A good surgical outcome as shown by preserved Achilles tendon and H reflexes was related to the immediate return of H wave and SRP on stopping the harmful manipulation, and preservation of the H wave and SRP at the end of surgery.SRP monitoring brings up additional information concerning initial root injury and cumulative manipulative effects. The technique of dynamic nerve root retraction in posterior lumbar discectomy can therefore be made safer.

Summary. Background: This study attempted to correlate neurological symptoms in awake patients undergoing carotid endarterectomy (CEA) under local anaesthesia (LA) with serum concentration of S100B protein and measurement of cerebral oximetry with near-infrared spectroscopy (NIRS). Patients and methods: A total of 64 consecutive CEAs in 60 patients operated under LA during an 18-month period were prospectively evaluated. A cerebral oximeter was used to measure cerebral oxygen saturation (rSO2) before and after cross-clamping along with serum concentration of the S100B protein. Selective shunting was performed when neurological changes occurred, regardless of NIRS. Neurological deterioration occurred (neurological symptoms group) in 7 (10.9 %) operations. In 57 (89.1 %) operations, the patients were neurologically stable (no neurological symptoms group). Results: The neurological symptoms that occurred after clamping correlated with an increase in the serum level of S100B ( P = .040). The cut-off of 22.5 % of S100B increase was determined to be optimal for identifying patients with neurological symptoms. There was no correlation between rSO2 decline and neurological symptoms ( P = .675). Two (3.1 %) perioperative strokes occurred. Conclusions: We found a correlation between neurological symptoms and serum S100B protein increase. However, because of the long evaluation time of serum S100B, this monitoring technique cannot be performed during CEA.

No abstract

Priporočila za odkrivanje in zdravljenje kronične venske bolezniRecommendations for the diagnosis and treatment of chronic venous disease AbstractClinical manifestations of chronic superficial venous insufficiency are described, followed by recommendations for diagnostic evaluation and various treatment possibilities. Opredelitev kronične venske bolezni in popuščanjaKronična venska bolezen (KVB) zajema vse stadije bolezni od telangiektazij, varic in otekanja do kožnih sprememb z razjedo, kronično vensko popuščanje (KVP) pa napredovale faze s stalnim otekanjem in kožnimi spremembami z razjedo (1). Kronična venska bolezen je klinično opredeljena kot sklop simptomov in znakov, ki nastanejo zaradi povečanega tlaka v povrhnjih in/ali globokih venah spodnjih udov. Simptomi KVB so lahko težke noge, tope bolečine, srbenje, utrujenost nog, krči ponoči in nemirne noge. Znaki KVB so lahko metličaste vene, mrežaste vene ali krčne žile (varice), otekline in kožne spremembe, kot so temnejša obarvanost (hiperpigmentacija), lipodermatoskleroza, hipostazični dermatitis in venska razjeda (1).Povečan tlak v venah najpogosteje nastane zaradi nepravilnega delovanja venskih zaklopk, ki niso več sposobne preprečevati obratnega toka (refluksa) krvi v venah, redkeje pa zaradi zožitve ali zapore proksimalne vene. Nezadostno delovanje (insuficienca) venskih zaklopk onemogoča, da bi med hojo golenska mišična črpalka zmanjšala venski tlak v spodnjih udih na normalno raven. Okvara venskih zaklopk je najpogosteje primarna, pri kateri osnovnega vzroka ne poznamo (1). Sekundarna okvara zaklopk, ki vodi v nastanek varic, se pojavlja ob akutni venski trombozi spodnjega uda, nerekanalizirani trombozi medeničnih ven ali v sklopu potrombotičnega sindroma, prirojena (kongenital-