Ocena ekspresji TNF-a oraz kolagenu I i III w tkance raka żołądka

Introduction: Neoplasms are the second most frequent cause of death in Poland after vascular diseases. Recently, gastric cancer morbidity has decreased, but mortality is steel at a high level. Material and methods: Tissues from 24 patients with a histopathologically diagnosed mucosal and adenomucosal gastric cancer have been tested. Patients were divided in two equal groups: patients without metastases (G1) and patients with metastases in the liver (G2). RNA was isolated from homogenates after preliminary powdering of tissues in liquid nitrogen. RNA concentration was determined using spectrophotometer with RNA/DNA calculator ’Gene Quant’ (LKB Pharmacia Biotech). The tissue expression of the TNF-a, collagen type I and collagen type II encoding genes were assessed. Results: Higher TNF-a RNA expression was observed only for 2 patients from group G1, while in G2 group higher expression was observed in 5 from 12 patients in comparison to mean expression in margin. Higher expression of collagen I was found in 6 of 12 patients from the G1 group in comparison to margin. In the tissues with metastases (G2) higher expression of collagen type I was found in 5 tested tissues in comparison to margin. Higher expression of collagen III gene in comparison to margin was found in 8 from 12 tested tissues from G1 group. Higher expression in group 2 was also observed in 8 out of 12 tissues, in comparison to margin value in group I. Correlation analysis showed correlation between collagen I and TNF-a only in the healthy tissue (r = –0.603; p < 0.05). Conclusions. A statistically non-significant increase in expression of the TNF-a coding genes, type I and III collagen and lack of their mutual correlation weighs in favor of the fact that they are independent parameters. A statistically non-significant increase in expression of the TNF-a and collagen type I coding genes and a negative correlation between them indicates that TNF can’t affect the synthesis of collagen I.Wstęp: Nowotwory są drugą, po chorobach naczyń, przyczyną zgonów w Polsce. Ostatnio zachorowalność na raka żołądka się zmniejszyła, ale śmiertelność jest stale na wysokim poziomie. Materiał i metody: Materiał do badań stanowiły tkanki pobrane od 24 pacjentów z rozpoznanym histopatologicznie rakiem gruczołowym żołądka. Pacjentów podzielono na dwie grupy: pacjentów bez przerzutów do wątroby (G1) i pacjentów z przerzutami (G2). RNA izolowano z homogenatów po wstępnym kruszeniu komórek w ciekłym azocie. Stężenie RNA oznaczano techniką spektrofotometryczną z zastosowaniem RNA/DNA kalkulator „Gene Quant” (LKB Pharmacia Biotech). Ocenie poddano ekspresję tkankową genów dla TNF-a, kolegenu typu I i kolegenu typu III. Wyniki: Zwiększoną ekspresję genu dla TNF-a zaobserwowano jedynie u 2 pacjentów z grupy G1, podczas gdy w grupie G2 wyższą ekspresję zaobserwowano u 5 z 12 chorych w porównaniu ze zdrową tkanką. Zwiększoną ekspresję kolagenu I stwierdzono u 6 z 12 pacjentów z grupy G1 w porównaniu ze zdrową tkanką. W tkankach z przerzutami (G2) podwyższoną ekspresję genu dla kolagenu typu I stwierdzono w 5 badanych tkankach w porównaniu z marginesem. Zwiększoną ekspresję genu dla kolagenu III w porównaniu z marginesem stwierdzono w 8 z 12 badanych tkanek z grupy G1. Podwyższoną ekspresję w grupie II zaobserwowano także w 8 z 12 tkanek w porównaniu z wartością graniczną w grupie I. Analiza korelacji wykazała korelację między kolagenem I i TNF-a tylko w zdrowej tkance (r = –0,603, p < 0,05). Wnioski: Statystycznie nieznamienne zwiększenie ekspresji genu kodującego TNF-a, kolagen typu I i III oraz brak ich wzajemnych korelacji przemawia za faktem, że są to parametry niezależne. Nieznamienny statystycznie wzrost ekspresji genu kodującego TNF-a i kolagen typu I oraz ujemna korelacja między nimi wskazuje, że TNF-a nie może wpływać na syntezę kolagenu I

The usefulness of assessing the serum levels of S-100 protein in patients with ischemic stroke

Wstęp. W ostatnim okresie opublikowano wiele prac podkreślających konieczność poszukiwania nowych biochemicznych czynników, które obok badania klinicznego oraz badań neuroobrazujących mogłyby pomóc w określeniu stopnia ciężkości udaru niedokrwiennego mózgu, a w konsekwencji w prowadzonym leczeniu i określaniu rokowania. Od kilku lat w związku z nowymi możliwościami terapeutycznymi przy zastosowaniu leczenia neuroprotekcyjnego oraz fibrynolitycznego podkreśla się znaczenie oceny stopnia uszkodzenia mózgu już w pierwszych godzinach wystąpienia choroby. Celem pracy jest ocena stężenia białka S-100 w surowicy krwi u chorych z udarem niedokrwiennym mózgu w zależności od stopnia ciężkości udaru oraz ustalenie wartości diagnostycznej takiej oceny. Materiał i metody. Badaniem objęto 47 chorych z udarem niedokrwiennym mózgu. Rozpoznanie ustalono na podstawie badania klinicznego i tomografii komputerowej wykonywanej po 2. dobie od wystąpienia udaru. Stężenie białka S-100 w surowicy oznaczano w 1. dobie od zachorowania. Stan chorych przy przyjęciu do szpitala oraz po 30 dniach oceniano, stosując Skandynawską Neurologiczną Skalę Udarową, a oceny powrotu funkcji neurologicznych dokonywano, używając wskaźnika Barthel w 14. i 30. dobie po zachorowaniu. Grupę kontrolną stanowiło 10 zdrowych ochotników dobranych pod względem płci i wieku. Oznaczenia wykonano za pomocą metod enzymoimmunologicznych, stosując zestawy komercyjne. Wyniki. W grupie badanej stwierdzono znamiennie statystycznie wyższe stężenia białka S-100 niż w grupie kontrolnej. Wniosek. Białko S-100 jest parametrem o istotnej wartości diagnostycznej.Background. It is important to identify new biochemical markers of strokes to monitor and predict the neurological outcome, as well as to elucidate the multiple molecular mechanisms after ischemic brain infarction. Recently, an elevation of S-100 protein in serum were reported in strokes, but still, different biochemical techniques must be developed as soon as possible in order to help us to improve effective treatment. Modern neuroradiological techniques help to predict the outcome; however, repeating neuroradiological imaging is impractical. The aim of the study was to evaluate the serum levels of S-100 protein after brain infarction in correlation with clinical data and prognosis. Material and methods. S-100 protein serum levels were determined in 47 patients with an acute ischemic brain infarction in the first day (within 12 hours after the onset of symptoms) and sex and age matched control subjects. The clinical status was documented using the Scandinavian Stroke Scale. The functional deficit 4 weeks after stroke onset was scored with the Barthel Index. A cranial computed tomography (CCT) was performed after 2 days. Results. Elevated concentrations of S-100 protein were observed in patients with strokes. The S-100 concentrations in serum were significantly higher in patients with severe neurological deficits at the time of admission and correlated with the functional prognosis. Conclusions. The measurement of S-100 protein in serum is useful to diagnose and predict the outcome in patients after brain infarction

Usefulness of ultrasound guidance for central venous catheterisation in patients with end-stage renal disease

BACKGROUND: Renal replacement therapy often requires the insertion of a central venous catheter. The procedure is invasive and can lead to a number of complications. To minimise the risk of such complications, ultrasonography is used. The aim of the present study was to assess the usefulness of ultrasound-assisted vs. traditional method of location of anatomical orientation points for the placement of central venous catheters.METHODS: The prospective and randomised study was carried out, which included 135 patients requiring central venous catheterisation. Patients were allocated into two groups: group I (without ultrasound) — 70 patients and group II (ultrasound guidance) — 65 patients. In the latter, the procedure was performed in 38 cases due to technical problems. The following parameters were compared: age, patient’s condition, results of blood clotting tests, and selected renal function parameters. Moreover, the mode of procedure (emergent, scheduled), factors directly affecting the efficacy of catheter insertion and complications (use of anticoagulants, anatomical variants, sites of access, number of cannulation attempts) were analysed.RESULTS: Ultrasound was significantly more commonly used during emergent cannulation procedures (P = 0.002), in the elderly (P = 0.001) and unconscious patients (P = 0.001). Moreover, it was more frequently applied in patients undergoing anticoagulation (P = 0.01) and during the insertion of access through the subclavian and femoral vein (P = 0.013). The percentage of successful first attempt cannulation was higher in ultrasound-guided cases (P = 0.013). There were no significant intergroup differences in the incidence of early complications (P = 0.269).CONCLUSIONS: The study findings did not demonstrate significant differences in the incidence of early complications during cannulation with and without ultrasound guidance. The first attempt success rate was found to be significantly higher in cases of ultrasound-assisted central venous catheterisation.BACKGROUND: Renal replacement therapy often requires the insertion of a central venous catheter. The procedure is invasive and can lead to a number of complications. To minimise the risk of such complications, ultrasonography is used. The aim of the present study was to assess the usefulness of ultrasound-assisted vs. traditional method of location of anatomical orientation points for the placement of central venous catheters.METHODS: The prospective and randomised study was carried out, which included 135 patients requiring central venous catheterisation. Patients were allocated into two groups: group I (without ultrasound) — 70 patients and group II (ultrasound guidance) — 65 patients. In the latter, the procedure was performed in 38 cases due to technical problems. The following parameters were compared: age, patient’s condition, results of blood clotting tests, and selected renal function parameters. Moreover, the mode of procedure (emergent, scheduled), factors directly affecting the efficacy of catheter insertion and complications (use of anticoagulants, anatomical variants, sites of access, number of cannulation attempts) were analysed.RESULTS: Ultrasound was significantly more commonly used during emergent cannulation procedures (P = 0.002), in the elderly (P = 0.001) and unconscious patients (P = 0.001). Moreover, it was more frequently applied in patients undergoing anticoagulation (P = 0.01) and during the insertion of access through the subclavian and femoral vein (P = 0.013). The percentage of successful first attempt cannulation was higher in ultrasound-guided cases (P = 0.013). There were no significant intergroup differences in the incidence of early complications (P = 0.269).CONCLUSIONS: The study findings did not demonstrate significant differences in the incidence of early complications during cannulation with and without ultrasound guidance. The first attempt success rate was found to be significantly higher in cases of ultrasound-assisted central venous catheterisation

Penetrating brain injury: a case report

Background: Gunshot wounds as a result of attempted suicide, criminality or warfare comprise a significant group among penetrating injuries of the brain. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high, up to 98.5%. Although there are also many other prognostic factors for high mortality, such as damage to the ventricular system or the involvement of two or more lobes, GCS score seems to be the most important determinant. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improve the prognosis and final outcome. Case report: The authors present the case of a 27-year-old man who suffered a gunshot wound to the right temporal region, self-inflicted from an air-gun. On admission to the intensive care unit he received a score of 3 points on the GCS. There were also other negative prognostic factors — the pellet penetrated two lobes and damaged the third ventricle. Despite the serious prognosis, the appropriate multiprofile treatment and rehabilitation resulted in unexpectedly good recovery. Two years after the trauma the patient was conscious, maintained logical verbal contact, and was able to walk using a walking-aid. Conclusion: Rapid transport to a major trauma center is essential for patients with penetrating brain injury. Among all interventions it seems essential to provide the prevention of posttraumatic nervous tissue damage and associated neurological dysfunction.Background: Gunshot wounds as a result of attempted suicide, criminality or warfare comprise a significant group among penetrating injuries of the brain. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high, up to 98.5%. Although there are also many other prognostic factors for high mortality, such as damage to the ventricular system or the involvement of two or more lobes, GCS score seems to be the most important determinant. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improve the prognosis and final outcome. Case report: The authors present the case of a 27-year-old man who suffered a gunshot wound to the right temporal region, self-inflicted from an air-gun. On admission to the intensive care unit he received a score of 3 points on the GCS. There were also other negative prognostic factors — the pellet penetrated two lobes and damaged the third ventricle. Despite the serious prognosis, the appropriate multiprofile treatment and rehabilitation resulted in unexpectedly good recovery. Two years after the trauma the patient was conscious, maintained logical verbal contact, and was able to walk using a walking-aid. Conclusion: Rapid transport to a major trauma center is essential for patients with penetrating brain injury. Among all interventions it seems essential to provide the prevention of posttraumatic nervous tissue damage and associated neurological dysfunction

Epileptiform EEG patterns during different techniques of induction of general anaesthesia with sevoflurane and propofol: a randomised trial

Background: The aim of the study was to assess the influence of volatile induction of general anaesthesia with sevoflurane using two different techniques and intravenous anaesthesia with propofol on the possible presence of epileptiform electroencephalograph patterns during the induction of general anaesthesia. Methods: Sixty patients (age 18-70 years) were recruited. Exclusion criteria included history of epilepsy, neurological or neurosurgical diseases, pre-existing EPs in initial EEG recordings, medication interfering with EEG patterns. Patients were randomly allocated into three different groups: A (sevoflurane, increasing concentrations technique); B (sevoflurane, vital capacity technique); C (intravenous propofol). The clinical and instrumental monitoring included arterial blood pressure, heart rate, standard electrocardiography II, arterial oxygen saturation, facial electromyography, fraction of inspired sevoflurane, fraction of expired sevoflurane, minimal alveolar concentration of sevoflurane, and BIS. Results: Neurophysiological analysis of EEGs showed different EPs: polyspikes (PS), rhythmic polyspikes (PSR), and periodic epileptiform discharges (PED). EPs (p < 0.05) were observed in Group A (56%) and Group B (37%), but not in Group C. One patient in group B presented with clinical seizures. No significant differences in the vital parameters and anaesthesia parameters between groups was observed, regardless of the presence of EPs, which were associated with both low and more likely high (falsely indicating awakening from anaesthesia) BIS scores. Conclusion: Our study shows that the BIS score variations do not detect epileptiform activity, which was associated with both low and high scores. The sevoflurane concentration reached either sedative or toxic concentrations.Background: The aim of the study was to assess the influence of volatile induction of general anaesthesia withsevoflurane using two different techniques and intravenous anaesthesia with propofol on the possible presence ofepileptiform electroencephalograph patterns during the induction of general anaesthesia. Methods: Sixty patients (age 18–70 years) were recruited. Exclusion criteria included a history of epilepsy, neurologicalor neurosurgical diseases, pre-existing EPs (epileptiform patterns) in initial EEG recordings, medication interferingwith EEG patterns. Patients were randomly allocated into three different groups, namely: A (sevoflurane, increasingconcentrations technique); B (sevoflurane, vital capacity technique); and C (intravenous propofol).The clinical and instrumental monitoring included arterial blood pressure, heart rate, standard electrocardiography II,arterial oxygen saturation, facial electromyography, fraction of inspired sevoflurane, fraction of expired sevoflurane,minimum alveolar concentration of sevoflurane, and BIS. Results: Neurophysiological analysis of EEGs showed different EPs: polyspikes (PS), rhythmic polyspikes (PSR), andperiodic epileptiform discharges (PED). EPs (P &lt; 0.05) were observed in group A (56%) and group B (37%), but notin group C. One patient in group B presented clinical seizures. No significant differences in the vital parameters andanaesthesia parameters between groups was observed, regardless of the presence of EPs, which were associatedwith both low and more likely high (falsely indicating awakening from anaesthesia) BIS scores. Conclusion: Our study shows that the BIS score variations do not identify epileptiform activity, which was associatedwith both low and high scores. In addition, the sevoflurane concentration reached either sedative or toxicconcentrations

Personalised Approach to Diagnosing and Managing Ischemic Stroke with a Plasma-Soluble Urokinase-Type Plasminogen Activator Receptor

Background: The increasing incidence of ischemic stroke has led to the search for a novel biomarker to predict the course of disease and the risk of mortality. Recently, the role of the soluble urokinase plasminogen activator receptor (suPAR) as a biomarker and indicator of immune system activation has been widely examined. Therefore, the aim of the current study was to assess the dynamics of changes in serum levels of suPAR in ischemic stroke and to evaluate the prognostic value of suPAR in determining mortality risk. Methods: Eighty patients from the Department of Neurology, diagnosed with ischemic stroke, were enrolled in the study. Residual blood was obtained from all the patients on the first, third and seventh days after their ischemic stroke and the concentrations of suPAR and C-reactive protein (CRP), as well as the number of leukocytes and National Institute of Health&rsquo;s Stroke Scale (NIHSS) scores, were evaluated. Results: On the first day of ischemic stroke, the average suPAR concentration was 6.55 ng/mL; on the third day, it was 8.29 ng/mL; on the seventh day, it was 9.16 ng/mL. The average CRP concentration on the first day of ischemic stroke was 4.96 mg/L; on the third day, it was 11.76 mg/L; on the seventh day, it was 17.17 mg/L. The number of leukocytes on the first day of ischemic stroke was 7.32 &times; 103/mm3; on the third day, it was 9.27 &times; 103/mm3; on the seventh day, it was 10.41 &times; 103/mm3. Neurological condition, which was assessed via the NIHSS, on the first day of ischemic stroke, was scored at 10.71 points; on the third day, it was scored at 12.34 points; on the seventh day, it was scored at 13.75 points. An increase in the values of all the evaluated parameters on the first, third and seventh days of hospitalisation was observed. The patients with hypertension, ischemic heart disease and type 2 diabetes showed higher suPAR and CRP concentrations at the baseline as well as on subsequent days of hospitalisation. The greatest sensitivity and specificity were characterised by suPAR-3, where a value above 10.5 ng/mL resulted in a significant increase in mortality risk. Moreover, an NIHSS-1 score above 12 points and a CRP-3 concentration above 15.6 mg/L significantly increased the risk of death in the course of the disease. Conclusions: The plasma suPAR concentration after ischemic stroke is strongly related to the patient&rsquo;s clinical status, with a higher concentration on the first and third days of stroke resulting in a poorer prognosis at a later stage of treatment. Therefore, assessing the concentration of this parameter has important prognostic value

Quelques remarques touchant la procedure d’obtenir le consentement des patients prepares a la therapie de l’electrochoc

Electroconvulsive therapy (ЕСТ) as a medical procedure of higher risk as well as a therapy evoking certain controversies requires strict obedience to the conditions of acquiring the patient’s informed consent to the offered method of treatment. To acquire the patient’s consent it is necessary to inform him/her about the different aspects of electroconvulsive therapy. The paper stresses that in the case of ECT therapy, the spoken information given to the patient seems insufficient. It is necessary to work out a Polish questionnaire for acquiring the patient’s consent to electroconvulsive therapy and to apply it in all psychiatric institutions that carry out ECT procedures

Randomised controlled trial of analgesic effectiveness of three different techniques of single-shot interscalene brachial plexus block using 20 mL of 0.5% ropivacaine for shoulder arthroscopy

  BACKGROUND: Shoulder arthroscopic procedures impose a challenge to anaesthesiologists in terms of postoperative analgesia. Proper pain management after arthroscopic procedures improves patient satisfaction and facilitates early rehabilitation. METHODS: We performed a randomized, prospective clinical study to assess the influence of anthropometric parameters and IBPB technique on the quality of postoperative analgesia. A total of 106 randomly selected patients of ASA I–III status scheduled for elective shoulder arthroscopy. Reasons for exclusion were neurological deficit in the upper arm, allergies to amide-type local anesthetics, coagulopathy, and pregnancy.The patients received 20 mL of 0.5% ropivacaine for an ultrasound-guided interscalene brachial plexus block (IBPB) (group U), peripheral nerve stimulation (PNS)-confirmed IBPB (group N), or ultrasound-guided, PNS-confirmed IBPB (dual guidance; group NU). RESULTS: We observed that the three groups did not differ in mean time of sensory and motor block terminations. In individual cases in each group, sensory block lasted up to 890–990 minutes, providing satisfactory long lasting postoperative analgesia in patients receiving IBPB. We observed a negative correlation between body mass index and termination of motor block (P = 0.037, Pearson’s correlation coefficient) and a positive correlation between age and termination of sensory block (P = 0.0314, Pearson’s correlation coefficient) in group U compared to the other two groups. We found a positive correlation between male gender and termination of motor block (P = 0.0487, Pearson’s correlation coefficient) in group N compared to the other two groups. CONCLUSION: In our study, patients received satisfactory analgesia in the postoperative period regardless of technique used, age, gender, or potentially uncommon anthropometry.  BACKGROUND: Shoulder arthroscopic procedures impose a challenge to anaesthesiologists in terms of postoperative analgesia. Proper pain management after arthroscopic procedures improves patient satisfaction and facilitates early rehabilitation. METHODS: We performed a randomized, prospective clinical study to assess the influence of anthropometric parameters and IBPB technique on the quality of postoperative analgesia. A total of 106 randomly selected patients of ASA I–III status scheduled for elective shoulder arthroscopy. Reasons for exclusion were neurological deficit in the upper arm, allergies to amide-type local anesthetics, coagulopathy, and pregnancy.The patients received 20 mL of 0.5% ropivacaine for an ultrasound-guided interscalene brachial plexus block (IBPB) (group U), peripheral nerve stimulation (PNS)-confirmed IBPB (group N), or ultrasound-guided, PNS-confirmed IBPB (dual guidance; group NU). RESULTS: We observed that the three groups did not differ in mean time of sensory and motor block terminations. In individual cases in each group, sensory block lasted up to 890–990 minutes, providing satisfactory long lasting postoperative analgesia in patients receiving IBPB. We observed a negative correlation between body mass index and termination of motor block (P = 0.037, Pearson’s correlation coefficient) and a positive correlation between age and termination of sensory block (P = 0.0314, Pearson’s correlation coefficient) in group U compared to the other two groups. We found a positive correlation between male gender and termination of motor block (P = 0.0487, Pearson’s correlation coefficient) in group N compared to the other two groups. CONCLUSION: In our study, patients received satisfactory analgesia in the postoperative period regardless of technique used, age, gender, or potentially uncommon anthropometry

Risk factors for occurrence of failed interscalene brachial plexus blocks for shoulder arthroscopy using 20 mL 0.5% ropivacaine: a randomised trial

Background: Adequate pain management after arthroscopic procedures improves patients’ satisfaction with the performed procedure, as well as facilitating early rehabilitation. The aim of the current randomised, prospective clinical study was to assess the influence of anthropometric parameters and the interscalene brachial plexus block (IBPB) technique on the quality of post-operational analgesia. Methods: 109 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. Reasons for non-inclusion were as follows: neurological deficit in the upper arm; allergies to amide Las; coagulopathy; and pregnancy. The patients received 20 mL of 0.5% ropivacaine for an ultrasound (US)-guided IBPB (group U), peripheral nerve stimulation (PNS)-confirmation IBPB (group N), or US-guided, PNS-confirmed IBPB (dual guidance; group NU). Results: We observed that the studied groups did not differ in mean time of sensory and motor block terminations and, surprisingly, in each group in individual cases the sensory block lasted up to 890-990 minutes providing satisfactory long-lasting post-operational analgesia in patients receiving IBPB. We observed a negative correlation between BMI and termination of the motor block and a positive correlation between age and termination of the sensory block in patients receiving US-guided IBPB (group U) in comparison with the two other groups. We found a positive correlation between the male gender and termination of the motor block in patients receiving PNS-guided IBPB (group N) in comparison with two other groups. Conclusion: In our study, patients received satisfactory analgesia in the post-operational period no matter what technique was used regardless of their age, gender or potentially uncommon anthropometry.Background: Adequate pain management after arthroscopic procedures improves patients’ satisfaction with theperformed procedure, as well as facilitating early rehabilitation. The aim of the current randomised, prospectiveclinical study was to assess the influence of anthropometric parameters and the interscalene brachial plexus block(IBPB) technique on the quality of post-operational analgesia. Methods: 109 randomly selected patients of ASA I–III status were scheduled for elective shoulder arthroscopy. Reasonsfor non-inclusion were as follows: neurological deficit in the upper arm; allergies to amide Las; coagulopathy; andpregnancy. The patients received 20 mL of 0.5% ropivacaine for an ultrasound (US)-guided IBPB (group U), peripheralnerve stimulation (PNS)-confirmation IBPB (group N), or US-guided, PNS-confirmed IBPB (dual guidance; group NU). Results: We observed that the studied groups did not differ in mean time of sensory and motor block terminations and,surprisingly, in each group in individual cases the sensory block lasted up to 890-990 minutes providing satisfactorylong-lasting post-operational analgesia in patients receiving IBPB. We observed a negative correlation between BMIand termination of the motor block and a positive correlation between age and termination of the sensory block inpatients receiving US-guided IBPB (group U) in comparison with the two other groups. We found a positive correlationbetween the male gender and termination of the motor block in patients receiving PNS-guided IBPB (group N)in comparison with two other groups. Conclusion: In our study, patients received satisfactory analgesia in the post-operational period no matter whattechnique was used regardless of their age, gender or potentially uncommon anthropometry

Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial

Background: Horner’s syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateralsympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinalanaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of thisrandomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB)technique on the occurrence rate of Horner’s syndrome and identify contributing risk factors. Methods: 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. Thepatients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation(PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU). Results: We observed that Horner’s syndrome developed in 12% of the N group, 6% of the NU group, and 9% of theU group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used toinduce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patientsto the development of Horner’s syndrome. Interestingly, our results showed that NU patients with Horner’s syndromewere significantly younger than NU patients without Horner’s syndrome. Conclusion: The precision of IBPB by use of the dual guidance technique may reduce the rate of Horner’s syndrome.The higher water concentration in the prevertebral spaces of younger patients may create better conditions for thediffusion of ropivacaine, which may result in a statistically significant higher HS rate.