The incidence of difficult intubation (DI) is 1-10%, and DI leading to inability to intubate occurs in 0.04% of the population. The aim of this study was to evaluate the incidence of DI in thyroid surgery and to assess possible correlation of difficult tracheal intubation with sex and primary diagnosis.
We studied 2000 consecutive patients (1705 females) scheduled for thyroid surgery who were assessed for DI prior to general anesthesia, with respect to primary disease diagnosis and sex. Patients were divided into four groups: patients with nodal goiter (group A), polynodal goiter (group B), hyperthyroidism (group C) and thyroid carcinoma (group D). Difficult intubation was predicted using the scoring system which included 13 parameters ranged from 0 to 2. Additive score > 5 was accepted as a predictor of DI. True DI was defined as impossible visualization of glottis with direct laryngoscopy (grade III and IV).
Difficult intubation was observed in 110/2000 patients (5.5%). The incidence of DI was higher in males (26/295, 8.8%) than females (84/1705, 4.9%) (p < 0.01). The incidence of DI was highest in the group B (6.2%). Extremely DI occurred in 15/2000 patients (0.75%), the most of them in the group C (1.1%). Sensitivity of used scoring system was 91.8% and specificity 86.5%.
The incidence of DI was higest in patients with polynodal goiter but extremly DI was present mostly in patients with hyperthiroidism. Men seem to be at higher risk for DI than women. Scoring system used in this study for prediction of DI may be useful in this patient population.
Experimental parkinsonism was induced in adult Wistar rats by selective nigrostriatal neurotoxine, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in a single dose of 0.09 g/kg, by unilateral intrastriatal application using stereotaxic instrument. Control group included rats treated with 0.9% saline solution in the same manner. Animals were sacrificed by decapitation seven days after the treatment. Total glutathione was measured in the crude mitochondrial fraction of thalamus and striatum. Total glutathione content, as a measure of reduced cell atmosphere, was mutually decreased in the thalamus and striatum of MPTP-treated animals, compared to controls: thalamus ipsi- = 24.8 +/- 3.11, contralateral = 26.81 +/- 5.31; striatum ipsi- = 19.96 +/- 4.13, contralateral = 17.3 +/- 4.09 nmol/mg prot. Mutually depleted glutathione content in the thalamus and contralateral striatum, the structures distant from ipsilateral treated striatum, could indicate on spatial propagation of oxidative stress, not only in the selective vulnerable dopaminergic nigrostriatal neurons, but in the structures included in the motor and cognitive loops of basal ganglia.
123I-FP-CIT brain single-photon emission computed tomography (SPECT), DaTSCAN imaging, offers a possibility to study structural and biochemical integrity of presinaptic dopaminergic neurotransmitter system. The aim of this study was to evaluate the usefulness of 123I-FP-CIT brain SPECT scintigraphy in patients with extrapyramidal diseases.
Fifteen patients (8 males and 7 females), aged 26-81 years, presenting with extrapyramidal symptoms entered the study. Out of them, 7 patients were diagnosed with definite clinical form of idiopathic Parkinson's disease (PD) or clinical probable for PD clinical stage 2-4 using the Hoehn & Yahr scale (H & Y); 6 patients were with atypical parkinsonism (AP), 1 patient with essential, and 1 with psychogenic tremor. SPECT was performed 180 min after injection of 185 MBq 123I FP-CIT using a dual head Gamma camera. Sixty four one minutes' frames were acquired using a noncircular rotation mode into a 128 x 128 image matrix. Transverse slices were reconstructed using a 0.6 order Butterworth filter. Visual interpretation was based on striatal uptake, left to right asymmetry and substructures most affected. The ratio of binding for the entire striatum, caudate and putamen to nonspecific binding in occipital cortex was calculated. SPECT findings were categorized as normal and abnormal (incipient, moderate and severe presinaptic deficit).
123I-FP-CIT uptake was reduced in the striatum of 6/7 patients with PD and 5/6 patients with AP. Two patients with PD and AP showed a negative finding. The remaining 2 negative results were obtained in the patients diagnosed with essential tremor and psychogenic tremor. The mean striato-occipital ratio (SDR) of the most affected side was lower in the patients with PD.
Our first results confirm the usefulness of 123I-FP-CIT brain SPECT in differential diagnosis of extrapyramidal diseases.
The glycoprotein of a high molecular weight CA-125, which is not a specific tumor marker of ovarian cancer, is secreted by the endothelial cells of most pelvic organs. Endometriosis, inflammatory processes in the pelvic cavity, as well as some nongynecoligical malignant diseases, could be followed by the increased values of CA-125. Serial assessment of the values of CA-125 makes it possible to avoid surgical treatment, and, by means of the used conservative treatment, to avoid malignant diseases not to be noticed.
The study included 57 female patients hospitalized due to inflammable adnexal tumors. Besides following the values of serum CA-125 during and after the therapy, also performed were the transvaginal Doppler ultrasonography and the determination of the values of resistance index (RI).
In 27 patients (55.1%) the CA-125 values ranged from 38.8 U/ml to 794 U/ml, while in 30 of the patients they were within the range of normal. In this group of the patients, besides the increased values of CA-125, also increased were the values of leucocytes (11(9)/1-20(9)/1), as well as the sedimentation rates (65-120) within the first hour. In all the 57 patients, transvaginal Doppler ultrasonography revealed the presence of adnexal tumor of inflammatory kind. The measured values of RI were within the range of 0.539-0.681. Eight of the patients were treated by the conservative--triple antibiotic therapy, while in 49 patients explorative laparotomy was performed. Hystorectomy was done in 12 of the patients, and one-side adnexectomy in 37 of them.
The method for the assessment of CA-125 is simple and available which facilitates the monitoring of surgical, conservative or the combined therapy that is particularly significant in younger patients with inflammable adnexal tumor developed on the basis of endometrosis.
Matrix metalloproteinases (MMPs) are proteolytic enzymes capable of degrading almost all extracellular matrix and basement membrane components in many destructive pathological processes, such as chronic inflammation and bone-destructive lesions. The aim of this study was to determinate the correlation between concentration of collagenases (MMP-1, -8, -13) in chronic periapical lesions and their dimension calculated with software predilection through X-ray.
Chronic periapical tissues were collected by periapical surgery from 60 teeth with clinically and radiographically verified different chronic periapical lesions (20 granulomas, 20 diffuse periapical lesions, 10 cysts). Ten normal pulps used as controls were obtained by extirpation of the pulp of impacted third molars after their surgery. For rapid analysis of MMP-1, -8, -13 collagenase activities in the examined material Chemicon Collagenase Activity Assay Kit were used. From the X-ray trough software predilection (Image Tool3 Program) of the volume of chronic periapical tissue, correlation between concentration of MMPs in the periapical lesions and their dimension was confirmed.
Different concentrations of collagenases (MMP-1, -8 and -13) in chronic periapical process from different inflammation types showed different activity of MMPs. The obtained results showed the highest values of collagenases concentration (MMP-1, -8, -13) in chronic diffuse lesions (5.39 ng/ml). Low values of concentration of MMPs accompanied less serious lesions, whereas chronical periapical lesions of large dimension had high concentration of MMPs, which was proportional to progression of the lesion and destruction of bone tissue.
This study confirmed the destructive role of collagenases (MMP-1, -8 and -13) in inflammation process, which directly depends on the concentration of MMPs in pathologically changed tissue.