ФГБУ Московский научно-исследовательский онкологический институт им. П. А. Герцена Минздравсоцраз... more ФГБУ Московский научно-исследовательский онкологический институт им. П. А. Герцена Минздравсоцразвития РФ; Отделение анестезиологии и реанимации В работе приведен клинический случай успешного ведения больного со сверхмассивной кровопотерей после обширной резекции печени. Описан опыт эффективного использования препарата факторов свертывания крови Протромплекс 600 с целью остановки диффузного интраоперационного кровотечения. Обсуждаются методы оптимизации анестезиологического обеспечения и послеоперационной интенсивной терапии данного вида Рис. 5. Топография и подскуловая блокада нижнечелюстного нерва (по Вайсблату) с использованием нейростимуляции. К ст. Озолиня А. и соавт.
www.thelancet.com Vol 381 February 2, 2013 369 Submissions should be made via our electronic subm... more www.thelancet.com Vol 381 February 2, 2013 369 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ six hospitals in Poland to the whole country, as Pearse and colleagues have done, seems inappropriate. We assessed data for 2011 from the database of the National Health Foundation (NHF) in Poland. The database, which is not publicly accessible, includes almost all major and most minor surgical procedures (it does not cover obstetric, radiological, or paediatric procedures, nor the usually minor procedures done privately, but does cover planned 1-day, cardiac, and neurological surgery, which were excluded by Pearse and colleagues). We noted the type of discharge from hospital (in this case “death”), predefi ned in the computer system and reported to the NHF. As shown in the table, the average in-hospital mortality for all surgical procedures in 2011 in Poland was 0·98%—ie, 18 times lower than that shown by Pearse and colleagues. Additionally, we have extracted from the NHF database the data on mortality in the six hospitals in Poland that took part in Pearse and colleagues’ study. In those six hospitals, average in-hospital mortality after all surgical procedures in 2011 was 1·07%, which is very similar to the whole-country rate. We suggest that Pearse and colleagues’ methods are misleading Mortality after surgery in Europe
Background & Objectives: Free flap transfer has become a routine surgery to close tissue defe... more Background & Objectives: Free flap transfer has become a routine surgery to close tissue defects. Microvascular thrombosis leading to free flap failure still remains a serious threat; it can occur due to external or intrinsic thrombogenic factors, such as hypercoagulability. The aim was to evaluate influence of preoperative thrombogenic factors on incidence of transferred tissue thrombosis in patients undergoing microvascular surgery.
cavity has an indication for One-Lung Ventilation (OLV)(1,2I. To minimise hypoxic effectduring OL... more cavity has an indication for One-Lung Ventilation (OLV)(1,2I. To minimise hypoxic effectduring OLV we selected Balanced Anesthesia conceming: Thoracic Epidural Anesthesia (TEA) and IV infusion of propofol with controlled ventilation through double lumen tubes(3j. Theaim of studywas to Investigate the effect of propofol as complement to regional anesthesia. Material and methods:After institutional ethic committee approval was obtained 186 consenting patients (ASA II-IV) scheduled for elective thoracicsurgery requiring OLVwerestudied. Patients werepremedicated with 10 mg diazepam orally. An IV infusion of 500 ml crystalloids was started before TEA catheter implacement. After test dose (3 ml) complemental portion of bupivacaine 0.5%withadrenaline 1:20000) up to initialepidural dose6-8 mland0.1 mgfentanyl wasgiven. Gelatine 500mlwasconnected IV and after 20 minutes when TEA was established (mostly Th2-Th8) induction of General Anesthesia (GA)was performed with midazolam 0.07 mglkgandpropofol 1.25-1.5mglkgadministered over30 sec.unti.1 eyelash reflex was lost. Propofol infusion at rate 2 g/kglmln started straight after intubation with double-lumen tube by the use of succinylcholine. Patients were ventilated by mixture Alr/02 with FI02 = 0.4 in the beginning and 2FiO =0.6 during OLV. The following parameters have been monitored: side effects, Blood Pressure (mean), Heart Rate, EKG,Sat 02, Er C02, Recovery Time, Awakening Characteristics (with a special attendance to qualityaspects in the postoperative period). Results and discussion: Mean induction dose of propofol was 1.38 (± 0.18) mg/kg, maintenance dos 2.33 (± 0.38) mglkg and total 498.6 (± 240.8) mg. Average duration of anesthesia was 139.9 (± 48.6) min. Adequate surgical anesthesia was obtained in all cases. Circulatory parameters were stable in majority of operations .even in period of OLV. Patients were able to open eyes in 3.5 min and sigh/cough on command within5 minutes fromstopping infusion of propofo!. Only2 (1.07%) needed prolonged Intubation. No one required assisted ventilation. Conclusions: Infusion of propotol in relatively low doses with TEA secured satisfactory anesthesia for thoracotomy requiring OLV with assurance of good cardiocirculatory stability, rapid recovery and minimal needs for postoperative respiratory support. Operating area remains unpolluted with volatile anesthetic agents while maintaining anesthetic safetyfor the patients.
Proceedings of the Latvian Academy of Sciences. Section B, Natural, Exact and Applied Sciences, 2008
Communicated by Rafails Rozentâls Interleukin (IL-6) is a key cytokine in the pathogenesis of sev... more Communicated by Rafails Rozentâls Interleukin (IL-6) is a key cytokine in the pathogenesis of severe sepsis. The importance of a regulatory polymorphism within the IL-6 promoter remains unclear in these patients. The aim of the study was to determine if IL-6 (-174 G/C) promoter polymorphism has an effect on IL-6 plasma level and outcome of severe sepsis. The study was conducted in general ICU of Stradiòð Clinical University Hospital. A total of 103 critically ill patients with confirmed severe sepsis were prospectively included. Association analysis of the IL-6 (-174C) allele with serum level and clinical outcome was performed. We found no differences in genotype distribution between survivors and nonsurvivors. The serum IL-6 level was significantly higher in nonsurvivors compared with survivors. We found an association of genotype with the IL-6 level in nonsurvivors, but not in survivors. Our findings show a functional significance of IL-6 promoter polymorphisms in nonsurviving severe sepsis patients.
Background and aims Chronic pelvic pain is described as continuous or intermittent pain in lower ... more Background and aims Chronic pelvic pain is described as continuous or intermittent pain in lower abdomen with duration of 3 to 6 months. Pain leads to patients’ functional disability and long-lasting treatment. Even careful examination does not help to find the cause of pain. Methods The retrospective study approved by the Ethics Committee of Riga 1st Hospital. 40 medical cards have been included in the study. All patients visit a pain specialist complaining about chronic pelvic pain. Results The study includes 40 patients’ medical histories, 24 women (60%) and 16 men (40%) p=0.268. The average age was 38 years. The duration of pain varied from 3 to 240 months. Somatoform autonomic dysfunction was diagnosed more often in 12 patients (30%). 11 patients (27%) had the diagnose of low back pain, 7 (17.5%) irritable bowel syndrome, adenomyosis, diverticulosis, hemorrhoidal disease and chronic prostatitis. 6 patients (15%) suffered from depression. Pelvic surgery, endometriosis, unspecified colitis, interstitial cystitis was diagnosed in 5 patients (12.5%). 4 patients (10%) had ovarian dysfunction and adhesion disease, 3 (7.5%) pilonidal cyst, 2 (5%) prolapse or tumor of lesser pelvic organs, urogenital infection and chronic appendicitis. 1 (2.5%) patient had kidney leiomyoma, Chron’s disease and pelvis congestion disease. Most patients 10 (25%) had one diagnosis. 9 (22.5%) patients had 3 diagnosis at once. 3 patients (7.5%) had 7 diagnosis that might cause chronic pelvic pain. Conclusions Chronic pelvic pain is a multidisciplinary problem; 75% of patients have diagnosed more than one disease that may cause chronic pelvic pain.
Background and aims Fluoroscopy-guided epidural steroid injections (FESI) are widely used for man... more Background and aims Fluoroscopy-guided epidural steroid injections (FESI) are widely used for managing low back pain (LBP). There is lack of data on cumulative radiation dose in patients receiving more than one FESI. To determine cumulative radiation dose for three consecutive FESI. To find factors that correlate with higher dose area product (DAP) or longer fluoroscopy time (FT). Methods Three groups of patients: LBP duration for 2, 5 and more than 5 years. One-way ANOVA and independent t-test used to compare FT. Results 48 females and 8 men (mean age 56), mean LBP 4.6 years. Mean cumulative DAP 872.57cGycm2 (SD 275.53), mean FT 70.39s (SD 17,69 s); strong positive correlation between FT and DAP (r=0.755; p=0.01). Mean FT during 1st procedure 24.5s; 2nd 23.6s; 3rd - 22.3s. Mean DAP during 1st procedure 294,67cGycm2; 2nd 287,79cGycm2; 3rd 296,61cGycm2. FT and DAP positively correlated in each group, 1st ESI time ρ 0,750; 2nd 0,797; 3rd 0,682 (p=0.01). First FT was longer in LBP for more than 5 years (p=0.05) n=13 (mean 29.38s); LBP less 1 year n=13 (mean 21s) and LBP from 1 to 5 years n=30 (mean 21.27s). Mean DAP was higher during three procedures and LBP longer than 5 years (p=0.05). Conclusions FT is in uphill linear relationship with DAP. Mean cumulative dose is 57 times lower than radiation dose for FESI allowed by Society of Interventional Radiology of Europe. Patients with longer LBP have longer FT and higher DAP, probably due to severe degenerative spinal lesions.
Background Global epidemiological data regarding outcomes for patients in intensive care units (I... more Background Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality. Methods 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country. Findings 10 069 patients were included from ICUs in Europe (5445 patients; 54•1%), Asia (1928; 19•2%), the Americas (1723; 17•1%), Oceania (439; 4•4%), the Middle East (393; 3•9%), and Africa (141; 1•4%). Overall, 2973 patients (29•5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16•2% (95% CI 15•5-16•9) across the whole population and 25•8% (24•2-27•4) in patients with sepsis. Hospital mortality rates were 22•4% (21•6-23•2) in the whole population and 35•3% (33•5-37•1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested signifi cant between-country variations (var=0•19, p=0•002) and betweenhospital variations (var=0•43, p<0•0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income. Interpretation This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our fi ndings also show a signifi cant association between the risk of death and the global national income and suggest that ICU organisation has an important eff ect on risk of death. Funding None.
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2021
Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee ... more Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee free flap thrombosis advancement after microvascular flap surgery, patient assessment, flawless surgical technique, and eligible perioperative care are pivotal. In this prospective observational study, we aimed to elucidate the most common inherited single nucleotide polymorphisms (SNPs) attributable to free flap thrombosis. A total of 152 patients undergoing microvascular flap surgery during the study period of 2016–2019 were analysed for five SNPs: rs6025 in Factor V Leiden (FVL) gene, rs1799963 in Factor II (FII) gene, rs2066865 in Fibrinogen Gamma Chain gene (FGG), rs2227589 in SERPINC 1 gene and rs1801133 in Methylene Tetrahydrofolate Reductase (MTHFR) gene. Activated protein C resistance (aPCR), prothrombin, antithrombin (AT), fibrinogen and homocysteine plasma levels were measured to determine association with the analysed SNPs and with free flap thrombosis advancement. Our prelim...
Background and Objective. The plasminogen activator inhibitor type-1 (PAI-1) gene promoter contai... more Background and Objective. The plasminogen activator inhibitor type-1 (PAI-1) gene promoter contains 675 (4G/5G) polymorphism. The aim of this study was evaluate the effect of the PAI-1 promoter-675 (4G/5G) polymorphism on the concentrations of PAI-1 and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex and bleeding volume after on-pump cardiac surgery.Material and Methods. A total of 90 patients were included in the study at Pauls Stradins Clinical University Hospital. Seven patients were excluded due to surgical bleeding. Eighty-three patients were classified according to the PAI-1 genotype: 21 patients had the 4G/4G genotype; 42, the 4G/5G genotype; and 20, the 5G/5G genotype. The following fibrinolysis parameters were recorded: the PAI-1 level preoperatively, D-dimer level at 0, 6, and 24 hours after surgery, and t-PA/ PAI-1 complex level 24 hours postoperatively. A postoperative bleeding volume was registered in mL 24 hours after surgery.Results. The patients with the 5G/5...
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2014
Acute respiratory distress syndrome (ARDS) is common and multi factorial, clinically described as... more Acute respiratory distress syndrome (ARDS) is common and multi factorial, clinically described as an inflammatory lung disorder that is associated with major morbidity and high mortality in intensive care patients. Recently, investigators have revised the AECC criteria from 1994. To diagnose ARDS and discover its severity we presently use Berlin definition criteria. An important role in developing of ARDS may be through a disbalance between reactive oxygen species (ROS), which have both oxidant and antioxidant compartments. The pathogenesis of ARDS is very complex, and unfortunately, the dynamic development of ARDS in an individual patient is difficult to recognise. ROS can initiate cellular tissue damage by modifying lipids, proteins and DNA, which can seriously compromise cell life ability or induce a large number of cellular responses through generation of secondary reactive species, leading, at last, to cell death by necrosis or apoptosis. Studies have shown that many patients w...
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2014
Sepsis is characterised by massive inflammatory response, which can affect vascular function. Thi... more Sepsis is characterised by massive inflammatory response, which can affect vascular function. This study was designed to assess the impact of early severe sepsis and septic shock on arterial stiffness and the relationship of this impact to outcome. Twelve patients with severe sepsis and 22 with septic shock were included in the study. We measured carotid to femoral and carotid to radial pulse wave velocity (PWV), an index of aortic and brachial arterial stiffness, in patients with early severe sepsis and septic shock within 24 hours of admission to intensive care unit and repeatedly after 48 hours. No difference was observed between patients with severe sepsis and septic shock regarding carotid to femoral PWV (11.7 ± 2.2 vs. 11.3 ± 3.6 m/s) and carotid to radial PWV (12.0 ± 3.8 vs. 9.5 ± 2.2 m/s). On 48 hour follow-up, PWV did not significantly differ between survivors and non-survivors. A positive, similar correlation occurred between PWV and pulse pressure in all patients (r = 0.3...
ФГБУ Московский научно-исследовательский онкологический институт им. П. А. Герцена Минздравсоцраз... more ФГБУ Московский научно-исследовательский онкологический институт им. П. А. Герцена Минздравсоцразвития РФ; Отделение анестезиологии и реанимации В работе приведен клинический случай успешного ведения больного со сверхмассивной кровопотерей после обширной резекции печени. Описан опыт эффективного использования препарата факторов свертывания крови Протромплекс 600 с целью остановки диффузного интраоперационного кровотечения. Обсуждаются методы оптимизации анестезиологического обеспечения и послеоперационной интенсивной терапии данного вида Рис. 5. Топография и подскуловая блокада нижнечелюстного нерва (по Вайсблату) с использованием нейростимуляции. К ст. Озолиня А. и соавт.
www.thelancet.com Vol 381 February 2, 2013 369 Submissions should be made via our electronic subm... more www.thelancet.com Vol 381 February 2, 2013 369 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ six hospitals in Poland to the whole country, as Pearse and colleagues have done, seems inappropriate. We assessed data for 2011 from the database of the National Health Foundation (NHF) in Poland. The database, which is not publicly accessible, includes almost all major and most minor surgical procedures (it does not cover obstetric, radiological, or paediatric procedures, nor the usually minor procedures done privately, but does cover planned 1-day, cardiac, and neurological surgery, which were excluded by Pearse and colleagues). We noted the type of discharge from hospital (in this case “death”), predefi ned in the computer system and reported to the NHF. As shown in the table, the average in-hospital mortality for all surgical procedures in 2011 in Poland was 0·98%—ie, 18 times lower than that shown by Pearse and colleagues. Additionally, we have extracted from the NHF database the data on mortality in the six hospitals in Poland that took part in Pearse and colleagues’ study. In those six hospitals, average in-hospital mortality after all surgical procedures in 2011 was 1·07%, which is very similar to the whole-country rate. We suggest that Pearse and colleagues’ methods are misleading Mortality after surgery in Europe
Background & Objectives: Free flap transfer has become a routine surgery to close tissue defe... more Background & Objectives: Free flap transfer has become a routine surgery to close tissue defects. Microvascular thrombosis leading to free flap failure still remains a serious threat; it can occur due to external or intrinsic thrombogenic factors, such as hypercoagulability. The aim was to evaluate influence of preoperative thrombogenic factors on incidence of transferred tissue thrombosis in patients undergoing microvascular surgery.
cavity has an indication for One-Lung Ventilation (OLV)(1,2I. To minimise hypoxic effectduring OL... more cavity has an indication for One-Lung Ventilation (OLV)(1,2I. To minimise hypoxic effectduring OLV we selected Balanced Anesthesia conceming: Thoracic Epidural Anesthesia (TEA) and IV infusion of propofol with controlled ventilation through double lumen tubes(3j. Theaim of studywas to Investigate the effect of propofol as complement to regional anesthesia. Material and methods:After institutional ethic committee approval was obtained 186 consenting patients (ASA II-IV) scheduled for elective thoracicsurgery requiring OLVwerestudied. Patients werepremedicated with 10 mg diazepam orally. An IV infusion of 500 ml crystalloids was started before TEA catheter implacement. After test dose (3 ml) complemental portion of bupivacaine 0.5%withadrenaline 1:20000) up to initialepidural dose6-8 mland0.1 mgfentanyl wasgiven. Gelatine 500mlwasconnected IV and after 20 minutes when TEA was established (mostly Th2-Th8) induction of General Anesthesia (GA)was performed with midazolam 0.07 mglkgandpropofol 1.25-1.5mglkgadministered over30 sec.unti.1 eyelash reflex was lost. Propofol infusion at rate 2 g/kglmln started straight after intubation with double-lumen tube by the use of succinylcholine. Patients were ventilated by mixture Alr/02 with FI02 = 0.4 in the beginning and 2FiO =0.6 during OLV. The following parameters have been monitored: side effects, Blood Pressure (mean), Heart Rate, EKG,Sat 02, Er C02, Recovery Time, Awakening Characteristics (with a special attendance to qualityaspects in the postoperative period). Results and discussion: Mean induction dose of propofol was 1.38 (± 0.18) mg/kg, maintenance dos 2.33 (± 0.38) mglkg and total 498.6 (± 240.8) mg. Average duration of anesthesia was 139.9 (± 48.6) min. Adequate surgical anesthesia was obtained in all cases. Circulatory parameters were stable in majority of operations .even in period of OLV. Patients were able to open eyes in 3.5 min and sigh/cough on command within5 minutes fromstopping infusion of propofo!. Only2 (1.07%) needed prolonged Intubation. No one required assisted ventilation. Conclusions: Infusion of propotol in relatively low doses with TEA secured satisfactory anesthesia for thoracotomy requiring OLV with assurance of good cardiocirculatory stability, rapid recovery and minimal needs for postoperative respiratory support. Operating area remains unpolluted with volatile anesthetic agents while maintaining anesthetic safetyfor the patients.
Proceedings of the Latvian Academy of Sciences. Section B, Natural, Exact and Applied Sciences, 2008
Communicated by Rafails Rozentâls Interleukin (IL-6) is a key cytokine in the pathogenesis of sev... more Communicated by Rafails Rozentâls Interleukin (IL-6) is a key cytokine in the pathogenesis of severe sepsis. The importance of a regulatory polymorphism within the IL-6 promoter remains unclear in these patients. The aim of the study was to determine if IL-6 (-174 G/C) promoter polymorphism has an effect on IL-6 plasma level and outcome of severe sepsis. The study was conducted in general ICU of Stradiòð Clinical University Hospital. A total of 103 critically ill patients with confirmed severe sepsis were prospectively included. Association analysis of the IL-6 (-174C) allele with serum level and clinical outcome was performed. We found no differences in genotype distribution between survivors and nonsurvivors. The serum IL-6 level was significantly higher in nonsurvivors compared with survivors. We found an association of genotype with the IL-6 level in nonsurvivors, but not in survivors. Our findings show a functional significance of IL-6 promoter polymorphisms in nonsurviving severe sepsis patients.
Background and aims Chronic pelvic pain is described as continuous or intermittent pain in lower ... more Background and aims Chronic pelvic pain is described as continuous or intermittent pain in lower abdomen with duration of 3 to 6 months. Pain leads to patients’ functional disability and long-lasting treatment. Even careful examination does not help to find the cause of pain. Methods The retrospective study approved by the Ethics Committee of Riga 1st Hospital. 40 medical cards have been included in the study. All patients visit a pain specialist complaining about chronic pelvic pain. Results The study includes 40 patients’ medical histories, 24 women (60%) and 16 men (40%) p=0.268. The average age was 38 years. The duration of pain varied from 3 to 240 months. Somatoform autonomic dysfunction was diagnosed more often in 12 patients (30%). 11 patients (27%) had the diagnose of low back pain, 7 (17.5%) irritable bowel syndrome, adenomyosis, diverticulosis, hemorrhoidal disease and chronic prostatitis. 6 patients (15%) suffered from depression. Pelvic surgery, endometriosis, unspecified colitis, interstitial cystitis was diagnosed in 5 patients (12.5%). 4 patients (10%) had ovarian dysfunction and adhesion disease, 3 (7.5%) pilonidal cyst, 2 (5%) prolapse or tumor of lesser pelvic organs, urogenital infection and chronic appendicitis. 1 (2.5%) patient had kidney leiomyoma, Chron’s disease and pelvis congestion disease. Most patients 10 (25%) had one diagnosis. 9 (22.5%) patients had 3 diagnosis at once. 3 patients (7.5%) had 7 diagnosis that might cause chronic pelvic pain. Conclusions Chronic pelvic pain is a multidisciplinary problem; 75% of patients have diagnosed more than one disease that may cause chronic pelvic pain.
Background and aims Fluoroscopy-guided epidural steroid injections (FESI) are widely used for man... more Background and aims Fluoroscopy-guided epidural steroid injections (FESI) are widely used for managing low back pain (LBP). There is lack of data on cumulative radiation dose in patients receiving more than one FESI. To determine cumulative radiation dose for three consecutive FESI. To find factors that correlate with higher dose area product (DAP) or longer fluoroscopy time (FT). Methods Three groups of patients: LBP duration for 2, 5 and more than 5 years. One-way ANOVA and independent t-test used to compare FT. Results 48 females and 8 men (mean age 56), mean LBP 4.6 years. Mean cumulative DAP 872.57cGycm2 (SD 275.53), mean FT 70.39s (SD 17,69 s); strong positive correlation between FT and DAP (r=0.755; p=0.01). Mean FT during 1st procedure 24.5s; 2nd 23.6s; 3rd - 22.3s. Mean DAP during 1st procedure 294,67cGycm2; 2nd 287,79cGycm2; 3rd 296,61cGycm2. FT and DAP positively correlated in each group, 1st ESI time ρ 0,750; 2nd 0,797; 3rd 0,682 (p=0.01). First FT was longer in LBP for more than 5 years (p=0.05) n=13 (mean 29.38s); LBP less 1 year n=13 (mean 21s) and LBP from 1 to 5 years n=30 (mean 21.27s). Mean DAP was higher during three procedures and LBP longer than 5 years (p=0.05). Conclusions FT is in uphill linear relationship with DAP. Mean cumulative dose is 57 times lower than radiation dose for FESI allowed by Society of Interventional Radiology of Europe. Patients with longer LBP have longer FT and higher DAP, probably due to severe degenerative spinal lesions.
Background Global epidemiological data regarding outcomes for patients in intensive care units (I... more Background Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality. Methods 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country. Findings 10 069 patients were included from ICUs in Europe (5445 patients; 54•1%), Asia (1928; 19•2%), the Americas (1723; 17•1%), Oceania (439; 4•4%), the Middle East (393; 3•9%), and Africa (141; 1•4%). Overall, 2973 patients (29•5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16•2% (95% CI 15•5-16•9) across the whole population and 25•8% (24•2-27•4) in patients with sepsis. Hospital mortality rates were 22•4% (21•6-23•2) in the whole population and 35•3% (33•5-37•1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested signifi cant between-country variations (var=0•19, p=0•002) and betweenhospital variations (var=0•43, p<0•0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income. Interpretation This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our fi ndings also show a signifi cant association between the risk of death and the global national income and suggest that ICU organisation has an important eff ect on risk of death. Funding None.
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2021
Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee ... more Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee free flap thrombosis advancement after microvascular flap surgery, patient assessment, flawless surgical technique, and eligible perioperative care are pivotal. In this prospective observational study, we aimed to elucidate the most common inherited single nucleotide polymorphisms (SNPs) attributable to free flap thrombosis. A total of 152 patients undergoing microvascular flap surgery during the study period of 2016–2019 were analysed for five SNPs: rs6025 in Factor V Leiden (FVL) gene, rs1799963 in Factor II (FII) gene, rs2066865 in Fibrinogen Gamma Chain gene (FGG), rs2227589 in SERPINC 1 gene and rs1801133 in Methylene Tetrahydrofolate Reductase (MTHFR) gene. Activated protein C resistance (aPCR), prothrombin, antithrombin (AT), fibrinogen and homocysteine plasma levels were measured to determine association with the analysed SNPs and with free flap thrombosis advancement. Our prelim...
Background and Objective. The plasminogen activator inhibitor type-1 (PAI-1) gene promoter contai... more Background and Objective. The plasminogen activator inhibitor type-1 (PAI-1) gene promoter contains 675 (4G/5G) polymorphism. The aim of this study was evaluate the effect of the PAI-1 promoter-675 (4G/5G) polymorphism on the concentrations of PAI-1 and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex and bleeding volume after on-pump cardiac surgery.Material and Methods. A total of 90 patients were included in the study at Pauls Stradins Clinical University Hospital. Seven patients were excluded due to surgical bleeding. Eighty-three patients were classified according to the PAI-1 genotype: 21 patients had the 4G/4G genotype; 42, the 4G/5G genotype; and 20, the 5G/5G genotype. The following fibrinolysis parameters were recorded: the PAI-1 level preoperatively, D-dimer level at 0, 6, and 24 hours after surgery, and t-PA/ PAI-1 complex level 24 hours postoperatively. A postoperative bleeding volume was registered in mL 24 hours after surgery.Results. The patients with the 5G/5...
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2014
Acute respiratory distress syndrome (ARDS) is common and multi factorial, clinically described as... more Acute respiratory distress syndrome (ARDS) is common and multi factorial, clinically described as an inflammatory lung disorder that is associated with major morbidity and high mortality in intensive care patients. Recently, investigators have revised the AECC criteria from 1994. To diagnose ARDS and discover its severity we presently use Berlin definition criteria. An important role in developing of ARDS may be through a disbalance between reactive oxygen species (ROS), which have both oxidant and antioxidant compartments. The pathogenesis of ARDS is very complex, and unfortunately, the dynamic development of ARDS in an individual patient is difficult to recognise. ROS can initiate cellular tissue damage by modifying lipids, proteins and DNA, which can seriously compromise cell life ability or induce a large number of cellular responses through generation of secondary reactive species, leading, at last, to cell death by necrosis or apoptosis. Studies have shown that many patients w...
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2014
Sepsis is characterised by massive inflammatory response, which can affect vascular function. Thi... more Sepsis is characterised by massive inflammatory response, which can affect vascular function. This study was designed to assess the impact of early severe sepsis and septic shock on arterial stiffness and the relationship of this impact to outcome. Twelve patients with severe sepsis and 22 with septic shock were included in the study. We measured carotid to femoral and carotid to radial pulse wave velocity (PWV), an index of aortic and brachial arterial stiffness, in patients with early severe sepsis and septic shock within 24 hours of admission to intensive care unit and repeatedly after 48 hours. No difference was observed between patients with severe sepsis and septic shock regarding carotid to femoral PWV (11.7 ± 2.2 vs. 11.3 ± 3.6 m/s) and carotid to radial PWV (12.0 ± 3.8 vs. 9.5 ± 2.2 m/s). On 48 hour follow-up, PWV did not significantly differ between survivors and non-survivors. A positive, similar correlation occurred between PWV and pulse pressure in all patients (r = 0.3...
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