General or local anaesthesia in one-day thyroid surgery-does it matter?

Objective: We aimed to determine the safety and feasibility of general anaesthesia (GA) compared with local anaesthesia + Monitored Anaesthesia Care (LA+MAC) for One-Day Thyroid Surgery (ODTS); to assess patient and operator satisfaction with either of the anesthetic approaches.

Material And Methods: We reviewed prospectively 130 patients who underwent ODTS from 2008 to 2011. 64 patients were operated on under GA and 62 - under LA+MAC.

Use of activated recombinant Factor VII (NovoSeven) during neurosurgery.

Diffuse bleeding during neurosurgical operations is a major complication that can be difficult to control. In extreme circumstances, it may be necessary to clamp cerebral blood vessels or resect additional tissue. Both of these procedures can result in brain damage and, ultimately, in disability for the patient.

[Orthotopic liver transplantation - recipient selection criteria].

In a great number of patients with progressive liver diseases whose terminal phases are cirrhosis and hepatic insufficiency, liver transplantation is the only feasible therapeutic alternative. However, the undertaking of liver transplantation is largely dependent on the availability of donor organs. Hence, the process of selecting the most adequate recipient is of critical importance from both medicolegal view-point, and in terms of the likelihood of a successful outcome of transplantation.

[Hemodynamic changes and nitric oxide production in an experimental model of sepsis].

Nitric [correction of Nitrous] oxide is most likely a queer "end mediator" giving rise to vasoplegia in septic shock patients. The study is aimed at comparative assessment of kinetic changes in the synthesis of nitric [correction of nitrous] oxide in experimentally induced sepsis model with the corresponding hemodynamic parameters. The laboratory animals--pigs--are divided up in two groups, and exposed to general narcosis induction, orotracheal intubation and mechanical ventilation under controlled regimen.

[The use of Diprivan as an anticonvulsant in the early postoperative period of an otogenic brain abscess].

This is a report on a female patient with otogenic cerebellar abscess and symptomatic generalized convulsions, irresponsive to conventional diazepam and phenobarbital therapy. Fractionated propofol administration yields good effect without noteworthy changes in respiration and circulation.

[The multiple organ failure syndrome--its pathophysiology and treatment].

Polyorganic deficiency syndrome (PODS) is a generalized response to the effect of a variety of agents hardly lending itself to control, becoming manifest with rapid proliferation within the body. The issues discussed include: epidemiology with a special reference to panendothelial trauma to pulmonary and other systems with impairment of oxygen utilization by the cells, microcirculation disorders, mediators, ARDS development, disturbed barrier function of the intestinal mucosa, enhanced glutamine consumption with ensuing villous atrophy. Symptoms presented by various organs, treatment consisting in block of stimulation and block of mediators, as well as selective decontamination and adequate diet are also dealt with.

[Nitric oxide--a basic mediator of vasodilation and septic shock].

Nitric oxide is synthesized from the amino acid I-arginine by a family of enzymes, the nitric oxide synthases. The synthesis of nitric oxide by vascular endothelium is responsible for the vasodilatator tone that is essential for the regulation of blood pressure. NO also contributes to the control of platelet aggregation and the regulation of cardiac contractility.

[The pathophysiological and intensive care-resuscitation aspects of septic shock].

Sepsis and septic shock continue to be the most common causes of death and multiple organ failure among patients in intensive care units. The standard therapeutic regimens include surgical removal of the source of sepsis, antimicrobial therapy, optimizing oxygenation, volume resuscitation, and treatment with catecholamines. The ever extending knowledge of the pathophysiological role played by cytokines and nitrous oxide in septic shock promote the efforts to control their synthesis and pharmacologic action in clinical situations.

[Glutamate antagonists--a new stage in the development of cerebral protection?].

This is a survey of 35 papers, published in medical journals worldwide over the past 5 years, in an attempt to disclose the current level of understanding the fine biochemical mechanism underlying neuronal lesions, as well as to outline the possible trends of cerebroprotective therapy evolution, as put forward by the authors of the cited works. A number of researches demonstrate the role of glutamate and other excitatory amino acids in neuronal lesions' development during hypoxia, hypoglycemia, cranio-cerebral trauma and the like. It is logical to presume that the antagonists of glutamate receptors and their relationship to ionic canals may be considered as having an essential bearing on the build-up of a complex cerebroprotective strategy, corroborated in turn by a number of studies on cell cultures in vitro, and in numerous animal models as well.

[Controlled hypotension against a background of nimodipine during an operation on neurosurgical patients with hypertension].

Operative interventions in subarachnoid hemorrhages caused by brain vessel aneurysm require meticulous dissection of the latter. Regardless of the preoperative preparation of hypertensives, hypertension is a factor predisposing to intraoperative blood pressure fluctuation which, in turn, is extremely unfavourable and interferes with the operation proper on the aneurysm. What is more, it augments the spasm of cerebral vessels and brain edema.

[Morphine and benzodiazepine derivatives in cerebral angiographies].

This is a report on thirty-two patients undergoing cerebral angiography, performed under combined local analgesia in conjunction with morphine and benzodiazepine derivatives. Emphasis is laid on the lack of serious life-endangering complications. The risks of general anesthesia are avoided, and the patient's psyche is conserved.

[A case of generalized convulsion during induction with Diprivan].

The case report concerns a male patient presenting oligophrenia and epilepsy of long duration, adequately prepared for anesthesia with anticonvulsants, sustaining generalized convulsion during anesthesia induction with Diprivan. On deepening Diprivan anesthesia, the convulsion subsides. The patient runs an uneventful postoperative course, free of convulsions.

[A case of an impossible cannulation of the v. jugularis and v. subclavia in a female patient with longstanding myasthenia gravis and immunosuppressive therapy].

The report deals with a female patient presenting myasthenia gravis of 8-year duration, maintained on continuous APV, repeatedly cannulated central veins, and immunosuppressive therapy with corticosteroids--Imuran and Sandimmun. Repeated CT examination of the mediastinum fails to detect any process. The consecutive scanning is necessitated because of the impossibility to cannulate v.

Hypoxia reduces the conduction velocity of the excitation along the striated muscles in man.

The conduction velocity of the excitation along the striated muscles in man, hereafter refered to as muscle fiber conduction velocity (MFCV) was used to estimate the muscle functional state under hypoxaemic hypoxia. The averaged MFCV was counted by the method based on the surface measurements (using bipolar "branched" multielectrodes) of the electrically elicited compound action potentials of the brachial biceps muscle. The arterial and venous blood-gas and acid-base parameters were simultaneously measured and the body temperature was controlled intramuscularly.

[Optimal operating mode for x-ray diagnostic apparatus].

By analyzing quite a number of studies a correlation between some parameters in making X-ray diagnoses, X-ray emitters and converters is determined. From this, a new optimum duty cycle for the X-ray diagnostic generator, securing a maximum diagnostic value and examination effectiveness of a high degree automation and reliability of the system may be suggested.