To estimate the prevalence of antibodies to the hepatitis C virus ((HCV) and hepatitis virus (HBV) and the presence of infection, 101 patients receiving renal replacement therapy and 75 staff members caring for them were tested. Evaluation included detailed history, screening for anti-HCV antibody, HBV markers and liver enzymes 38% of patients were anti-HCV positives and 15 (40%) of these had antibodies to the hepatitis B core antigen indicating previous hepatitis B infection. Positive markers indicating HBV infection only, accounted for another 18% of patients. All staff members were anti-HCV negative, although 34 (45%) were anti-HBc positive. Age, sex and history of blood transfusions did not influence the prevalence of anti-HCV and anti-HBC in patients. There was, however, a significant difference in the prevalence of anti-HCV and anti-HBc positivity between polytransfused and occasionally transfused patients (p < 0.05). During a 24-months follow-up a decline was observed in HBs antigen carriers from 20% to 10% and in HBc antibody carriers from 47% to 33%. At the same time, regardless of accurate preventive measures, an increase in incidence of anti-HCV seropositivity from 30% to 38% was detected.

SummaryDuring neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent postoperative pain relief, especially after spinal surgery

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Epidermolysis bullosa is a rare genetic hereditary disease characterized with mechanobullous dermatosis. Except cutaneous, these patients have various extracutaneous manifestations and some types of epidermolysis bullosa comprise almost all organ systems. Because of prolonged life span, chronic renal insufficiency has become an important cause of morbidity and death in these patients. Establishment of functional vascular dialysis access is a great challenge for both the doctors and the patients. Multidisciplinary approach is essential. We present a case of successful establishment of dialysis access via Tesio catheter in a young woman suffering from epidermolysis bullosa dystrophica Hallopeau-Siemens and end-stage renal disease. Since then, the Tesio catheter inserted via the right internal jugular vein has been the functional mean of dialysis. The patient was given the opportunity to lead a quality and active life in spite of disabling disease. Several cases of successful dialysis access establishment with dialysis catheters via central veins have been reported. We report the successful establishment of long-term dialysis access via Tesio catheter and suggest this approach as ideal for these patients. This is the first report dealing with vascular access in this group of patients.

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SUMMARY -Acute kidney injury (AKI) is a serious complication associated with increased morbidity and mortality. Total incidence of AKI in hospitalized patients is 1%-5%. As many as 30% of these patients develop AKI in the perioperative period, which is associated with anesthesia and surgery. Despite scientifi c advances and improved surgery techniques, as well as treatment in intensive care units, no signifi cant decrease in AKI incidence has been achieved. To change this outcome, it is important to identify patients at risk of AKI and prevent its occurrence. Correct selection of anesthetic drugs during general anesthesia, adjusted to the individual needs of patients, also infl uences the overall outcome of treatment. Nowadays, inhalational anesthetics are not considered nephrotoxic. Th e more so, inhalational anesthetics have a strong and direct protective eff ect on many organs through preconditioning and postconditioning. New studies have shown that sevofl urane diminishes ischemia/ reperfusion kidney injury and has an anti-infl ammatory eff ect, thus having the potential to reduce the occurrence of AKI. Given the incidence of AKI in the perioperative period, as well as new fi ndings about anesthetics, the issue of anesthetic selection during general anesthesia might be of crucial importance for the fi nal outcome of treatment.