**4. Summary**

Cognitive dysfunctions in hospitalized patients were important clinically and socially, but difficult to analyze methodologically. Disturbances at the cellular level can manifest themselves as mood disorders and lead to a deterioration in the patients' functioning and their social assessment. It is very difficult to define either the normal state or the pathology of cognitive functions.

Although there was no agreement as to the correlation between an increased serum concentration of the S100B protein and the results of neuropsychological tests, we know that the measurement of the S100B protein as a single parameter was not sufficient to anticipate the occurrence of POCD in the postoperative period following orthopedic procedures.

The identification of patients with preexisting risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication (Blaise, et al., 2007) play an important role in decreasing the incidence of neurocognitive deficits in the elderly.

### **5. References**


According to Sharrock et al. (Sharrock et al., 2005), there occurred a worsening of testevaluated cognitive functions occurred during the first hour after the surgery, with significant improvement during the second hour. However, in patients aged over 70 years the problem can last longer (Sharrock, et al., 2005), probably due to the influence of centrally acting analgesics administered after the operation. Insufficient postoperative analgesia,

There were studies (Herrmann et al., 2001; Kilminster, Treasure, McMillan, & Holt, 1999; Snyder-Ramos et al., 2004) showing that an elevated serum S100B protein correlated with a worsening of the results of neuropsychological tests, while in some papers those correlations (Anderson, 2002) were not observed. Patients after cardiac surgery with an increased serum S100B concentration who showed any signs of brain injury had a shorter time of survival (Johnsson, 2000); thus, an elevated level of the S100B protein may reflect subclinical brain damage. Linstedt et al.(Linstedt, et al., 2002) did not observe any differences in S100B protein serum concentrations in urological patients, irrespective of the presence (or absence) of signs of POCD, but in all the patients after hip or knee arthroplasty an increased serum level of the S100B protein was noted, regardless of the presence (or absence) of POCD. An elevated concentration of the S100B protein may partially reflect a release of the protein from an extracerebral localizations, e.g. from bone marrow. During bone cement use, however, one of the reasons of an increased S100B protein level may be a thermal bone

Cognitive dysfunctions in hospitalized patients were important clinically and socially, but difficult to analyze methodologically. Disturbances at the cellular level can manifest themselves as mood disorders and lead to a deterioration in the patients' functioning and their social assessment. It is very difficult to define either the normal state or the pathology

Although there was no agreement as to the correlation between an increased serum concentration of the S100B protein and the results of neuropsychological tests, we know that the measurement of the S100B protein as a single parameter was not sufficient to anticipate the occurrence of POCD in the postoperative period following orthopedic procedures. The identification of patients with preexisting risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication (Blaise, et al., 2007) play an important role in

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**4. Summary** 

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**2** 

Barbara Lisowska

*Poland* 

*Institute of Rheumatology, Warsaw,* 

**The Stress Response and Its Functional** 

**Implications in the Immune Response After Surgery in Patients with Chronic** 

**Inflammation Undergoing Arthroplasty** 

Surgical injury evokes an injury response involving immunologic mechanisms. Alterations in the immune response after surgery are recognized as physiological reactions of the organism to restore its homeostasis. The immune responses are characterized by the release of cytokines, inflammatory mediators and acute-phase proteins. The activation of immune cells is followed by the release of various cytokines as well as by a migration of leukocytes into inflamed tissues. Cytokines play roles in the immune response, inflammatory reaction and homeostasis maintaining. Alternations of cytokines concentration in patients with normal immune system function are probably not sufficient and temporary to cause the relevant immune problems postoperative. Moreover, this response is characterized by proper balance between pro-and anti-inflammatory cytokines. Conversely, in patients with chronic inflammatory state the surgery stimulated immune response can be an additional aggravating factor that can contribute to the weakening or pathological intensification of

The surgery is associated with trauma-related immunological changes. The level of these immunological changes directly correlates with the degree of tissue damage. Both surgery and anesthesia are immunosuppressive factors, but regional anesthesia seems to be less than

Rheumatoid arthritis is an autoimmune disorder characterized by immune-mediated chronic inflammation including a degradation of the connective tissue and bone. The chronic inflammatory state is related with a strong prolonged stimulation of the immune system including a release of the complete cytokines cascade and inflammatory mediators targeted against self cells. So suddenly and unexpectly the friend turns into the enemy with

The surgery-associated tissue damage leads to the activation of the immune system and the inflammatory response. The bidirectional *r*elationship between the neuroendocrine and

**2. The short overview of the immune system and stress response to a** 

**1. Introduction** 

the response.

**surgery** 

general anesthesia.

a excited powerful destructive force.

