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Background: The primary objective of this study was to evaluate the impact of neuroprotection, administered during carotid endarterectomy, on brain metabolism. The secondary objective was to assess the impact on clinical outcome of the resulting changes to brain metabolism., Methods: A total of 35 patients underwent carotid endarterectomy with prophylactic combined neuroprotection (Sendai cocktail: Manitol, Phenhydan, Solumedrol, Tokoferol; Cerebrolysin; fraction of inspired oxygen (FiO2) = 1, middle arterial pressure (MAP) = 100 mm Hg, total intravenous anaesthesia--TIVA). The influence of neuroprotection on brain metabolism (S100B, glycaemia, lactate, pH, jugular vein bulb oxygen saturation--SvjO2) was evaluated. Metabolic parameters were acquired from the jugular bulb during surgery, just before unclamping of the vessel. The clinical outcome was evaluated by NIHSS (National Institutes of Health Stroke Scale). There were 35 patients in the control group who where operated on without any neuroprotection. The results from both groups of patients were compared and statistically analyzed., Results: Postoperative NIHSS did not change in any patients in either group. An intraoperative shunt was not inserted in any patients in either group. In the group with neuroprotection there were significantly higher levels of S100B (median 0.117 vs. 0.088; p < 0.0182), lactate (median 1.92 vs. 1.020; p < 0.0006), glycaemia (median 9.5 vs. 8.2; p < 0.0243), and SvjO2 (median 0.79 vs. 0.65; p < 0.0001). There were no postoperative changes to NIHSS in either group., Conclusions: Neuroprotection administered before carotid endarterectomy influences some parameters of brain metabolism both positively and negatively, but with no impact on clinical outcome.

Naturally contaminated soil, sediment and water at the Mokrsko-West gold deposit, Central Bohemia, have been studied in order to determine the processes that lead to release of As into water and to control its speciation under various redox conditions. In soils, As is bonded mainly to secondary arseniosiderite, pharmacosiderite and Fe oxyhydroxides and, rarely, to scorodite; in sediments, As is bonded mainly to Fe oxyhydroxides and rarely to arsenate minerals. The highest concentrations of dissolved As were found in groundwater (up to 1141 microg L(-1)), which mostly represented a redox transition zone where neither sulphide minerals nor Fe oxyhydroxide are stable. The main processes releasing dissolved As in this zone are attributed to the reductive dissolution of Fe oxyhydroxides and arsenate minerals, resulting in a substantial decrease in their amounts below the groundwater level. Some shallow subsurface environments with high organic matter contents were characterized by reducing conditions that indicated a relatively high amount of S(-2,0) in the solid phase and a lower dissolved As concentration (70-80 microg L(-1)) in the pore water. These findings are attributed to the formation of Fe(II) sulphides with the sorbed As. Under oxidizing conditions, surface waters were undersaturated with respect to arsenate minerals and this promoted the dissolution of secondary arsenates and increased the As concentrations in the water to characteristic values from 300 to 450 microg L(-1) in the stream and fishpond waters. The levels of dissolved As(III) often predominate over As(V) levels, both in groundwaters and in surface waters. The As(III)/As(V) ratio is closely related to the DOC concentration and this could support the assumption of a key role of microbial processes in transformations of aqueous As species as well as in the mobility of As.

Background: Incidence of meningococcal diseases and sepsis caused by a new invasive strain of Neisseria meningitidis group C: 2a: P 1,2 has been observed in the Czech republic within the last 3 years. In 1994 the highest incidence of this disease was in the West region. Ten of the most critically ill patients were treated at the Department of Anaesthesiology and Intensive Care. The aim of this work was to present principles of the treatment of this disease., Methods and Results: In 1994 we treated 10 patients, 8 male and 2 female with average age of 11 years (range from 5 months to 20 years). Causing strain identification was done in 9 patients, in one patient causing strain was not identified. All patients had typical clinical symptoms of the disease. All of them were treated according to the same protocol of the invasive complex treatment including artificial ventilation, circulation support, Ceftriaxon combined with potassium salt of benzylpenicillin, i.v. immunoglobulins, fresh frozen plasma, heparin, fibrinogen and antitrombin III. Average length of the stay in the Intensive Care Unit was 5 days (range from 1.5 hour to 10 days). Survival in our group was 70%., Conclusions: Early started complex therapy is a decisive factor of its success. A uniform protocol of treatment and its wide publication even to the first contact level can increase a chance for survival.