The bone microstructure from anterior cruciate ligament footprints is similar after ligament reconstruction and does not affect long-term outcomes.

PURPOSE: The purpose of this study was to assess the quality of the bone tissue microstructure from the footprints of the anterior cruciate ligament (ACL) and its impact on late follow-up outcomes in patients who undergo anterior cruciate ligament reconstruction (ACLR). METHODS: The records of 26 patients diagnosed with a completely torn ACL who underwent ACLR were collected. During the surgery performed using the Felmet method, bone blocks from the native ACL footprints were collected. The primary measurements of the bone microstructure were made using a microtomographic scanner. In late follow-up examinations, a GNRB arthrometer was used. RESULTS: There was no significant difference in the bone microstructure assessed using micro-CT histomorphometric data according to the blood test results, plain radiographs, age or anthropometric data. There was no difference in the bone volume/total volume ratio or trabecular thickness in the area of the native ACL footprints. Routine preoperative examinations were not relevant to the quality of the bone microstructure. The elapsed time from an ACL injury to surgery had no relevance to the results of arthrometry. CONCLUSION: The similarities in the microstructure of bone blocks from ACL footprints from the femur and tibia allow the variable use of these blocks to stabilize grafts in the Felmet method. The bone microstructure is not dependent on the time from injury to surgery. Histomorphometric values of the structure of the femoral and tibial ACL footprints have no impact on the long-term stability of the operated knee joint. TRIAL REGISTRATION: The approval of the Bioethics Committee of the Silesian Medical Chamber in Katowice, Poland (resolution 16/2014) was given for this research. LEVEL OF EVIDENCE: II.

Relationship between stroke severity, extensity of leukoaraiosis, and brain atrophy in patients with ischaemic stroke.

PURPOSE: Leukoaraiosis (LA), according to the latest classification, is white matter hyperintensity - morphological findings of small blood vessel disease of the brain. This radiological detection of small vessels disease is important because there are no technical possibilities to assess small vessels of the brain using computed tomography (CT) or magnetic resonance imaging (MRI) angiography. Our aim was to analysis the relationship between the extension of leukoaraiosis and severity of ischaemic stroke and brain atrophy. MATERIAL AND METHODS: We retrospectively analysed 77 head CT scans of patients admitted from the emergency room (ER) to the Radiology Department due to suspected stroke. We assessed the severity of leukoaraiosis using the van Swieten scale and brain atrophy by numerous linear measurements. RESULTS: Statistical analysis failed to demonstrate differences between LA1 and LA2 groups with regard to stroke severity in National Institutes of Health Stroke Scale (NIHSS) (p = 0.2159). There were no differences with regard to clinical severity of stroke between the study groups divided depending on the extent of brain atrophy. There were statistically significant differences with regard to the anterior horn width of the right and left lateral ventricle, posterior horn width of the right and left lateral ventricle, distance between occipital horn of the left lateral ventricle and internal surface of the cranium and third ventricle width depending on the severity of leukoaraiosis. CONCLUSIONS: The results of our studies present an association between the degree leukoaraiosis extension and brain atrophy, but no association between central nervous system tissue atrophy of extent of leukoaraiosis and ischaemic stroke severity.

What you cannot get from routine MRI of MS patient and why - The growing need for atrophy assessment and seeing beyond the plaque.

Multiple sclerosis is a disease that still has not been fully understood and calls for better diagnostic procedures for the improvement of everyday patient care and drug development. Routine magnetic resonance examinations reveal demyelinating focal lesions, but they do not correlate sufficiently with the patients' disability and cognitive impairment. For more than 100 years it has been known that demyelination affects not only white but also grey matter of the brain. Recent research has confirmed the serious consequences of grey matter pathology. Over the last several years, atrophy of the brain and especially of its grey matter has become a most promising marker of the patients' clinical status. The paper discusses the concept and importance of atrophy assessment in relation to the standard magnetic resonance results.

Expression of chemokine receptors on peripheral blood T cells in children with chronic kidney disease.

Chemokine receptors play a role in leukocyte recruitment, activation, and maintaining effector functions and regulate adaptive immune response and angiogenesis. The study aimed at flow cytometric analysis of T cell subsets with selected surface chemokine receptors (CCR4, CCR5, CCR7, CXCR3, and CXCR4) or receptor combination in peripheral blood of children with chronic kidney disease (CKD) on hemodialysis (HD). The percentage of T lymphocytes with CD8 and combined CD28,CCR7 expression was higher in HD children. The percentage of T lymphocytes expressing CCR7, CD28,CCR7, and CXCR4,CD8 was increased in children on conservative treatment. Total number (tn) of CXCR4+ cells was reduced in children on hemodialysis. The tn of T CXCR3+ cells was lower in children on conservative treatment. During HD the percentage of T CD4+ cells was higher and of T CXCR3+ lymphocytes was lower after HD session as compared to 15 min of session duration. During HD tn of T cells with expression of CCR4, CCR5, CCR7, CXCR3, and CXCR4 was constant. The alteration of chemokine receptors expression in children with CKD occurs early in the development. Diminished expression of CXCR3, CXCR4 on T cells in patients with CKD on HD might result in impaired inflammatory response. Increased CCR7+ T cell percentage could be responsible for the alteration of migration of cells into secondary lymphatic organs.

Bone metabolism and the muscle-bone relationship in children, adolescents and young adults with phenylketonuria.

The aim of the study was to assess body composition in subjects with phenylketonuria (PKU). Forty-five patients aged 13.8 ± 5.2 years were evaluated. Among them, 15 patients had not reached sexual maturity, showing normal serum values of phenylalanine (Phe) (subgroup 1), and 30 subjects were sexually mature (Tanner 5 stage), showing either normal serum Phe (18 cases; subgroup 2a) or increased serum Phe (12 cases; subgroup 2b). DXA-assessed spine and total body (TB) measurements [bone mineral density (BMD), bone mineral content (BMC), lean body mass (LBM) and the calculated ratios BMC/LBM] as well as laboratory parameters (serum carboxyterminal telopeptide of type I collagen, bone alkaline phosphatase, osteocalcin, parathormone, calcitonin, total and ionized calcium) were analyzed. Statistically significant differences were revealed between subgroup 1 versus 2a for TB BMC/LBM ratio SD scores and between subgroup 2a versus 2b for TB BMD, spine BMD, TB BMC/LBM ratio and spine BMC/LBM ratio SD scores. Stepwise multiple regression analysis revealed that serum Phe negatively affected bone status. The skeletal status in children with PKU is impaired by the disease. Applying body composition parameters instead of BMD alone may reflect the level of impairment in a new, different way.

Clinical features of asthma in children differ with regard to the intensity of distal gastroesophageal acid reflux.

BACKGROUND: The prevalence of gastroesophageal reflux (GER) in children with asthma is higher than in healthy controls, but the nature and direction of this association is unclear. OBJECTIVE: The aim of our study was to assess the relationship between esophageal acid exposure and the clinical features of asthma in children. METHODS: In total, 66 children (mean age 122.8 months [SD 44.89 months]) with chronic pulmonary symptoms, fulfilling diagnostic criteria of persistent asthma, underwent 24-hour esophageal pH monitoring and answered a detailed questionnaire-based survey. The questionnaire topics included environmental factors, familial history, current and previous clinical symptoms, atopy, asthma severity, and medication. RESULTS: Abnormal results of 24-hour esophageal pH monitoring were found in 28 out of 66 children (42.4%). Age, sex, severity of asthma, environmental factors, spirometry results, and the type of medication did not correlate with esophageal acid exposure. However, children with abnormal pH results developed asthma significantly earlier (asthma onset 3.63 years [SD 2.52 years] vs 5.77 years [SD 3.82 years]; p < .01). Nonatopic individuals had more intensive esophageal acid exposure than atopic ones (Boix-Ochoa score 28.19 [SD 18.26] vs 18.26 [SD 12.84]; p < .048). The intensity of GER was also significantly correlated with frequent or difficult-to-control nighttime asthma attacks. CONCLUSIONS: There are differences in clinical features of asthma in children with regard to the intensity of esophageal acid exposure. Symptoms of asthma in nonatopic individuals with early onset and difficult-to-control nighttime asthma attacks suggest the possibility of concomitant, clinically relevant GER.

The Effect of Immunosuppression on Selected Antioxidant Parameters in Patients with Graves' Disease with Active Thyroid-Associated Orbitopathy.

BACKGROUND AND STUDY AIMS: Thyroid-associated orbitopathy, the most common extrathyroidal manifestation of Graves' disease, is an autoimmune inflammation of orbital soft tissue. We report the study assessing the effect of immunosuppressive treatment with methylprednisolone on selected antioxidant parameters in patients with Graves' disease with active thyroid-associated orbitopathy. PATIENTS AND METHODS: Activity and serum levels of selected antioxidant parameters as well as lipid peroxidation products were determined in a group of 56 patients with active thyroid-associated orbitopathy at three time-points: at baseline, after the discontinuation of intravenous methylprednisolone treatment and at 3 months after the discontinuation of additional oral methylprednisolone treatment. A control group consisted of 20 healthy age- and sex-matched volunteers. RESULTS: We found an increased activity of superoxide dismutase and glutathione peroxidase and increased serum levels of uric acid, malondialdehyde and conjugated dienes, as well as a reduced activity of paraoxonase-1 and reduced serum vitamin C level in the study group at baseline. Systemic intravenous and oral methylprednisolone therapy led to normalization of activity and concentration of the most studied parameters. CONCLUSION: Results of our study confirmed that oxidative stress is one of the factors involved in the pathogenesis of thyroid-associated orbitopathy and the methyloprednisolone treatment is effective in reducing both clinical symptoms and oxidative stress in patients with this disease.

Chemokine receptors on peripheral blood T lymphocytes in children on peritoneal dialysis.

BACKGROUND: Immune cell dysfunction is listed among complications resulting from chronic kidney disease (CKD). It could be associated with T-cells, which play a role in the lymphocytic migration and infiltration. However, the data on chemokine receptors expression on T-cells in patients with CKD particularly treated with peritoneal dialysis (PD) are still limited. METHODS: The study aimed at multiparameter flow-cytometric analysis of the absolute numbers and percentage of T-cell subsets with surface chemokine receptors (CCR4, CCR5, CCR7, CXCR3, and CXCR4) or receptors' combinations in 47 children treated with PD. RESULTS: We found lower absolute numbers of total T lymphocytes, lymphocytes with surface CCR5, CXCR4+CCR5, CXCR3+CCR5 antigens and T-cells with CCR4, CCR4+CD4, CXCR3, CXCR3+CD4, and CD8 receptors. Lymphocytes T with CD4, CCR7, CD28+CCR7, CXCR3+CD8 antigens showed higher percentage in children on PD as compared to healthy children and opposite percentage values of CCR4+, CCR4+CD4+, CXCR3+ T lymphocytes were diminished. Mean fluorescent intensity for CCR7+, CCR7+CD45RO+, CCR7+CD28+, CXCR4+CD4+, CCR5+CD4+, CCR4+, CCR4+CD4+ T-cells was lower in the PD group than in healthy children. The analysis of correlation between T lymphocyte subpopulations with chemokine receptors and other parameters revealed positive correlation of CCR7+ and CCR7+CD28+ T-cells and weekly creatinine clearance, negative correlation between the percentage of CD45RO+CCR7 antigen positive T-cells and KT/Vurea. SUMMARY: In conclusion, we could not confirm the phenomenon of earlier senescence of T-cells in children with CKD on PD treatment. This still requires further investigation. The higher percentage of T-cells with CCR7 surface receptor could be responsible for the increase of proliferation activity in this group of children.

Evaluation of postural balance control in patients with multiple sclerosis - effect of different sensory conditions and arithmetic task execution. A pilot study.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the effect of concomitant cognitive task execution and different sensory conditions on balance control in patients with multiple sclerosis (MS). MATERIAL AND METHODS: Thirty-two subjects with MS and 30 healthy age- and sex-matched control subjects were included in the study. Balance Performance Oriented Mobility Assessment was performed in all subjects. Their spontaneous sway characteristics while standing with different sensory conditions and during execution of a simple arithmetic task were analysed. Mean sway in the coronary and sagittal plane, as well as sway velocity, were measured. RESULTS: The values of all evaluated variables obtained in all tests were significantly higher in the MS group than in controls. In the MS group, more pronounced progression of changes in response to increased difficulty of the test was also observed. Analysis of risk of falls in MS revealed a significant increase of sway velocity and mean sway in the mediolateral and anteroposterior plane in the majority of tests. CONCLUSIONS: Postural stability in patients with MS is significantly decreased in comparison with the control group in all evaluated conditions. Stability deficit is enhanced in response to more difficult conditions of evaluation. Increased risk of falls is related to the increased postural sway velocity and length of mean sway; this association is most pronounced in the coronary plane.

[Comparison of selected elements of neonate immunological system with relation to indications for cesarean section and time of delivery]. / Porównanie wybranych parametrów ukladu odpornosciowego noworodka w zaleznosci od wskazan do ciecia cesarskiego i czasu rozwiazania ciazy.

AIM OF STUDY: To define to what degree time and the way of delivery cause changes in CD3+ lymphocytes and their subpopulations CD4+, CD8+, CD25+ and CD19+ lymphocytes and their subpopulations CD5+, CD23+. MATERIAL AND METHODS: 49 healthy neonates born in the years 1998-2003 in the Clinical Ward of Perinatology and Gynecology of Silesian Medical University in Zabrze were examined. Taking into account the time of pregnancy and the way of delivery the children were divided into the following groups: Group Ib--23 full-term neonates born by Cesarean section, including 15 neonates with elective indications (Ibe), 8 with emergency indications (Ibn). Group IIb--26 pre-term neonates born by Cesarean section, including 18 with elective indications (IIbe) and 8 with emergency indications (IIbn). Our study applied a method of umbilical blood sampling with the following red blood cells lysis. RESULTS: Statistically significant lower mean number of B CD5+ lymphocytes was found in full-term neonates born by Cesarean section in comparison to pre-term neonates born by the same method. Similar differences concern full-term and pre-term neonates born by elective Cesarean section. Statistically significant lower mean number of CD3+, CD4+ and CD25+ lymphocytes was found in pre-term neonates born by elective Cesarean section in comparison to pre-term neonates by emergency Cesarean section. CONCLUSIONS: Time of pregnancy termination in a mother by Cesarean section can be related to the occurrence of statistically significant changes in B CD5+ lymphocytes quantities in her neonate. Emergency Cesarean section in a mother can be related to the increased quantity of T lymphocytes, helper T lymphocytes, activated T lymphocytes in her pre-term born neonate. No statistically significant differences were found in mean values of other immunological parameters among study groups.

[Emergency and elective cesarean section and selected elements of immunological system of full-term neonates]. / Wskazania nagle lub elektywne do ciecia cesarskiego a wybrane elementy ukladu immunologicznego u noworodków urodzonych o czasie.

AIM OF STUDY: To define a relationship between emergency and elective indications for cesarean section and quantitative changes of percentage and quantity of T and B lymphocytes and their subpopulations in healthy full-term neonates. MATERIAL AND METHODS: The study included 43 healthy neonates born in the years 1998 - 2003 in the Department of Perinatology and Gynecology of Silesian Medical University in Zabrze, Taking into account operative delivery, a group of 43 full-term neonates born by cesarean section were examined, including 25 neonates with elective indications [Ibe] and 18 with emergency indications (Ibn). Immunological studies included evaluation of the percentage of T and B lymphocytes and of their subpopulations in umbilical blood. Our study applied a method of umbilical blood sampling with the following red blood cells lysis. RESULTS: The study showed that mean number of CD3+, CD23+, CD25+ lymphocytes and mean percentage and number of CD8+ lymphocytes in full-term neonates born by elective Cesarean was statistically significantly lower than in neonates born by emergency Cesarean section. No statistically significant differences were found in mean values of other parameters among the study groups. CONCLUSIONS: Cesarean section performed in a mother with emergency indications can favor an increase of mean quantity of T lymphocytes, cytotoxic - suppressor T lymphocytes, activated T lymphocytes, B CD23 lymphocytes in full-term neonates.

[Application of long term subcutaneously implanted access into the central veins system of "PORT" type in the Clinic of Pediatry, Pediatric Hematology and Oncology in Zabrze--15 year own observations]. / Zastosowanie dlugoterminowego, implantowanego podskórnie akcesu do ukladu zyl centralnych typu "PORT" w Klinice Pediatrii, Hematologii i Onkologii Dzieciecej w Zabrzu--15 lat obserwacji wlasnych.

INTRODUCTION: Long term disease treatment in children is a very special medical problem due to a necessity of maintaining an efficient venous access for many months and even years. Vascular ports applied in those children improved the conditions of treatment and a quality of life, additionally, made the job of personnel taking care of them easier. MATERIAL AND METHODS: The study presents own experience in long-term venous access into the central veins system, so called vascular ports, gathered for 15 years of using them in children with hemato-oncogical diseases. The analysis of 309 of implanted vascular ports was done taking into consideration the maintenance and complications. Ports were implanted in 300 children with oncological diseases. The received results are presented in numbers and percentage. RESULTS: Mean time of port insertion has decreased in comparison to earlier studies by 35 days and now is 722 days, median 658 days, however, minimal and maximal time of port insertion has changed respectively 7 and 2099 days. The total time of port insertion in this period was 232 536 days. The observation showed 31 (10.03%) cases of complications, out of which the most common were set infection (16 - 5.18%), catheter occlusion by a clot (7 - 2.27%) and "spontaneous" catheter move out of vessel lumen (3 - 0.97%), migration of a torn-off catheter into the right heart ventricle (2 - 0.65%). CONCLUSIONS: 1. Application of vascular ports enabled a long-term and intensive chemotherapy in children with oncological and hematological diseases. 2. Application of vascular ports bears a minor risk of complications, the most dangerous observed complication was a replacement of a torn-off catheter into the right heart ventricle.

Evaluation of retinal function improvement in neovascular age-related macular degeneration after intravitreal aflibercept injections with the use of the assessment of retinal sensitivity: The use of the assessment of retinal sensitivity in anti-VEGF treatment - a STROBE-compliant observational study.

This study compares 2 methods of macular function evaluation: the microperimetric examination (mean central retinal sensitivity and fixation stability) and the distance best-corrected visual acuity (BCVA) examination, which is the most frequently used method of assessing macular function in patients with newly diagnosed wet age-related macular degeneration (AMD) who have been treated with anti-vascular endothelial growth factor (VEGF) drug (aflibercept).Prospective analysis was conducted on 44 eyes of 44 patients treated with intravitreal injection of anti-VEGF (aflibercept) because of newly diagnosed neovascular AMD. According to the research protocol, all patients had a 6-month follow-up. The response to treatment was monitored functionallybyMP-1 microperimetry, fixation, and distance BCVA assessment after injection. Improvement of retinal sensitivity and BCVA was found under aflibercept treatment. There was statistically significant improvement in retinal sensitivity in the MP-1 study 3 and 6 months from the beginning of anti-VEGF therapy. Moreover, a significant improvement in retinal sensitivity between 3 and 6 months of observation was demonstrated. At the same time, up to 3 months from the beginning of treatment, BCVA improved significantly compared to the baseline value. In the 6th month of the study BCVA remained stable without further significant improvement.Microperimetric examination with medium sensitivity and fixation stability assessment is a very valuable test determining the retinal function. It is clear that examining the macular morphology itself in modern diagnostics is not enough to assess retinal function. Microperimetry technique is a valuable tool for functional long-term evaluation of retinal function (also for a period of more than 3 months).

The assessment of the kinematics of the rescuer in continuous chest compression during a 10-min simulation of cardiopulmonary resuscitation.

BACKGROUND: In pursuit of improvement in cardiopulmonary resuscitation (CPR), new technologies for the measurement and assessment of CPR quality are implemented. In our study, we assessed the kinematics of the rescuer during continuous chest compression (CCC-CPR). The proper performance of the procedure is a survival predictor for patients with cardiac arrest (CA). The purpose of the study was a prospective assessment of the kinematics of the rescuer's body with consideration given to the depth and rate of chest compression (CC) as the indicator of properly performed CC maneuver by professional and non-professional rescuers during a simulation of a 10-min CCC using a manikin. METHODS: Forty participants were enrolled in the study. CCC-CPR was performed in accordance with the 2015 AHA guidelines on a manikin positioned on the floor. Kinematic data on the movement were obtained from the measuring system (X-sens MVN Biomech) transmitting information from 17 inertial sensors. Measurement data were imported to the author's program RKO-Kinemat written in the Matlab and C # environments. Two groups of results were distinguished: Group I-results of CC with the depth of ≥ 40 mm and Group 2-CC results with the depth of < 40 mm. RESULTS: The multiple regression model demonstrated that the path length, left knee flexion angle, and left elbow flexion angle were the essential elements of the rescuer's kinematics that facilitated achieving and maintaining the normal depth of CC. CONCLUSIONS: We believe that raising the rescuer's hips by moving the center of the rescuer's body over the point of sternal compression increases the value of the CC force vector, thereby increasing the depth of CC. In addition, we observed that, during an effective CC, the rescuer was unable to maintain arms straight and, in consequence, a slight elbow flexion was observed. It, however, did not influence the quality of the maneuver.

Is there any relation between hyperinsulinemia, insulin resistance and colorectal lesions in patients with acromegaly?

INTRODUCTION: Pathogenesis of colonic lesions in patients with acromegaly remains still unclear. There are suggestions that apart from somatotropin axis hormones (GH and IGF-1), other agents also take part in this process. Molecular and animal studies indicate a vital role of hyperinsulinemia in development of colorectal neoplasms. AIM OF THE STUDY: To evaluate a relation between insulin level, insulin resistance and its anthropometric markers and colorectal lesions in patients with acromegaly. MATERIAL AND METHODS: The study consisted of 40 patients with active, newly diagnosed acromegaly; 24 women and 16 men aged from 24 to 77 years (mean age 50.1, SD+/-12.1). The analysis included the results of somatotropin axis function (GH and IGF-1 level), carbohydrate metabolism assessment (fasting serum glucose and insulin levels, oral glucose tolerance test, HOMA-IR for insulin resistance), the results of anthropometric measurement (BMI, WHR) and colonoscopy. RESULTS: Colon pathologies (60 polyps and 2 flat lesions) were discovered in 19 (47.5%) patients with acromegaly, 8 of them had multiple polyps. Hyperplastic polyps were revealed in 11 (27.5%), while adenomas in 8 (20%) acromegalics. Patients with colorectal lesions were found to have higher WHR then subjects with normal colon (p=0.033). Positive correlation between the number of hyperplastic polyps in the patients with multiple changes in the colon and IGF-1 (p=0.025), insulin level (p=0.005) and HOMA-IR (p=0.001) was found. Multiple adenomas correlated positively with insulin level (p=0.007), HOMA-IR (p=0.006) and BMI (p=0.015). CONCLUSIONS: The study results show a relation between hyperinsulinemia, insulin resistance and colon pathologies in acromegaly. Fasting insulin level and HOMA-IR correlate positively with the number of hyperplastic polyps and adenomas in acromegalic patients with multiply colorectal lesions.

Central venous access ports in children treated for hematopoietic malignancies.

During past 10 years 234 central venous access ports (CVAP) were implanted in 225 patients at the Department of Pediatric Hematology and Oncology in Zabrze. Mean exposure time was 745 days and total implantation time reached 173,768 days. Complications were encountered in 17 patients (7.6%). This mainly concerned central venous line infection, which led to removal of 10 CVAP (4.4%). The remaining complications necessitating removal of the CVAP consisted mainly of mechanical problems (catheter fracture, occlusion, and erroneous implantation to artery). In the opinion of the authors, subcutaneously implanted CVAP are a safe and effective option for high-dose chemotherapy deliverance in childhood cancer patients.

Effect of dexmedetomidine or propofol sedation on haemodynamic stability of patients after thoracic surgery.

BACKGROUND: Dexmedetomidine and propofol are commonly used sedative agents in non-invasive ventilation as they allow for easy arousal and are relatively well controllable. Moreover dexmedetomidine is associated with low risk of respiratory depression. However, both agents are associated with significant hemodynamic side effects. The primary objective of this study is to compare the influence of both drugs on hemodynamic effects in patients after thoracic surgical procedures receiving dexmedetomidine or propofol for noninvasive postoperative ventilation. METHODS: A prospective, randomised, observational study University Hospital. Interventions: Continuous sedation with dexmedetomidine or propofol for six hours of postoperative non-invasive ventilation after thoracic surgery, with concomitant use of continuous epidural analgesia. RESULTS: A total of 38 patients (20 dexmedetomidine and 18 propofol) were included in the analysis. The primary outcomes of this study is that heart rate, systolic and mean arterial blood pressure did not differ significantly between the groups, but diastolic arterial blood pressure was significantly higher in propofol group. Comparison analysis of epinephrine usage did not reveal significant differences between the groups. Cardiac output (CO) and cardiac index (CI) analysis did not show significant differences between the groups, but there is a clear tendency of lower values of CO/CI in group receiving propofol. We also observed similar tendency in stroke volume index (SVI) and stroke volume variation (SVV) values, but also those differences did not reach statistical significance. Systemic vascular resistance index (SVRI) values were higher in propofol group, exceeding reference values, but similarly, the difference between the groups was not significant. CONCLUSIONS: The main finding of this study is that dexmedetomidine and propofol provide similar advantages in haemodynamic stability during short-term sedation for non-invasive ventilation after thoracic surgical procedures in patients receiving continuous epidural analgesia.

Ropivacaine has no advantage over bupivacaine in thoracic epidural analgesia for patients with pectus excavatum undergoing the Nuss procedure - a single blind randomized clinical trial comparing efficacy and safety.

INTRODUCTION: Pectus excavatum repair (Nuss procedure) is a painful procedure requiring effective postoperative analgesia. AIM: To establish whether thoracic epidural analgesia with ropivacaine is non-inferior to epidural analgesia with bupivacaine following the Nuss procedure in children. MATERIAL AND METHODS: The prospective, randomized, controlled, single blind study included 81 children. Computer-generated random numbers were used to allocate treatment. All children received general anesthesia. Intraoperative and postoperative analgesia was achieved with either 0.5% and 0.1% ropivacaine (group R) or 0.375% and 0.0625% bupivacaine (group B). The Numeric Rating Scale (NRS) and the Prince Henry Hospital Pain Score (PHHPS) were used to assess postoperative pain directly after and 1, 8, 20 and 24 hours after awakening from general anesthesia. NRS scores of more than 2 and a PHHPS score of more than 1 were considered as pain requiring intervention. Hemodynamic stability and side effects were also compared between the groups. RESULTS: The durations of the procedure and extubation times in groups R and B were similar (59 ±7 vs. 56 ±10 minutes and 9 ±5 vs. 10 ±5 minutes, respectively). Pain scores requiring intervention were below 10% and were recorded with similar frequency in both groups, except for one difference in the PHHPS score in favor of group R after 24 hours (12% vs. 40%, p < 0.05). The frequency of side effects and hemodynamic stability were similar in both groups. CONCLUSIONS: 0.1% epidural ropivacaine has no advantage over 0.0625% epidural bupivacaine for pectus excavatum repair in children.

[Effect of whole body cryotherapy on the levels of some hormones in professional soccer players]. / Wplyw krioterapii ogólnoustrojowej na stezenie wybranych hormonów u zawodników wyczynowo uprawiajacych pilke nozna.

INTRODUCTION: The study was undertaken to determine blood serum concentrations of selected steroid hormones (estradiol--E(2), testosterone--T, dehydroepiandrosterone sulfate--DHEA-S) and luteinizing hormone (LH) in professional footballers subjected to whole body cryotherapy. MATERIAL AND METHODS: Twenty-two clinically healthy males, mean age 26.7 years, were studied. The subjects underwent ten sessions of whole body cryotherapy in Wroclaw-type chamber, with kinesitherapy following each session. Blood samples were collected before and two days after the treatment and the results were analyzed statistically. RESULTS: After the treatment there was a significant decrease in the concentrations of T (6.01 vs. 4.80 ng/mL, p < 0.01) and E(2) (102.3 vs. 47.5 pg/mL, p < 0.00001), but no DHEA-S and LH. The T/E(2) ratio showed a significant increase form 72.2 to 136.5 (p < 0.01). CONCLUSIONS: Whole body cryotherapy leads to a significant decrease in serum T and E(2), with no effect on LH and DHEAS levels. As a results of cryotherapy, the T/E(2) ratio was significant increased. The changes observed are probably due to cryotherapy-induced alternation in the blood supply to the skin and subcutaneous tissue, as well as to modulation of the activity of aromatase which is responsible for conversion of testosterone and androstenedione to estrogens.

The blood concentration of intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) in patients with active thyroid-associated orbitopathy before and after methylprednisolone treatment.

BACKGROUND: The soluble forms of vascular cell adhesion molecule-1 (sVCAM-1) and intercellular adhesion molecule-1 (sICAM-1) have been found to be increased in the blood of patients with Graves disease. The aim of this study is evaluation of the serum concentrations of soluble forms of adhesion molecules ICAM-1 and VCAM-1 in patients with thyroid-associated orbitopathy (TAO) before and after methylprednisolone treatment. MATERIAL AND METHODS: The study was performed in 40 Graves disease, hyperthyroid and euthyroid patients with a clinically active form of TAO. Serum concentrations of sVCAM-1 and sICAM-1 in TAO patients were determined by enzymelinked immunoabsorbent assay (ELISA) before and after intensive pulse methylprednisolone treatment. RESULTS: We did not find any significant changes in the studied parameters between TAO patients with hyperthyroidism and those with euthyroidism. The serum concentrations of sICAM-1 and sVCAM-1 were significantly increased in patients with TAO before methylprednisolone therapy when compared with the control group. After treatment serum concentrations of sICAM-1 and sVCAM-1 decreased significantly but were still significantly higher than for the control group. CONCLUSION: From the results obtained we can conclude that Graves orbitopathy itself but not thyroid function is probably responsible for the elevated level of the adhesion molecules studied.