Background: This study evaluated the ability of dexmedetomidine to provide analgesia and sedation for outpatient colonoscopy, examining outcomes including cardiorespiratory variables, side effects, and discharge readiness. Methods: Sixty-four patients were randomly assigned to one of three treatment regimens. In group D, patients received 1 microg/kg dexmedetomidine over 15 min followed by an infusion of 0.2 microg x kg x h. Group P received meperidine (1 mg/kg) with midazolam (0.05 mg/kg), and group F received fentanyl (0.1-0.2 mg intravenous) on demand. The assessment included measurements of heart rate, blood pressure, oxygen saturation, respiratory rate, quality of sedation/analgesia, and an evaluation of the recovery time. Results: The study was terminated before the planned 90 patients had been recruited because of adverse events in group D. In all groups, negligible hemoglobin oxygen saturation and respiratory rate variations were observed. In group D, there was a significantly larger decrease in heart rate (to approximately 40 beats/min in 2 of 19 cases) and blood pressure (to less than 50% of the initial value in 4 of 19 patients). Supplemental fentanyl was required in 47% of patients receiving dexmedetomidine to achieve a satisfactory level of analgesia (vs. 42.8% of patients in group P and 79.2% of patients in group F). Vertigo (5 patients), nausea/vomiting (5 patients), and ventricular bigeminy (1 patient) were observed only in group D. Time to home readiness was longest in group D (85 +/- 74, 39 +/- 21, and 32 +/- 13 min in groups D, P and F, respectively; P = 0.007). Conclusions: The use of dexmedetomidine to provide analgesia/sedation for colonoscopy is limited by distressing side effects, pronounced hemodynamic instability, prolonged recovery, and a complicated administration regimen.

Neoplasms are the second leading cause of death in Poland after vessel diseases, despite the huge progress in medical sciences in the last 20 years. Recently, gastric cancer morbidity has decreased, but mortality is still at a high level. Tissues from 24 patients with a histopathologically diagnosed mucosal and adenomucosal gastric cancer were tested. Patients were divided into 2 equal groups: patients without metastases (G1) and patients with metastases in the liver (G2). In all tested tissues of G1 and G2, the expression of VEGF (vascular endothelial growth factor) and metalloproteinase 2, respectively, were estimated. Results revealed a statistically significant increase in the VEGF expression for G1 and G2 in relation to the margin (p1<0.001; p2<0.001). The increase of gene expression for VEGF did not significantly differ statistically in G1 and G2. The obtained results revealed a statistically significant difference in the increase of gene expression for MMP-2 in G1 in relation to the margin (p<0.05) and a very high one in G2 in relation to the average margin value (p<0.001). A highly statistically significant correlation was obtained for VEGF and MMP-2 in the tissue of patients with metastases (p<0.001; r=0.714). The highly elevated expression of MMP-2 in the tissue of gastric cancer in patients with metastases confirms its participation in the invasiveness of the neoplasmatic process. The highly significant correlation between VEGF and MMP-2 suggests a connection between both mechanisms in the progression of gastric cancer.

Background: Horner's syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateral sympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinal anaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of this randomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB) technique on the occurrence rate of Horner's syndrome and identify contributing risk factors. Methods: 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. The patients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation (PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU). Results: We observed that Horner's syndrome developed in 12% of the N group, 6% of the NU group, and 9% of the U group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used to induce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patients to the development of Horner's syndrome. Interestingly, our results showed that NU patients with Horner's syndrome were significantly younger than NU patients without Horner's syndrome. Conclusion: The precision of IBPB by use of the dual guidance technique may reduce the rate of Horner's syndrome. The higher water concentration in the prevertebral spaces of younger patients may create better conditions for the diffusion of ropivacaine, which may result in a statistically significant higher HS rate. Background: Horner's syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateral sympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinal anaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of this randomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB) technique on the occurrence rate of Horner's syndrome and identify contributing risk factors. Methods: 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. The patients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation (PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU). Results: We observed that Horner's syndrome developed in 12% of the N group, 6% of the NU group, and 9% of the U group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used to induce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patients to the development of Horner's syndrome. Interestingly, our results showed that NU patients with Horner's syndrome were significantly younger than NU patients without Horner's syndrome. Conclusion: The precision of IBPB by use of the dual guidance technique may reduce the rate of Horner's syndrome. The higher water concentration in the prevertebral spaces of younger patients may create better conditions for the diffusion of ropivacaine, which may result in a statistically significant higher HS rate.