of 15 renal arteries). After a median follow-up period of 28 months, one patient required Ch-EVAR-related re-intervention due to a type Ia endoleak, and 13 of the 15 renal arteries were patent at the end of the follow-up period. Our findings demonstrate that Ch-EVAR can be completed with a high rate of success. Although early target vessel occlusion or early postoperative mortality might occur, Ch-EVAR could be an alternative treatment for JAA, especially in high risk patients.

Influence of the change in the shape of the corneal epithelium removal in postoperative PRK visual acuity.

Objective: To determine if the change in the shape of the corneal epithelial removal in photorefractive keratectomy (PRK), from circular to oval shape, modifies the recovery of the postoperative visual acuity (VA). Methods: Forty-three(43) patients subjected to bilateral simultaneous PRK were prospectively evaluated. Randomly for each patient, one eye underwent epithelial removal in circular shape and the other in oval shape. On the sixth day of postoperative period (D6) the follow items were recorded: the subjective comparative perception, informed by the patient, of the quality of vision between the eyes, the objective monocular VA and the appearance of the central corneal epithelial suture line. Results: With regard to subjective quality of vision perception, it was observed that 48.8% of patients did not realize the difference between the eyes, while 51.2% did (41.9% reported better quality of vision in the eye with the oval shape and 9.3% reported better vision in the eye with the circular shape). With regard to the VA (Snellen), the average in the oval shape of 0.62 was significantly higher (p < 0.001) than the circular shape of 0.53. As for the appearance of the epithelial suture line, in 64.3% of the cases there was a lower density of the suture line in the eyes submitted to the oval shape, 31.0% did not demonstrate difference and in 4.8% of eyes submitted to oval shape the suture line was denser. These results are due to the fact that in the oval shape the epithelial cells come from non-equidistant edges of the corneal periphery to the center and run across a smaller area, determining a smoother, sometimes off-center, epithelial suture line. Conclusion: The change in the shape of the corneal epithelial removal in photorefractive keratectomy (PRK), from circular to oval shape, determines a better recovery of the postoperative visual acuity (VA).

Character and evolution of humoral immune disorders under the course of acute intestinal obstruction due to strangulated hernia

A study of immune reactivity in 120 patients with strangulated hernia depending on the presence (I group patients) or no signs of acute intestinal obstruction (II group patients) has been conducted. It was found that changes in the humoral immunity were less pronounced and characterized by a decrease in the number of immunoglobulins G and A on the third day of postoperative period and may be associated not only with quantitative and functional deficiency of B-cells, but with insufficient activity of cytokines, secreted by T-cells. The obtained data lead to the conclusion that in strangulated hernia complicated with acute intestinal obstruction there are significant disorders in the system of immunological reactivity,which are manifested themselves with a decline in both cellular and humoral immunity and with an increased activity of nonspecific immunological reactivity. These changes are more profound and persistent than in patients with uncomplicated course of strangulated hernia. Immunosuppression is most pronounced in the 1st and 3rd postoperative day and with the patients’ clinical recovering, in positive course of the disease, the studied parameters get gradually normalized, but, at the same time even up to the 7th postoperative day they do not reach control values.

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

OBJECTIVE The aim of this study was to determine whether radiofrequency ablation (RFA) of the pancreas and subsequent transection of the main pancreatic duct may avoid the risk of both necrotizing pancreatitis and postoperative pancreatic fistula (POPF) formation. METHODS Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15, and 21 days (groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis), and incidence of POPF were evaluated. RESULTS A significant increase in serum amylase levels (P < 0.05) on the third postoperative day, which return to baseline levels in the following weeks, was noted in groups 0 to 3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1 to 3 compared with group 0 and control groups showed a significant increase of small islets (<1000 µm). CONCLUSIONS The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.

Liver Function Tests Following Open Cardiac Surgery.

Introduction: The cardiopulmonary bypass may have multiple systemic effects on the body organs as liver. This prospective study was planned to explore further the incidence and significance of this change. Methods: Two hundred patients with coronary artery bypass grafting (CABG), were randomly selected for the study. Total and indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase were measured preoperatively and at 24, 48 and 72 hours, following coronary artery bypass grafting. Postoperative value of the liver function tests with respect to hypothermia or hypotension were compared by one way analysis of variance for repeated measure and compared with t test. Patient’s characteristics with bilirubin value (≤1.5 mg or >1.5 mg) were compared with t test. Results: A significant increase of total bilirubin, aspartate aminotransferase, and alkaline phosphatase were noted in the third postoperative day. Significant relation was seen between hypotension and alkaline phosphatase, and aspartate aminotransferase change but hypothermia had not affected alanine aminotransferase, total bilirubin and indirect bilirubin change. Pump time, alanine aminotransferase in third postoperative day and direct bilirubin in first and second day of postoperative period had significant relation with pre and post-operative bilirubin change. Conclusion: Transient but not permanent alterations of hepatic enzymes after coronary artery bypass grafting presumably attributed to the decreased hepatic flow, hypoxia, or pump-induced inflammation.

Radiofrequency Pancreatic Ablation and Section of the Main Pancreatic Duct Does Not Lead to Necrotizing Pancreatitis

The aim of this study was to determine whether radiofrequency ablation (RFA) of the pancreas and subsequent transection of the main pancreatic duct may avoid the risk of both necrotizing pancreatitis and postoperative pancreatic fistula (POPF) formation. Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15, and 21 days (groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis), and incidence of POPF were evaluated. A significant increase in serum amylase levels (P < 0.05) on the third postoperative day, which return to baseline levels in the following weeks, was noted in groups 0 to 3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1 to 3 compared with group 0 and control groups showed a significant increase of small islets (<1000 µm). The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.

S1P1 receptor modulation preserves vascular function in mesenteric and coronary arteries after CPB in the rat independent of depletion of lymphocytes.

BackgroundCardiopulmonary bypass (CPB) may induce systemic inflammation and vascular dysfunction. Sphingosine 1-phosphate (S1P) modulates various vascular and immune responses. Here we explored whether agonists of the S1P receptors, FTY720 and SEW2871 improve vascular reactivity after CPB in the rat.MethodsExperiments were done in male Wistar rats (total n = 127). Anesthesia was induced by isoflurane (2.5–3%) and maintained by fentanyl and midazolam during CPB. After catheterization of the left femoral artery, carotid artery and the right atrium, normothermic extracorporeal circulation was instituted for 60 minutes. In the first part of the study animals were euthanized after either 1 hour, 1 day, 2 or 5 days of the recovery period. In second part of the study animals were euthanized after 1 day of postoperative period. We evaluated the contractile response to phenylephrine (mesenteric arteries) or to serotonin (coronary artery) and vasodilatory response to acethylcholine (both arteries).ResultsContractile responses to phenylephrine were reduced at 1 day recovery after CPB and Sham as compared to healthy control animals (Emax, mN: 7.9±1.9, 6.5±1.5, and 11.3±1.3, respectively). Mainly FTY720, but not SEW2871, caused lymphopenia in both Sham and CPB groups. In coronary and mesenteric arteries, both FTY720 and SEW2871 normalized serotonin and phenylephrine-mediated vascular reactivity after CPB (p<0.05) and FTY720 increased relaxation to acetylcholine as compared with untreated rats that underwent CPB.ConclusionPretreatment with FTY720 or SEW2871 preserves vascular function in mesenteric and coronary artery after CPB. Therefore, pharmacological activation of S1P1 receptors may provide a promising therapeutic intervention to prevent CPB-related vascular dysfunction in patients.

Effect of prophylactic supplementation of allopurinol, magnesium and statin on the incidence of atrial fibrillation in off pump and on pump coronary artery surgery

BACKGROUND: Postoperative atrial fibrillation (POAF) is an adverse event after coronary artery bypass grafting (CABG). Various studies have reported, POAF is associated with increased early and late mortality, stroke, and prolonged hospital length of stay. Objective: To evaluate the combined effect of prophylactic supplementation of allopurinol in the immediate preoperative period, magnesium in the immediate post operative period and atorvastatin perioperatively. METHODS: This was an observational, prospective study. A total of 120 patients, underwent elective CABG surgery were allocated to off pump group or on pump group depending on whether surgery was planned off pump or on pump. Primary outcome evaluated was the incidence of AF of 5 minutes duration or longer (by rhythm analysis on ECG) requiring therapy in the first six days of postoperative period in all the patients under study and also we evaluated if there was any difference in its occurrence between off pump and on pump CABG. Statistical Analysis: Continuous variables were compared by means of students unpaired t test and categorical variables were compared by Fischers exact test. Kaplan-Meier analysis was used to compare the probability of atrial fibrillation in the Off pump and on pump groups. RESULTS: Overall 12 patients (10%) developed AF in the postoperative period. In that, 7 patients (11.6%) were from on pump group, where as 5 patients (8.3%) were from off pump group (P =0.20) and there was no statistical difference in the incidence of AF between the two groups CONCLUSION: Off pump CABG has no advantage over on pump CABG on occurrence of POAF, but perioperative supplementation of allopurinol, statin and Mg in combination may have some beneficial role in reducing the overall incidence of POAF.