Cytokinemia and oxidative stress are important factors responsible for an inadequate immune response in the early course of acute pancreatitis (AP). The aim of the study was to evaluate the profiles of interleukin 18 (IL-18), glutathione peroxidase (GPx), and selenium concentrations in serum with respect to AP severity and to study the relationships between these parameters and recognized prognostic indicators of AP severity. Prospective clinical analyses were performed on 61 patients with mild and severe forms of AP and for 15 healthy volunteers. In both forms of AP severity, the IL-18 concentration in the serum was significantly higher than in healthy controls. In the severe form of AP, the IL-18 concentration was the highest and exceeded significantly the values recorded on the 1st, 2nd, 3rd, 5th, and 10th days of mild AP. A significantly lower GPx concentration in the serum was recorded in severe AP compared to the mild form and in the control group. There was a significantly lower selenium concentration in the severe form of AP. Significant correlations between GPx and selenium, between IL-18 and GPx, and between IL-18 and selenium were recorded. The ROC analysis shows a high prognostic accuracy of IL-18 and GPx concentrations in the determination of AP severity. IL-18 is released early in the course of AP and may be a key immunomodulator of the inflammatory response in the severe form of this disease. Low GPx and selenium concentrations in severe AP reflect the lower antioxidative ability in this form of AP. IL-18 and GPx may represent new indicators of AP severity.
Regional anesthesia techniques are commonly used for many surgical procedures alone or as an addition to general anesthesia, because they offer many advantages over general anesthesia. Unfortunately these techniques are partially limited by the time of action of local anesthetics. One of the methods of overcoming this limitation is adding to the local anesthetic solution additional drug--so called adjuvant. Among many adjuvants to local anesthetic drugs tested so far one seems to be particularly interesting--buprenorphine. The aim of this paper is to present pharmacological background for using buprenorphine for regional anesthesia and to review clinical trials of using buprenorphine for all regional anesthesia techniques: spinal and epidural anesthesia, peripheral nerves blocks, local anesthesia and intravenous regional anesthesia.
During last 30 years orthopedic surgery dramatically improved. The most significant progress had place in joint surgery. Today in many orthopedic centers total hip and knee arthroplasties are made and may be counted in hundreds per year. Surgeons can choose among many different implant operation systems. Nevertheless this type of operations is connected with pain in immediate postoperative course. The aim of the paper was presentation of contemporary methods of pain management after big knee surgery, especially after total knee arthroplasty (TKA). Among presented methods of pain management the anesthetic techniques were discussed: epidural anesthesia (EA) and peripheral nerves blocks (PNB). They seem to be most interesting and evolutionary because of possibility of early ambulation and more effective postoperative rehabilitation. It directly corresponds to therapeutic effect of surgical procedure and patient's satisfaction. In the paper there are presented advantages and possible complications of regional techniques, particular block techniques and technical problems with possible modifications of pain management. This review is based on latest medical literature, especially on metaanalyses published during last few years comparing different modes of postoperative pain management.
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