Jacek Karpe

Changes in lipid metabolism in women with age-related macular degeneration

Age-related macular degeneration (AMD) is one of the leading causes of visual loss among people aged 65 and older. At present the origin of AMD still remains unknown. The objective was to evaluate the chosen lipid and lipoprotein concentrations in blood of patients with AMD. Sixty women aged 55–71 (mean age 65.1±5.7) were treated in the outpatient ophthalmological clinic for more than two years because of AMD. We evaluated total serum cholesterol (TCH), triglycerides (TG), HDL-cholesterol (HDL), LDL-cholesterol (LDL), lipoprotein (a) (Lp(a)), apolipoprotein AI (Apo AI) and apolipoprotein B (Apo B) by direct spectrophotometry (Human and Randox standard kits, USA). We found a significant increase of TCH, LDL and TG (224.36±41.67 mg/dl, 159.02±39.66 mg/dl and 120.92±42.64 mg/dl), and a significant decrease of HDL (38.68±6.36 mg/dl) in the AMD patients when compared with the control group. We have not found a significant difference in the average TG level between the studied groups. The concentration of Apo B was markedly increased (164.66±46.46 mg/dl) and Apo AI concentration was markedly decreased (128.9±17.01 mg/dl) in the AMD patients when compared with the control group. There was no significant difference in the concentration of the Lp(a) between the two groups. The results of our present study could point to the fact that changes in the lipid metabolism could be one of the very important risk factors involved in the pathogenesis of AMD.

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.

Sensory blockade after thoracic paravertebral injection of ropivacaine or bupivacaine.

Background and objective: No clinical trials comparing the characteristics of sensory blockade caused by various local anaesthetics in thoracic paravertebral blockade have been published. The aim of this prospective study was a clinical assessment of sensory blockade after paravertebral injection of ropivacaine or bupivacaine in patients undergoing modified radical mastectomy. Methods: Seventy ASA I–II patients were randomized to receive a single injection of ropivacaine 0.5% (n = 35) or bupivacaine 0.5% (n = 35) at the T4 level. General anaesthesia with propofol and fentanyl was provided during the procedure and patients were not intubated. The following parameters were analysed: duration and dynamics of the sensory blockade and the patients and surgeons assessment. Results: Both ropivacaine and bupivacaine provided a similar level of analgesia. Ropivacaine was characterized by more rapid onset – after only 5 min 53% of patients in this group had the extent of sensory blockade wide enough to perform modified radical mastectomy in comparison to only 20% after bupivacaine (P < 0.01). The initial spread of sensory blockade (>9 segments blocked) was noted more often in the ropivacaine group (88% vs. 65%, P < 0.05), lasted longer and appeared to be wider than sensory blockade produced by bupivacaine. Regression of sensory blockade was initially similar, but after 24 h sensory blockade in the ropivacaine group still had a potential to provide analgesia for modified radical mastectomy in 81% of patients in comparison to only 50% of such patients in the bupivacaine group (P < 0.05). Degree of postoperative pain, performance of the cardiovascular system, consumption of medications and complications were all similar between the study groups. Conclusions: Both agents provide satisfactory conditions for mastectomy, but ropivacaine seems to be superior to bupivacaine for thoracic paravertebral blockade during breast cancer surgery.

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.

Results of cataract surgery in the very elderly population

Aim The aim of our study was to retrospectively evaluate the effectiveness and safety of cataract surgery and intraocular lens implantation (IOL) for patients aged 90 years or older, whom we define as “very elderly.” Methods The study involved a total number of 122 patients (122 eyes) with senile cataracts. The mean age of patients was 91.2 ± 2.3 years (range 90–100 years old). Phacoemulsification (phaco) was done on 113 of 122 eyes, and 9 of 122 eyes had extracapsular cataract extraction (ECCE). Postoperative visual acuity and intraocular pressure (IOP) were analyzed on the first postoperative day, 3 months after surgery, and 6 months after surgery. Results Best corrected visual acuity (BCVA) improved in 100 of 122 eyes (82.0%). BCVA remained the same in 20 of 122 eyes (16.4%) and decreased in 2 of 122 eyes (1.6%), mainly because of coexisting age-related macular degeneration (AMD). The BCVA 3 months after surgery was ≥0.8 in 23 of 122 eyes (18.9%), between 0.5 and 0.7 in 28 of 122 eyes (22.3%), and between 0.2 and 0.4 in 33 of 122 eyes (27.1%). We found significant implications of cataract surgery on decreasing IOP in the studied group of patients suffering from glaucoma compared to the patients without glaucoma. Conclusion Advanced age is not a contraindication for cataract surgery. The results of the study showed that when systemic conditions are stable, both phaco and ECCE with IOL for very elderly patients are effective and safe.

Haemodynamics, gas exchange and surgical conditions during bilateral high frequency jet ventilation in lung surgery: A-285

Haemodynamics, gas exchange and surgical conditions during bilateral high frequency jet ventilation in lung surgery H. Misiolek1, P. Knapik1, H. Kucia1, J. Karpe1, M. Campbell2 1Department of Clinical Anaesthesia, Silesian University of Medicine; 2Students Research Team of Silesian University of Medicine, Zabrze, Poland Background and Goal: Bilateral high frequency jet ventilation (HFJV) applied to conventional endotracheal tube may be an attractive alternative to the usage of double lumen endotracheal tube and one lung ventilation (OLV) for major thoracic procedure. The aim of present study was to compare haemodynamics, oxygenation and surgical conditions during bilateral HFJV and OLV during anaesthesia for lung surgery. Material and Method: 56 patients were randomly allocated to receive either HFJV (n 28) or OLV (n 28) during major thoracic procedures. All patients were anaesthetized with TCI propofol. Muscle relaxation was achieved with rocuronium and analgesia was provided with continuous epidural infusion of 0.5% ropivacaine with fentanyl. Transoesophageal probe for non-invasive cardiac output measurements was inserted after induction of anaesthesia. Arterial and central venous blood samples for gas analysis were taken before induction of anaesthesia (0), prior to the start of the studied mode of ventilation (I), and then every 30 min during HFJV or OLV. Haemodynamic parameters were recorded at baseline (I) and every 15 min during HFJV or OLV. Measurements were taken for 120 minutes. ANOVA or Mann-Whitney tests were used when appropriate and p 0.05 was considered significant. Results: Patients in study groups were comparable. Arterial oxygen saturation and systemic vascular resistance values were significantly higher in HFJV group. Peak inspiratory pressures and shunt fraction were significantly higher in OLV group. No differences in blood pressure, heart rate, stroke volume, cardiac index and PaCO2 values were recorded. Surgeons have found comparable and satisfactory operational conditions in both groups. Conclusions: Bilateral HFJV is superior to OLV regarding both gas exchange and ventilation-perfusion ratio. This mode of ventilation may be an attractive alternative to OLV for major thoracic procedures. Reference: 1 Ihra G, et al. Eur J Anaesthesiol 2000; 17: 418–430.

Comparison of epidural ropivacaine, epidural bupivacaine and conventional opioid analgesia for pectus excavatum repair: A-410

Department of Clinical Anaesthesia, Silesian School of Medicine, Giwice, Poland Background and Goal of Study: Thoracic epidural analgesia (TEA) is increasingly used for pectus excavatum repair (PER) [1, 2]. The aim of this study was to compare continuous thoracic epidural infusion of ropivacaine (R), bupivacaine (B) and conventional opioid analgesia (O) for perioperative analgesia in children undergoing PER. Materials and Methods: 60 children (11–18 years) were randomized to receive either 0,5% R with 7,5 g/ml fentanyl (n 20) or 0,375% B with 7,5 g/ml fentanyl (n 20) by epidural infusion. Children were recruited to O (n 20) when the epidural catheter was not inserted due to the lack of parent’s consent or technical difficulties. Standard general anaesthesia, supplemented by epidural infusion was performed. In the postoperative period epidural infusion of 0,1% Ropivacaine with 6 g/ml fentanyl, 0,075% Bupivacaine with 6 g/ml fentanyl or repeated s.c. injections of morphine (0,1 mg/kg every 5 hours) were administered. Standard haemodynamic parameters and the level of pain (Prince Henry Hospital Pain Score – PHHPS, Numerical Rating Scale – NRS) were recorded. Sedation score (Ramsay Score – RS) and side-effects were also noted. Data were compared with the use of ANOVA and Kruskal-Wallis test. p 0,05 was considered significant. Results and Discussions: Extubation time was shorter in both epidural analgesia groups , when compared to O group (8 5 for R, 10 4 for B and 30 15 for O, p 0.01). Haemodynamic stability was comparable in R and B group with the mean heart rate being significantly lower in both epidural groups in comparison to O group. Level of pain and the requirement of “rescue” analgesia was higher in O group and comparable in both epidural groups. Conclusions: TEA combined with general anasthesia is superior to general anesthesia alone for PER in children. Epidural analgesia with R is comparable to B in this group of patients. References: 1 Barros F. et al. Paediatr Anaesth 2004; 14: 192. 2 Nuss D. et al. J Pediatr Surg 1998; 33: 545.