Regional anesthesia for upper extremity surgery--our experience.

Brachial plexus block using axillary approach is a simple and safe method of regional anesthesia often used for elbow, forearm and hand surgery. Different techniques can be used to achieve brachial plexus block. On using perivascular approach to brachial plexus, we neither searched for paresthesia nor used nerve stimulator to identify the correct needle position within the neurovascular sheet. Axillary artery was palpated and a mixture of local anesthetic agents was injected into the neurovascular sheet above and below axillary artery at the site of strongest artery pulsation. The local anesthetic solution comprised equal volumes of lidocaine 2% and bupivacaine 0.5% without adrenaline, in a total volume of 30-40 mL, depending on body mass. This technique is used in more than 150 patients per year at our department. In the present study, 158 patients undergoing upper extremity surgery under brachial plexus block were retrospectively assessed. Successful anesthesia was achieved in 135 (85.0%) patients using brachial plexus block alone, 19 (12.5%) patients required additional medication, two patients required supplementation with intravenous regional anesthesia, and another two patients required general anesthesia. The incidence of successful blocks, latency time of onset, local and systemic complications or allergic skin reactions were investigated. There were no significant complications attributed to the anesthetic technique.

Retrospective study of specific immunotherapy - what should be done in the future.

In this retrospective study, data on 241 atopic patients treated with specific cutaneous immunotherapy during the 1985-2006 period at Allergy Clinic, University Department of Dermatology and Venereology, were reviewed. The following diagnoses were recorded: atopic dermatitis, pure or in combination with allergic rhinitis or allergic bronchitis, or allergic bronchitis and asthma, allergic rhinitis, allergic conjunctivitis, urticaria, and Quincke's edema. The aim was to retrospectively analyze clinical efficacy and laboratory findings in atopic patients undergoing specific immunotherapy. Before specific immunotherapy administration, eosinophil count, immunoglobulins, skin prick test, total IgE (RIST) and specific IgE (IgE UniCAP) were determined. The following allergens were included in specific immunotherapy: Dermatophagoides pteronyssinus, house dust mite (mixed or separately), mixed and single pollens (grass, tree, weed), feather, and animal dander. The most frequent allergens in 241 atopic patients were grass pollen mixture, Dermatophagoides pteronyssinus, ragweed, tree pollen mixture, cocksfoot, birch, animal dander, and feather. Treatment efficacy was demonstrated after 3 years of continuous therapy by clinical evaluation and with the same diagnostic procedure. After several months of therapy, initial clinical improvement was noticed in atopic dermatitis patients as well as in patients with respiratory diseases that were sensitive to airborne allergens. According to literature, specific immunotherapy was used as a treatment option, which may affect the natural course of allergic diseases. It reduces development of asthma in patients with allergic rhinitis and prevents the onset of new sensitizations.