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Zupcic SG, Zupcic M, Duzel V, Simurina T, Sakic L, Grubjesic I, Tonković D, Udovic IS, Ferreri VM. The potential role of micro-RNA-211 in the pathogenesis of sleep-related hypermotor epilepsy. Med Hypotheses 2020; 143:110115. [PMID: 32763656 DOI: 10.1016/j.mehy.2020.110115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
Sleep-related hypermotor epilepsy (SHE) is a rare epileptic syndrome characterized by epileptic seizures which occur during the non-rapid eye movement (NREM) stage of sleep. It manifests with hypermotor semiology resembling violent limb movements and an asymmetric tonic-dystonic posture. The genes which are responsible for the autosomal dominant form of SHE (ADSHE) and whose function is to code the sub-unit of the neuronal acetylcholine receptor are well known. Considering that ADSHE is a prototype of SHE, it is thought that the dysfunction of the cortico-subcortical cholinergic network, which regulates the cycle of sleep, has a key role in the epileptogenesis of this syndrome. Namely, studies to date, have shown that the hypercholinergic activity is sufficient for the development of epileptic seizures, even though the exact mechanism remains to be elucidated. NREM parasomnias are sleep disorders that are the most difficult to differentiate from SHE due to a similar clinical presentation. Considering the clinical similarities, NREM occurrence and probable genetic connection, it is considered that fundamentally, both of these conditions share a common pathophysiological mechanism i.e. cholinergic dysfunction. The main difference between SHE and NREM parasomnias are the genuine epileptic seizures that are responsible for the semiology in SHE. These genuine seizures are not present in NREM parasomnias. Why this is so, remains to be elucidated. Considering that animal studies have shown that dynamic changes and the decreased levels of microRNA-211 contribute to epileptic seizures and to changes in cholinergic pathways, our hypothesis is that epileptic seizures and the development of epileptogenesis in SHE are a consequence of cholinergic dysfunction and decreased levels of microRNA-211 as opposed to NREM parasomnias where there is a stable level of microRNA-211, preventing epileptogenesis despite the cholinergic system dysfunction.
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Affiliation(s)
- Sandra Graf Zupcic
- Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia.
| | - Miroslav Zupcic
- University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia
| | - Viktor Duzel
- Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom
| | - Tatjana Simurina
- J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; Department of Health Studies, University of Zadar, General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia
| | - Livija Sakic
- J. J. Strossmayer University, Faculty of Dental Medicine and Health, Osijek, Croatia; University Hospital "Sveti Duh", Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia
| | - Igor Grubjesic
- Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia
| | - Dinko Tonković
- School of Medicine, University of Zagreb, Croatia; Clinical Hospital Centre Zagreb, Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia
| | - Ingrid Sutic Udovic
- University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia
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Zupcic SG, Zupcic M, Duzel V, Šimurina T, Milošević M, Basic S, Vuletic V, Kapural L. Effect of clonidine on the cutaneous silent period during spinal anesthesia. World J Clin Cases 2018; 6:1136-1145. [PMID: 30613672 PMCID: PMC6306629 DOI: 10.12998/wjcc.v6.i16.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/17/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the effect of clonidine on the cutaneous silent period (CSP) during spinal anesthesia.
METHODS A total of 67 adult patients were included in this randomized, prospective, single-center, double-blind trial. They did not have neurological disorders and were scheduled for inguinal hernia repair surgery. This trial was registered on ClinicalTrials.gov (NTC03121261). The patients were randomized into two groups with regards to the intrathecally administered solution: (1) 15 mg of 0.5% levobupivacaine with 50 µg of 0.015% clonidine, or (2) 15 mg of 0.5% levobupivacaine alone. There were 34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group. CSP and its latency were measured four times: prior to the subarachnoid block (SAB), after motor block regression to the 0 level of the Bromage scale, with ongoing sensory blockade, and both 6 and 24 h after SAB.
RESULTS Only data from 30 patients in each group were analyzed. There were no significant differences between the groups investigated preoperatively and after 24 h. The CSP of the L group at the time point when the Bromage scale was 0 was 44.8 ± 8.1 ms, while in the LC group it measured 40.2 ± 3.8 ms (P = 0.007). The latency in the L group at the time point when the Bromage scale was 0 was 130.3 ± 10.2 ms, and in the LC group it was 144.7 ± 8.3 ms (P < 0.001). The CSP of the L group after 6 h was 59.6 ± 9.8 ms, while in the LC group it was 44.5 ± 5.0 ms (P < 0.001). The latency in the L group after 6 h was 110.4 ± 10.6 ms, while in LC group it was 132.3 ± 9.7 ms (P < 0.001).
CONCLUSION Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone results in a diminished inhibitory tonus and shortened CSP.
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Affiliation(s)
- Sandra Graf Zupcic
- Clinic of Neurology, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
| | - Miroslav Zupcic
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Viktor Duzel
- Department of Anaesthesia, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, United Kingdom
| | - Tatjana Šimurina
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Department of Health Studies University of Zadar, Zadar 23000, Croatia
- Department of Anesthesiology and Intensive Care Medicine, General Hospital Zadar, Zadar 23000, Croatia
| | - Milan Milošević
- University of Zagreb, School of Medicine, Andrija Stampar School of Public Health WHO Collaborative Centre for Occupational Health, Zagreb 10000, Croatia
| | - Silvio Basic
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Department of Neurology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Vladimira Vuletic
- Clinic of Neurology, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Leonardo Kapural
- Center for Clinical Research, Winston Salem, NC 27103, United States
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Župčić M, Graf Župčić S, Duzel V, Šimurina T, Šakić L, Fudurić J, Peršec J, Milošević M, Stanec Z, Korušić A, Barišin S. A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone. Croat Med J 2017; 58:270-280. [PMID: 28857520 PMCID: PMC5577647 DOI: 10.3325/cmj.2017.58.270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics. METHOD A prospective, single-center, randomized, double-blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n=42) or 0.5% levobupivacaine with 2% lidocaine (n=43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale. RESULTS Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean time-to-block onset (14 minutes; P<0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P<0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P=0.006) and more episodes of hypotension (17.5%; P=0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P<0.001). CONCLUSION The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect.
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Affiliation(s)
- Miroslav Župčić
- Miroslav Župčić, Anesthesiology, Reanimatology and Intensive Care Medicine, Clinical Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia,
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Stambolija V, Stambolija TP, Holjevac JK, Murselovic T, Radonic J, Duzel V, Duplancic B, Uzun S, Zivanovic-Posilovic G, Kolenc D, Drmic D, Romic Z, Seiwerth S, Sikiric P. BPC 157: The counteraction of succinylcholine, hyperkalemia, and arrhythmias. Eur J Pharmacol 2016; 781:83-91. [PMID: 27060013 DOI: 10.1016/j.ejphar.2016.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022]
Abstract
After the demonstration of its life-saving effect in severe hyperkalemia and the recovery of skeletal muscle after injury, pentadecapeptide BPC 157 has been shown to attenuate the local paralytic effect induced by succinylcholine, in addition to systemic muscle disability (and consequent muscle damage). Hyperkalemia, arrhythmias and a rise in serum enzyme values, were counteracted in rats. Assessments were made at 3 and 30min and 1, 3, 5, and 7 days after succinylcholine administration (1.0mg/kg into the right anterior tibial muscle). BPC 157 (10µg/kg, 10ng/kg) (given intraperitoneally 30min before or immediately after succinylcholine or per-orally in drinking water through 24h until succinylcholine administration) mitigated both local and systemic disturbances. BPC 157 completely eliminated hyperkalemia and arrhythmias, markedly attenuated or erradicated behavioral agitation, muscle twitches, motionless resting and completely eliminated post-succinylcholine hyperalgesia. BPC 157 immediately eliminated leg contractures and counteracted both edema and the decrease in muscle fibers in the diaphragm and injected/non-injected anterior tibial muscles. Therefore, the depolarizing neuromuscular blocker effects of succinylcholine were successfully antagonized.
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Affiliation(s)
- Vasilije Stambolija
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Tamara Murselovic
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jelena Radonic
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Viktor Duzel
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bozidar Duplancic
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sandra Uzun
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Danijela Kolenc
- Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Domagoj Drmic
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zeljko Romic
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia.
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Korusić A, Merc V, Duzel V, Tudorić-Djeno I, Zidak D, Brundula A, Sojcić N, Milanović R, Barić A, Beslić G. Who is the patient? Disclosure of information and consent in anesthesia and intensive care (informed consent). Coll Antropol 2013; 37:1033-1038. [PMID: 24308256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Physicians have always strived to uphold all the ethical postulates of the medical profession in all aspects of the practice, however with the vast advances in science and technology, numerous ethical dilemmas regarding all aspects of life and ultimately death have emerged. Medical decisions however, are no longer in the sole jurisdiction of traditional Hippocratic medicine but are now deliberated and delivered by the patient and they are comprised of a number of additional determining aspects such as psychological, social, legal, religious, esthetic, administrative etc., which all together represent the complete best interest of the patient. This is the basic goal of the "Informed Consent". The widening of legal boundaries regarding professional liability may consequentially lead to a "defensive medicine" and a deterioration in the quality of healthcare. In the Republic of Croatia there a four types of liability and the hyperproduction of laws which regulate healthcare geometrically increase the hazards to which physicians are exposed to on a daily basis. When evaluating the Croatian informed consent for anesthesia, we can come to the conclusion that it is completely impractical and as such entirely unnecessary. Anesthesiologists should concentrate on an informed consent which would in brief explain all the necessary information a "reasonable" anesthesiologist would disclose to a "reasonable" patient so that a patient could undertake a diagnostic or therapeutic procedure unburdened and with complete confidence in the physicians who are involved in the treatment of the respective patient.
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Affiliation(s)
- Andelko Korusić
- University of Zagreb, University Hospital "Dubrava", Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia.
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Nikolić I, Stancić-Rokotov D, Macan JS, Korusić A, Mikecin V, Duzel V. Gastric tube ulcer perforating the pericardium after subtotal esophagectomy. Coll Antropol 2013; 37:615-618. [PMID: 23941013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Subtotal esophagectomy with retrosternal transposition of the gastric tube to the neck was performed in a 62-year-old patient with squamous cell carcinoma of the proximal third of the esophagus. He developed a salivatory fistula in the early postoperative period that healed spontaneously. Five months later, the patient developed partial stenosis of the esophagogastric anastomosis which required recervicotomy and excision, after numerous failed dilatation attempts. Eighteen months later, the patient presented to the hospital for severe pain in the upper abdomen. Clinical work-up revealed pericardial perforation by the gastric tube ulcer necessitating emergent surgery and gastric tube removal. We present a patient who developed both early and late complications of subtotal esophagectomy with gastric tube transposition as well as a review of the literature.
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Affiliation(s)
- Igor Nikolić
- University of Zagreb, University Hospital Dubrava, Department of Thoracic Surgery, Zagreb, Croatia.
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Djeno IT, Duzel V, Ajduk M, Oremus ZS, Zupcić M, Dusper S, Jukić D, Husedzinović I. Increase in specific density of levobupivacaine and fentanyl solution ensures lower incidence of inadequate block. Coll Antropol 2012; 36:375-380. [PMID: 22856218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The clinical presentation of a subarachnoid block (SAB) is dependent upon the intrathecal spread of local anesthetic (LA). Intrathecal distribution depends on the chemical and physical characteristics of LA, puncture site, technique used, patient anatomical characteristics and hydrodynamic properties of cerebrospinal fluid. We tried to determine whether a combined glucose/LA solution can render a clinically significant difference in sensory block distribution and motor block intensity.This was a controlled, randomized and double blinded study. The surgical procedures were stripping of the great or small saphenous vein and extirpation of remaining varicose veins. The study included 110 patients distributed into two groups: Hyperbaric (7.5 mg levobupivacaine (1.5 ml 0.5% Chirocaine) + 50 microg Fentanyl (0.5 ml Fentanil) and 1 ml 10% glucose (Pliva)) vs. Hypobaric (7.5 mg levobupivacaine (1.5 ml 0.5% Chirocaine) + 50 microg Fentanyl (0.5 ml Fentanil) and 1 ml 0.9% NaCl (Pliva, Zagreb)) adding to a total volume of 3.5 ml per solution. Spinal puncture was at L3-L4 level. Spinal block distribution was assessed in five minute intervals and intensity of motor block was assessed according to the modified Bromage scale. Pain was assessed with the Visual Analogue Scale. A statistically significant difference in sensory block distribution, motor block intensity and recovery time was established between hyperbaric and hypobaric solutions. By increasing the specific density of anesthetic solution, a higher sensory block, with lesser variability, a diminished influence of Body Mass Index, decreased motor block intensity and faster recovery time may be achieved.
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Affiliation(s)
- Ivana Tudorić Djeno
- University of Zagreb, Dubrava University Hospital, Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia.
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Korusić A, Hauptman A, Brundula A, Duzel V, Husedzinović I, Horić M, Gasparović S, Salamon T. Perioperative management with glucose solution and insulin. Coll Antropol 2009; 33:653-657. [PMID: 19662793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The objective of this study was to analyze how preoperative glucose treatment influences the blood glucose level as a measured exponent of surgical stress and to establish the best postoperative replacement considering glucose solutions and insulin. This prospective clinical trial involved 208 non-diabetic patients with normal glucose tolerance, who underwent major surgical procedures and needed 24 hours ICU monitoring postoperatively. Patients were randomly given 5% glucose solution (1000 mL) one day before surgery or after overnight fasting. Group A and group B were randomized to be given 5 different kinds of postoperative replacement with cristalloids and insulin. None of the patients from group A or group B were given glucose solutions during surgical procedures. Blood glucose levels were measured 14 times from the preoperative period until 24 hours after admission to the ICU and the main outcome measure was blood glucose level. All patients had a statistically significant increase in blood glucose levels in comparison to basal levels (p < 0.05) in all measurements. All data were processed with descriptive statistics, chi-square test, parametric ANOVA test and ANOVA test with repeated measure, non parametric Kruskal-Wallis test and Mann-Whitney U-test. Statistically significant change was accepted with p < 0.05. Preoperative glucose infusion decreased metabolic and endocrine response only during surgery; the smallest increase of postoperative blood glucose level was noticed after administering postoperative non-glucose crystalloid solutions; there is no clinical evidence that one specific postoperative replacement is better than the other; there is no clinical evidence that postoperative use of insulin can decrease or attenuate surgical induced insulin resistance.
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Affiliation(s)
- Andelko Korusić
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Dubrava Zagreb, Croatia.
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