Browsing by Author "Nemme, Janis"

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    Fibrinolytic system changes in liver surgery : A pilot observational study
    (2018) Ozolina, Agnese; Nemme, Janis; Ozolins, Arturs; Bjertnæs, Lars J.; Vanags, Indulis; Gardovskis, Janis; Viksna, Ludmila; Krumina, Angelika; Rīga Stradiņš University
    Introduction: Bleeding occurs frequently in liver surgery. Unbalance between tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) concentrations might increase bleeding. Our aim was to analyze perioperative fibrinolytic changes during liver surgery. Materials and Methods: We evaluated 15 patients for inclusion into a prospective pilot study of liver surgery. We assessed fibrinolysis by plasma PAI-1 and t-PA: before surgery (T1), before Pringle maneuver (PM;T2), at the end of surgery (T3) and 24 h postoperatively (T4), and registered demographic and laboratory data, extent and duration of surgery, hemodynamic parameters, blood loss, and transfused volumes of blood products. Data presented as mean ± SD. Significance at P < 0.05. Results: After exclusion of six patients only undergoing biopsies, we included six women and three men aged 49.1 ± 19.6 years; two patients with liver metastases of colorectal cancer and hepatocellular carcinoma, respectively, two with focal nodular hyperplasia, two with hepatic hemangioma, and one with angiomyolipoma. Six patients underwent PM. PAI-1 plasma concentration (n = 9) rose from 6.25 ± 2.25 at T1 through 17.30 ± 14.59 ng/ml at T2 and 28.74 ± 20.4 (p = 0.007) and 22.5 ± 16.0 ng/ml (p = 0.04), respectively, at T3 and T4. Correspondingly, t-PA plasma concentration (n = 9) increased from 4.76 ± 3.08 ng/ml at T1 through 8.00 ± 5.10 ng/ml (p = 0.012) at T2 and decreased to 4.25 ± 2.29 ng/ml and 3.04 ± 3.09 at T3 and T4, respectively. Plasma t-PA level at T2 was significantly different from those at T1, T3, and T4 (p < 0.004). In PM patients, t-PA levels increased from T1, peaked at T2 (p = 0.001), and subsequently decreased at T3 and T4 (p = 0.011 and p = 0.037), respectively. Mean blood loss was 1,377.7 ± 1,062.8 ml; seven patients received blood products. Patients with higher PAI-1 levels at T3 received more fresh frozen plasma (r = 0.79; p = 0.01) and red blood cells (r = 0.88; p = 0.002). Conclusions: During liver surgery, fibrinolysis increased, as evidenced by rises in plasma PAI-1and t-PA, especially after start of surgery and following PM. Transfused volumes of blood products correlated with higher plasma concentrations of PAI-1. Confirming this tendency requires a larger cohort of patients.
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    Minimal shedding of the glycocalyx layer during abdominal hysterectomy
    (2017-08-22) Nemme, Janis; Hahn, Robert G.; Krizhanovskii, Camilla; Ntika, Stelia; Sabelnikovs, Olegs; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Background: Surgery with and without hypervolaemia may cause shedding (breakdown) of the endothelial glycocalyx layer, but the severity of this problem is unclear. Methods: In this preliminary report of a larger clinical trial, the plasma and urine concentrations of three biomarkers of glycocalyx shedding (syndecan-1, hyaluronic acid and heparan sulfate) were measured in seven patients before, during, and after open hysterectomy. The fluid therapy consisted of 25ml/kg (approximately 2l) of Ringer's lactate, which was infused over 30min when the surgery started. The resulting plasma volume expansion at the end of the infusion was estimated from the haemodilution. Results: The mean plasma concentration of syndecan-1 was 21.7ng/ml before surgery and averaged 19.7ng/ml during and after the surgery. The plasma concentration of hyaluronic acid decreased from 38.0 to 27.7ng/ml (P<0.05), while heparan sulfate increased from 3.4 to 5.5μg/ml (P<0.05). The urine concentrations of syndecan-1 decreased significantly, while they increased for hyaluronic acid and heparan sulfate. Despite the vigorous fluid load, the urine flow did not exceed 1ml/min. Conclusions: No clear evidence was found for shedding of the endothelial glycocalyx layer when 2l of Ringer's lactate was infused over 30min during abdominal hysterectomy. Urine analyses yielded patterns of changes that differed from those in plasma. Trial registration:ISRCTN81005631. Registered May 17, 2016.