SummaryImmunological changes in anaesthetic personnel exposed to occupational concentrations of holothane and nitrous oxide 1040 times greater than the advised maximum were studied during routine work and after 3-4 weeks holiday. Red Occupational exposure of anaesthetic personnel to anaesthetic gases has been widely investigated,'-I3 but information on how the immune system is affected is limited.l"16 Nitrous oxide" and halothane" decreased the number of leukocytes in the peripheral blood of rodents, but allogenic skin transplant rejection was not affected." Halothane and nitrous oxide in mice caused partial inhibition of cellmediated cytotoxicity;" halothane decreased the responsiveness of human lymphocytes to phytohaemagglutinin.20 Halothane also impaired lymphocytotoxicity against allogenic tumour cells of the same histological type in children.2' Nunn's group reported that neutrophil migration, chemotaxis, phagocytosis, degranulation and enhanced non-mitochondria1 respiration associated with phagocytosis were unaffected after in vitro exposure to halothane,22 but nitrous oxide decreased motility of human neutrophils.*' A similar negative finding for halothane was reported by others,"s25 but nitrous oxide was shown to increase polymorphonuclear leukocyte chemotaxis26 and even counteract the adverse effect of hal~thane.~' Some authors hold that in vivo inhibition of phagocytosis during anaesthesia results from factors such as stress or altered blood flow and not from the effects of anaesthetics2* This present study investigates the effects of nitrous oxide and halothane on the immunological system of anaesthetic personnel. The staff had been complaining of weakness and recurrent infections and decreased peripheral blood leukocyte counts had often been found on routine control testing. We therefore checked the concentrations of halothane and nitrous oxide in operating theatres and determined some immunohaematological variables in the personnel at the peak of the working season and after the summer holidays. It turned out that the operating theatres were improperly ventilated, with increased concentrations

N-terminal pro-atrial natriuretic peptide [proANP(1-98)] has been extensively investigated in patients with chronic heart failure and ishemic heart disease. It is found to be a better marker of cardiac dysfunction than atrial natriuretic peptide (ANP). The possible involvement of proANP(1-98) in cardiac depression caused by sepsis has not been studied yet. Therefore, we analyzed atrial plasma concentration of proANP(1-98) in 17 septic patients with hemodynamic variables measured or calculated using pulmonary artery catheter. The results of altogether 96 measurements show a significant negative correlation of proANP(1-98) and cardiac index (p<0.024), oxygen delivery (p<0.03) and oxygen consumption (p<0.03). There is also a positive correlation with pulmonary vascular resistance (p<0.03). ProANP(1-98) is significantly higher in patients who developed acute respiratory distress syndrome (ARDS) (p<0.001). This study implies that proANP(1-98) is a possible novel hormone marker of cardiac depression caused by sepsis that could be used for prediction of ARDS.

Background Long‐term occupational exposure to volatile anesthetic agents may result in various adverse health effects. Additionally, certain surgical procedures involve exposure to the other agents such as X rays. Identification of chromosome damages in peripheral blood lymphocytes serves as a useful indicator of exposure to mutagenic agents. Methods The frequency of chromosomal aberrations was assayed in peripheral lymphocytes obtained from 129 subjects working in operating theatres and 41 control subjects. Results The results show an increased rate of chromosome aberrations in the exposed subjects. The differences in frequency of chromosome aberrations between particular job tasks were not distinct. Acentric fragments in anesthesiologists and dicentrics in surgeons seem to stand out. Conclusions As the findings do not differ significantly between the exposed groups, one can hardly distinguish radiation and anesthetics effects from one another. Am. J. Ind. Med. 35:642–646, 1999. © 1999 Wiley‐Liss, Inc.

Background Ventilator-associated pneumonia caused by Pseudomonas aeruginosa (PA) in hospitalised patients is associated with high mortality. The effectiveness of the bivalent, bispecific mAb MEDI3902 (gremubamab) in preventing PA nosocomial pneumonia was assessed in PA-colonised mechanically ventilated subjects. Methods EVADE (NCT02696902) was a phase 2, randomised, parallel-group, double-blind, placebo-controlled study in Europe, Turkey, Israel, and the USA. Subjects ≥ 18 years old, mechanically ventilated, tracheally colonised with PA, and without new-onset pneumonia, were randomised (1:1:1) to MEDI3902 500, 1500 mg (single intravenous dose), or placebo. The primary efficacy endpoint was the incidence of nosocomial PA pneumonia through 21 days post-dose in MEDI3902 1500 mg versus placebo, determined by an independent adjudication committee. Results Even if the initial sample size was not reached because of low recruitment, 188 subjects were randomised (MEDI3902 500/1500 mg: n = 16/87; placebo: n = 85) between 13 April 2016 and 17 October 2019. Out of these, 184 were dosed (MEDI3902 500/1500 mg: n = 16/85; placebo: n = 83), comprising the modified intent-to-treat set. Enrolment in the 500 mg arm was discontinued due to pharmacokinetic data demonstrating low MEDI3902 serum concentrations. Subsequently, enrolled subjects were randomised (1:1) to MEDI3902 1500 mg or placebo. PA pneumonia was confirmed in 22.4% (n = 19/85) of MEDI3902 1500 mg recipients and in 18.1% (n = 15/83) of placebo recipients (relative risk reduction [RRR]: − 23.7%; 80% confidence interval [CI] − 83.8%, 16.8%; p = 0.49). At 21 days post-1500 mg dose, the mean (standard deviation) serum MEDI3902 concentration was 9.46 (7.91) μg/mL, with 80.6% (n = 58/72) subjects achieving concentrations > 1.7 μg/mL, a level associated with improved outcome in animal models. Treatment-emergent adverse event incidence was similar between groups. Conclusions The bivalent, bispecific monoclonal antibody MEDI3902 (gremubamab) did not reduce PA nosocomial pneumonia incidence in PA-colonised mechanically ventilated subjects. Trial registration Registered on Clinicaltrials.gov (NCT02696902) on 11th February 2016 and on EudraCT (2015-001706-34) on 7th March 2016.

S-w Key words Anaesthetists. Complications.Various effects of chronic exposure to anaesthetic gases have been described [l-191. The development of more sophisticated immunological tests has coincided with an improvement in scavenging of gases such that there are relatively few complete studies of the immunological effects of chronic exposure at high concentrations [8,15]. None of these studies have considered the effect of age on these disturbances.A fault in the scavenging system in one of our hospitals allowed us to study the immunological haematology of a number of anaesthetic personnel chronically exposed to high concentrations of anaesthetic gases. The general results of this study have previously been reported [ZO]. The current study presents a further analysis of the data. In the original study, we reported various disturbances in the cellular immune mechanism and haematology in anaesthetic staff both following exposure, and after 3 weeks holiday away from the exposure, and compared them with a sex-and agematched group of nonexposed healthy individuals. In this study, we have presented the effect of age on these changes. Subjects and MethodsTwenty-one anaesthetic staff, 5 male and 16 female, were examined before the holidays (the peak of the working season), and after 3 weeks holiday; 17 of these were retested. A control group of 35 healthy subjects were matched for age and sex. The groups were further subdivided by age into two (aged 29-40 and 41-50 years) thus providing six sets of results.Data were compared by paired and unpaired Student's t-test (for normally distributed data) and Ma-Whitney and Wilcoxon's tests (for nonparametric data). Two comparisons were performed (a) between younger and older anaesthetic staff before and after the holidays and the control group, and (b) between all corresponding age groups.We analysed erythrocyte count, haemoglobin concentration, haematocrit, white blood cell count and differential leucocyte count: eosinophils, basophils, total neutrophils, segmented and nonsegmented neutrophils, monocytes, lymphocytes, lymphocyte CD2 (Tll), CD4 (T4), CD8 (T8)

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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.

Objective: To investigate analgesia using lidocaine suppository for prostate biopsy.Material and methods: From 2007 to 2009, 160 patients underwent the trans-rectal ultrasound guided prostate biopsy at the Department of Urology, KBC Zagreb. Eighty patients received 60 mg lidocaine suppository intra-rectally at different time points from 15 to 120 minutes before biopsy and 80 patients received glycerine suppository as placebo. We also collected data about patient age, prostate specific antigen levels, prostate volume and pathohistological findings after the biopsy. The pain level was evaluated using a visual analogue scale (VAS).Results: There were no statistically significant differences between the groups i.e. they were similar regarding the patients' age, prostate specific antigen levels, prostate volume and the incidence of diagnosis of malignancy on biopsy. The mean pain score in the lidocaine group (3 ± 1) was significantly lower than the mean pain score in the glycerine group (4.1 ± 1.3) [p< 0.001]. A noticeable trend towards lower pain scores in the lidocaine group was observed with more time elapsed from placing the suppository till the biopsy and the optimal time for performing the biopsy starts approximately one hour after placing the suppository.Conclusion: Lidocaine suppository is an easy to use, self applicable (by the patient) and cheap method of local analgesia, with acceptable results. Possible complications related to this procedure are insignificant.