ABSTRACT
STUDY DESIGN: A prospective, randomized study wias performed to compare two anesthetic methods. OBJECTIVE: To evaluate the effect of epidural analgesia on postoperative pain, endocrine- metabolic and inflammatory stress response and cellular inmmune responses during major corrective spine surgetry. METHODS: The study included 350 patients aged 15 to 65 who were randomly allocated to two equal groups. Group I (n=205) had continuous epidural analgesia (E4) and sevoflurane anesthesia during surgety and continuous epidural analgesia with ropivacaine and fentanil after surgery; Group 2 (n= 145) had general anesthesia with sevoflurane and fentanil and systemic administration of opioids after surgery. Patient pain, PONV syndrome, mobility, and satisfaction were measured after surgery along with plasma levels ofcortisol, ghmcose, interleukins IL-1ß, IL-6, and IL-10 during and after surgemy C-reactive protein (CRP), and cell-surface receptor expression of immune cells (cluster of differentiation) HLA-DR+/CD3-, HLA-DR+/CD3+, HILA-DR, CD3, CD4, CD8, CD16, CD19 CD16/56+, and CD16/56+/CD3+) were measured perioperatively. RESULTS: In group 1, there were significantly less pain, less nausea, earlier mobility, and higher satisfaction than those in group 2. Group I has also demonstrated significantly less plasma levels of glucose, cortisol, CRP, IL-lß, IL-6, IL-10 at various stages. The ratio of CD4/CD8 (p=0.001) and B cells (p=0.01) have increased by postoperative day 3 in group 1. NK-cells (CD16/56+) have decreased significantly by day 3 after surgery (p=0.001) compared to the group 2. T-lymphocytes, (CD3) have decreased in all patients, but they were significantly lower in patients receiving opioids, compared wiith EA. CONCLUSIONS: Polerfulr afferent stimulation in major corrective spine surgery accompanied by immunosuppression for at least a wieek after surgery. EA reduces the surgical stress response, prevents postoperative lymphocyte apoptosis and thus, increases stress and infectious resistance.
Subject(s)
Anesthesia, Epidural/methods , Immune Tolerance , Immunity, Cellular , Orthopedic Procedures , Oxidative Stress , Pain, Postoperative/prevention & control , Spinal Diseases/surgery , Adolescent , Adult , Aged , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Anesthesia, Inhalation/methods , Apoptosis/immunology , Blood Glucose/analysis , Cytokines/blood , Cytokines/immunology , Humans , Hydrocortisone/blood , Lymphocytes/immunology , Lymphocytes/pathology , Middle Aged , Orthopedic Procedures/methods , Pain, Postoperative/diagnosis , Pain, Postoperative/immunology , Pain, Postoperative/metabolism , Prospective Studies , Treatment Outcome , Young AdultSubject(s)
Diverticulum, Colon/diagnostic imaging , Adult , Aged , Diverticulum, Colon/complications , Female , Humans , Intestinal Perforation/etiology , Male , Middle Aged , RadiographyABSTRACT
Usefulness of double contrast examination in diagnosis of colonic cancer is discussed. As a result of application of the procedure, tumors were detected in 74 patients, including 15 asymptomatic patients at high risk who underwent irrigoscopy in the course of a medical check-up. Examination in a double contrast was found to be of diagnostic value in the identification of tumors of all macroscopic patterns and sites. A reverse correlation between tumor size and procedure efficacy was established. A detailed description of X-ray patterns of lesions is given.
