Etiopathogenesis of Graves' disease

Graves' disease is an autoimmune disorder, caused by thyroid-stimulating antibodies, which bind to and activate the thyrotropin receptor on thyroid cells, inducing the synthesis and release of thyroid hormones. It is a polygenic and multifactorial disease that develops as a result of complex interaction between genetic susceptibility and environmental and/or endogenous factors. Graves' disease differs from other autoimmune diseases of the thyroid by specific clinical features, including hyperthyroidism, vascular goitre, ophthalmopathy and--less commonly--infiltrative dermopathy. This article discusses current theories, regarding the etiology and pathogenesis of Graves' disease, including possible predisposing factors, autoimmune aspects of Graves' disease, ophthalmopathy, and dermopathy.     

Cataract surgery and postoperative complications in diabetic patients

Diabetes mellitus influences the function and morphology of the eye lens. The cataract is the second most common complication of diabetes mellitus on the eye. A hundred patients with cataract were examined in the prospective study. The patients were divided into two groups. The first group consisted of 50 patients with cataract who had not suffered from a system or local disease. The second group consisted of 50 patients with cataract and diabetes mellitus that had lasted for at least five years. In both groups the patients underwent identical cataract extra capsular extraction with intraocular PMMA (polymethylmethacrylate) lens implantation in camera posterior. The objective of this study was to compare the two groups of patients in order to find out the most common intraoperative or postoperative complications in diabetics. The most common postoperative complications in patients suffering from diabetes were inflammatory reactions and bleeding: postoperative keratopathy, uveitis anterior serous and uveitis anterior fibrinous with posterior sinechia and opacity of the posterior lens capsule as results. Postoperative visual acuity was worse in the patients in group II on the seventh day and six months after operation. It was diabetic retinopathy and its progression that caused deterioration of visual acuity. Diabetic retinopathy and its progression, as well as maculopathy were found only in patients who were not treated with photocoagulation before the operation.     

Antibiotic prophylaxis of postoperative suppurative complications in surgical urology

Preoperative sanation of the urinary tracts is an obligatory condition for lowering the risk of severe infectious complications. When there is no bacteriuria it is recommended in the cases subject to short-term surgical interventions without subsequent drainage of the urinary tracts to perform single or one-day prophylaxis with cephalosporins or semi-synthetic penicillins in the routine doses. The same principle is applicable to transurethral operations, endourological manipulations and lithotripsy. When there are urinary fistulas preventing complete sanation of the urinary tracts before operations it is advisable to use combinations of aminoglycosides with carbenicillin. The treatment terms in such cases amount to 7 to 10 days. Antibiotics of the reserve group, i.e. amikacin, sisomicin and ureidopenicillins should not be used prophylactically in such cases.     

Effects of patient-controlled analgesia with hydromorphone or sufentanil on postoperative pulmonary complications in patients undergoing thoracic surgery: a quasi-experimental study

Objective

To compare the analgesic effects of patient-controlled intravenous analgesia (PCA) with hydromorphone and sufentanil after thoracic surgery on postoperative pulmonary complications (PPCs).

Methods

A total of 142 patients who were scheduled for thoracic surgery were randomly allocated to receive PCA with hydromorphone (group A: experimental group): hydromorphone 0.2?mg/kg?+?dezocine 0.5?mg/kg?+?ramosetron 0.6?mg diluted with normal saline to 200?mL; or with sufentanil (group B: control group): sufentanil 3.0μg/kg?+?dezocine 0.5?mg/kg?+?ramosetron 0.6?mg diluted with normal saline to 200?mL. The parameters of intravenous analgesia pump were set as background dose 4?ml/h, PCA dose 1?mL, locking time 15?min. Pain NRS (numerical rating scale), Ramsay sedation score, nausea or vomiting score were evaluated at 0?h, 6?h, 12?h, 24?h, 48?h after operation. The cases of PPCs (atelectasis, pulmonary infection, respiratory failure), CRP (C-reaction protein) and inflammatory cells (white cell count and percentage of neutrophils) and blood gas analysis at 12?h after operation, length of ICU and postoperative stay were recorded for each patient.

Results

Data of 136 patients were analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A (2[IQR:4,4]) was significantly lower at 6?h after operation (P?=?0.000). The CRP in group A (69.79?±?32.13?mg/L) were lower than group B (76.76?±?43.42?mg/L) after operation, but the difference was not significant (P?=?0.427). No difference of nausea or vomiting was found between group A (7.3%) and group B (5.8%) postoperatively (P?=?0.999). The PPCs were happened in 11 patients in group A (16.2%) and 22 patients in group B (32.4%) and the difference between two groups was significant (P?=?0.027). Seven patients in group A (10.3%) and eighteen patients in group B (26.5%) had clinical evidence of pneumonia and the difference between two groups was significant (P?=?0.014). The length of ICU and postoperative stay in group A were 2.73?h and 1.82?days less than group B respectively but the differences were not significant (P?=?0.234, P?=?0.186 respectively).

Conclusion

Compared with sufentanil, hydromorphone may provide better postoperative analgesic effect with less pulmonary complications for patients undergoing thoracic surgery, and it may accelerate patients’ rehabilitation.

Trial registration

Randomized Controlled Trials ChiCTR1800014282c. Registered 3 January 2018.

     

Prevention and treatment of postoperative pyoinflammatory complications and cefuroxime]

Antibacterial activity and efficacy of cefuroxime (ketocef, Pliva, Zagreb) in the treatment and prophylaxis of surgical infections in a general hospital and particularly in the unit of vessel and aorta surgery, the unit of lung surgery and the unit of microsurgery were estimated. The study included 57 patients (43 males and 14 females) at the age of 21 to 70 years. Cefuroxime was administered intravenously in a dose of 1.5 g followed by its intramuscular administration in a dose of 750 mg with an interval of 8 hours. The results showed that cefuroxime was effective in the treatment (80 per cent) and prophylaxis (93.6 per cent) of the pyo-inflammatory complications and was active against the majority of the surgical infection pathogens.     

The antibiotic prophylaxis of postoperative complications in breast cancer patients

The studies showed that infectious complications in patients operated for breast cancer (BC) most frequently developed after removal of the drainage tube resulting in poorer discharge favourable for development of infections. The causative agents in such cases are usually exogenous bacteria differing from endogenous ones (Staphylococcus epidermidis) inhabiting the human skin and sometimes contaminating the operative field. The endogenous bacteria are detectable bacteriologically in 60 per cent of the cases. Still, since the operation wound contains humoral and tissue immunity factors (specifically active against the host microflora) such bacteria rarely grow on artificial media (18 per cent) and even more rarely cause infections. Therefore, to prevent postoperative infections in patients with BC it should be recognized rational to use broad-spectrum antibacterial drugs such as ampiox, ampicillin, doxycycline, cephalosporins of the 2nd and 3rd generations, etc. for 5 to 6 days after the drainage removal. If an infection develops the preventive therapy should be replaced by an adequate therapy in accordance with the pathogen sensitivity.