Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis-A Novel Strategy for Improving Outcomes.

Scoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemodynamic monitoring and goal-directed therapy in relation to patient outcomes following posterior fusion surgery for adolescent idiopathic scoliosis (AIS). The control group (n = 35, mean age: 15 years) received standard blood pressure management during the surgical procedure, whereas the intervention group (n = 35, mean age: 14 years) underwent minimally invasive haemodynamic monitoring. Arterial pulse contour analysis (APCO) devices were employed, along with goal-directed therapy protocol centered on achieving target mean arterial pressure and stroke volume. This was facilitated through the application of crystalloid boluses, ephedrine, and noradrenaline. The intervention group was subjected to a comprehensive protocol following Enhanced Recovery After Surgery (ERAS) principles. Remarkably, the intervention group exhibited notable advantages (p < 0.05), including reduced hospital stay durations (median 7 days vs. 10), shorter episodes of hypotension (mean arterial pressure < 60 mmHg-median 8 vs. 40 min), lesser declines in postoperative haemoglobin levels (-2.36 g/dl vs. -3.83 g/dl), and quicker extubation times. These compelling findings strongly imply that the integration of targeted interventions during the intraoperative care of AIS patients undergoing posterior fusion enhance a set of treatment outcomes.

BDNF G196A (Val66Met) polymorphism associated with cognitive impairment in Parkinson's disease.

Brain-derived neurotrophic factor (BDNF) is a neurotrophin widely expressed in the mammalian brain, regulating neuronal survival and known to influence dopaminergic neurons and cognitive processes. The present study investigated the BDNF Val66Met polymorphism associations with PD risk, and cognitive impairment in PD. A total of 486 study subjects (244 PD and 242 age and sex matched controls) were included in the study. UPDRS score, Hoehn-Yahr staging and the Schwab-England scale were used to assess motor abilities and activity during daily life. The patients were classified into groups with dementia (PDD, n=69) and without it (nPDD, n=166) on the basis of neuropsychological assessment. The most common functional polymorphism in BDNF Val66Met (rs6265, G196A) gene was determined using TaqMan real-time PCR assay. Frequencies of evaluated BDNF alleles and genotypes were similar in PD and the controls. The mean age of disease onset among BDNF Met/Met carriers was later (65.00±6.13) in comparison to Val/Val (57.45±10.68) and Val/Met (56.33±10.91) subjects (p=0.077). The studied BDNF polymorphism was not associated with cognitive status in PD patients. However, patients with Met/Met alleles demonstrated better delayed recall of information than patients with Val/Val alleles. The results of multivariate logistic regression analysis revealed age (p=0.0003) and the disease stage (p=0.002) as independent risk factors predisposing to PD dementia.

[Paralysis of vocal fold as the first symptom of Vernet's syndrome in the course of jugular chemodectoma]. / Porazenie faldu glosowego jako pierwszy objaw zespolu Verneta w nastepstwie klbczaka otworu zyly szyjnej.

INTRODUCTION: Chemodectomas are relatively frequent tumors of the head and neck but their diagnosis in consideration of the slow growth is difficult. The aim of this study is pointing out of the attention on: (1) non-typical beginning of ill and diagnostic difficulties leading to delaying of putting the proper diagnosis, (2) symptoms which are cause of notifying the patient to the doctors of different specializations e.g. the laryngologist and the neurologist. MATERIAL AND METHODS: The case of 72-year-old man with the paraganglioma situated near to the foramen of the jugular vein is discribed. Clinical symptoms, giving at last typical picture of Vernet's syndrome, the diagnostic procedure as well as treatment of the entity are discussed in the report. CONCLUSIONS: (1) In cases of paralysis of any cranial nerve is necessary close cooperation among a laryngologist and a neurologist. (2) In idiopathical paralysis of the vocal fold, changes runing near by the internal jugular vein's foramen should be taken into account. (3) The computer scanning of skull's bases and angiograpy are the most useful in the differential diagnostics. (4) The radiotherapy allow to obtain good therapeutic's results especially in persons stricken in years.