Altered Plasma Concentrations of Trace Elements in Ulcerative Colitis Patients Before and After Surgery

Ileal pouch-anal anastomosis (IPAA) is a classical surgery for ulcerative colitis patients. However, knowledge on trace element alteration in patients who had undergone this surgery is limited. This study was conducted to assess trace element alteration in patients with ulcerative colitis before and after ileal pouch-anal anastomosis. Preoperative (40) and postoperative (35) ulcerative colitis patients were studied. The dietary assessment of trace element intake was undertaken by a semiquantitative food frequency questionnaire. Patients' trace element status of zinc, copper, manganese, selenium, calcium, iron, and vitamin D₃ was assessed by measuring their blood concentrations. We found that with the similar dietary intake, there was no statistical difference in the concentrations of plasma copper, iron, calcium, and vitamin D₃ in the two groups (P?>?0.05). Compared with preoperative patients, postoperative patients had higher concentrations of plasma zinc (14.51?±?4.75 μmol/l) and manganese (0.21?±?0.11 μmol/l) and lower concentrations of plasma selenium (0.86?±?0.58 μmol/l). Both preoperative and postoperative mean concentrations of plasma calcium and vitamin D₃ were below their reference range, respectively. We conclude that IPAA does not seem to alter patients' abnormal trace elements completely. It is important to monitor and supply some specified trace elements even in postoperative patients.     

心内直视手术中七十岁以上患者的体外循环管理

目的总结分析心内直视手术中七十岁以上患者的体外循环特点和管理方法。方法 2005年3月至2008年7月间7000余例手术中70岁以上患者共有194例,分类进行心内直视手术。体外循环时全部应用进口膜肺,勃脉力A和胶体预充,常规加入白蛋白、激素和乌司他丁;心肌保护采用间断灌注4：1冷含血停搏液,顺灌逆灌和桥灌相结合;常规监测混合静脉氧饱和度和血细胞压积,积极应用超滤技术。结果术中转流平稳,血流动力学稳定,监测指标均在正常范围,平均体外循环时间和主动脉阻断时间分别为111.5±40.4m in和63.6±21.0m in,自动复跳率52.6%,平均搭桥数目3.4±0.8支,术后平均气管拔管时间24.0±12.7h,平均ICU时间4.7±3.5d。结论 70岁以上患者以瓣膜和冠状动脉病变为主、病变复杂,体外循环时间和主动脉阻断时间较长,各脏器保护要求高,针对高龄患者的特点,制定相应的体外循环管理方法,是保证手术成功的重要因素。     

Brucellosis Causes Alteration in Trace Elements and Oxidative Stress Factors

Brucellosis is regarded as one of the most common diseases among humans and livestock. In the present study, we aimed to assess the effect of this disease on the level of various cations including copper (Cu), manganese (Mn), zinc (Zn), and magnesium (Mg) as well as oxidative stress status in the serum of people suffering from brucellosis. The present case-study was carried out on 40 patients with brucellosis (case) and 20 healthy people (control). Blood specimens were taken from all the people and the level of essential trace elements and oxidative stress status were measured. The serum level of copper in the case group (165.39 ± 43.19 μg/dl) was significantly higher compared with that in the control group (122.12 ± 28.88 μg/dl). Whereas the serum level of zinc was significantly lower in the case group compared with that in the control group (76.47 ± 28.88 vs. 92.85 ± 23.16 μg/dl). The manganese and magnesium serum levels did not differ significantly between the two groups. Furthermore, total antioxidant capacity level was significantly lower in the case group (122.12 ± 28.22 μmol/ml) than that in the control group (3.08 ± 0.12 μmol/ml) and the level of serum malondialdehyde was significantly higher in the case group (7.20 ± 0.23 mmol/ml) than that in the control group (4.0 ± 0.19 mmol/ml). Brucellosis can cause alteration in the serum level of essential trace elements. Moreover, the present study indicated that brucellosis produces oxidative stress in patients.     

Characteristics of Patients Undergoing Bariatric Surgery in Canada

Objective: The increasing prevalence of obesity has led to an increased use of bariatric surgery in the treatment of severely obese individuals. The characteristics of patients undergoing bariatric procedures outside of clinical studies and on a national level have not previously been reported. Research Methods and Procedures: Acute‐care hospital discharge data from the Canadian Institute for Health Information were analyzed to determine the demographic and clinical features and in‐hospital mortality rates of individuals undergoing bariatric surgery in Canada. Data from individuals undergoing surgery in fiscal year 2002/2003 were compared with data from 1993/1994. Results: Over 1100 bariatric surgeries were performed in Canada in 2002/2003, with the vast majority being performed in middle‐aged women. Ten percent of patients had hypertension or diabetes, and only 1% or fewer had dyslipidemia or cardiovascular or cerebrovascular disease. Compared with 1993/1994, patients undergoing surgery in 2002/2003 were older, more likely to have diabetes or hypertension, and had shorter hospital stays. In‐hospital mortality rates were <1% in both years. Discussion: In the last decade, there has been a small increase in the average age and the number of patients with concomitant cardiovascular risk factors who are undergoing bariatric procedures in Canada. However, the vast majority of surgeries are being performed in middle‐aged women with little cardiovascular comorbidity, and this is likely contributing to very low in‐hospital death rates. Such individuals likely represent a highly selected sample of severely obese patients within Canada.     

Plasma Concentrations of Brain-derived Neurotrophic Factor in Patients Undergoing Minor Surgery: A Randomized Controlled Trial

We measured perioperative plasma concentrations of brain-derived neurotrophic factor (BDNF), a major mediator of synaptic plasticity in the central nervous system, in males, 30-65 years old, undergoing lumbar or cervical discotomy. Patients were randomly allocated to a general anesthetic with propofol induction and maintenance or with thiopental induction and isoflurane maintenance. BDNF plasma concentrations were measured before induction (baseline), 15 min after induction but before start of surgery, at skin closure, in the post-anesthetic care unit, and 24 h postoperatively. Data from 26 patients (13 in each group) were analyzed. At each time point, BDNF plasma concentrations showed large variability. At baseline, concentrations were 631 +/- 337 (mean +/- SD) pg ml(-1) in the propofol group and were 549 +/- 512 pg ml(-1) in the thiopental-isoflurane group (P = 0.31). At 15 min, concentrations significantly decreased in the propofol group (247 +/- 219 pg ml(-1), P = 0.0012 compared with baseline) but remained unchanged in the thiopental-isoflurane group (597 +/- 471 pg ml(-1), P = 0.798 compared with baseline). At skin closure and in the post-anesthetic care unit, concentrations were not different from baseline in both groups. At 24 h, concentrations significantly decreased below baseline in both groups (propofol: 232 +/- 129 pg ml(-1), P = 0.0015; thiopental-isoflurane: 253 +/- 250 pg ml(-1), P = 0.016). In the propofol group, there was a weak but statistically significant positive correlation (R2 = 0.38, P = 0.026) between the duration of surgery and BDNF plasma concentrations at skin closure. These data suggest that in males undergoing elective minor surgery, BDNF plasma concentrations show a specific pattern that is influenced by the anesthetic technique and, possibly, by the duration of surgery.     

Trace Elements in the Hair of Hemodialysis Patients

Trace element disturbance is often observed in hemodialysis patients. While trace element concentrations have been reported in blood samples from hemodialysis patients, they have not been well investigated in scalp hair. In the present study, 22 trace elemental concentrations were measured by inductively coupled plasma-atomic emission spectrometry in the scalp hair of 80 male hemodialysis patients and compared with those of 100 healthy male subjects. In hemodialysis patients, the concentrations of beryllium, arsenic, magnesium, chromium, manganese, iron, selenium, molybdenum, iodine, vanadium, and cobalt were significantly higher than those in healthy subjects, while lead, mercury, copper, germanium, and bromine were significantly lower than those in the former group. No significant differences were observed for lithium, aluminum, cadmium, zinc, boron, or nickel. There were significant positive correlations between the duration of hemodialysis and the magnesium and manganese concentrations. There was a significant negative correlation between cadmium concentration and the duration of hemodialysis. There were significant positive correlations between dialysis efficacy (Kt/V) and magnesium, manganese, zinc, and selenium concentrations. In conclusion, trace element concentrations of the scalp hair are different between hemodialysis patients and healthy subjects. Essential trace elements, such as magnesium, manganese, zinc, and selenium, may be affected by the duration of hemodialysis and Kt/V.     

Albumin Kinetics in Patients Undergoing Major Abdominal Surgery

Background

The drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation.

Methods

This was a clinical trial of radiolabeled human serum albumin for the study of TER and plasma volume. Ten patients were studied immediately preoperatively and on the 2nd postoperative day after major pancreatic surgery. Albumin synthesis rate was measured by the flooding dose technique employing incorporation of isotopically labelled phenylalanine.

Results

Fractional synthesis rate of albumin increased from 11.7 (95% CI: 8.9, 14.5) to 15.0 (11.7, 18.4) %/day (p = 0.027), whereas the corresponding absolute synthesis rate was unchanged, 175 (138, 212) versus 150 (107, 192) mg/kg/day (p = 0.21). TER was unchanged, 4.9 (3.1, 6.8) %/hour versus 5.5 (3.9, 7.2) (p = 0.63). Plasma volume was unchanged but plasma albumin decreased from 33.5 (30.9, 36.2) to 22.1 (19.8, 24.3) g/L. (p<0.001).

Conclusion

Two days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, TER and plasma volume as compared with values obtained immediately pre-operatively. This suggests that capillary leakage, if elevated postoperatively, had ceased at that time-point. The temporal relations between albumin kinetics, capillary leakage and generalised inflammation need to be further explored.

Trial Registration

clinicaltrialsregister.eu: EudraCT 2010-08529-21 ClinicalTrials.gov NCT01194492     

Acute Renal Failure and Open Heart Surgery

A retrospective study of 428 open heart operations showed the incidence of mild and severe renal failure to be 26% and 4·7% respectively. The mortality rate was 38% in the mild cases and 70% in the severe cases. Only half of the patients whose death was associated with renal failure showed macroscopic or microscopic renal lesions at necropsy. The patients who developed renal impairment had significantly higher mean preoperative blood urea (40 mg/100 ml) than the non-renal-failure cases (33 mg/100 ml). Periods of perfusion over 60 minutes, mean perfusion pressures below 80 mm Hg, and multiple valve replacement operations also increased the incidence of renal failure. There was no statistical correlation between the age of individual patients, the degree of cooling, and postoperative blood urea values. There was no evidence to suggest that frusemide or mannitol separately or together influenced the development of renal failure. Peritoneal dialysis was preferred for initial treatment of patients with severe renal failure, and haemodialysis was required only in special cases.     

Open Heart Surgery of PI-3 Kinase Signaling

no absract available     

89例正颌外科手术患者围手术期的护理

目的:探讨正颌外科患者术前术后的最佳护理措施。方法:回顾性分析了89例正颌外科患者术前术后护理的过程。在这个护理过程中部分病例采取了实用护理学,护理心理学或护理诊断学技术。注重术后口腔卫生,保持术后呼吸道通畅并采取术区冷敷的方法以减轻肿胀,强调了心理护理在正颌手术患者中应用的重要性。结果:全部89例经过正颌外科手术的患者在应用了此护理方法后,术后均恢复良好,无一例患者因为护理出现不良症状影响手术效果。结论:综合应用实用护理学,护理心理学,护理诊断学在正颌外科患者的治疗和康复过程中具有关键的作用。     

Trace Element Status of Chronic Renal Patients Undergoing Hemodialysis

The purpose of this study was to examine the status of trace elements (Cu, Zn, and Fe) and minerals (Mg, K, Na, and Cl) and the level of biochemical parameters (urea, creatinine, total protein, albumin, and glucose) in hemodialysis (HD) patients. This study included 30 HD patients (25 men and 5 women) aged 52.12 +/- 3.13 years and 30 healthy subjects (23 men and 7 women) aged 51.64 +/- 2.22 years. This study investigated the status of trace elements and minerals in HD patients. It was found that the total HD patients (before and after dialysis) had statistically lower Zn and albumin in the after-dialysis group K and Cl levels and higher Mg, creatinine, and urea in the before-dialysis group K and in the after-dialysis group glucose levels than those of the controls. It was determined that the results might be helpful in monitoring patients with renal failure in terms of insufficiency or excess of trace elements and minerals. There was positive correlation for Mg-K (r = 0.64; p = 0.001), creatinine-urea (r = 0.59; p = 0.001), K-urea (r = 0.56; p = 0.001), K-creatinine (r = 0.52; p = 0.003), Mg-creatinine (r = 0.47; p = 0.008), Zn-albumin (r = 0.40; p = 0.028), and Zn-creatinine (r = 0.40; p = 0.031) in the before-dialysis session. There was also positive correlation for creatinine-urea (r = 0.56; p = 0.001), K-urea (r = 0.39; p = 0.035), and Mg-creatinine (r = 0.38; p = 0.041) in the after-analysis session. As a result of the analysis of regression between serum levels of albumin and zinc in total HD patients, the use of the level of albumin might be a suitable choice in determining zinc deficiency resulting from the decrease in the level of zinc in parallel to that of albumin. The results also suggest that the relationship between creatinine and K, Mg, and Zn could be ascribed to the loss of renal function.     

Insulin Pump Therapy in Patients with Diabetes Undergoing Surgery

ObjectiveTo assess perioperative management of patients with diabetes mellitus who were being treated with insulin pump therapy.MethodsWe reviewed records for documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of surgery.ResultsThirty-five patients (21 men) with insulin pumps underwent surgical procedures between January 1, 2006, and December 31, 2010. Mean age was 56 years, mean diabetes duration was 31 years, and mean duration of insulin pump therapy was 7 years. All patients were white, and 29 had type 1 diabetes mellitus. Of the 50 surgical procedures performed during the study period, 16 were orthopedic, 9 were general surgical, 7 were urologic, and 7 were kidney transplant operations; the remaining 11 procedures were in other surgical specialties. The mean (± standard deviation) time in the preoperative area was 118 ± 75 minutes, mean intraoperative time was 177 ± 102 minutes, and mean PACU time was 170 ± 78 minutes. Of the 50 procedures, status of pump use was documented in 32 cases in the preoperative area, 14 cases intraoperatively, and 30 cases in the PACU. Glucose values were recorded in 47 cases preoperatively, 30 cases intraoperatively, and 48 cases in the PACU.ConclusionsResults showed inconsistent documentation of pump use and glucose monitoring throughout the perioperative period, even for patients with prolonged anesthesia and recovery times. It was often unclear whether the pump was in place and operational during the intraoperative period. Guidelines should be developed for management of insulin pump–treated patients who are to undergo surgery. (Endocr Pract. 2012;18:49-55)     

Copper and Ceruloplasmin in Children Undergoing Heart Surgery with Cardiopulmonary Bypass

Heart surgery with cardiopulmonary bypass (CPB) nowadays has become a routine procedure. However, under nonadequate hemodynamic conditions and because of the changes related to ischemia–reperfusion, there is a possibility to provoke oxidative stress with all undesirable consequences. Copper (Cu) is closely related to this stress, taking part in the formation of the hazardous-free radicals. Meanwhile, at least in the pediatric area, little is known about Cu kinetics during cardiac surgery. The purpose of the present work was to study Cu and ceruloplasmin (Cp) dynamics during surgery with CPB in children. Twenty-one patients of both genders from Campo Grande, Brazil with congenital heart conditions were enrolled in the investigation. Blood samples were collected before the surgery and during and 24 h after it. Cu and Cp levels were measured at selected moments and the influence of hemodilution studied. It was concluded that serum Cu dynamics during cardiopulmonary bypass reflects the protective effects of this trace element. Ceruloplasmin levels correlate positively with copper.     

Substance P and Acute Pain in Patients Undergoing Orthopedic Surgery

Objective

There is a limited information about the role of Substance P (SP) in acute pain nociception following surgical stimulation in patients with a chronic inflammatory state not to mention the link between this neuropeptide level changes and intensity of pain. The goal of the research was to find the correlation between SP level changes and acute pain intensity in patients with rheumatoid arthritis undergoing elective orthopedic surgery.

Material and Methods

Patients with rheumatoid arthritis (RA) were enrolled in the study. The correlation between acute pain intensity and concentration of SP in serum as well as in drainage fluid from postoperative wound was assessed in patients with RA who underwent Total Knee Replacement (TKA) under spinal anesthesia.

Results

In patients with RA a correlation between intensity of acute pain and serum SP was found postoperatively, whereas there was no correlation between intensity of acute pain and concentration of SP in drainage fluid.

Conclusions

1. The correlation between acute pain intensity and SP serum concentration was found postoperatively in patients with RA. 2. The correlation between acute pain intensity and SP concentration in drainage fluid was not found postoperatively in patients with RA.     

超声刀在425例妇科腹腔镜手术中的应用分析

目的:探讨超声刀在妇科腹腔镜手术中的应用方法和特点;方法:回顾我院2006年1月～2010年3月因妇科疾病住院使用超声刀行腹腔镜手术425例病例构成和手术效果.结果:全部病例均顺利完成手术,无中转开腹,其中腹腔镜下完全子宫切除术36例,腹腔镜辅助阴式子宫切除术89例,子宫次全切切除术145例,子宫肌瘤剔除手术68例,附件手术87例.子宫手术时间平均100 min,术中出血平均120 ml,附件手术时间平均55 min,出血平均60 ml,术后平均住院4天,未发生术中及术后严重并发症.结论:应用超声刀进行妇科腹腔镜手术是安全可行的,并具有良好效果.     

Evaluation of Plasma Trace Elements in Different Stages of Nonalcoholic Fatty Liver Disease

Biological Trace Element Research - Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome. Its global prevalence is estimated between 25 and 45%,...     

The Insulin Tolerance Test in Morbidly Obese Patients Undergoing Bariatric Surgery

Objective: To assess the effect of massive weight loss in relation to insulin resistance and its correlation to changes in glycemic homeostasis and lipid profile in severely obese patients. Research Methods and Procedures: A prospective clinical intervention study was carried out with 31 morbidly obese women (body mass index: 54.2 ± 8.8 kg/m²) divided into three groups according to their glucose tolerance test: 14 normal, 8 impaired glucose tolerance, and 9 type 2 diabetes. All subjects underwent an insulin tolerance test with intravenous bolus of 0.1 U insulin/kg body weight before silastic ring vertical gastroplasty Roux‐en‐Y gastric bypass surgery, and again at 2, 4, 6, and 12 months postoperatively. Fasting plasma glucose, hemoglobin A1c, and lipid profile were also evaluated. Results: A reduction of 68 ± 15% in initial excess body weight was evident within 1 year. Along with weight loss, the following statistically significant changes were found: an increase in the insulin‐sensitivity index (Kitt) and a decrease in fasting plasma glucose and hemoglobin A1c, most notably in the type 2 diabetes group. An overall improvement in lipid profile was observed in all three groups. Discussion: Bariatric surgery was an effective therapeutic approach for these obese patients because it reduced both weight and insulin resistance, along with improving metabolic parameters. Significant correlations were found between insulin resistance and metabolic improvements. Weight loss after bariatric surgery induced an improvement in metabolic fitness, related to the reduction in insulin resistance over a range of glucose tolerance statuses from normal to diabetic.