Tamás Végh

Impaired cerebrovascular reactivity in sepsis-associated encephalopathy studied by acetazolamide test

IntroductionThe pathophysiology of sepsis-associated encephalopathy (SAE) is not entirely clear. One of the possible underlying mechanisms is the alteration of the cerebral microvascular function induced by the systemic inflammation. The aim of the present work was to test whether cerebral vasomotor-reactivity is impaired in patients with SAE.MethodsPatients fulfilling the criteria of clinical sepsis and showing disturbance of consciousness of any severity were included (n = 14). Non-septic persons whithout previous diseases affecting cerebral vasoreactivity served as controls (n = 20). Transcranial Doppler blood flow velocities were measured at rest and at 5, 10, 15 and 20 minutes after intravenous administration of 15 mg/kgBW acetazolamide. The time course of the acetazolamide effect on cerebral blood flow velocity (cerebrovascular reactivity, CVR) and the maximal vasodilatory effect of acetazolemide (cerebrovascular reserve capacity, CRC) were compared among the groups.ResultsAbsolute blood flow velocities after adminsitration of the vasodilator drug were higher among control subjects than in SAE. Assessment of the time-course of the vasomotor reaction showed that patients with SAE reacted slower to the vasodilatory stimulus than control persons. When assessing the maximal vasodilatory ability of the cerebral arterioles to acetazolamide during vasomotor testing, we found that patients with SAE reacted to a lesser extent to the drug than did control subjects (CRC controls:46.2 ± 15.9%, CRC SAE: 31,5 ± 15.8%, P < 0.01).ConclusionsWe conclude that cerebrovascular reactivity is impaired in patients with SAE. The clinical significance of this pathophysiological finding has to be assessed in further studies.

One-lung ventilation does not result in cerebral desaturation during application of lung protective strategy if normocapnia is maintained

BACKGROUND Previously a report has suggested that administration of lung protective strategy for one-lung ventilation(OLV) results in oxygen desaturation of the brain parenchyma. The aim of our work was to confirm that the maintenance of normocapnia during protective OLV strategy results in alteration of cerebral blood fl ow and cerebral oxygen saturation as compared to double-lung ventilation. METHODS Data were obtained from 24 patients undergoing thoracic surgery. Cerebral oxygen saturation (rSO2) was continuously monitored by INVOS 5100C Cerebral Oxymeter System along with measurement of cerebral blood fl ow velocity (MCAV) by transcranial Doppler sonography. Arterial blood samples were taken for blood gas analysis in the awake state, in the supine and lateral decubitus position during double-lung ventilation (DLV), and during OLV. RESULTS When ventilation was changed from DLV to OLV, no significant change was observed in rSO2. A significant decrease of rSO2 was found compared to the value observed during DLV in lateral decubitus at the time point 60 minutes after the start of OLV. No clinically significant changes in the MCAV was observed throughout the course of the thoracic surgical procedure. CONCLUSIONS OLV does not result in clinically relevant decreases in cerebral blood fl ow and cerebral oxygen saturation during application of lung protective ventilation if normocapnia is maintained.

Tüdőreszekciót követő tüdővérzés ritka esete

Absztrakt: Tudőműteteket kovetően gyakori, hogy a beteg leguti valadekanak mennyisege megnő, ami legzesi nehezitettseget, radiologiai elterest okoz. Ugyanakkor a beteg anamnezisetől fuggően elterő ...

Optimized angiotensin-converting enzyme activity assay for the accurate diagnosis of sarcoidosis

Abstract Background: Serum angiotensin-converting enzyme (ACE) activity determination can aid the early diagnosis of sarcoidosis. We aimed to optimize a fluorescent kinetic assay for ACE activity by screening the confounding effects of endogenous ACE inhibitors and interfering factors. Genotype-dependent and genotype-independent reference values of ACE activity were established, and their diagnostic accuracies were validated in a clinical study. Methods: Internally quenched fluorescent substrate, Abz-FRK(Dnp)P-OH was used for ACE-activity measurements. A total of 201 healthy individuals and 59 presumably sarcoidotic patients were enrolled into this study. ACE activity and insertion/deletion (I/D) genotype of the ACE gene were determined. Results: Here we report that serum samples should be diluted at least 35-fold to eliminate the endogenous inhibitor effect of albumin. No significant interferences were detected: up to a triglyceride concentration of 16 mM, a hemoglobin concentration of 0.71 g/L and a bilirubin concentration of 150 μM. Genotype-dependent reference intervals were considered as 3.76–11.25 U/L, 5.22–11.59 U/L, 7.19–14.84 U/L for II, ID and DD genotypes, respectively. I/D genotype-independent reference interval was established as 4.85–13.79 U/L. An ACE activity value was considered positive for sarcoidosis when it exceeded the upper limit of the reference interval. The optimized assay with genotype-dependent reference ranges resulted in 42.5% sensitivity, 100% specificity, 100% positive predictive value and 32.4% negative predictive value in the clinical study, whereas the genotype-independent reference range proved to have inferior diagnostic efficiency. Conclusions: An optimized fluorescent kinetic assay of serum ACE activity combined with ACE I/D genotype determination is an alternative to invasive biopsy for confirming the diagnosis of sarcoidosis in a significant percentage of patients.

How About Esophagectomies

Esophagectomy is a complex surgical procedure, and most patients presenting for this surgery have poor preoperative conditions due to malnutrition and immunosuppression. Surgery itself as well as anesthetic and analgesic technique may lead to life-threatening complications.

Cerebral Oximetry in General Anaesthesia

Address for Correspondence/Yazışma Adresi: Dr. Tamás Végh E-mail: veghdr@gmail.com ©Telif Hakkı 2016 Türk Anesteziyoloji ve Reanimasyon Derneği Makale metnine www.jtaics.org web sayfasından ulaşılabilir. ©Copyright 2016 by Turkish Anaesthesiology and Intensive Care Society Available online at www.jtaics.org Received / Geliş Tarihi : 23.09.2016 Accepted / Kabul Tarihi : 26.09.2016 247 Cerebral Oximetry in General Anaesthesia Genel Anestezide Serebral Oksimetre

Reexpansion pulmonary edema

Reexpansion pulmonary edema (RPE) is a rare entity that develops after reexpansion in a chronically collapsed lung. There is a broad clinical spectrum of the disease ranging from asymptomatic appearance to lethal form that occurs in approximately 20% of the cases. The pathophysiological background is complex and not clarified in all details. RPE may be prevented by knowing and treating potential risk factors. This review summarizes the updated knowledge on the pathophysiological background, clinical picture and treatment modalities of RPE.

A complicated case of spontaneous oesophageal rupture managed by transgastric drainage

Spontaneous rupture of the oesophagus is an extremely serious condition with high morbidity and mortality. Primary surgical repair may be followed by numerous complications. A 29-year-old man had undergone primary surgical repair due to spontaneous rupture of the lower third of the oesophagus. After the operation he developed suture insufficiency, which could not have been stented, and transgastric drainage was performed therefore. After a slow healing of the fistula, we could avoid another operation and his oesophagus was preserved. Fortunately, a stricture did not develop either. Transgastric drainage of the oesophagus could be a good therapeutic choice in selective and complicated cases.

Spontán nyelőcsőruptura komplikált esetének megoldása transgastricus drainage-zsal

Spontaneous rupture of the oesophagus is an extremely serious condition with high morbidity and mortality. Primary surgical repair may be followed by numerous complications. A 29-year-old man had undergone primary surgical repair due to spontaneous rupture of the lower third of the oesophagus. After the operation he developed suture insufficiency, which could not have been stented, and transgastric drainage was performed therefore. After a slow healing of the fistula, we could avoid another operation and his oesophagus was preserved. Fortunately, a stricture did not develop either. Transgastric drainage of the oesophagus could be a good therapeutic choice in selective and complicated cases.

Spontán nyelőcsőruptura komplikált esetének megoldása transgastricus drainage-zsal@@@A complicated case of spontaneous oesophageal rupture managed by transgastric drainage

Spontaneous rupture of the oesophagus is an extremely serious condition with high morbidity and mortality. Primary surgical repair may be followed by numerous complications. A 29-year-old man had undergone primary surgical repair due to spontaneous rupture of the lower third of the oesophagus. After the operation he developed suture insufficiency, which could not have been stented, and transgastric drainage was performed therefore. After a slow healing of the fistula, we could avoid another operation and his oesophagus was preserved. Fortunately, a stricture did not develop either. Transgastric drainage of the oesophagus could be a good therapeutic choice in selective and complicated cases.