Uncomplicated Course Research Articles

The Role of Endothelial Dysfunction Markers in Pregnant Women with Chorion Detachment, Included in the Program of Auxiliary Reproductive Technologies

An urgent medical and social problem is the restoration of reproductive function of womenwho suffer from infertility, which became possible due to auxiliary reproductive technologies. Women with induced pregnancy make thegroup of a high-risk on miscarriage, due to interrelated processes –immunological disorders and endothelial dysfunction that occur in the body of pregnant women after the use of extracorporal fertilization programs, and can lead to the chorion detachment and the formation of subchorionic hematomas.The purpose of the study is to determine the role of endothelial dysfunction as one of the leading factors that determine the development of a local non-progressive chorion detachment in infertile patients included in the program of auxiliary reproductive technologies.Materials and methods. We have examined 130 pregnant women, who were divided into groups: the control group included 30 women, whose pregnancy occurred in the natural cycle and with uncomplicated gestational course; the main group – 50 patients with induced pregnancy and risk factors of the occurrence of chorion detachment, who wereperformed the proposed pre-gravidapreparation; the comparative group – 50 pregnant women who received a standard scheme of pregnancy management before and after in-vitro fertilization. A general clinical examination, ultrasound examination, homocysteine level determination, endothelin-1 and nitrogen oxide metabolites were performed.Results. In women included into the program of auxiliary reproductive technologies with local chorion detachment were recorded changes of vascular endothelial function with a possible increase in endothelin-1 production and a decrease of the nitric oxidesynthesis. During the induced pregnancy with the presence of subchorionic hematoma, an increase of the level of endothelium-damaging factor of homocysteine was noted.Conclusions.This study identifies the parameters that reflect the main links of endothelial dysfunction and can be used as markers of local chorion detachment.

Heart Carcinoid Disease with Patent Foramen Ovale Treated by Mini Sternotomy

This case report was an attempt to present the importance of diagnostic echocardiography and closure of a patent foramen ovale in carcinoid heart disease. Herein, we present a case of a 48-year-old woman with a carcinoid metastasis presenting with tricuspid regurgitation, pulmonic stenosis, patent foramen ovale, and borderline left ventricular ejection fraction on an echocardiogram. Surgical intervention included closing the patent foramen ovale and replacing the tricuspid valve via mini-sternotomy. The tricuspid valve was repaired and the ejection fraction was preserved. The patient had an uncomplicated post-operative course. As indicated in this report, closing the patent foramen ovale along with fixing malfunctioning valves can improve the ejection fraction and the associated symptoms.

Pentalogy of Cantrell

Pentalogy of Cantrell is a rare syndrome that consists of defects involving the diaphragm, abdominal wall, pericardium, heart and lower sternum. A 2 –day- old male neonate presented to the pediatric surgical unit in the Maternity and Child Teaching hospital\AL-diwaniya with abdominal wall defect,precious baby deliverd by C\S to the mother with history of primary infertility for more than 13 year, The first clinical evaluation revealed epigastric omphalocele ( liver ,spleen and transverse colon were exposed with rupture sac , sternal defect , and ectopia cordis. U\S ,echocardogram and radiological studies were done to exclude others associated anomalies , Staged closure decided because the primary closure will significantly compromise ventilation or abdominal viscera .The first surgery was closure of both abdominal and thoracic defect ,bilateral flank and lateral chest wall release incisions and skin flap done for this closure. The patient had an uncomplicated postoperative course. A chest CT was performed at 2 weeks of life and demonstrated a very hypoplastic appearing anterior chest wall and a stenosis of the left mainstem bronchus as the cause of the patient's left lung hyperinflation. Monthly evaluation were done till he became at age of two years and every thinks were normal a part from abdominal distention (herniated viscera) which affected and limited the physical activity so the second stage was done, reinforced Dacron mesh placed to the anterior abdominal wall to protects the herniated bowel and redirects the pressure in the abdomen and to promotes enlargement of abdominal cavity.

Intraperitoneal lactate/pyruvate ratio and the level of glucose and glycerol concentration differ between patients surgically treated for upper and lower perforations of the gastrointestinal tract: a pilot study

BackgroundSecondary peritonitis is a condition associated with high morbidity and mortality. Continuous postoperative monitoring of patients to ensure timely intervention to treat complications without delay is important for survival and outcome. We aimed to (1) investigate potential differences in postoperative intraperitoneal biomarker levels between patients with upper and lower gastrointestinal tract lesion, and (2) compare postoperative biomarker levels between complicated and uncomplicated patients.MethodsWe included a total of 15 consecutive patients operated for upper (n = 7) and lower (n = 8) gastrointestinal tract perforation. We registered postoperative complications during a 30 days follow up-period. Complications were defined as intraabdominal complications, septic shock, and mortality. 5 patients were complicated. A microdialysis catheter was placed intraperitoneally in each patient. Samples were collected every 4th hour for up to 7 postoperative days. Samples were analysed for concentrations of glucose, lactate, pyruvate and glycerol.ResultsMicrodialysis results showed that patients with upper gastrointestinal tract lesions had significantly higher levels of postoperative intraperitoneal glucose and glycerol concentrations, as well as lower lactate/pyruvate ratios and lactate/glucose ratios. In the group with perforation of the lower gastrointestinal tract, those patients with a complicated course showed lower levels of postoperative intraperitoneal glucose concentration and glycerol concentration and higher lactate/pyruvate ratios and lactate/glucose ratios than those patients with an uncomplicated course.ConclusionPatients with upper and lower gastrointestinal tract lesions showed differences in postoperative biomarker levels. A difference was also seen between patients with complicated and uncomplicated postoperative courses.

Acromegaly discovered during a routine out-patient surgical procedure: a case report

BackgroundAcromegaly is a rare syndrome in which there is unregulated hypersecretion of growth hormone. The anesthetic management of patients with this disorder is particularly challenging due to pre-existing cardiovascular and respiratory dysfunction, as well as recognized difficulties with airway management. Because of the insidious progression of the disease and the presence of nonspecific signs and symptoms, diagnosis is often made late when characteristic acromegalic features become apparent.Case presentationWe report the management of a 35-year-old African American man with previously undiagnosed acromegaly, who underwent a general anesthetic for same day surgery. Subtle physical features and difficult endotracheal intubation raised our suspicion for the diagnosis of acromegaly. Following an uncomplicated postoperative course he underwent workup for the disease, which was confirmed. In addition, brain magnetic resonance imaging showed a pituitary adenoma. A subsequent transsphenoidal hypophysectomy was performed successfully.ConclusionsThis case underscores the notable absence of recognizing the clinical presentation of acromegaly in this patient by his primary care physician, and the value of thorough history taking, vigilance, and observation in making a new diagnosis that has the potential to alter a patient’s health care and mitigate impending morbidity and/or mortality.

A Rare Uterine Malformation: Asymmetric Septate Uterus

Study ObjectiveTo demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature. DesignResection of an asymmetric uterine septum by laparoscopy and ultrasound-guided hysteroscopy (Canadian Task Force classification III). The video was assumed exempt from official review by our institutional review board. SettingA septate uterus is defined as the uterus in which the uterine cavity is longitudinally divided by the septum [1]. The most common uterine anomaly, septate uterus has a spectrum of configurations ranging from complete septate to incomplete septate uterus. Asymmetric uterine septum was reported only as case reports in the literature and is described as Robert's uterus [2]. This unique malformation is described as a septate uterus with a noncommunicating hemicavity, composed of a blind uterine horn usually with unilateral hematometra, and a contralateral unicornuate uterine cavity. The external uterine shape is normal. The asymmetric septum with transverse uterine septum in the present case has not yet been reported in the literature. PatientA 29-year-old woman presented to our clinic with primary amenorrhea, cyclic pelvic pain, and the desire to have pregnancy. She previously had failed 2 laparoscopy and hysteroscopy procedures for fertility treatments. Hysterosalpingography previously had been failed. The patient previously underwent magnetic resonance imaging. The magnetic resonance imaging report states there was no connection between the uterus and cervix. On external genital organs assessment, there was no abnormal sign. Ultrasonography revealed 2 uterine cavities and hematometra. Both ovaries were in normal view. InterventionsIn view of her examination findings, the patient was scheduled for laparoscopy and hysteroscopy. Laparoscopy revealed extensive adhesions on both the pelvis and upper abdomen. Initially, the uterus and ovaries were not visualized. Adhesiolysis was performed, and normal anatomy was restored. After this step, the operation was continued by laparoscopy and ultrasound-guided hysteroscopy. Under ultrasound and laparoscopy guidance, the transverse uterine septum at the level of uterine isthmus was incised and the left endometrial cavity was observed with hysteroscopy. The asymmetric uterine septum was then incised, and the right-sided endometrial cavity was then accessed. Finally, the uterine septum was completely incised and both sides of the endometrial cavities were merged. The patient had an uncomplicated postoperative course and was discharged 24 hours after surgery. She returned for follow-up examination in the second month after surgery. She had regular menstrual cycles, and her pain was cured. ConclusionHysteroscopy and laparoscopy combined with ultrasound is a useful method for the diagnosis and treatment of asymmetric uterine septum. The skill and experience of the laparoscopic surgeon is another important factor to identify and manage unusual uterine malformations.

Abstract 526: Thromboembolic Phenomenon in a Patient With Unexplained Transverse Aortic Thrombus

A 55 year-old Caucasian male, with no known past medical history, presented to the ER complaining of left upper extremity pain with finger tingling and difficulty speaking that started 8 hours before presentation, while driving his car. In the ER, physical exam was remarkable for mild expressive aphasia with difficulty finding words. His left arm was tender without any edema or erythema and normal range of motion. His left hand fingertips appeared cyanotic ( Picture 1) , however his radial and ulnar pulses were intact bilaterally. Laboratory evaluation revealed a platelet count 1,416,000/mcl, and normal PT/INR and PTT. CT of the brain showed no intracranial bleed. MRI of the brain showed multiple small sub-acute infarcts in the left occipital lobe, left basal ganglia and bilateral cerebellar hemispheres suggesting a shower of emboli. Because of a concern for possible aortic dissection by the ER physician, a CT angiogram of the chest was done. It revealed a large filling defect (up to 3.1 cm) in the distal transverse thoracic aorta, consistent with non-occlusive thrombus adjacent to the origin of the left subclavian artery ( Picture 2) . Subsequently, TEE was done and again showed a large mobile thrombus attached to the inferior posterior wall of the transverse thoracic aorta ( Picture 3) . Given the extremely mobile and large sized thrombus, with high risk for further embolization, the patient underwent surgery with excision of the aortic thrombus ( Picture 4) . The patient had an uncomplicated post-operative course and warfarin was started empirically post-operatively. Further Hematology work up was suggestive of Essential Thrombocytosis. The patient was started on hydroxyurea. On his 3-week follow up appointment, his platelet count decreased to 202,000/mcl. Anti-coagulation was continued for 3 months. His neurologic symptoms significantly improved with only mild residual left hand finger tips claudication which resolved by 1 month post discharge.

МІНЛИВІСТЬ ВМІСТУ АНТИФОСФОЛІПІДНИХ АНТИТІЛ У ДРУГОМУ ТРИМЕСТРІ ВАГІТНОСТІ У ПАЦІЄНТОК З РАННІМ ГЕСТОЗОМ

Мета дослідження – дослідити мінливість циркуляції антифосфоліпідних антитіл у вагітних залежно від перебігу першого триместру вагітності.Матеріали та методи. Обстежено 109 вагітних з гестаційним терміном 11–12 тижнів, яких було розділено на 2 групи. Групу 1 утворили 58 вагітних, що мали прояви раннього гестозу, групу 2 – 51 вагітна з неускладненим перебігом першого триместру вагітності. У всіх вагітних в 11–12 та в 20 тижнів методом імуноферментного аналізу було визначено циркуляцію антитіл до основних фосфоліпідів, проаналізовано частоту виявлення різних субтипів антитіл при першому та другому обстеженні залежно від перебігу першого триместру вагітності.Результати дослідження та їх обговорення. Частота виявлення антифосфоліпідних антитіл в першому триместрі вагітності в обох групах не перевищувала 3,4–3,9 %, не більше 1-2 вагітних у кожній групі мали циркуляцію двох або більше субтипів антитіл. Переважним субтипом, що його було виявлено в обох групах, були Ig G до кардіоліпіну. Вже в 20 тижнів між групами було виявлено відмінності – в групі 2 частота виявлення антитіл до негативно зарядженого фосфатидилсерину сягнула 13,7 %, а нейтрального фосфатидилетаноламіну – 17,6 %, в групі частка вагітних з виявленими антитілами до фосфоліпідів залишилась сталою.Висновки. Вагітним властива мінливість концентрації АФА протягом першої половини гестації – від незначної частоти виявлення їх в 11–12 тижнів до значного зростання в 20 тижнів. Враховуючи домінування антифосфоліпідних антитіл до негативно заряджених фосфоліпідів у вагітних в 20 тижнів, які не мали їх у першому триместрі, їх поява може бути свідченням початку ендотеліальної дисфункції, що лежить в основі більшості акушерських ускладнень. Частота появи АФА до негативно заряджених фосфоліпідів є меншою серед пацієнток з раннім гестозом, ніж серед жінок з неускладненим перебігом першого гестаційного триместру.

PREDICTION OF COLORECTAL ANASTOMOSIS FAILURE

Aim. To study the possibilities of using chemiluminescent blood analysis and determining blood plasma lactate content for prediction of colorectal anastomosis failure. Materials and methods. Chemoluminescent blood analysis was carried out and blood plasma lactate content was determined within the days 1, 4 and 8 after the surgery in 78 patients with colorectal cancer, who had undergone the radical surgical intervention. Blood of 10 donors was used as a control. All patients were divided into 2 groups. Group I included 5 patients with interintestinal anastomosis failure developed, group II included the rest 73 persons. Results. Before the treatment started, a reliable elevation of chemiluminescence intensity was revealed in patients with colorectal cancer. Within the days 1 and 4 after the surgery, chemiluminescence indices were significantly higher in the group of patients with anastomosis failure than in patients of the second group. By the postoperative day 8, patients of group II experienced normalization of chemiluminescence indices, whereas in patients with anastomosis failure these indices remained reliably increased. Within the postoperative days 1 and 4, blood plasma lactate content significantly raised in patients of group I. No changes in lactate level among patients with uncomplicated postoperative course were noted. Conclusions. Chemiluminescent erythrocyte analysis and determination of blood plasma lactate content within the postoperative day 1 can be used to predict colorectal anastomosis failure in patients with malignant neoplasms of the colon.

Liver transplant for hepatocellular carcinoma associated with very high serum alfa-fetoprotein

Objective: Selection of patients with hepatocellular carcinoma (HCC) for liver transplant is still debatable, Milan criteria remain the gold standard. However, some centers consider biological behavior of HCC, as reflected by serum Alfa-fetoprotein (AFP), in patient selection. AFP higher than 400 IU/mL was considered as an exclusion criterion. Here, we present a case of HCC associated with very high levels of AFP that had loco-regional treatment followed by liver transplant with no tumor recurrence 24 months post-transplant. Methods: Results: This is a case of a 55-year-old male who had end-stage liver disease due to Hepatitis C Virus (HCV) infection since 2008, and was treated with ribavirin and interferon. He was diagnosed with HCC lesion 2.6 cm in the maximal diameter in April 2014. AFP was 341 IU/mL that jumped to 2599 IU/mL. He underwent transarterial chemoembolization that showed a dramatic drop of AFP down to 21 IU/mL after six weeks. The patient was listed for liver transplant as HCC was within Milan criteria. He underwent liver transplant in September 2014 when AFP was 9 IU/mL. He had an uneventful liver transplant with uncomplicated post-operative course and was discharged in a good condition on the twelfth post-operative day. Serial follow-up of the patient with dynamic magnetic resonance imaging and serum AFP for 24 months post-transplant showed no recurrence of HCC with normal levels of AFP. Conclusion: Exclusion of patients based on their initial serum Alfa-fetoprotein levels at time of diagnosis of HCC could preclude patients with potentially favorable outcome.

Complex portal venous inflow reconstruction in liver transplantation: the option of left renal portal vein transposition

Objective: Portal vein thrombosis (PVT) is a technically challenging complication of portal hypertension arising in 25% of liver transplant candidates. Management largely depends on anatomy and extent of the thrombosis. There is a growing need for innovative options for portal inflow reconstruction. In complicated cases where reconstruction options are limited, strategies to avoid the morbidity associated with portocaval transposition should be considered. In these circumstances, a renal-portal transposition may be a unique option for establishing portal inflow. We report a case of a patient who underwent successful transplant by performing a left renal-portal transposition. Methods: Pre-operative CT imaging demonstrated splenorenal varices and a large spontaneous splenorenal shunt. Attempts at intraoperative primary thrombectomy were unsuccessful. The donor portal vein was anastomosed end-to-end to the left renal vein. Portal inflow was measured to be 1.8 liters/minute Results: Successful portal inflow was established by utilizing an enlarged left renal vein for a renal-portal transposition. The patient had an uncomplicated post transplant course. At one year, the patient is doing well with good graft function and patent portal inflow (Figure 1). Conclusion: Patients with portal vein thrombosis manifest various patterns of venous collaterals. Large varices communicating with spontaneous splenorenal shunts can be a viable source of splanchnic venous inflow for portal vein reconstruction. In highly selected patients, a renal-portal transposition is a unique reconstructive option that should be considered as an alternative to performing a portocaval transposition.

Cost of achieving equivalent outcomes in sicker patients after liver transplant

Objective: Determinants of cost after liver transplant (OLT) are unknown. We aimed to characterize the variability in cost after uncomplicated OLT and determine impact on graft and overall survival. Methods: Using a linkage between the University Health Systems Consortium and Scientific Registry of Transplant Recipients databases, we identified 12,245 patients who underwent OLT between 2011 and 2014. Patients who met criteria for uncomplicated OLT, defined as length of stay (LOS) <14 days with discharge to home, were selected (n=5,763). Patients were grouped into tertiles (low, medium, high) according to cost of perioperative stay. Results: Patients undergoing uncomplicated OLT were of similar age, gender, insurance status, and etiology of liver disease across all three groups. High cost patients were more likely on hemodialysis preoperatively, had higher severity of illness, and had higher MELD score (all p < 0.01). High cost patients required increased utilization of resources including lab tests, blood transfusions, and opioids (all p < 0.01). Despite higher burden of disease necessitating increased resource utilization, high cost OLT patients with an uncomplicated perioperative course were shown to have identical 2-year graft and overall survival compared to lower cost patients (p=0.66 and p=0.94, respectively). Conclusion: Improved perioperative outcomes in OLT patients with higher severity of illness and disease burden will require increased cost and resource utilization; however doing so provides these patients with equivalent long term survival. These findings support a recipient risk-based bundled reimbursement for liver transplantation.

V5-11 ROBOTIC SIMPLE PROSTATECTOMY: THE RETROPUBIC APPROACH

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-11 ROBOTIC SIMPLE PROSTATECTOMY: THE RETROPUBIC APPROACH Unwanaobong Nseyo, Yahir Santiago-Lastra, and Jill Buckley Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Yahir Santiago-LastraYahir Santiago-Lastra More articles by this author , and Jill BuckleyJill Buckley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1416AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several surgical options for the management of BPH. We present the case of a patient with a large prostate gland on TRUS during prostate biopsy and transient urinary retention. GIven size of the gland and long distance to bladder neck as well as patient's status as Jehovah's witness, decision made to use retropubic approach to robotic simple prostatectomy. METHODS Video recorded of surgical procedure RESULTS Patient with minimal blood loss during the procedure, no additional need for transfusion. Patient discharged on post-op day 3 after uncomplicated hospital course. Small leak seen on post-op VCUG resulted in additional week of catheter use and resolution on repeat imaging. Patient with resolution of lower urinary tract symptoms. CONCLUSIONS Retropubic approach to robotic simple prostatectomy can be an option for surgical management of large glands and a safe and effective alternative to the transvesical approach. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e602 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Unwanaobong Nseyo More articles by this author Yahir Santiago-Lastra More articles by this author Jill Buckley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Корекція кровотеч в ранні терміни гестації залежно від стану ембріона та екстраембріональних структур

The objective: the study of the status of the embryo and extraembryonic structures for bleeding that is not associated with the detachment of the chorion in the first trimester of gestation. Patients and methods. Were examined 34 patients in the gestational age 6-9 weeks (main group) with bleeding from the genital tract, in which, at the primary ultrasonic inspection revealed no detachment of the chorion. The control group included 30 women with uncomplicated course And trimester of gestation. The average age of the pregnant women of the main group was 25.3±3.1 years in the control group 26.4±4.3 years. All women underwent standard clinical and laboratory examination. Results. Studies have shown that prognostic markers of unfavorable development of the embryo in the early stages of pregnancy bleeding not related to chorion detachment was not detected. For the purpose of hemostasis in pregnant of the main group of prescribed drugs traneksamic acid 0.25 mg 3-4 times a day for 3 days. Traneksam – antifbrinolytic tool is able to block not only plasminogen, and plasmin that has already formed. It also stimulates the synthesis of collagen, through which increases the elasticity of the fibrin clot. Pregnant women in both groups received vitamin E 1 capsule per day magnesium products, Magnicum 1 tablet 3 times a day, folic acid 400 micrograms per day. Assessing clinical signs of disease in dynamics of treatment, it should be noted that the hemostasis in the main group was achieved in an average of 2.3±0.7 days. Conclusion. Bleeding in early gestation, not connected with the detachment of the chorion, the use of Traneksam provides fast absolute hemostasis, which in turn contributes to the normalization of tone of the uterus and the physiological course of placentation. Key words: bleeding in early pregnancy, the chorion detachment, hemostasis, hemostatic therapy, Traneksam.

Декомпенсована плацентарна дисфункція: діагностика і тактика розродження

The objective: depression of frequency of perinatal pathology at women with decompensation form of placental dysfunction by improvement of the main diagnostic and treatment-and-prophylactic actions. Patients and methods. 154 pregnant women in gestation term from 22 to 40 weeks were surveyed. Depending on features of course of pregnancy and families of all surveyed it was divided into 4 groups. The group of the retrospective analysis was made by 45 pregnant women with decompensation placental dysfuction, the group of prospective research included 109 pregnant women of whom the main group was made by 38 women with decompensation form of placental dysfunction, the group of comparison included 47 pregnant women with the compensated form of placental dysfunction. The control group was made by 24 pregnant women with the uncomplicated course of pregnancy and labors. The complex of the conducted researches included clinical, ehografical, dopplerometrical, laboratory, morphological and statistical methods. Results. Use of advanced algorithm of diagnostic and treatment-and-prophylactic actions allows to increase efficiency of diagnostics of decompensation form of placental dysfunction for 33.3%, and rational tactics of a delivery leads to depression of perinatal pathology for 22.7%. Conclusion. Decompensation placental dysfuction is one of the main reasons for perinatal mortality and a case rate at the present stage. Use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows major factors of risk of this complication and the indication for change of tactics and delivery times. Key words: decompensation placental dysfunction, diagnostics, delivery tactics.

Прокальцитонин и С-реактивный белок — ранние предикторы несостоятельности низких колоректальных анастомозов

Aim of investigation. To determine diagnostic value of procalcitonin (PCT) and C-reactive protein (CRP) at anastomotic leakage (AL) following lower anterior resection (LAR) of the rectum. Material and methods. Overall 100 patients underwent surgery for epithelial tumors of rectum in the period 2013-2016 yy in the volume of LAR with the formation of anastomosis and preventive stoma. In patients without clinical symptoms radiopaque study was performed in order to identify asymptomatic AL on day 7 after the surgery. AL rate, difference in PCT and CRP levels in patients with AL and consistent anastomosis were assessed along with sensitivity, specificity, positive and negative predictive value of these markers. Results. AL was diagnosed in 20% (20 of 100) of patients: in 11% (11 of 100) - with clinical manifestations, in 9% (9 of 100) - without clinical symptoms (contrast leakage according to X-ray study). In the group of patients with anastomotic leak, the median of C-reactive protein level differed from that in patients with uncompromised integrity of anastomosis at 3rd day after surgery (156 mg/L vs 81 mg/L, respectively - t-test, p=0.0004) and postoperative day 6 (136 mg/L vs. 52 mg/L, respectively - t-test, p <0.0001). In patients with AL the median procalcitonin level was significantly higher compared to the group of uncomplicated course: at the day 3 it was 0.50 ng/mL versus 0.10 ng/mL, respectively - Mann-Whitney test, p<0.0001, at the day 6:1.16 vs. 0.10 ng/mL, respectively - Mann-Whitney test, p<0.0001. Conclusion. Anastomotic leakage rate was 20%, but only 11% of the patients had AL-related clinical manifestations. Changes in PCT and CRP levels in postoperative period correlated to the presence of AL.

An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy.

To review literature associated with external beam radiotherapy and skin damage. A focus of the literature search is to highlight and discuss the myriad of skin assessment tools that are available to the clinician when assessing skin injury in patients receiving external beam radiation therapy. It is apparent that despite considerable work being progressed in the development of individualised skin assessment tools, uptake and use is poor. These tools are designed to assist the clinician in the evaluation of damaged skin and predict the radiation wound development pathway. An integrated review can be used to address a mature or new and emerging topic through a systematic methodology, which is either theoretical or empirical, gained from research, practice or policy initiatives (Whittemore & Knafl, Journal of Advanced Nursing, 52, 2005, 546). This review is particularly concerned with the employment of skin assessment tools by clinicians in patients with radiation damaged skin. Using the search terms synonyms for radiation, skin and epidermal damage, PubMed/MEDLINE, Medical Complete and Web of Science databases were searched. Consulting professional peers was employed as part of the inclusion and exclusion process. There is a high level of unpredictability about which patient will have an uncomplicated course of external beam radiotherapy. Variables may include, but are not limited to, an acute reaction, a delayed reaction resulting in actual skin damage or no visible skin disturbance. The skin assessment tools that are readily available are not regularly referenced in clinical practice when attempting to manage the many side effects of radiation therapy. Skin assessment tools require ongoing clinical validation, so they can be used to guide practitioners to undertake further assessment of skin integrity. The current body of knowledge suggests clinicians caring for patients receiving therapeutic radiotherapy should consider integrating a recognised patient assessment skin framework into their daily routine. Such validated tools may add value to postradiotherapy patient care by providing a consistency of management and accordingly refining best practice.

Endoscopic Endonasal Approach for Craniovertebral Junction Pathologic Conditions: Myth and Truth in Clinical Series and Personal Experience.

For many years, the microsurgical transoral approach has been accepted as the gold standard for anterior decompressions of the craniovertebral junction (CVJ). The introduction of the endoscopic endonasal approach (EEA) has gained wide recognition and overwhelming support in recent years, including for diseases of the CVJ. The aim of this study was to critically analyze and discuss all cases of CVJ diseases approached by means of an EEA so far reported in the literature, including our institutional experience consisting of 6 consecutive patients. Six consecutive patients affected by CVJ disease underwent an EEA. Three patients had a tumor (2 chordomas and 1 myeloma) and 3 had impressio basilaris. Five patients had an uncomplicated postoperative course and 1 developed an intraoperative cerebrospinal fluid leak and subsequent meningitis and died 5 weeks after surgery. A total of 107 patients (including our 6) affected by CVJ disease and treated with EEA have been reported so far. Among these patients, cerebrospinal fluid leak was reported in 13 (12.4%), transient velopharyngeal incompetence in 6 (5.6%), postoperative epistaxis in 2 (1.86%), and respiratory dysfunction requiring a tracheostomy in 2 (1.86%). In our extended institutional series of more than 20 consecutive anterior decompressions for CVJ diseases (including transoral and transnasal microsurgical approaches), the only fatal complication was associated with EEA. On the basis of the reviewed literature and our personal experience, the reported increased safety of the EEA needs to be reassessed and discussed.

The reference intervals of main parameters of urine for analyzers SYSMEX UF 1000I/500I in dynamics of uncomplicated pregnancy.

The analyzer Sysmex UF1000i/500i were used to measure 8 parameters of urine of pregnant women; the upper reference values were formed. The women (n=158) with uncomplicated course of pregnancy were examined. No calculation of reference intervals was applied to leukocytes, erythrocytes, pavement and transitional/renal epithelium, cylinders (pathological ones included) due to their correspondence to similar values for non-pregnant women. for indices of bacteria and crystals proper upper reference thresholds were calculated that in trimesters I, II and III amounted to 452,8, 687,9 и 571,4 u/mkl for bacteria, and 0,59, 0,92 и 0,7 u/mkl for salts correspondingly.

Significant Sleep Dysregulation in a Toddler With Developmental Delay

Derrick's parents made an appointment with a new pediatrician for a second opinion about disordered sleep. Now 22-months old, he was evaluated at 18 months of age for developmental delay when he was found to have "a regulatory disorder associated with delays in language and motor development, hypotonia and significant sleep problems." The parents are now most concerned about his sleeping pattern. Prolonged sleep onset and frequent night awaking occur each night since 6-months of age. These problems are more severe in the past few months when he awakes screaming and cannot be settled. The awakening episodes occur 2 to 4 times each night when "he screams and thrashes his body for up to an hour." Daytime tantrums increased. After the parents read a book about sleep in young children, they provided a calm atmosphere at bedtime including a dark room and singing a quiet lullaby. When these changes did not alter sleep, they purchased a vibrating mattress which was also unsuccessful.Derrick was born full term after an uncomplicated prenatal and perinatal course. He sat at 10 months, crawled at 12 months, and walked at 18 months. He currently drinks from a sippy cup and he can use a utensil to eat. He has few words saying only "no" and "mama" in the past month. Imitation of some words occurred recently. He has responded to simple directions in the past 2 months. Derrick passed the newborn audiology screen. He does not have difficulty swallowing and he does not drool. He plays with many different toys and he plays in parallel with his older brother who also experienced delays in motor and language development. His brother is now doing very well in school. There is no family history of cognitive delay, seizure disorder, cerebral palsy, early developmental delay (other than the brother) or a significant sleep problem. PHYSICAL EXAMINATION:: head circumference, length and weight (75th percentile). He had mild generalized hypotonia, mild weakness, 2+ symmetrical deep tendon reflexes, and absence of ankle clonus. His gait was slightly wide based, steady, and without a limp. Neither ataxia nor drooling was observed. He was easily engaged in play with the examiner without evidence of irritability. The remainder of the examination was normal.