Traumatic tension pneumopericardium and amputation of the left main bronchus.

A 27-year-old woman sustained a blunt chest trauma after a car accident. Computed tomography revealed tension pneumopericardium, bilateral pneumothorax, and a suspected rupture of the left main bronchus. Emergent pericardial needle aspiration was successfully performed. Bronchial amputation was confirmed by bronchofiberoscopy. Despite total detachment of the distal part of the bronchial tree, the ventilation of the left lung was maintained without air leakage by use of pleural drains. Bronchial obturation resulted from the injury, and was effectively treated by bronchoscopic sputum suction at the distal end of the bronchus. Finally, the patient underwent a left thoracotomy with an end-to-end bronchial anastomosis. The patient was discharged home on the 32nd day after the trauma, and no complications were recorded during a 3-month follow-up period.

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy.

BACKGROUND: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared. METHODS: This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed. RESULTS: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups. CONCLUSIONS: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.

VEGF and metalloproteinase 2 (MMP 2) expression in gastric cancer tissue.

BACKGROUND: Neoplasms are the second leading cause of death in Poland after vessel diseases, despite the huge progress in medical sciences in the last 20 years. Recently, gastric cancer morbidity has decreased, but mortality is still at a high level. MATERIAL/METHODS: Tissues from 24 patients with a histopathologically diagnosed mucosal and adenomucosal gastric cancer were tested. Patients were divided into 2 equal groups: patients without metastases (G1) and patients with metastases in the liver (G2). In all tested tissues of G1 and G2, the expression of VEGF (vascular endothelial growth factor) and metalloproteinase 2, respectively, were estimated. RESULTS: Results revealed a statistically significant increase in the VEGF expression for G1 and G2 in relation to the margin (p1<0.001; p2<0.001). The increase of gene expression for VEGF did not significantly differ statistically in G1 and G2. The obtained results revealed a statistically significant difference in the increase of gene expression for MMP-2 in G1 in relation to the margin (p<0.05) and a very high one in G2 in relation to the average margin value (p<0.001). A highly statistically significant correlation was obtained for VEGF and MMP-2 in the tissue of patients with metastases (p<0.001; r=0.714). The highly elevated expression of MMP-2 in the tissue of gastric cancer in patients with metastases confirms its participation in the invasiveness of the neoplasmatic process. CONCLUSIONS: The highly significant correlation between VEGF and MMP-2 suggests a connection between both mechanisms in the progression of gastric cancer.

Automatic detection and analysis of the EEG sharp wave-slow wave patterns evoked by fluorinated inhalation anesthetics.

OBJECTIVE: The aim of this study was to develop a method for the automatic detection of sharp wave-slow wave (SWSW) patterns evoked in EEG by volatile anesthetics and to identify the patterns' characteristics. METHODS: The proposed method consisted in the k-NN classification with a reference set obtained using expert knowledge, the morphology of the EEG patterns and the condition for their synchronization. The decision rules were constructed and evaluated using 24h EEG records in ten patients. RESULTS: The sensitivity, specificity and selectivity of the method were 0.88 ± 0.10, 0.81 ± 0.13 and 0.42 ± 0.16, respectively. SWSW patterns' recruitment was strictly dependent on anesthetic concentration. SWSW patterns evoked by different types of anesthetics expressed different characteristics. CONCLUSIONS: Synchronization criterion and adequately selected morphological features of "slow wave" were sufficient to achieve the high sensitivity and specificity of the method. SIGNIFICANCE: The monitoring of SWSW patterns is important in view of possible side effects of volatile anesthetics. The analysis of SWSW patterns' recruitment and morphology could be helpful in the diagnosis of the anesthesia effects on the CNS.

[Fractal dimension--a new EEG-based method of assessing the depth of anaesthesia]. / Próba wykoraystania analizy sygnalów EEG metoda wymiaru fraktalnego do okreslania stopnia zniesienia swiadomosci podczas indukcji znieczulenia ogólnego.

BACKGROUND: It has been suggested that analysis of the EEG signal using the fractal dimension method may be useful for assessment of depth of anaesthesia. METHODS: Thirty ASA I and II patients, scheduled for elective surgery under general anaesthesia were induced with midazolam, fentanyl and propofol and paralyzed with rocuronium or cis-atracurium. Clinical signs of the depth of anaesthesia were classified to one of five OAA/S levels. Standard vital parameters were observed and brain electrical activity was measured using the bispectral index (BIS) and burst suppression ratio (BSR). The EEG signal was recorded and processed postoperatively to calculate Higuchi's fractal dimension (FD). The latter was presented as a derivative: (D(F)-1) x 100. RESULTS: Mean correlation coefficients between OAA/S scale levels, and BIS and (D(F)-1) x 100 values, were respectively: 0.749+/-0.172 and 0.753+/-0.220. In 28 (93.3%) patients, BIS correlated well with FD (r=0.63+/-0.33). In twenty cases, burst suppression occurred and the correlation coefficient between BIS and DF was much lower (r=0.5860+/-3650), when compared to the group of 10 patients in which no burst suppression was detected (r=0.711+/-0.251). Appropriate correction was made using the following formula: D(FK)=D(F)-(D(F) x BSR). The mean correlation coefficient between BIS values and D(FK) in the BS group was r=0.629+/-0.331. In all cases, the mean correlation coefficient between (D(F)-1) x 100 and BIS was r=0.661+/-0.307 (p<0.001). CONCLUSIONS: The fractal dimension method can be regarded as equal to BIS for assessment of depth of anaesthesia.