[Paraneoplastic limbic encephalitis]. / Paraneoplasticki limbicki encefalitis.

Paraneoplastic limbic encephalitis (PLE) is a condition characterized by nervous system damage or dysfunction without indication that the nervous system is directly affected by tumor cells. Since it is clinically presented with an array of neuropsychiatric symptoms that usually precede the occurrence of malignant disease, and because of mimicking a psychiatric disease, it can sometimes make the diagnosis difficult and can be overlooked. Typical presentations consist of progressive confusion and deficits in short-term memory, which worsen over days to weeks. The current hypothesis on the pathogenesis of PLE implicates an autoimmune process involving antigens shared by tumor cells and neuronal cells in limbic structures. It has been considered that the autoantibodies cross-react with antigens on normal cells such as the neurons, resulting in cytotoxicity, or they can form complexes with a circulating antigen to induce organ damage through immune complex deposition. The treatment of PLE involves underlying cancer removal by surgery, chemotherapy, radiotherapy or hormonal treatment, and immunosuppressive therapy. Unfortunately, this therapy combination is still generally unsatisfactory. Although PLE is a relatively rare neurologic disorder, because of its association with malignancies and difficulty in diagnosing, this article gives a brief review of the literature and summarizes current knowledge of this syndrome.

Local or spinal anesthesia in acute knee surgery.

The aim of the study was to assess the efficacy, safety and complications of two anesthetic techniques including local and spinal anesthesia. A total of 436 patients received local (LA group = 250) or spinal (SA group = 186) anesthesia during a year period. SA group received 0.5% Bupivacaine 5 mg/mL. LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: intraoperative pain (10 cm VAS: 0 = no pain, 10 = extreme pain), surgical operating conditions, patient satisfaction score (1 = very satisfied, 4 = very unsatisfied), postoperative analgesia, and time to discharge. In LA group, 97.6% (244/250) of patients experienced no pain throughout the procedure. Only six (2.4%) patients required conversion to general anesthesia. In SA group, two patients required conversion to general anesthesia. In both groups, 93.6% of patients were either satisfied or very satisfied with their anesthesia. The need ofpostoperative analgesics was higher in SA compared with LA group (p = 0.001). The mean postoperative stay was significantly shorter in LA than in SA group (p = 0.001). Ninety-four percent of LA and only 68% of SA patients were discharged from the hospital within 2 hours of the procedure. The rate of complications differed significantly between LA and SA groups (p = 0.037). Outpatient arthroscopy of the knee under local anesthesia is a simple, reliable, and safe alternative to spinal anesthesia, for patients in whom intraarticular disorders requiring diagnostic arthroscopy and arthroscopic surgery.