No abstract

Background. Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe­sio­logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal­gesia is necessary to achieve this goal. Material and methods. A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re­ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was per­formed under ultrasound guidance, and systemic analgesics were administered according to a standardized pro­to­col. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study. Results. Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB. Conclusion. The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.

Background. carcinoid syndrome (cs) is a rare syndrome, most commonly associated with neuroendocrine neoplasms (nens) of the small intestine. carcinoid syndrome consists of diarrhea, vomiting, abdominal pain, cutaneous flushing, teleangiectasias, bronchoconstriction and increased perspiration. diagnosis of carcinoid syndrome remains a challenge and it is often delayed. Objectives. the aim of this study was to characterize patients with cs and define the most sensitive, primary diagnostic tools for cs. Material and methods. 26 consecutive patients admitted to the department because of carcinoid-like symptoms. diagnosis of cs was based on clinical findings and laboratory data (levels of 5-hydroxyindoloacetic acid). diagnosis of nen was based on laboratory findings, imaging studies (us, ct, gallium-68-dota tate Pet-ct) and histopathological analysis. cs due to nen was diagnosed in 16 subjects (nen-cs). Results. the most common symptoms in non-nen were increased perspiration, flushes and diarrhea. cga was elevated (40%; n = 4) in this group. However, elevated levels of 5-Hiaa and liver lesions were not presented. in the nen-cs symptoms were reported more often: flush (93.7%; n = 15), diarrhea (87.5%; n = 14), abdominal pain and teleangiectasis (81.2%; n = 13). elevated cga and 5-Hiaa were noted in 87.5% (n = 14) and 81.2% (n = 13) respectively. us and ct revealed liver metastases in all patients. the mean duration of symptoms before diagnosis was 28.6 months. Conclusions. the combination of several symptoms of carcinoid syndrome and liver lesion in easily available abdominal imaging (us and/or ct) should prompt physicians to quick referral to centres specialized in the diagnosis and treatment of nen. Key words: carcinoid syndrome, chromogranin a, 5-Hiaa.Wstęp. zespół rakowiaka (carcinoid syndrome -cs) występuje najczęściej w przebiegu nowotworów neuroendokrynnych (neuroendocrine neoplasms -nen) przewodu pokarmowego z ogniskiem pierwotnym w jelicie cienkim. do głównych objawów należą luźne wypróżnienia, nudności, bóle brzucha, zaczerwienienia twarzy, teleangiektazje, skurcz oskrzeli i wzmożona potliwość. rozpoznanie zespołu rakowiaka jest najczęściej opóźnione. Cel pracy. charakterystyka pacjentów z zespołem rakowiaka i ustalenie podstawowego narzędzia diagnostycznego. Materiał i metody. do badania włączono 26 pacjentów przyjętych do kliniki z powodu objawów zespołu rakowiaka. diagnostyka cs obejmowała ocenę kliniczną oraz badania dodatkowe (stężenie kwasu 5-hydroksyindolooctowego). diagnostyka nowotworu neuroendokrynnego obejmowała badania laboratoryjne oraz obrazowe (usg, tk, 68ga-dota tate Pet/ct) oraz badanie histopatologiczne. cs w przebiegu nen został stwierdzony u 16 pacjentów (nen-cs). Wyniki. najczęściej zgłaszanymi objawami w grupie badanych non-nen były: wzmożona potliwość, zaczerwienienia twarzy oraz biegunki. stężenie cga było podwyższone (40%; n = 4) w tej grupie. nie stwierdzono podwyższenia stężenia kwasu 5-hydroksyindolooctowego i zmian ogniskowych w wątrobie. w grupie nen-cs najczęściej zgłaszane ob...

Renal procedures are performed within the realm of urology, general and transplant surgery. The implementation of new operating techniques imposes on anaesthetists the need to adapt their methods, aiming to improve the patient’s perioperative comfort and safety. Laparoscopy is gaining increasing interest as a less invasive procedure; however clinical research shows that pain after the procedure is underestimated and therefore poorly controlled. Multimodal analgesia is very promising, though, as it allows better pain control, expedites discharge and enhances recovery. This is achieved through a combination of general and regional anaesthesia with administration of adjuvant drugs intraoperatively, resulting in reduced opioid requirements in the recovery room with diminished side effects of pain treatment. Good communication between the surgeon and the anaesthetist is the key to effective anaesthesia and analgesia.