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Pentadekapeptid BPC 157 pospješuje cijeljenje mišića te pokazuje neuroprotektivna svojstva. Proučili smo antagonizirajuća svojstva BPC 157 na intramuskularnoj aplikaciji sukcinilkolina. Sukcinilkolin je injiciran u desni kvadriceps štakora i proučavan je lokalni paralitički utjecaj u injiciranom mišiću, neposredna kontraktura ekstremiteta, inicijalna agitiranost pred mišičnu blokadu, trzajevi pred kompletni gubitak mišićnog tonusa, bespomično ležanje, bolnu vokalizaciju na lagani dodir te smanjnje mišičnih vlakana i edem u tretiranom i netretiranom kvadricepsu i dijafragmi. BPC 157 je u potpunosti uklonio lokalne učinke sukcinilkolina (kontraktura ekstremiteta) i značajno smanjio ili uklonio bihevioralnu agitiranost, mišične trzajeve i mišičnu blokadu. Kod tretiranih životinja nije bilo bolnih vokalizacija na lagani dodir. BPC 157 je antagonizirao smanjenje broja mišičnih vlakana i edema koje je nastalo u tretiranom i netretiranom kvadricepsu te dijafragmi., Pentadecapeptide BPC 157 improves muscle healing and has neuroprotective properties. We tested BPC 157 counteracting effect on intramuscular application of succinylcholine. Succinylcholine was given into the right quadriceps muscle of the rats, and we assessed local paralytic effect in injected muscle, immediate leg contracture, initial agitation before muscle disability, countless muscle twitches before complete muscle tonus loss, motionless laying, and thereafter, violent screaming upon light touch, and muscle fibers decrease, and edema in injected and non-injected quadriceps muscle and diaphragm. BPC 157 completely eliminated the local succinylcholine effect (leg contracture) and markedly attenuated or eliminated behavioral agitation, muscle twitches, motionless laying. No violent screaming upon light touch appeared in IM succinylcholine-rats. BPC 157 counteracted muscle fibers decrease and edema that otherwise appeared in injected and non-injected quadriceps muscle and diaphragm.

Operacije mozga, odnosno kraniotomije u budnom stanju omogućuju kortikalno i subkortikalno mapiranje, kao i kontinuiranu kliničku procjenu te se primjenjuju u neurokirurškim resekcijama prvenstveno tumora mozga, poglavito difuznih glioma niskog gradusa, koji se nalaze ili u blizini klinički funkcionalnih područja, poput kortikalnih regija za govor (inzula, rolandičko područje, lijevi perisilvijani korteks), ili tumora koji se nalaze u blizini kapsule interne ili bazalnih ganglija, a kako bi se smanjio mogući rizik neurokirurških komplikacija i deficita kao što su disfazija, neglect ili motorni deficit. Značajni napredak u područjima neuroradiologije, neurofiziologije, neuroanestezije, neurokirurgije i mapiranja mozga doveo je do razvoja tehnika intraoperacijskog praćenja u budnih bolesnika primjenom metode izravne električne stimulacije (engl. Direct electric stimulation- DES). Kortikalno mapiranje primjenom DES omogućuje funkcionalno mapiranje mozga u stvarnom vremenu te vodi resekciju tumora tijekom operacije u budnom stanju čime se smanjuje rizik trajnih neuroloških deficita i omogućuje maksimalna resekcija tumora. DES omogućuje i mapiranje subkortikalnih struktura odnosno identifikaciju i mapiranje senzomotornih, vizuospacijalnih, jezičnih i socio-kognitivnih putova i njihove interakcije. Također se mogu ispitati i multimodalni sustavi, kao što je radna memorija, pozornost, izvršne funkcije i svijest. Pristup svakom bolesniku je individualiziran, multimodalan i koordiniran te obuhvaća timsku obradu, odabir prikladnih kandidata te opsežno predoperacijsko funkcijsko mapiranje i planiranje, intraoperacijsko praćenje i testiranje kao i poslijeoperacijsko timsko praćenje stručnjaka tima - neurokirurga, neuroanesteziologa, neurologa, logopeda, neuropsihologa i neurofiziologa. Multimodalnim pristupom bolesnicima reducira se rizik razvoja trajnih postoperacijskih neuroloških deficita i maksimalizira opseg resekcije što rezultira kraćim postoperativnim oporavkom, bržim povratkom normalnom društvenom i profesionalnom životu uz dulje preživljenje i kvalitetu života operiranih bolesnika.

Svrha rada: Ispitati učestalost i liječenje komplikacija nakon otpusta pacijenata koji su bili podvrgnuti stomatološkom liječenju u općoj anesteziji (OA) u sustavu jednodnevne kirurgije i identificirati čimbenike koji povećavaju rizik od navedenih komplikacija. Ispitanici i postupci: Anonimni upitnik poslan je roditeljima/skrbnicima pacijenata koji su bili podvrgnuti stomatološkoj sanaciji u OA u našoj ustanovi između 1. siječnja 2017. i 31. srpnja 2019. Prikupljeni su demografski i klinički podatci o pacijentima te podatci o pojavi komplikacija i njihovu liječenju. Rezultati: Na upitnik je odgovorilo 66 roditelja/skrbnika (30, 5 %). Najčešće komplikacije bile su ošamućenost i bol koje su se pojavile kod 40 pacijenata (60, 6 %). Liječene su konzervativnim mjerama kod kuće u 57 slučajeva (91, 9 %). Telefonska konzultacija sa stomatologom bila je potrebna u pet slučajeva (8, 1 %). Jedan pacijent (1, 6 %) bio je ponovo primljen u bolnicu. Mlađa dob i dijagnoza bile su povezane s povećanim rizikom od ošamućenosti. Zaključak: Komplikacije stomatološkog liječenja u općoj anesteziji poslije otpusta iz jednodnevne kirurgije su česte, no roditelji/skrbnici mogu ih u većini slučajeva liječiti konzervativnim mjerama kod kuće. Postotak ponovnih prijama u bolnicu je nizak. Stomatološko liječenje u OA u sustavu jednodnevne kirurgije siguran je zahvat koji se može obaviti uz prihvatljiv rizik ako se pacijenti pomno odaberu.

Najčešći razlog provođenja stomatoloških zahvata u općoj anesteziji jest nesuradljivost bolesnika (fizički i psihička ograničenost ili oboje) i zahtjevniji operativni zahvat (osobito oralni kirurški zahvati). Naše operacije se provode u prostorima Dnevne bolnice s jednodnevnom oralnom kirurgijom (ASA I-III) ili Centralnom operacijskom bloku (ASA I-IV). Najčešće korišteni anestetici su propofol i remifentanil koji su dostavljeni bolesnicima putem intravenskog puta uz pomoć specijaliziranih pumpi sa mikročipom za dostavu lijekova. Inhalacijski anestetici se koriste samo kod vrlo nesuradljivih bolesnika kod kojih nije bilo moguće postaviti venski put za dostavu lijekova. Nazalno plasirani endotrahealni tubus uz mehaničku ventilaciju za nesmetano izvođenje zahvata te monitor dubine anestezije se redovito koristi.

Gliomas are the most common primary brain tumors, which include a variety of different histologic tumor types and malignancy grades. Neurosurgical resection is the standard therapeutic procedure in multimodal treatment plan, based on the goal of achieving maximal tumor resection without inducing new neurologic deficits. However, brain tumors located within or in the proximity to critical functional areas, such as eloquent cortical regions (insula, rolandic and left perisylvian cortex) or tumors located near internal capsule and basal ganglia still bear a high risk of surgery related deficits such as dysphasia, neglect or motor deficit. In the last decades, we have witnessed improvement in neuroradiology, neurophysiology, neuroanesthesiology, neurosurgery and brain mapping techniques, which have allowed intraoperative monitoring in awake patients with direct electrical stimulation (DES). DES allows direct and real-time investigation of individual functional connectivity of the brain, not only for cortical regions, but also for subcortical mapping of sensorimotor, visuospatial, language and socio- cognitive pathways and their interactions. Multimodal systems such as working memory, attention, executive functions and consciousness can also be investigated by axonal stimulation. Coordinated teamwork and multimodal approach tailored for each patient is required, which includes preoperative functional mapping and planning, intraoperative monitoring and postoperative follow-up by a team consisting of surgeon, anesthesiologist, neurologist, speech therapist, neuropsychologist and neurophysiologist. Following this postulate, we can minimize permanent postoperative deficits while maximizing the extent of resection, especially in cases of infiltrative tumors such as low-grade gliomas, which implies shorter recovery to normal social and professional life with better patient survival and quality of life. Our experiences and dilemmas in awake brain surgery in patients with diffuse infiltrative brain tumors will be presented.

The aim of this study is to evaluate the effectiveness of single photon emission tomography (SPECT) with Tc-99m HMPAO in the diagnosis of brain death (BD). It is widely accepted that BD is a clinical diagnosis, but sometimes confirmatory tests are recommended when clinical testing cannot be evaluated reliably. In our study we compared the outcome of planar brain scintigraphy with Tc-99m pertechnetate, with Tc-99m HMPAO brain SPECT for the assessment of brain blood flow in patients suspected of BD. Methods and Materials: In a period of five years (2012-2107) 36 patients with a clinical diagnose of BD (22 men and 14 women, age 6-86 y) were referred to our department for the confirmation of a clinical diagnosis of BD. We performed planar brain scintigraphy with Tc-99m pertechnetate 21 times, and Tc-99m HMPAO brain SPECT 20 times in patients. In 4 of 36 patients brain scintigraphy were performed few times because of doubtful findings. Flow images are acquired at the time of the injection of 1110 MBq of selected radiopharmaceutical with one-second dynamic images for a period of 60 seconds. Anterior, posterior and both lateral static images were obtained within 5 minutes after dynamic images, and than late static images when we use pertechnetate as a radiopharmaceutical. When we use Tc-99m HMPAO, brain SPECT images were obtained in addition to flow and early static images. Results: In 21 planar brain scintigraphy with Tc- 99m pertechnetate we confirmed a clinical diagnose of BD in 10 patients (47, 6%) while in 11 of them (52, 4%) we found different signs of cerebral blood flow. In 2 of them we performed a brain SPECT with Tc-99m HMPAO in few days and found the absence of brain perfusion. In 20 brain SPECT with Tc-99m HMPAO we confirm a clinical diagnose of BD in 15 patients (75%), while 5 cases (25%) were not consistent with BD. Conclusions: Our results suggest that Tc- 99m HMPAO brain SPECT is a non-invasive procedure, more sensitive in confirmation of clinical diagnosis of brain death than planar scintigraphy. SPECT also could facilitate the interpretation of doubtful planar images. So, we propose cerebral perfusion SPECT with Tc-99m HMPAO as a reference standard in the diagnosis of brain death wherever is possible, considering patient conditions and organization possibilities to perform it.

Pentadecapeptide BPC 157 improves muscle healing and has neuroprotective properties. We tested BPC 157 counteracting effect on intramuscular application of succinylcholine. Succinylcholine was given into the right quadriceps muscle of the rats, and we assessed local paralytic effect in injected muscle, immediate leg contracture, initial agitation before muscle disability, countless muscle twitches before complete muscle tonus loss, motionless laying, and thereafter, violent screaming upon light touch, and muscle fibers decrease, and edema in injected and non-injected quadriceps muscle and diaphragm. BPC 157 completely eliminated the local succinylcholine effect (leg contracture) and markedly attenuated or eliminated behavioral agitation, muscle twitches, motionless laying. No violent screaming upon light touch appeared in IM succinylcholine-rats. BPC 157 counteracted muscle fibers decrease and edema that otherwise appeared in injected and non-injected quadriceps muscle and diaphragm.

Zbornik radova 5. tečaj. Committee for European Education in Anaesthesiology (CEEA), European Society of Anaesthesiology, Hrvatsko društvo za anesteziologiju i intenzivno liječenje HLZ.

Hearing loss accompanied with middle ear effusion was analyzed according to audiometric frequencies for different age group. Results for left and right ears were compared in/and between study and control group. Pure tone audiometry for bone and air conduction and tympanometry was performed in study group of ninety-eight children with conductive hearing loss and otitis media with effusion. Control group included fifty-seven children with hearing loss, enlarged adenoids, dysfunction of Eustachian tube and no present middle ear effusion served. Means of hearing loss thresholds for 250 Hz-4 kHz were established and compared between groups of right vs. left ears of tested vs. control ears according to age subgroups: 1-3 yr, 4-6 yr, 7-9 yr, 10-12 yr, 13-15 yr. At age 1-3 yr otitis media with effusion children showed no ear side difference in hearing loss. Age groups of 4-6 and 7-9 yr otitis media with effusion children showed left ears with higher threshold of hearing loss across all of the tested frequencies than right ears in study and control ears. Right ears showed smaller hearing loss in study and control group and no age group predicted for hearing impairment. Higher hearing loss threshold for 4 kHz in adolescence in otitis media with effusion ears is early sign of sequels after repetitive episodes of middle ear effusion. Control groups showed no ear side or age group dependent difference of hearing loss threshold. Age group of 4-6 and 7-9 y have faster craniofacial structural change in soft tissue than bone base so ear side differences suggest being developmentally determined.

Hearing loss accompanied with middle ear effusion was analyzed according to audiometric frequencies for different age group. Results for left and right ears were compared in/and between study and control group. Pure tone audiometry for bone and air conduction and tympanometry was performed in study group of ninety-eight children with conductive hearing loss and otitis media with effusion. Control group included fifty-seven children with hearing loss, enlarged adenoids, dysfunction of Eustachian tube and no present middle ear effusion served. Means of hearing loss thresholds for 250 Hz-4 kHz were established and compared between groups of right vs. left ears of tested vs. control ears according to age subgroups: 1-3 yr, 4-6 yr, 7-9 yr, 10-12 yr, 13-15 yr. At age 1-3 yr otitis media with effusion children showed no ear side difference in hearing loss. Age groups of 4-6 and 7-9 yr otitis media with effusion children showed left ears with higher threshold of hearing loss across all of the tested frequencies than right ears in study and control ears. Right ears showed smaller hearing loss in study and control group and no age group predicted for hearing impairment. Higher hearing loss threshold for 4 kHz in adolescence in otitis media with effusion ears is early sign of sequels after repetitive episodes of middle ear effusion. Control groups showed no ear side or age group dependent difference of hearing loss threshold. Age group of 4-6 and 7-9 y have faster craniofacial structural change in soft tissue than bone base so ear side differences suggest being developmentally determined.