Cerebrospinal fluid and serum IL-8, CCL2, and ICAM-1 concentrations in astrocytic brain tumor patients.

BACKGROUND: The aim of the study was the evaluation of serum and CSF concentrations of CCL2, IL-8, and sICAM-1 in patients with astrocytic tumors as compared to a group of non-tumoral patients. METHODS: Chemokine concentrations were measured using the ELISA method. RESULTS: Regardless of the parameter tested and the patient group (brain tumor or non-tumoral patients), statistical differences (P < 0.05) were found between concentrations obtained in CSF compared to values obtained in serum for all proteins tested. CSF IL-8 concentrations were significantly elevated in CNS tumor patients as compared to non-tumoral individuals (P = 0.000); serum CCL2 and sICAM-1 concentrations were significantly decreased in CNS tumors in comparison with the comparative group (P = 0.002 and P = 0.026, respectively). Among proteins tested in the serum, a higher area under the ROC curve (AUC) revealed CCL2 compared to sICAM-1 in differentiating subjects with CNS brain tumors from non-tumoral subjects. AUC for CSF IL-8 was higher than for its index (CSF IL-8/serum IL-8). CONCLUSIONS: For individual biomarkers (IL-8 and CCL2, sICAM-1), measured in CNS brain tumor patients, the appropriate material, respectively CSF or serum, should be chosen and quantitatively tested. Increased cerebrospinal fluid IL-8 with decreased serum CCL2 create a pattern of biomarkers, which may be helpful in the management of CNS astrocytic brain tumors.

Severity of airway hyperreactivity associated with laryngeal mask airway removal: correlation with volatile anesthetic choice and depth of anesthesia.

STUDY OBJECTIVE: To compare the influence of anesthetic depth and choice of volatile anesthetic drug on the incidence and severity of airway hyperreactivity associated with Laryngeal Mask Airway (LMA) removal. DESIGN: Randomized observer-blinded study. SETTING: Ambulatory Surgical Center at a University Medical Center. PATIENTS: 123 ASA physical status I and II children undergoing infraumbilical procedures. INTERVENTIONS: Patients were randomly assigned to one of four treatment groups: Group 1 = anesthetic induction with halothane, maintenance with isoflurane, nitrous oxide (N(2)O), and oxygen (O(2)), LMA removed when child awakened; Group 2 =anesthetic induction and maintenance as in Group 1, LMA removed while child anesthetized with age adjusted 2 minimum alveolar concentration (MAC) end-tidal concentration of isoflurane; Group 3 = anesthetic induction and maintenance with sevoflurane, N(2)O, and O(2), LMA removed when child awakened; Group 4 = anesthetic induction and maintenance as in Group 3, but LMA removed while child anesthetized with age-adjusted 2 MAC end-tidal concentration of sevoflurane. MEASUREMENTS AND MAIN RESULTS: Severity of airway hyperreactivity was graded as mild, moderate, or severe. A significant difference was not found amongst the four groups with respect to mild and moderate airway hyperreactivity. Severe airway hyperreactivity leading to a critical event [partial or complete laryngospasm with oxygen saturation (SPO(2)) < 85%] was only encountered in Group 1 patients (incidence 13%). Adverse airway events (SPO(2) < 90%, vomiting and bronchospasm) were also significantly higher in Group 1 (p < 0.05). Isoflurane use was independently associated with significantly higher airway hyperreactivity when compared with sevoflurane (p < 0.05). CONCLUSIONS: Depth of anesthesia during LMA removal does not appear to affect the incidence or severity of airway hyperreactivity when sevoflurane is the maintenance anesthetic. However, awake LMA removal during isoflurane anesthesia results in a higher incidence of adverse airway events and carries the risk of severe airway hyperreactivity.

Recovery from neuromuscular blockade after either bolus and prolonged infusions of cisatracurium or rocuronium using either isoflurane or propofol-based anesthetics.

UNLABELLED: We examined the recovery characteristics of cisatracurium or rocuronium after bolus or prolonged infusion under either isoflurane or propofol anesthesia. Sixty patients undergoing neurosurgical procedures of at least 5 h were randomized to receive either isoflurane with fentanyl (Groups 1 and 2) or propofol and fentanyl (Groups 3 and 4) as their anesthetic. Groups 1 and 3 received cisatracurium 0.2 mg/kg IV bolus, spontaneously recovered, after which time an infusion was begun. Groups 2 and 4 received rocuronium 0.6 mg/kg IV, spontaneously recovered, and an infusion was begun. Before the end of surgery, the infusion was stopped and recovery of first twitch (T(1)), recovery index, clinical duration, and train-of-four (TOF) recovery was recorded and compared among groups by using appropriate statistical methods. Clinical duration was shorter for rocuronium compared with cisatracurium using either anesthetic. Cisatracurium T(1) 75% recovery after the infusion was shorter with propofol compared with isoflurane. Cisatracurium TOF 75% recovery was similar after either bolus or infusion, but rocuronium TOF 75% recovery after the infusion was delayed. Infusion rates decreased for cisatracurium but remained relatively constant for rocuronium regardless of the anesthetic used. Isoflurane enhances the effect of both muscle relaxants but prolonged cisatracurium recovery more than rocuronium. Of the two muscle relaxants studied, rocuronium's recovery was most affected by length of the infusion. Cisatracurium may be a more desired muscle relaxant for prolonged procedures because recovery was least affected by prolonged infusion. IMPLICATIONS: This study describes the effect of different anesthetic techniques on the recovery of two different muscle relaxants, cisatracurium and rocuronium, when administered as either a single bolus or prolonged infusion during neurosurgery. This study demonstrates the feasibility of using these relaxants for these prolonged procedures.

Port-access minimally invasive cardiac surgery increases surgical complexity, increases operating room time, and facilitates early postoperative hospital discharge.

BACKGROUND: Proposed advantages of port-access cardiac surgery have yet to be substantiated. The authors retrospectively compared patients undergoing port-access cardiac surgery with a matched group undergoing conventional cardiac surgery. METHODS: Forty-six patients who underwent port-access cardiac surgery were matched with 46 who underwent conventional cardiac surgery. Absolute criteria for matching included morning-of-surgery admission, procedure undergone, and care being delivered by one of two surgeons. If possible, matching included care delivered by one of two anesthesiologists. Patients were matched as closely as possible for preoperative demographic and clinical characteristics. RESULTS: All 46 pairs of patients were matched for procedure and admitted the morning of surgery. All 92 operations were performed by one of two surgeons, and 89% were performed by one of two anesthesiologists. Preoperative demographic and clinical characteristics were equivalent between groups. Compared with conventional cardiac surgery, port-access cardiac surgery increased surgical complexity (it almost tripled cardiopulmonary bypass time during coronary artery bypass grafting and increased it almost 40% during mitral valve procedures) and increased total operating room time (P < 0.0001). Port-access cardiac surgery had no beneficial effect on earlier postoperative extubation, decreased incidence of atrial fibrillation, or intensive care unit time, yet it decreased postoperative duration of stay (P = 0.029, all patients), a benefit observed primarily in patients undergoing coronary artery bypass grafting (P = 0.002). CONCLUSIONS: This retrospective analysis revealed that port-access cardiac surgery increases surgical complexity, increases operating room time, has no effect on earlier postoperative extubation or decreased incidence of atrial fibrillation or intensive care unit time, and may facilitate postoperative hospital discharge (primarily in patients undergoing coronary artery bypass grafting). Properly designed prospective investigation is necessary to ascertain whether port-access cardiac surgery truly offers any benefits over conventional cardiac surgery.

The position of the monozygotic twins among their school class-mates in the light of results of Janusz Korczak's "Plebiscite on likes and dislikes".

Within the "Wroclaw Longitudinal Twin Study" in a part of the material the liking level of singletons (SIN) to identical twins (TMZ) and of TMZ to SIN was analysed cross-sectionally, in the period of 11th to 18th year of life. In each of the 76 classes of elementary and high schools in Wroclaw (Poland), including the investigated in 1976-7 TMZ (64 pairs), were evaluated the relations between school-mates, using the Korczak's five-degree scale of liking. The declared by TMZ and SIN liking decreased with age between pupils of the same sex, and increased between pupils of opposite sex, however, in TMZ with some delay. The liking declared by TMZ of both sexes to SIN was on average lower than that declared by SIN to TMZ. The degree of liking declared by SIN to TMZ of the same sex was average higher than in relation of SIN to SIN particularly among girls. Thus, there occurred the so-called "prima donna effect". The liking declared to pupils of opposite sex in relation of SIN to TMZ was on average lower than the analogous one in relation of SIN to SIN and in relation TMZ to SIN even worse. The higher contrast in treating pupils of the same and opposite sex in TMZ than in SIN indicates a lower social maturity in TMZ. A diverse influence of socio-economic conditions on the declared toward then liking by boys and girls was found. The low number of separated twins did not allow to make a generalisation on specificity of their position in class. The sending of TMZ to different classes appeared to be in Wroclaw elementary schools sporadic (1 repeater), and in high schools observed in 38%, from that 28% of twins went to equivalent classes, usually in different school, and in 10% of pairs one of the twins repeated the class.