Ipsilateral shoulder pain after thoracic surgery procedures under general and regional anesthesia - a retrospective observational study.

BACKGROUND: Ipsilateral shoulder pain (ISP) is a common complication of mixed etiology after thoracic surgery (its prevalence is estimated in the literature at between 42% and 97%). It is severe and resistant to treatment (patients complain of pain despite effective epidural analgesia at the surgical site). AIM OF THE STUDY: The aim of this retrospective, observational study was to evaluate the prevalence of ISP in patients operated on in our facility and to determine the risk factors for ISP development. MATERIAL AND METHODS: 68 patients after thoracotomy or videothoracoscopy (video-assisted thoracic surgery - VATS) conducted under general and regional anesthesia were enrolled in the study and divided into two groups: group I without ISP and group II with postoperative ISP. We recorded age, sex, BMI, duration of surgery, type of surgery, type of regional anesthesia, and, in patients with epidural anesthesia, level of catheter placement. RESULTS: Statistically significant differences between the groups were obtained for BMI (24.67 and 27.68, respectively; p = 0.049), type of surgery (24% for thoracotomy and 0% for VATS, p = 0.026), and level of epidural catheter placement (4.35% for catheters placed at the level of Th5 or higher and 40.47% for catheters placed below Th5; p = 0.003). CONCLUSIONS: The prevalence of ISP in our medical center amounts to 24% of thoracotomy patients. The fact that the difference in ISP prevalence was significantly related to the level of epidural catheter placement is consistent with the theory that ISP is related to phrenic nerve innervation. Moreover, epidural catheter placement is a modifiable factor, which can be used to reduce the prevalence of post-thoracotomy ISP.

Usefulness of ultrasound guidance for central venous catheterisation in patients with end-stage renal disease.

BACKGROUND: Renal replacement therapy often requires the insertion of a central venous catheter. The procedure is invasive and can lead to a number of complications. To minimise the risk of such complications, ultrasonography is used. The aim of the present study was to assess the usefulness of ultrasound-assisted vs. traditional method of location of anatomical orientation points for the placement of central venous catheters. METHODS: . The prospective and randomised study was carried out, which included 135 patients requiring central venous catheterisation. Patients were allocated into two groups: group I (without ultrasound) - 70 patients and group II (ultrasound guidance) - 65 patients. In the latter, the procedure was performed in 38 cases due to technical problems. The following parameters were compared: age, patient's condition, results of blood clotting tests, and selected renal function parameters. Moreover, the mode of procedure (emergent, scheduled), factors directly affecting the efficacy of catheter insertion and complications (use of anticoagulants, anatomical variants, sites of access, number of cannulation attempts) were analysed. RESULTS. Ultrasound was significantly more commonly used during emergent cannulation procedures (P = 0.002), in the elderly (P = 0.001) and unconscious patients (P = 0.001). Moreover, it was more frequently applied in patients undergoing anticoagulation (P = 0.01) and during the insertion of access through the subclavian and femoral vein (P = 0.013). The percentage of successful first attempt cannulation was higher in ultrasound-guided cases (P = 0.013). There were no significant intergroup differences in the incidence of early complications (P = 0.269). CONCLUSIONS: The study findings did not demonstrate significant differences in the incidence of early complications during cannulation with and without ultrasound guidance. The first attempt success rate was found to be significantly higher in cases of ultrasound-assisted central venous catheterisation.

Prospective assessment of continuous subcutaneous insulin infusion therapy in young children with type 1 diabetes.

The study assessed 3.5-year treatment with continuous subcutaneous insulin infusion (CSII) in well-controlled children with duration of type 1 diabetes mellitus longer than 1 year. Following groups were observed: the CSII group-40 children and the multiple injections (MDI) group-36 patients (age-matched, the mean of 6.5+/-2.1 and 7.1+/-1.8 years, respectively). At the onset of the follow-up both groups were comparable in age, HbA1c, daily insulin requirement (DIR), body weight, height and BMI. They were followed from the start, and every 6 months in relation to DIR, HbA1c, acute complications (DKA, hypoglycaemia) and physical development. Mean HbA1c and DIR for the whole study period were lower in the CSII versus MDI group (6.90+/-0.54 vs 7.22%+/-0.16 and 0.75+/-0.16 vs 0.88+/-0.13 U/kg/d; p<0.05). HbA1c was lower in the CSII versus MDI group in months 6 and 42 (6.95 vs 7.29%, and 6.91 vs 7.43%, respectively; p<0.05). DIR was significantly lower at most intervals in the CSII group. No significant differences regarding number of complications and anthropometry were found. CSII allows for near-normal metabolic control and lower insulin requirement comparing to the MDI method. CSII is safe treatment, assuring harmonious child's development.

[Treatment of type 1 diabetes mellitus revealed below 7 years of age in the Diabetes Center of Silesia, Poland].

INTRODUCTION: Frequency of type 1 diabetes mellitus diagnosis in young children increases. Within this group, such factors as limited cooperation, little acceptance of multiple injections and other typical patterns of behavior can strongly influence the insulin management outcome. AIM OF THE STUDY: The objective of the study was to provide information regarding metabolic control in young diabetes patients. MATERIAL AND METHODS: Charts of 58 children with T1DM, all subjects under control of our Department, that were aged at onset (1998-2003) below 7 years (mean 4.05+/-1.6) were studied retrospectively. HbA1c, total, bolus and basal daily insulin requirement (DIR), weight, height, severe hypoglycaemia and diabetic ketoacidosis (DKA) were analyzed till April 2006 in 2-year intervals. Insulin therapy model was also taken into consideration. RESULTS: Mean HbA1c was 7.2+/-1.2% for all children for the whole studied period and did not alter significantly between analyzed intervals. Most common treatment model at diabetes onset was the therapy with premixed insulin (Mix) (67%) and after 4 and 6 years - continuous subcutaneous insulin infusion (CSII) (50% and 75% respectively). A tendency for a better metabolic control was observed at multiple daily injections and CSII than at Mix. Change of the weight or height percentile channel was not revealed. Bolus and basal DIR increased in the first observation interval. Afterwards they stabilized respectively at 0.35-0.42 U/kg/24 h and 0.35-0.39 U/kg/24 h. Severe hypoglycaemia occurred 6.72/100 patient-years. CONCLUSION: Insulin therapy aimed at maintaining long-term good metabolic control is possible to achieve and is safe in young diabetic children.