Peter Scheer

Our experience with transoral incisionless plication of gastroesophageal reflux disease: NOTES procedure.

BACKGROUND/AIMS Natural Orifice Transluminal Surgery (NOTES) has been introduced in endoscopic surgery as a new system offering the advantage of a less invasive procedure. Gastroesophageal reflux disease (GERD) appears to be the most promising application of NOTES treatment. The aims of our study were to evaluate the safety and efficacy of this procedure and length of hospital stay. METHODOLOGY Patients indicated for surgery of GERD were randomly assigned (ratio 2:1) to transoral incisionless fundoplication (TIF group, n=34) and control group, where gold standard Nissen laparoscopic fundoplication was performed (NLF group, n=18). For TIF the Plicator® method was initially used for 18 patients, but the company terminated production in 2008 without a follower. During the last 2 years the EsophyX® method was used for 16 patients. RESULTS After the evaluation of 34 TIF patients and 18 NLF patients we observed similar efficacy of TIF procedures compared with NLF after 3 and 12 months. The hospital stay was significantly shorter (p<0.0001) in TIF group (average, 2.9±0.8 days) than in NLF group (6.4±0.7). The TIF procedure was safe; we observed 1 serious adverse event in the TIF group and 3 in the NLF group. CONCLUSIONS It can be summarized that both NOTES TIF procedures are, after the initial learning curve, safe and effective methods for treatment of GERD, allowing substantial shortening of hospital stay. The effect of both procedures was sustained over 12 months. Longer follow-up is necessary to verify efficacy for more years.

Terlipressin in the treatment of late phase catecholamine-resistant septic shock.

BACKGROUND/AIMS Norepinephrine, but also dopamine and epinephrine are recommended as first line vasopressors in the treatment of septic shock. In some patients, septic shock deteriorates and becomes to be resistant to catecholamines. In this situation, addition of vasopressin or terlipressin can be advantageous. The aim of our pilot study was to evaluate the impact of terlipressin on open label norepinephrine requirements and mortality. METHODOLOGY In a randomized, controlled, single centre study we assigned patients with late advanced septic shock refractory to catecholamines (norepinephrine >0.6µg/kg/min for more than 24h) to receive either continuously terlipressin 4mg/24h for 72 hours in addition to open label norepinephrine (TERLI group) or to continue therapy only with catecholamines (CON group). All vasopressor infusions were titrated to maintain a target blood pressure. RESULTS We enrolled 30 patients, of whom 13 were assigned to terlipressin and in 17 we continued in catecholamine therapy. There was no significant difference in norepinephrine consumption between the groups. Open label norepinephrine infusion rates decreased significantly in the TERLI group as compared with initial consumption, but the decrease we observed only in 7 (54%) patients. There was no significant difference between groups in the rate of death at day 28 (77% in TERLI group and 94% in CON group; p=0.18) or at day 90 (91% vs. 94%; p=0.85). CONCLUSIONS Continuous terlipressin infusion was not effective in reducing norepinephrine consumption or in the mortality of patients, if administered in late phase of catecholamine refractory septic shock.

Retention of nanoparticles-labeled bone marrow mononuclear cells in the isolated ex vivo perfused heart after myocardial infarction in animal model.

Cell therapy of myocardial infarction (MI) is under clinical investigation, yet little is known about its underlying mechanism of function. Our aims were to induce a sub-lethal myocardial infarction in a rabbit, to evaluate the abilities of labeled bone marrow mononuclear cells to migrate from the vessel bed into extracellular space of the myocardium, and to evaluate the short-term distribution of cells in the damaged left ventricle. Sub-lethal myocardial infarction was induced in rabbits by ligation of the left coronary vessel branch (in vivo). The Langendorff heart perfusion model (ex vivo) was used in the next phase. The hearts subjected to MI induction were divided into 3 groups (P1–P3), and hearts without MI formed a control group (C). Nanoparticles-labeled bone marrow mononuclear cells were injected into coronary arteries via the aorta. Perfusion after application lasted 2 minutes in the P1 group, 10 minutes in the P2 and C groups, and 25 minutes in the P3 group. The myocardium of the left ventricle was examined histologically, and the numbers of labeled cells in vessels, myocardium, and combined were determined. The numbers of detected cells in the P1 and C groups were significantly lower than in the P2 and P3 groups. In the P2 and P3 groups, the numbers of cells found distally from the ligation were significantly higher than proximally from the ligation site. Bone marrow mononuclear cells labeled with iron oxide nanoparticles proved the ability to migrate in the myocardium interstitium with significantly higher affinity for the tissue damaged by infarction.

Comparison of the effect of amphotericin B desoxycholate and amphotericin B colloidal dispersion on renal functions and renal morphology in rats

Background and Aim:  Amphotericin B (AmB) desoxycholate remains as one of the most efficacious agents currently available for the treatment of systemic fungal infections; however, amphotericin B colloidal dispersion (ABCD) has been developed because of AmB desoxycholate nephrotoxicity. The goal of our study was to compare the effect of administration of AmB desoxycholate and ABCD on renal functions and renal morphology in rats.

Determination of reference intervals of acid-base parameters in clinically healthy dogs.

OBJECTIVE To establish reference intervals for traditionally- and Stewarts approach-determined acid-base parameters in a population of clinically healthy dogs. DESIGN Prospective study (June 2011-September 2012). SETTING Veterinary teaching hospital. ANIMALS Two hundred twenty-four client-owned, clinically healthy dogs. INTERVENTIONS Blood was collected from the jugular vein and the dorsal pedal artery. MEASUREMENTS AND MAIN RESULTS In the whole blood samples, pH, PCO2 , and PO2 were measured and HCO3- , standard and total bicarbonate, base excess, oxygen content, and alveolar-arterial oxygen differences were calculated. Plasma sodium, potassium, chloride, calcium, albumin, and lactate concentrations were measured and the following parameters were calculated separately for venous and arterial samples: anion gap, anion gap corrected for albumin and phosphate, sodium chloride difference and ratio, chloride gap, strong ion difference, strong ion gap, and unmeasured anions. CONCLUSION Reference intervals for traditionally- and Stewarts approach-determined acid-base parameters were established for venous and arterial blood in dogs.Objective To establish reference intervals for traditionally- and Stewarts approach-determined acid-base parameters in a population of clinically healthy dogs. Design Prospective study (June 2011–September 2012). Setting Veterinary teaching hospital. Animals Two hundred twenty-four client-owned, clinically healthy dogs. Interventions Blood was collected from the jugular vein and the dorsal pedal artery. Measurements and Main Results In the whole blood samples, pH, PCO2, and PO2 were measured and HCO3−, standard and total bicarbonate, base excess, oxygen content, and alveolar–arterial oxygen differences were calculated. Plasma sodium, potassium, chloride, calcium, albumin, and lactate concentrations were measured and the following parameters were calculated separately for venous and arterial samples: anion gap, anion gap corrected for albumin and phosphate, sodium chloride difference and ratio, chloride gap, strong ion difference, strong ion gap, and unmeasured anions. Conclusion Reference intervals for traditionally- and Stewarts approach-determined acid-base parameters were established for venous and arterial blood in dogs.

Changes in Hematologic and Coagulation Profiles in Rabbits with Right-ventricle Pacing

Abstract Objectives: The aim of this study was to evaluate changes in hematology and coagulation in rabbits with right-ventricle pacing without medication. Animals and methods: Blood was collected from ten non-anesthetized male rabbits from the jugular vein before and one month after pacemaker placement. Total erythrocyte, leukocyte and platelet count, hemoglobin, hematocrit and differential leukocyte count were done on automatic veterinary flow cytometry hematologic analyzer. Prothrombin time, activated partial thromboplastin time, fibrinogen level, D-dimers and kaolin-activated thromboelastography was measured from citrated blood. Results: We found an increase in red blood cell mass and decrease in platelet count, while coagulation tests did not diff er between samplings. Conclusion: Right-ventricle pacing seems to have no influence on hemostasis in rabbits.