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An observational study examining the effects of a surgically induced inflammatory response on the distribution of morphine and its metabolites into cerebrospinal fluid

AbstractPurpose Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function.MethodsWe conducted a prospective pharmacokinetic study of the plasma and CSF distribution of the P-glycoprotein (PGP) substrate morphine in 33 patients undergoing open thoracic (n = 18) or endovascular (n = 15) aortic aneurysm repair. Morphine was administered with induction of anesthesia and in the intensive care unit. Plasma and CSF concentrations of interleukin (IL)-6, morphine, M3G, M6G, and albumin were measured prior to surgery (baseline), during surgery, and postoperatively every six hours until removal of the CSF drain. The area under the curve (AUC) was determined for plasma and CSF IL-6, morphine, M3G, and M6G concentrationsvs time. The primary endpoint measures were the correlations between the morphine, M6G, and M3G AUC CSF/plasma ratios and systemic inflammation as quantified by the time-normalized IL-6 exposure, which was calculated for each individual by dividing the total exposure (AUC) by time (t). A Bonferroni correctedP 
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research

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The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and a low risk control group. METHODS: Historical matched case-control study: participants were adults>18 years old presenting to two tertiary care emergency departments (ED) or one regional cardiac referral center. CASES: new ED or in-hospital diagnosis of non-traumatic AAD confirmed by computed tomography or echocardiography. CONTROLS: triage diagnosis of truncal pain (
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Acad Emerg Med Source Type: research
n C Abstract Screening for abdominal aortic aneurysm (AAA) has proven to reduce AAA-related mortality, but how the knowledge of having an untreated AAA affects health and daily life requires further clarification. The aim was to investigate the psychosocial consequences and sense of coherence (SOC) in 65-year-old men diagnosed with AAA and participating in a national screening program during a 6-month follow-up compared with men with no AAA. The single-center cohort study included 52 men with AAA and 118 men without AAA. A questionnaire including the Short Form 36 Health Survey, Hospital Anxiety and Depression Sca...
Source: Pain Physician - Category: Anesthesiology Authors: Tags: J Vasc Nurs Source Type: research
We would like to tell you about the December issue of the Journal of Vascular Surgery and some of the key articles. The first paper, by Chandra and co-authors from Stanford, entitled “Management and outcomes of symptomatic abdominal aortic aneurysms during the past 20 years,” compares symptomatic patients with abdominal aortic aneurysm (AAA), defined as those who had new onset abdominal pain or aneurysm tenderness with no rupture found by computed tomography scan or in the operating room. In these patients, the repair of AAA was primarily open from 1995 to 2004 and evolved to primarily endovascular repair ...
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Journal of Vascular Surgery – December 2017 Audiovisual Summary Source Type: research
CONCLUSION: We observed a good clinical outcome. PMID: 29084477 [PubMed - as supplied by publisher]
Source: Acta Chirurgica Belgica - Category: Surgery Tags: Acta Chir Belg Source Type: research
AbstractTo assess feasibility, efficacy and safety of carbon dioxide (CO2) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6  ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0  ± 8.0 mm. CO2 angiography was performed by automatic (n  = 7) or hand (n&thins...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and a low risk control group. MethodsHistorical matched case‐control study: participants were adults>18 years old presenting to two tertiary care emergency departments (ED) or one regional cardiac referral center. Cases: new ED or in‐hospital diagnosis of non‐traumatic AAD confirmed by computed tomography or echocardiography. Controls: triage diagnosis of truncal pain (
Source: Academic Emergency Medicine - Category: Emergency Medicine Authors: Tags: Original Contribution Source Type: research
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Source: Arthritis and Rheumatism - Category: Rheumatology Authors: Tags: Clinical Image Source Type: research
In this report, we report such a case that was successfully treated with a novel approach. To the best of our knowledge, this was the first case occurring in China, in which an infection of the abdominal aortic aneurysm was caused by a Brucella species. Patient concerns: Patient concerns:The clinical findings included high fever, fatigue, and abdominal pain. Diagnoses: Diagnoses:The diagnosis was confirmed by computed tomography angiography and by bacteriologic isolation from the patient's blood culture. Interventions: Interventions:The patient was given endovascular aneurysm repair (EVAR) and Brucella-sensitive antibio...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
A 25-year-old woman with Takayasu arteritis in a quiescent state presented with postprandial abdominal pain and bilateral lower limb claudication for 6  months. Her blood pressure was 140/80 mm Hg on atenolol (25-mg tablet), and lower limb pulses were feeble with an ankle-brachial index of 0.6 in each limb. Computed tomography angiography showed multiple saccular aneurysms of Crawford type III thoracoabdominal extent, nonvisualized right kidney, and hypertrophied precious left kidney, with near-total occlusion of the infrarenal aorta and its reformation by a prominent arc of Riolan (A/Cover).
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Vascular images Source Type: research
n A Abstract Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. Therefore, its prompt and proper diagnosis is vital to increase a patient's chance of survival and to prevent grievous complications. Typical symptoms of acute aortic dissection include severe chest pain, hypotension or syncope and, hence, mimic acute myocardial infarction or pulmonary embolism. Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. H...
Source: Swiss Medical Weekly - Category: General Medicine Authors: Tags: Swiss Med Wkly Source Type: research
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