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Measurement of carboxyhemoglobin could be a new method for evaluation of the severity of inflammatory airway disease, acute organ dysfunction, or stress by surgery and anesthesia. To use this measurement during mechanical ventilation, it is important to clarify the effects of factors that interfere with carboxy- hemoglobin levels. The aim of our study was to investigate the preoperative changes of carboxyhemoglobin to inspired oxygen fraction during general anesthesia and mechanical ventilation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemo- globin. Methods: The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18-60 years, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin levels were determined preoperatively, after preoxygenation, and one hour after induction in anesthesia. Results: carboxyhemoglobin levels were decreased after preoxygenation in both groups. One hour after induction in anesthesia under mechanical ventilation with inhaled fraction of a mixture of O2 (50%) and air (50%) the average values of carboxyhemoglobin between the two groups were different. The average values of carboxyhemoglobin between the two groups in all three time points were statistically significantly different (p=0.00). Conclusion: Changes in carboxyhemoglobin concentrations in arterial blood occur during general anesthesia and mechanical ventilation, although these amplitudes are small when compared to carbon monoxide intoxication. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during surgery.

Introduction: Hand-assisted laparoscopic living donor nephrectomy has become the technique of choice for living donor kidney donations. Since 2018, 30 procedures have been performed at our clinic using this technique. The goal of this comparative analysis was to determine how surgical technique, specifically, hand-assisted laparoscopic living donor nephrectomy with hand assistance may affect early graft function when compared to open classical nephrectomy. Material and methods: Retrospective analyses were performed, comparing the two techniques of kidney donation. Kidney transplantation was performed with the open standard technique in both groups. The primary outcome was early graft function, and levels of urine output, and plasma creatinine were analyzed at three time points. A secondary outcome was the quality of the operative technique, which was determined by the time of warm ischemia, blood loss, and duration of surgery. Additionally, we noted all complications, length of hospital stay, and patient satisfaction. Results: In terms of warm ischemia time, there was no statistically significant difference between donors in both groups. It is important to note that in 2 recipients from Group II we did not observe diuresis at the conclusion of the operation. The recipients' diuresis was 515 ml ± 321SD in group I and 444 ml ± 271SD in group II. At 3, 12, and 36 hours postoperatively, there were statistically significant differences in the average serum creatinine values (p 0.05) in favor of group I. Similar results were observed in the second time measurement at 12 h and the third time measurement at 36 h for serum urea levels in recipients. The difference in serum urea values between the recipients in the groups at the first measurement (3h) following surgery was not statistically significant. Conclusion: Hand-assisted laparoscopic donor nephrectomy is recognized as a safe and effective treatment. Donors in this situation have a different profile from other surgical patients; hence, they do not undergo surgery due to their own medical condition but for an altruistic reason, and with hand-assisted living donor nephrectomy. Such patients receive all the advantages of minimally invasive surgery. The two main objectives of a donor nephrectomy are to give the recipient the best possible kidney and to ensure the donor's complete safety. [ABSTRACT FROM AUTHOR]

Introduction. Prostate cancer, the second most common cancer in males globally, frequently requires radical prostatectomy. Laparoscopic radical prostatectomy, a common approach, has uncertainties regarding pain reduction. This study investigates ultrasonography-guided erector spinae plane block for pain management in laparoscopic radical prostatectomy. Methods. This one-year prospective study involved 50 American Society of Anesthesiology classification IIII male patients (age 40-78) undergoing laparoscopic radical prostatectomy. An ultrasonography-guided erector spinae plane block was performed before surgery after induction of anesthesia. Postoperatively, pain was assessed using a numerical rating scale. Postoperative nausea and vomiting were evaluated using a verbal descriptive scale. Total time for block performance, anesthesia and surgery time, and any complications was noted as well. Results. The study demonstrated that erector spine block improved pain management in laparoscopic radical prostatectomy patients. At different times after surgery, numerical rating scale scores, rescue analgesia needs, postoperative nausea and vomiting scores were reduced with no adverse effects on the kidney function. Conclusion. This evaluation supports the beneficial role of ultrasonography-guided erector spine block in enhancing pain control during laparoscopic radical prostatectomy preventing any acute or chronic kidney injury. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer is one of the most common cancers worldwide. In most of these patients, quality of life is deteriorated. Aim: The aim of our study was to analyze how the disease affects health-related quality of life (HRQoL) and to examine the role of demographic, disease-related, and other factors in the overall quality of life. The second aim was to identify areas where HRQoL could be improved. Material and methods: A cross-sectional questionnaire survey was conducted. The study included a modified version of EQ-5D, as well as clinical and socioeconomic characteristics of the country. Patients over the age of 18, who had colorectar surgery, and were followed up at our clinic, were included in the survey. Results: In patients after colorectal surgery, bowel control is a major concern that has an impact on their quality of life. The majority of patients expressed gratitude for the care they received and thanked the health-care providers for it. With the EQ-5D modified questionnaire, the concept of "perfect" health was reviewed and analyzed. A response "no difficulty" in any of the five domains was classified as perfect health. Only one-third of the patients said their health was “ideal” (no problems in any of the EQ-5D five domains). Discussion: According to the results of this study, patients with CRC have considerably poorer HRQoL than the general population, as indicated by the EQ-5D utility scores. This discovery is in line with some previous research. Conclusion: Colorectal surgery survivors' total HRQoL has been found to be lower than in the general population. [ABSTRACT FROM AUTHOR]

Introduction. To our knowledge, currently no consensus or guidelines exist regarding perioperative and post-operative analgesia management in renal transplant recipients. Methods. We conducted an observational prospective clinical study to evaluate the analgesia management practice in kidney transplant recipients. All consecutive patients who underwent kidney transplant surgery were enrolled in this observational clinical study. According to current analgesia management practice in our institution, patients were divided in two groups: patients who received general anesthesia and epidural analgesia were group E, and patients who received general anesthesia and i.v. analgesia were group G. The primary outcome measure in this study was VAS score and 24 h analgesia requirements. The second outcome measures were com-plications and/or side effects related to analgesia treatment. Results. Group E had lower VAS pain score both at rest and on movement but only in the first 2 h, (VAS at rest E. 3.1±0.3 vs. G. 4.0±0.3, VAS on movement E. 4.2±0.6 vs. G. 4.5±0.3, p<0.05). The pain score by VAS scale did not differ between the groups at 6 h, 12 h and 24 h postoperatively, p=NS. Additionally, a small differrence was noticed in side effects. Patients in group E had reported more side effects than patients in group G. Conclusion. The study highlighted the variety in clinical practice regarding anesthesiologist preferences for pain management in kidney transplant recipients. This evaluation did not show any difference between anesthetic techniques and clinical results. [ABSTRACT FROM AUTHOR]

Background: The understanding of the etiopathogenesis of gastric carcinoma (GC) can be a base for development of new therapeutic methods to reduce mortality and to increase survival in patients with GC. The percentage of Epstein - Barr virus (EBV) positive gastric carcinomas is uncertain, and the etiologic importance of EBV in the pathogenesis of GC has still not been elucidated., Aim: This study aimed to determine the percentage of EBV associated GC as well as to determine their clinicopathological characteristics., Material and Methods: The study included 80 patients with GC who were analysed for ethnicity, local growth of a tumour (T status), the presence of nodal metastases (N), the presence of distant metastases (M), stage of the disease and degree of carcinoma differentiation. For detection of EBV, immunostainings were performed on tumour tissue and the peripheral non-tumour gastric mucosa., Results: Positive immunostaining with an antibody against EBV was found in 19 (23.75%) of the 80 patients with gastric carcinomas. EBV immunostainings were significantly different in patients with or without metastasis and between patients of Macedonian and Albanian ethnicity (p < 0.0001, p < 0.009, respectively). EBV immunoexpression was significantly associated with the presence of distant metastases and with patients of Albanian ethnicity., Conclusion: Association of EBV immunostainings with distant metastasis in patients with GC suggests the influence of EBV infection on the progression of gastric carcinoma. Due to scarce and doubtful literature data on EBV associated GC, further studies are necessary to determine the role of EBV regarding aetiology, treatment and prognosis in patients with EBV associated gastric carcinoma.

Introduction: Surgery is supposed to modulate the production of carbon monoxide by the reduction of heme oxygenase activity or transcriptional regulation of inducible heme oxygenase. On the other hand, the inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Furthermore, methemoglobin is maintained at a constant level. However, excessive production of methemoglobin relative to total methemoglobin reductase activity results in methemoglobin increase., Aim: The aim of our study was to investigate the perioperative variations of carboxyhemoglobin and methemoglobin during urologic surgeries, and at the same time to evaluate the changes in methemoglobin as a possible indicator of nitric oxide generation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemoglobin and methemoglobin and the influence of blood transfusion on their changes., Material and Methods: The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18-60 years without any history of respiratory disease, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels were determined preoperatively, after preoxygenation, and postoperatively., Results: COHb levels were decreased postoperatively in both groups. The average values of COHb between the two groups were statistically significantly different (p=0.00). MetHb levels increased postoperatively in the group of smokers and decreased in the group of non-smokers. There were no statistically significant differences in the average postoperative MetHb levels between the two groups., Conclusion: Changes in carboxyhemoglobin and methemoglobin concentrations in arterial blood occur during urologic surgery, although these amplitudes are small when compared with carbon monoxide intoxication and methemoglobinemia. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during urologic surgery., Competing Interests: • Conflict of interest: none declared.