The Journal of international medical research
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We evaluated postoperative concentrations of inflammatory indicators, including procalcitonin, after gynaecological operations for benign and malignant tumours in patients with a normal postoperative course and assessed the utility of procalcitonin in differentiating between non-bacterial inflammation and bacteraemic complications in the postoperative period. This prospective study included 99 patients: 47 after a standard gynaecological operation (Piver I) and no postoperative infectious complications (group 1), 35 after a major procedure (Piver II or III) and no postoperative infectious complications (group 2), and five with postoperative sepsis after Piver II or III procedures (group 3). We also studied serum procalcitonin concentrations in a group of 12 patients (group 4) with terminal forms of gynaecological cancer who were hospitalized for palliative treatment but did not undergo surgery. ⋯ In particular, procalcitonin was > 2 ng/ml in all patients with postoperative sepsis by postoperative day 2 but was always
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Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. ⋯ Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.
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To test whether the cerebral state index (CSI) can be used as a measurement of the level of consciousness in unsedated brain-injured patients, 21 brain-injured adults were prospectively assessed in 77 separate sessions. After CSI monitoring was set up, the patient's motor responses to verbal and/or painful stimuli were assessed. CSI values were recorded before and after external stimulation. ⋯ Mean maximal CSI values increased significantly after external stimulation: from 71 to 89 and 49 to 62 in patients exhibiting purposeful and non-purposeful movements, respectively. The CSI value showed a high prediction probability (P(K) > 0.8) for detecting purposeful movement to external stimuli, especially after external stimulation (P(K) > 0.9). These results suggest that CSI monitoring might be a valid method for detecting purposeful movement in response to external stimuli in unsedated brain-injured patients.
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Comment Letter Comparative Study
Fresh frozen plasma versus human albumin in paediatric craniofacial repair.
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This study evaluated the correlation and agreement between the Bispectral Index (BIS) or A-line Autoregressive Index (AAI) and a clinical scoring system, the Ramsay Sedation Scale (RSS), in 40 patients after elective cardiac surgery and admission to the intensive care unit. All patients received sedation with propofol according to the study protocol. BIS, AAI and RSS were documented at two different levels of sedation: deep sedation RSS 4 - 6; and slight sedation/extubation RSS 2 - 3. ⋯ The systems agreed well among each other (overall intra-class correlations of 0.670 for consistency and 0.676 for absolute agreement). There was significant discrimination between RSS 2 - 3 and RSS 4 - 6 with BIS and AAI (BIS mean difference of 24.73, 95% confidence intervals [CI] 21.08 - 28.37; AAI mean difference of 20.90, 95% CI 14.64 - 27.16). In conclusion, BIS and AAI correlated well with RSS overall and also at different levels of sedation.