Medicina
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The aim of this prospective study was to review incidence of neurological and cognitive complications after coronary artery bypass graft surgery and find out predictive factors, associated with perioperative cerebral dysfunction. ⋯ The Canadian Stroke Scale and The Confusion Assessment Scale are sensitive and objective methods for diagnostics of postoperative neurological dysfunction. To characterize the incidence and severity of neuropsychological dysfunction, a concise battery of neuropsychologic tests that provides reliable evidence of subtle brain trauma should be used.
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Severe acute adrenocortical insufficiency or adrenal crisis are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or ineffectively treated. Although more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are far the most abundant and physiologically active. In primary adrenocortical insufficiency, glucocorticoid and mineral-corticoid properties are lost; however, in secondary adrenocortical insufficiency (i.e., secondary to disease or suppression of the hypothalamic-pituitary axis), mineralocorticoid function is preserved. ⋯ The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, occasionally, laboratory findings. Delay in treatment while attempting to confirm this diagnosis can result in poor patient outcomes. This article review data about physiology, pathophysiology of the adrenal cortex, physiologic effects of glucocorticoids, aldosterone, causes of primary and secondary adrenal insufficiency, frequency, clinical picture, laboratory and imaging studies of adrenal crisis, laboratory evaluation of adrenal function and emergency therapy, replacement therapy, mortality/morbidity of this pathology.
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Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called noninsulin-dependent diabetes mellitus) is not as rare as was once thought. ⋯ The review discusses diagnostic procedures, laboratory evaluation, differential diagnosis and treatment: replacement of fluid and electrolytes, low-dose insulin therapy and recommendations for use of bicarbonate. A discussion of complications management of diabetic ketoacidosis (hypoglycemia, hypokalemia, cerebral edema, hyperchloremic metabolic acidosis, pulmonary edema, adult respiratory distress syndrome), mortality rate and prevention are included in this review.
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Comparative Study
[Patient-controlled analgesia in the treatment of postoperative pain in children and adolescents].
We aimed to evaluate the efficacy, morphine requirements and side effects in patients managed with patient-controlled analgesia postoperatively. ⋯ In the majority of patients patient-controlled analgesia was effective and used doses of morphine were low. Though nausea/vomiting was the most common side effect, decreased respiratory rate was observed in some patients. Regular patient evaluation for vital signs and side effects is recommended.
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Objective was to evaluate sensitivity, specificity and diagnostic accuracy of brain computed tomography (CTA) in patients with subarachnoid hemorrhage (SAH). ⋯ CTA is a quick, noninvasive method to be performed in outpatient and inpatient basis. It gives information about vessels and surrounding tissues. In some cases it can replace DSA. CTA must not be considered as replacement of DSA, instead, it should be considered as method providing more additional information.