Change of the State of the Natural Antioxidant Barrier of a Body and Psychological Parameters in Patients Aged above 60.

BACKGROUND: The goal of this study is to assess the natural antioxidant barrier of the organism and selected psychological aspects of the aging process in patients above 60 years old. METHODS: The study included a total of 52 patients aged above 60 (mean age 67 ± 3.4) and 32 healthy subjects (mean age 22 ± 3.4) as a control group. All patients underwent psychological assessment using Test of Attentional Performance version 2.3 (TAP 2.3, four subtests: alertness, cross-modal integration, neglect with central task, and working memory) and biochemical analysis of venous blood concerning values of the selected parameters of oxidative stress (HT, GSH, GPXOS, GPXRBC, GRRBC1, SODRBC1, MDARBC1, NO2-/NO3-, and CP). RESULTS: Disorders of attention were observed mainly in elderly people, but an assumption that elderly people have developed more efficient ways of working memory use than younger people may be true. Results showed the reduced effectiveness of the body's natural antioxidant barrier in elderly people. Moderate positive and negative correlations among parameters of oxidative stress and psychological parameters were observed in the control group. DISCUSSION: Intensification of the attention deficits and oxidative stress may be observed as one of the pathogenic factors of age-dependent diseases.

Comparison of serum prohepcidin and iron metabolism parameters in obese and non-obese elderly individuals.

INTRODUCTION: Current knowledge indicates that there is a close connection between being overweight, obesity and iron metabolism disorders,but the underlying mechanism is unclear. Hepcidin could be a major contributor to poor iron status observed in the obese population. MATERIAL AND METHODS: The study was performed in 58 obese elderly individuals (F/M 34/24) aged 65-91 (78.92 ± 8.32) years. The controlgroup consisted of 15 non-obese elderly volunteers, age- and sex-matched. Based on the WHO definition, 36 (62%) obese individualswere diagnosed with normo- or microcytic anaemia. The following parameters were determined: prohepcidin, haemoglobin, serum iron,erythropoietin, ferritin and C-reactive protein (CRP). RESULTS: Prohepcidin concentrations were significantly increased in obese elderly individuals without anaemia compared to obese andanaemic (p < 0.01) as well as non-obese volunteers (p < 0.01). In obese individuals with anaemia there was a decrease in serum iron,concomitant with increased levels of erythropoietin and CRP compared to two other groups. Ferritin concentration was increased inobese people (with and without anaemia) compared to the non-obese group. Serum prohepcidin levels were positively correlated withfat mass percentage in obese individuals without and with anaemia (r = 0.32; p = 0.02). CONCLUSION: Results of this preliminary study suggest that body fat content does have an impact on prohepcidin concentration, andthereby on iron homeostasis.

Serum prohepcidin and other iron metabolism parameters in elderly patients with anemia of chronic disease and with iron deficiency anemia.

INTRODUCTION: The diagnosis of iron deficiency anemia (IDA) in the context of the anemia of chronic disease (ACD) in elderly patients is often difficult due to the existence of many disorders. Recent studies have shown that hepcidin measurement (combined with the existing diagnostic methods) may possibly help in the differential diagnosis of IDA and ACD. OBJECTIVES: The aim of the study was to evaluate the differential diagnostic value of serum prohepcidin in elderly patients with IDA and ACD. PATIENTS AND METHODS: The study included 65 individuals aged 65 years or more: 26 patients with ACD, 13 patients with IDA, and 26 age-matched controls. Prohepcidin, ferritin, soluble transferrin receptor, erythropoietin, and interleukin 6 (IL-6) were measured using the commercially available enzyme-linked immunosorbent assay kits. Complete blood count, total iron-binding capacity (TIBC), and iron, transferrin, and C-reactive protein (CRP) levels were assayed using the standard laboratory methods. RESULTS: Prohepcidin concentrations were similar in patients with ACD (196.59 ng/ml) compared with those with IDA (230.16 ng/ml) (P = 0.35). Patients with ACD had significantly lower levels of TIBC compared with those with IDA (P <0.0001). Serum ferritin concentration in patients with ACD was almost 20-fold higher compared with those observed in patients with IDA (P <0.0001). CRP and IL-6 concentrations in patients with ACD were significantly higher compared with those with IDA. CONCLUSIONS: The results of the study indicate that serum prohepcidin has limited value in the differential diagnosis of IDA and ACD in elderly patients.

[Serum prohepcidin and other iron metabolism parameters in healthy adults]. / Ocena stezenia prohepcydyny na tle wybranych parametrów gospodarki zelazem w surowicy krwi ludzi zdrowych.

UNLABELLED: Hepcidin is a newly discovered iron metabolism regulator. It decreases iron absorption from the duodenal enterocytes and inhibits its release from the reticuloendothelial macrophages. The experiments on hepcidin and its precursor--prohepcidin seem very promising and underline the need to establish the reference intervals for these proteins and define the effects of age and sex on their concentrations. AIM: The aim of this study was to assess the impact of age and sex on serum prohepcidin concentration in healthy adults. MATERIAL AND METHODS: The study group consisted of 79 healthy volunteers (F-29, M-50) between 18 to 88 years of age. Healthy adults were divided into three groups according to age: group 1-33 healthy volunteers aged between 18-36, group 2-20 healthy volunteers aged between 38-53, group 3- 26 healthy volunteers aged between 58-88. Prohepcidin and ferritin concentrations were determined by enzyme-linked immunosorbent assays (ELISA). Serum iron concentration was measured on Architect c8000 System. RESULTS: In this work, we demonstrated that prohepcidin concentrations were significantly higher in group 3 (Me = 292,2 ng/ ml) in comparison with group 1 (Me = 150.7 ng/ml; p < 0.000001) or group 2 (Me = 118.1 ng/ml; p < 0.000001). We observed a positive correlation between age and prohepcidin concentration (R = 0.38; p = 0.001). The oldest group of volunteers also revealed significantly higher levels of ferritin and lower levels of serum iron in comparison with two groups of younger adults. Females showed significantly higher level of prohepcidin (Me = 226.51 ng/ml) than males (Me = 142.6 ng/ml; p = 0.01). We observed that females under 50 years of age had significantly higher levels of prohepcidin (Me = 290.9 ng/ml) in comparison with younger females (Me = 150.7 ng/ml; p = 0.0001), similar correlation was noticed in males (212.3 ng/ml vs 128.3 ng/ml; p = 0.007). CONCLUSIONS: Prohepcidin concentration increased significantly with age and was significantly higher in women than men. The results of our study show that serum prohepcidin concentration is age and sex dependent.

[Risk factors and frequency of postoperative nausea and vomiting in patients operated under general anesthesia]. / Czynniki ryzyka i czestosc wystepowania pooperacyjnych nudnosci i wymiotów u chorych operowanych w znieczuleniu ogólnym.

INTRODUCTION: Postoperative nausea and vomiting belong to fairly frequent postoperative complications, but they occupy a distant position on the list of complications, which most probably result from a general conviction that they do not pose a direct threat to patients. OBJECTIVE: The objective of this work is specification of factors facilitating occurrence of postoperative nausea and vomiting, and determination of frequency of their occurrence in patients operated under general anesthesia. MATERIAL AND METHODS: Questionnaire about the occurrence of postoperative nausea and vomiting (PONV), was carried out and included 253 adult sick persons (102 female and 151 male patients), in the age between 23-76 (average 42.3 +/- 6.1 years), who had undergone operative procedure in the field of abdominal and urology surgery, orthopedic, thyroid surgery and laryngological, ophthalmology and plastic surgery, under general anesthesia. The questionnaire form included preoperative characteristics of a patient (age, sex, smoking, motion sickness and migraine headaches in history, and PONV occurring earlier), type of operative procedure, used anesthetic agents, and analgesic agents applied in postoperative analgesia. The anesthesiologist administering anesthetic was not informed about the investigation carried out and did not receive any additional pieces of advice regarding the type of applied anesthetic agents or the method of conducting postoperative analgesia. Visual Analogue Scale (VAS) was used in the evaluation of nausea. Nausea and vomiting were assessed every two hours within the first postoperative 12 hours and every 4 hours for the next 24 hours. Nausea and vomiting were treated as two separate complications. RESULTS: Nausea itself occurred in 22.7% of patients; whereas vomiting in 13.2%. Both symptoms occurred in 14.2% of patients. Nausea occurred 4.1 +/- 0.8 hours after operation; whereas vomiting after 5.3 +/- 1.1 hours. Women suffered more often than men from (R = 0.678 p < 0.001). The same was registered for non-smokers (nausea: R = 0.623, vomiting: R = 0.437), and for the patients suffering from PONV earlier (R = 0.421 for nausea, and R=0.331 for vomiting). PONV also occurred more often in cases of obese patients (p < 0.002) and the patients anesthetized by younger anesthetists (p < 0.002). Clear relation between the frequency of postoperative nausea and vomiting occurrence and the type of operative procedure was also noticed. The relation appeared to be the strongest (R = 0.531; p < 0.001) in case of the sick who underwent abdominal and laryngological procedures (R= 0.421; p < 0.02), as well as ophthalmologic (R= 0.407; p < 0.02) procedures. However, the relation was the weakest in case of the sick who underwent orthopedic procedures (R =0.127; p < 0.02). The correlation between anesthesia induction agents and frequency of PONV was not observed. PONV was significantly more frequent in case of the sick receiving postoperative opioids than those who received nonsteroid anti-inflammatory drugs. CONCLUSIONS: (1) PONV is more frequent in women than in men. The same refers to non-smokers, suffering from migraine headaches, motion sickness, as well as obesity and suffering from PONV earlier. (2) The frequency of postoperative vomiting in the patients with nausea is higher by 65.2% than in the patients without nausea. (3) A clear relation between the frequency of postoperative nausea and vomiting occurrence and the type of operative procedure was noticed. It was the strongest in the sick who underwent orthopedic procedures. (4) The correlation between anesthesia induction agents and PONV was not observed.

[Effects of combined spinal-epidural anesthesia in patients undergoing abdominal aorta aneurysms stent-grafting]. / Przydatnosc polaczonej analgezji podpajeczynówkowo-zewnatrzoponowej do leczenia tetniaka aorty brzusznej metoda wprowadzenia stentgraftu z dostepu udowego.

We present the anesthetic combined spinal-epidural management of two patients undergoing endovascular abdominal aorta aneurysm stent-graft procedure. Due to many concomitant diseases: high blood pressure, chronic pulmonary obstructive disease, diabetes and obesity both patients were of high anesthesia risk. With no need for abdominal surgical opening, anesthetic muscles relaxation and intraoperative ventilatory support, CSEB was a method of choice. Additionally it provided sufficient intraoperative and postoperative analgesia with a possibility of anesthesia prolongation when needed and decreased the overall risk of intraoperative and postoperative cardiac and respiratory complication.

[Usefulness of urapidil during intraoperative rise of arterial blood pressure in patients operated under general anesthesia]. / Ocena przydatnosci urapidilu w leczeniu sródoperacyjnego wzrostu cisnienia tetniczego krwi u chorych operowanych w znieczuleniu ogólnym.

MATERIALS AND METHODS: Urapidil was administered in 69 patients aged between 46-79 age (average 62.7 +/- 8.4 age) to control intra-operative increase in arterial blood pressure accompanying endotracheal intubation, extubation, wakening of the patients, incision of abdominal integument and clamping of abdominal aorta. In presented group 47 patients suffered from arterial hypertension and 22 patients did not. Patients underwent various surgical procedures in general anesthesia and in 13 patients implantation of aortal prosthesis in result of abdominal aortic aneurysm (7 patients) and Leriche syndrome (5 patients) was performed. RESULTS: Urapidil turned out to be efficacious in 56 patients (81.1%), in 40 patients with previously diagnosed arterial hypertension and 16 patients who did not suffer from hypertension. In 13 other patients (18.9%) monotherapy with urapidil brought a desired hemodynamic effect and infusion of nitroglycerine was necessary. In a group of patients receiving urapidil during monotherapy, the average dosage of the medicine required to lower arterial blood pressure amounted to 26.3 +/- 2.4 mg, and respectively in patients with arterial hypertension 30.5 +/- 3.5 mg, and in patients without arterial hypertension to 22.1 +/- 4.5 mg and desired reduction of pressure was obtained on average after 11.2 +/- 3.4 minutes. Reduction of systolic pressure amounted on average to 30.5 +/- 13.5 mmHg (4.0 +/- 1.4 kPa) whereas diastolic pressure to 15.5 +/- 7.5 mmHg (2.0 +/- 1.0 kPa). In 13 patients subject to the administration of 83.7 +/- 6.5 mg of urapidil, on average desired effected was not achieved and it was necessary to infuse nitroglycerin. Among these patients reduction of systolic (average 35.3 +/- 10.7 mmHg/4.7 +/- 1.4 kPa) and diastolic pressure (average 16.7 +/- 8.3 mmHg/2.2 +/- 1.1 kPa) was obtained after 16.3 +/- 5.1 minutes on average. In patients receiving urapidil during monotherapy no acceleration of heart beat per minute was observed. On the other hand significant increase (p < 0.05) by 16.8 +/- 8.2 per minute was registered in patients receiving urapidil with nitroglycerine and it was significantly higher (p < 0.05) in patients not suffering from arterial hypertension. None of the patients suffered from arrhythmia. In 2 patients undergoing operation complications occurred within the area of abdominal aorta as ischemia of myocardium. CONCLUSIONS: Urapidil administered during monotherapy turned out to be efficacious in 81.1% of treated patients. Other 18.9% required an additional infusion of nitroglycerine, but these were patients operated on due to abdominal aorta. Average dosage of urapidil applied during monotherapy amounted to 26.3 +/- 2.4 mg. Intraoperative administration of urapidil did not result in acceleration of heart rate, and urapidil turned out to be a safe medicine to reduce intraoperative increase in arterial blood pressure also in patients who were previously diagnosed as suffering from arterial hypertension.