Early Postoperative Administration Research Articles

Clinical characteristics and risk factors for new-onset cervicogenic headache following elective craniotomy.

Clinical characteristics and risk factors for new-onset cervicogenic headache following elective craniotomy.

Early Postoperative Acetaminophen Administration and Severe Acute Kidney Injury After Cardiac Surgery

Oxidative stress may contribute to the development of acute kidney injury (AKI) after cardiac surgery. Acetaminophen can be considered an antioxidant because it inhibits hemoprotein-catalyzed lipid peroxidation. We hypothesized that perioperative acetaminophen administration is associated with reduced AKI after cardiac surgery. Retrospective observational cohort study. Patients aged≥18 years who had cardiac surgery were identified from 2 publicly available clinical registries: the Medical Information Mart for Intensive Care III (MIMIC-III) and the eICU Collaborative Research Database (eICU). Administration of acetaminophen in the first 48 hours after surgery. Severe AKI in the first 7 days after surgery, defined as stage 2 or stage 3 AKI according to KDIGO criteria. Multivariable cause-specific hazards regression analysis. We identified 5,791 patients from the MIMIC-III and 3,840 patients from the eICU registries. The overall incidence of severe AKI was 58% (3,390 patients) in the MIMIC-III cohort and 37% (1,431 patients) in the eICU cohort. Acetaminophen was administered in the early postoperative period to 4,185 patients (72%) and 2,737 patients (71%) in these 2 cohorts, respectively. In multivariable regression models, early postoperative use of acetaminophen was associated with a lower risk of severe AKI in both the MIMIC-III (adjusted hazard ratio [AHR], 0.86 [95% CI, 0.79-0.94]) and eICU (AHR, 0.84 [95% CI, 0.72-0.97]) cohorts. The benefit was consistent across sensitivity and subgroup analyses. No data on acetaminophen dose. Early postoperative acetaminophen administration was independently associated with a lower risk of severe AKI in adults recovering from cardiac surgery. Prospective trials are warranted to assess the extent to which the observed association is causal and estimate the extent to which acetaminophen administration might prevent or reduce the severity of AKI.

Результаты применения мультидисциплинарного подхода в лечении больных циррозом печени в исходе хронических вирусных гепатитов

Aim – to evaluate the results of applying a multidisciplinary approach to the treatment of patients with liver cirrhosis in the outcome of chronic viral hepatitis. Material and methods. From July 2018 to September 2021, 94 orthotopic liver transplants (OTLT) from a posthumous donor were performed at the surgical clinic of the Botkin Hospital. Of 94 recipients, 48 (51.1%) indicated for surgery as liver cirrhosis as a result of chronic viral hepatitis C (CVHC), in 8 (8.5%) cirrhosis as a result of chronic viral hepatitis B (CVHB). In the case of cirrhosis as a result of CVHB, the presence of viral replication was a contraindication for transplantation; patients with its presence at the stage of placing on the waiting list were sent to an infectious disease specialist to receive antiviral therapy (AVT). Prevention of recurrence of CVHB in the graft consisted of intraoperative, as well as early and late postoperative administration of 400–800 IU of immunoglobulin against hepatitis B. Among liver transplant recipients with liver cirrhosis in the outcome of CVHC, less than half (43.75%) did not have HCV RNA against the background of passed or the OEM received by the time of the operation. The rest of the patients had contraindications to AVT, and HCV eradication was performed after transplantation. Results. The average follow-up period for hepatic transplant recipients with liver cirrhosis as a result of CVHB was 12.28 ± 4.11 (7–23) months. Satisfactory graft function against the background of constant antiviral therapy was observed in all patients. No deaths were recorded. The average follow-up time for patients with cirrhosis of the liver in the outcome of chronic hepatitis C after OTTP was 21.67 ± 4.85 (1–38) months. Antiviral therapy was prescribed to 24 patients 2.7 ± 0.34 (2–4) months after surgery. Three patients did not receive AVT after surgery due to their low adherence to treatment. Satisfactory graft function was observed in all patients, confident virological response against the background of AVT – in 17 patients (70.8%). 7 patients (29.2%) are currently undergoing antiviral therapy. Of the three patients who did not receive AVT in the postoperative period of their own free will, 1 patient (33.3%) developed graft cirrhosis and death from decompensation of liver failure at 23 months after transplantation. Conclusion. The use of a multidisciplinary approach in the treatment of patients with liver cirrhosis as a result of chronic viral hepatitis allows achieving a confident virological response, radically curing liver cirrhosis, thereby preventing associated complications, improving the quality of life of patients and restoring their ability to work.

Integrated Multidisciplinary Brain Metastasis Care Reduces Patient Visits and Shortens Time to Adjuvant Irradiation.

Timely surgical cavity stereotactic radiosurgery (SRS) is an important adjuvant to brain metastasis resection, with earlier treatment associated with less frequent recurrence. The logistical complexity of treatment organization, however, has resulted in suboptimal start times postsurgically. We implemented a process improvement approach to reduce the time from surgery to adjuvant irradiation of resected brain metastases. A multidisciplinary working group used process mapping to identify opportunities to reduce visits and shorten treatment times. The care delivery process was modified to streamline perioperative SRS preparation with (1) early patient identification, (2) preoperative intrateam communication, and (3) consolidation of required steps. Plan-Do-Study-Act cycles were used for process improvement. The surgery-to-SRS initiation time interval was the primary outcome. Secondary outcomes included the number of associated patient encounters. After implementation, the median (interquartile range) interval from surgery to SRS was reduced 48% from 27 (21-34) to 14 days (13-17; P < .001). The rate of surgical cavity SRS within 30 days increased from 64% (n = 63 of 98) to 97% (n = 60 of 62; P < .001). The median (interquartile range) number of CNS-associated encounters between resection and SRS decreased from 5 (4-6) to 4 (3-5; P < .001). The proportion of patients who had > 1 magnetic resonance imaging/computed tomography between surgery and SRS decreased from 45% (44 of 98) to 13% (8 of 62; P < .001). The time from surgery to systemic therapy resumption/initiation among patients treated within 90 days postoperatively decreased from 35 (24-48) to 32 days (23-40; P = .074). There were no wound complications in either group. Adjuvant SRS latency and treatment-associated encounters were significantly reduced after care-coordination implementation. This approach reduces patient and health care system burden and can be applied to other scenarios where early postoperative SRS administration is critical.

MMAP-06 INTEGRATED TEAM-BASED BRAIN METASTASIS CARE REDUCES PATIENT VISITS AND SHORTENS TIME TO ADJUVANT IRRADIATION

PURPOSETimely surgical cavity stereotactic radiosurgery (SRS) is an important adjuvant to brain metastasis resection, with earlier treatment associated with less frequent recurrence. The logistical complexity of treatment organization, however, has resulted in suboptimal start times post-surgically. We implemented a team-based process improvement approach to reduce the time from surgery to adjuvant irradiation of resected brain metastases. METHODSA multidisciplinary working group used process-mapping to identify opportunities to reduce visits and shorten treatment times. The care delivery process was modified to streamline perioperative SRS preparation with (1) early patient identification, (2) preoperative intra-team communication, and (3) consolidation of required steps. Plan-Do-Study-Act cycles were used for process improvement. The surgery-to-SRS initiation time interval was the primary outcome. Secondary outcomes included the number of associated patient encounters. RESULTSFollowing implementation, the median (IQR) interval from surgery to SRS was reduced 48% from 27 (21,34) to 14 (13,17) days (p<0.001). The rate of surgical-cavity SRS within 30 days increased from 64% (n=63/98) to 97% (n=60/62; p<0.001). The median (IQR) number of CNS-associated encounters between resection and SRS decreased from 5 (4,6) to 4 (3,5; p<0.001). The proportion of patients who had >1 MRI/CT between surgery and SRS decreased from 45% (44/98) to 13% (8/62; p<0.001). The time from surgery to systemic therapy resumption/initiation among patients treated within 90 days post-operatively decreased from 35 (24,48) to 32 days (23,40; p=0.074). There were no wound complications in either group. CONCLUSIONAdjuvant SRS latency and treatment-associated encounters were significantly reduced after care-coordination implementation. This approach reduces patient and healthcare system burden and can be applied to other scenarios where early post-operative SRS administration is critical.

Management of post-transplant diabetes: immunosuppression, early prevention, and novel antidiabetics.

SummaryPost‐transplant diabetes mellitus (PTDM) shows a relationship with risk factors including obesity and tacrolimus‐based immunosuppression, which decreases pancreatic insulin secretion. Several of the sodium–glucose‐linked transporter 2 inhibitors (SGLT2is) and glucagon‐like peptide 1 receptor agonists (GLP1‐RAs) dramatically improve outcomes of individuals with type 2 diabetes with and without chronic kidney disease, which is, as heart failure and atherosclerotic cardiovascular disease, differentially affected by both drug classes (presumably). Here, we discuss SGLT2is and GLP1‐RAs in context with other PTDM management strategies, including modification of immunosuppression, active lifestyle intervention, and early postoperative insulin administration. We also review recent studies with SGLT2is in PTDM, reporting their safety and antihyperglycemic efficacy, which is moderate to low, depending on kidney function. Finally, we reference retrospective case reports with GLP1‐RAs that have not brought forth major concerns, likely indicating that GLP1‐RAs are ideal for PTDM patients suffering from obesity. Although our article encompasses PTDM after solid organ transplantation in general, data from kidney transplant recipients constitute the largest proportion. The PTDM research community still requires data that treating and preventing PTDM will improve clinical conditions beyond hyperglycemia. We therefore suggest that it is time to collaborate, in testing novel antidiabetics among patients of all transplant disciplines.

Short-Term Effects of Early Postoperative Celecoxib Administration for Pain, Sleep Quality, and Range of Motion After Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundWe hypothesized that early postoperative administration of celecoxib would reduce pain scores and improve sleep quality and active range of motion after total knee arthroplasty (TKA) under general anesthesia. MethodsPatients in the celecoxib group received 400 mg of celecoxib 2 hours after TKA, followed 6 hours later by 200 mg of celecoxib. Patients in the control group received 400 mg of celecoxib the second day after surgery. Patients in both group had access to patient-controlled analgesia fentanyl. The primary outcome measure was the patient-reported visual analog scale (VAS) pain score the second day after TKA. The secondary outcome measure was sleep quality (days 1, 2, and 7 postoperatively). Active knee joint range of motion was assessed on days 2 and 7 postoperatively, and VAS pain scores were evaluated on postoperative days 1 to 7. Total fentanyl consumption was also assessed. ResultsCompared to the control group, the celecoxib group had significantly lower median VAS pain scores on postoperative days 1 and 2, significantly less nocturnal awakening (in minutes) and frequency of body motion, and better sleep efficacy on postoperative day 1. The celecoxib group also had a significantly better median flexion angle (°) on postoperative days 2 and 7, and lower cumulative fentanyl consumption. ConclusionEarly administration of celecoxib after TKA was associated with significantly reduced early VAS pain scores and improved sleep quality and active knee flexion angles. Thus, the early administration of celecoxib after TKA under general anesthesia may reduce pain and improve sleep quality and functional recovery. Levels of EvidenceLevel II, therapeutic study. Trial RegistrationUMIN-CTR 000014624 (July 23, 2014).

Early postoperative statin administration does not affect the rate of atrial fibrillation after cardiac surgery.

Postoperative atrial fibrillation is the most frequent complication after cardiac surgery, and the use of statins in preventing them is being extensively studied. The aim of this study was to investigate whether a pause in the administration of statins affects the occurrence of atrial fibrillation after cardiac surgery in a prospective randomized and controlled setting. A total of 301 patients without chronic atrial fibrillation with prior statin medication scheduled for elective or urgent cardiac surgery involving the coronary arteries and/or heart valves were prospectively recruited and randomized for statin re-initiation on either the first (immediate statin group) or the fifth (late statin group) postoperative day, using the original medication and dosage. The immediate statin group comprised 146 patients and the late statin group 155 patients. Except for a somewhat higher rate of males (85% vs 73%, P = 0.016) in the immediate statin group, the baseline characteristics and the distribution of procedures performed within the groups were comparable. The occurrence of postoperative atrial fibrillation and the clinical course of the patients were compared between the groups. The incidence of atrial fibrillation was 46% and the median delay after surgery before the onset of atrial fibrillation was 3 days in both groups (P = NS). No differences were observed in the frequency of the arrhythmia in any subgroup analyses or in other major complications or clinical parameters. No adverse effects related to early statin administration were detected. Early re-initiation of statins does not appear to affect the occurrence of postoperative atrial fibrillation. European Union Drug Regulating Authorities Clinical Trials Database (EudraCT)-2016-001655-44.

Early preoperative versus postoperative administration of meloxicam in pain control, patient global status improvement, knee function recovery of arthroscopic knee surgery.

This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS). Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS. Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group. Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.

Efficacy of 50 mg pregabalin for prevention of postoperative neuropathic pain after video-assisted thoracoscopic surgery and thoracotomy: a 3-month prospective randomized controlled trial.

This study analyzed the preventive effect of 50 mg/day pregabalin on postoperative neuropathic pain, and any additional benefits related to sleep and respiratory function. This prospective randomized controlled study included lung resection patients 20-89 years of age. Patients were randomly assigned to the treatment (pregabalin; initial dose, 50 mg/day) or control (non-steroidal anti-inflammatory drugs) group. Pregabalin patients received non-steroidal anti-inflammatory drugs and pregabalin (25 mg, twice daily) from the second postoperative day. Pain scores, neuropathic pain, analgesic use, respiratory function, and insomnia scale scores for 3 months after surgery were evaluated. This study included 46 patients who received pregabalin and 46 control patients. Pregabalin patients had significantly less postoperative neuropathic pain than control patients (19.6% vs. 41.3%; P=0.0404), and their duration of neuropathic pain was significantly shorter (30 vs. 90 days; P=0.024). The onset of postoperative neuropathic pain, insomnia scale scores, and respiratory function were similar between groups. No pregabalin-related adverse events were reported. Pregabalin (50 mg/day) had a significant preventive effect on postoperative neuropathic pain after thoracic surgery, without side effects. Early postoperative administration of pregabalin would help prevent neuropathic pain and provide better pain control after thoracic surgery.

An analysis of the survival impact of dexmedetomidine in children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Objective: Recent evidence suggests the α2-adrenoreceptor agonist dexmedetomidine may promote metastasis of cancer cells. In this study we sought to evaluate the impact of dexmedetomidine administration on the survival of children and adolescents with cancer.Design: Retrospective chart review.Setting: Comprehensive cancer center.Patients: Children and adolescents who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis.Intervention: Intraoperative and/or early postoperative (within 24 hours of surgery) administration of dexmedetomidine.Measurements: Multivariable cox proportional hazard models were used to assess the association between dexmedetomidine administration and progression free survival (PFS) or overall survival (OS).Main results: Ninety-three patients were identified. The median age was 12 years, 42% were female, and 35% received dexmedetomidine. There were no significant differences between the baseline and perioperative characteristics of patients who received dexmedetomidine and those who did not. In the multivariable analysis, the administration of dexmedetomidine was not associated with PFS (HR = 1.20, 95% CI [0.60–2.41], p = .606) or OS (HR = 0.81, 95% CI [0.35–1.85], p = .611).Conclusion: In this retrospective study of children and adolescents who had undergone a major oncologic surgery, the intraoperative and/or early postoperative administration of dexmedetomidine was not associated with survival.

Postoperative Thromboembolic Prophylaxis with Low-Molecular-Weight Heparin and Risk of Rebleeding in Patients with Chronic Subdural Hematomas: A Comparative Retrospective Cohort Study.

Early postoperative administration of low-molecular-weight heparin (LMWH) to prevent thromboembolic events in patients with chronic subdural hematoma (CSDH) is controversial. Our goal was to investigate impact of early postoperative LMWH administration on recurrence rate of CSDHs. Retrospective review was performed of 136 patients with CSDHs who were operated on during an 18-month period. Early postoperative administration of LMWH was at the discretion of the treating surgeon. This resulted in patients treated (heparin [H] group) or not treated with LMWH (no heparin [NH] group). All patients underwent imaging 4 weeks after surgery or earlier in cases of deterioration. The primary outcome variable was reoperation. Secondary outcomes were reoperation, important residual hematoma (defined as hematoma depth of more than one third of original size), and incidence of thromboembolic complications. Relative risk and absolute risk reduction were calculated. We included 105 patients, 50 (47.6%) in the NH group and 55 (52.4%) in the H group. Nine patients (18%) in the NH group and 6 patients (10.9%) in the H group required secondary surgery (relative risk 0.61, 95% confidence interval 0.23-1.58, P= 0.404, absolute risk reduction 0.07). Eleven patients (22%) in the NH group and 15 patients (27.3%) in the H group presented with important residual hematoma or underwent surgery for hematoma recurrence (relative risk 1.24, 95% confidence interval 0.63-2.44, P=0.532, absolute risk reduction-0.05). Our data provide preliminary evidence that early postoperative administration of LWMH does not increase risk of clinically relevant recurrence of CSDHs.

The impact of prophylactic administration of a neutrophil elastase inhibitor on the postoperative course in older patients undergoing esophagectomy for esophageal cancer: a propensity score-matched analysis

Sivelestat, a selective inhibitor of neutrophil elastase, has been reported to reduce acute lung injury associated with systemic inflammatory response syndrome (SIRS). However, no study has addressed the effect of prophylactic sivelestat administration on the postoperative course following an esophagectomy in older patients. In this retrospective study of patients aged >70 years, we performed a propensity score-matched analysis to compare short and long-term outcomes between patients who received early postoperative sivelestat administration (n = 42) and those who did not receive sivelestat (controls; n = 42) after a transthoracic esophagectomy for esophageal cancer (EC). Patient backgrounds were well balanced between the two groups. The sivelestat group showed significantly shorter SIRS durations compared to the control group (2 vs 5 days, p = 0.001). In addition, postoperative hospital stays were shorter in the sivelestat group than in the control group (26 vs 31 days, p = 0.013). Other factors did not differ between the two groups, including the reoperation rate, ICU stay, duration of mechanical ventilation, and duration of O2 supply. Postoperatively, the sivelestat group showed significantly lower heart rates than the control group (repeated-measures ANOVA, p = 0.0389) while respiratory rates, the SpO2 levels, and body temperatures did not significantly differ between the two groups. Finally, long-term survival appeared to be not different between the two groups. Sivelestat effectively stabilized postoperative vital signs and shortened SIRS durations. Thus, prophylactic sivelestat led to shorter hospital stays among older patients with EC who underwent an esophagectomy.

Is early postoperative administration of pregabalin beneficial for patients with lung cancer?-randomized control trial.

Post-thoracotomy pain is an obstacle for lung-cancer patients even after introduction of less invasive surgical procedures. The aim of this prospective study was to evaluate if early postoperative administration of pregabalin is beneficial for patients with non-small cell lung cancer (NSCLC). We conducted a randomized open control trial. Patients with NSCLC were allocated randomly to epidural and nonsteroidal anti-inflammatory drug (NSAID) use for analgesia (control group) or pregabalin use (pregabalin group). Primary endpoint was the frequency of additional administration of a NSAID. Secondary endpoints were intensity of ongoing pain, frequency of neuropathic pain, and pain catastrophizing. Seventy-two patients were registered and allocated. Thirty-four cases in the control group and 33 in the pregabalin group were assessed. Age, sex, body mass index (BMI), type of surgical procedure, type of lymph-node dissection, operation time, bleeding, duration of chest-tube insertion, and postoperative hospital stay between the two groups was not significantly different. Frequency of additional NSAID use between the control group (2±4 suppositories) and pregabalin group (2±3 suppositories) was not significantly different (P=0.62). Numeric Rating Scale (NRS) for the intensity of ongoing pain, frequency of neuropathic pain, and Pain Catastrophizing Scale (PCS) between each group were not significantly different at any time until 3 months after surgery. Early postoperative administration of pregabalin is not beneficial for patients with NSCLC.

Ibuprofen timing for hand surgery in ambulatory care.

OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies.

Does Early Post-operative Administration of Aspirin Influence the Risk of Bleeding After Coronary Artery Bypass Graft Surgery? A Prospective Observational Study.

Background:Aspirin has a proven role in preventing thrombotic diseases. However, given its anti-platelet activity, it is often assumed that its early post-operative administration significantly increase the amount of post-operative bleeding.Aim:The aim of this study was to determine whether early post-operative administration of aspirin influence the risk of bleeding in patients undergoing coronary artery bypass graft (CABG) surgery.Methods:In a prospective observational study, 100 consecutive patients undergoing first time elective CABG surgery were include in the study. Patients received a low dose of aspirin (75-150 mg per day) either 1 hours (the early aspirin group; n=43) or 6 hours after surgery (the late aspirin group; n=57). Total mediastinal blood drainage, blood drainage after 6 hours, incidences of re-operation for the control of bleeding and transfusion of red blood cells (RBCs) and blood products were recorded and followed until chest tube removal.Results:The groups were found to be matched for the confounding variables and no significant differences were found between post-aspirin bleeding (p=0.37), RBCs and blood product usage (p=0.90) or incidences of re-operation for control of bleeding (p=1.00) between the two groups.Conclusions:Early administration (1 hour after surgery) of aspirin did not appear to increase the risk of post-operative bleeding in patients undergoing CABG. Thereby, its early administration in such cases may be considered. Although further well-designed randomized controlled trials to confirm the safety and efficacy of early administration of aspirin after CABG surgery are warranted.

Post-lesion administration of 7-NI attenuated motor and non-motor deficits in 6-OHDA induced bilaterally lesioned female rat model of Parkinson’s disease

The preoperative neuroprotective effect of the 7-nitroindazole (7-NI) in 6-hydroxydopamine (6-OHDA) induced unilateral male animal models of Parkinson’s disease (PD) has been widely reported. However, the therapeutic approach to PD pathology would be closely associated with the post-lesion treatment by 7-NI in 6-OHDA–induced bilateral model. Also, there is a scarcity of data on neuroprotective effect of 7-NI in PD in females. We have studied the neuroprotective effects of 7-NI in 6-OHDA-induced bilaterally lesioned female rats after short-term post-lesion treatment.Sprague–Dawley female rats with bilateral intraventricular injection of either 6-OHDA (10.5μg) (n=8–11/group) or saline (sham; n=8/group) at substantia nigra (SN) were provided with 7-NI (30mg/kg/day) intraperitoneal, once a day during the 3 consecutive days of short term treatment. 6-OHDA lesioned animals developed the motor and non-motor deficits, which were evaluated by behavioral and neuro-biochemical tests from the substantia nigra. Post-lesion administration of 7-NI reduced the motor deficits induced by 6-OHDA in the behavioral tasks such as Rota rod, open field test and forced swim test. Simultaneously, the dopamine levels were restored by 7-NI in post lesion animals up to 76% in comparison to 6-OHDA lesioned animals (23%). Furthermore, antioxidant-like effect of 7-NI was observed in lipid peroxidation, catalase, superoxide dismutase, and reduced glutathione tests. Conclusively, the present study showed that early postoperative administration of 7-NI attenuates the motor deficits induced by 6-OHDA in bilaterally lesioned female rat model of PD.

The impact of an algorithm on the optimization of beta-blockers after cardiac surgery.

To evaluate the impact of a simple written algorithm of early postoperative beta-blocker administration on daily practices. A prospective, single center observational study. A 16-bed cardiac surgical intensive care unit in a university teaching hospital. One hundred twenty-five consecutive adult patients chronically treated with beta-blockers and scheduled for conventional cardiac surgery. Two successive 4-month phases: Phase 1 = uncontrolled early postoperative beta-blocker administration (n = 73) and phase 2 = beta-blocker administration by an institutional written algorithm using incremental doses of bisoprolol and/or esmolol (n = 52). The main endpoint was the number of patients receiving beta-blockers on the morning of postoperative day 1. Secondary endpoints were the number of patients receiving beta-blockers on the morning of postoperative day 1 and reaching the targeted therapeutic goal and the incidence of postoperative atrial fibrillation in the intensive care unit. A 79% increase in the number of patients receiving beta-blockers on the morning of postoperative day 1 (42% v 75%, p<0.001) was observed during the second phase of the study. The number of patients receiving beta-blockers on the morning of postoperative day 1 and reaching the targeted therapeutic goal was increased significantly by 127% (33% v 75%, p<0.001). The incidence of atrial fibrillation was similar between both phases of the study: 37% versus 31%, p = 0.567. A simple written algorithm markedly improved early postoperative continuation of beta-blockers in chronically treated patients undergoing conventional cardiac surgery.

Early postoperative administration of probiotics versus placebo in elderly patients undergoing elective colorectal surgery: a double-blind randomized controlled trial

BackgroundPerioperative prophylactic antibiotic treatment significantly influences intestinal microflora, resulting in impaired bowel functioning in some patients, sometimes requiring further investigations. This may lead to a worse health-related quality of life (HRQoL). Probiotics administrated in the early post-operative period may help avoiding such nuisances in older people.MethodsWe prospectively enrolled patients undergoing laparoscopic colorectal surgery aged over 70 years between 2005 and 2012. The study was approved by IRB. All patients received perioperative antibiotic treatment. Patients were randomized to one of two treatment arms: Group A patients received probiotics after surgery (VSL#3, VSL Pharmaceuticals, Inc. USA - 900 × 109 daily, while Group B patients received a Placebo (cornstarch). Patients were further divided in sub-groups whether ileo-caecal valve was spared or not. Patients were followed-up every 7 days for 4 weeks. Patients daily annotated bowel frequency, stool shape and consistency - according to Bristol's scale. HRQoL was assessed every week by means of SF-36 questionnaire.ResultsGroup A included 10 while Group B included 8 patients. One patient in each group experienced a postoperative complication. Group A patients had fewer bowel movements than controls, during every week. Stool consistency was higher in patients undergoing resections including ileo-caecal valve receiving VSL#3. HRQoL gradually increased in both groups; Group A patients had higher "social functioning" item scores at week 1 and 4 than controls.ConclusionsElderly patients undergoing resection of ileo-caecal valve may benefit from an early probiotics administration pathway after perioperative antibiotic treatment.

Laparoscopic Distal Pancreatectomy with Preservation of the Spleen and of the Splenic Vessels, with Autologous Islet Transplantation. a New Minimally Invasive Technique to Treat Benign Neoplasm of the Pancreatic Body. Case Series of 3 Patients

Introduction: Benign pancreatic neoplasm located in the left pancreas can require resection because of the risk of malignant transformation. Distal pancreatectomy for body-neck lesions frequently results in postoperative diabetes because of the great amount of normal resected pancreatic tissue. Autologous islet transplantation (AIT) can prevent this event. The association of AIT, laparoscopic technique and the preservation of the spleen can minimize all the possible consequences of surgery in such cases. We herein present a case series of 3 non diabetic patients who underwent spleen preserving left laparoscopic pancreatectomy for symptomatic cystic lesions. Materials and methods: Three non-diabetic, female patients (age 37-44) were candidate to surgery because of pancreatic cystic lesions between May and September 2011. The lesions were located at the body/neck of the pancreas and measured 3, 4 and 10cm respectively. The planned operation was a laparoscopic spleen-preserving left pancreatectomy with preservation of the splenic vessels, associated with AIT from the normal pancreas distal to the neoplasm. Results: The procedure was successfully performed in all the three cases. Mean operation time was 266 minutes. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stay was 6, 6, and 7. Histopathological evaluation revealed mucinous cystic neoplasm in 2 cases e serous cystic neoplasm in 1 case. Pancreas weight was 33, 22, 30g and 105.200, 40.390, 94.790 Islet equivalents were isolated respectively and infused in the portal vein by percutaneous transhepatic approach the day after surgery. No early postoperative insulin administration was needed. One patient developed a transient partial portal thrombosis 2 months after islet infusion. The 3 patients are insulin independent at a mean follow up of 7 months. Conclusions: The combination of minimally invasive approach and autologous islets transplantation is safe and effective in prevent post surgical diabetes after resection for benign neoplasm located in the body-neck of the pancreas.