Medicina
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Comparative Study
[Analysis of treatment outcomes after electric injuries (1991-2000)].
During the 1991-2000 year period 1728 children and 1967 adults have been treated in the Unit of Plastic Surgery and Burns of Kaunas Medical University Hospital. A retrospective analysis of patients who sustained electric injuries during these years period was carried out. Among all patients 93 (2.517%) were injured by electricity. 38 (40.86%) of them were children and 55 (59.14%)--adult patients. ⋯ Five patients of adult high voltage injury group needed amputation. Three of them needed amputation of forearm, one--of upper arm and one--of the calf. From low voltage injury group 3 patients needed amputations of one or two fingers and only one patient needed amputation of upper arm.
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Case Reports Comparative Study
[Simultaneous myocardial revascularization and abdominal aortic aneurysm repair (report of a fatal case)].
Patients with coronary disease associated with abdominal aortic aneurysm or aortoiliac occlusive disease often raise problems of operative strategy. In particular, the order in which these lesions should be treated is a frequent source of controversy. Our approach for the past two years has been a combined myocardial revascularization with abdominal aortic reconstruction in patients with both lesions. ⋯ We report here the fatal case of combined coronary artery bypass grafting and abdominal aortic aneurysm repair. Partial heparinization and operation without extracorporeal circulation caused acute thrombosis of abdominal aortic aneurysm and femoral arteries. Our first experience advocates using total heparinisation and cardiopulmonary bypass for combined cardiac-aortic procedures.
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Between December 1972 and January 2002, 201 patients had replacement of the ascending aorta at Vilnius University Heart Surgery Clinic. 171 of them had aortic valve replacement, too, and 30 patients - without aortic valve correction. Septical complications post operation had 24 (11.94%) patients. Their age ranged from 30 to 73 years (mean 49.4 years). ⋯ Septical complications were not common in patients after ascending aorta replacement. Reoperations were associated with early mortality and satisfactory long-term results. Conservative treatment was not successful.
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Review Comparative Study
[Procalcitonin: a new infection marker. Its use in intensive care].
In daily routine diagnosis, there are few parameters available to monitor critically ill patients and to control the course of therapy in severe inflammations. There are also few reliable parameters differentiating acute bacterial infection from other types of inflammation. Most of the presently used indicators of the inflammatory response, like body temperature, white cell count, erythrocyte sedimentation rate or C reactive protein are unspecific parameters with changing reliability. ⋯ The incidence of noninfectious systemic inflammatory response syndrome associated with coronary artery bypass surgery and the potential role of several inflammatory parameters as early markers of pulmonary dysfunction induced by cardiopulmonary bypass were investigated. Procalcitonin seems to be appropriate parameter indicating the early development of severe noninfectious systemic inflammatory response syndrome and for predicting pulmonary dysfunction secondary to cardiopulmonary bypass. Hence, the review of the data of different authors may lead to the conclusion that because of wide spectrum of indications procalcitonin concentration can be used for differential diagnosis of bacterial versus non-bacterial inflammation, as monitoring parameter in critically ill patients, the course of disease, treatment control evaluating the effectiveness of antibacterial treatment, for evaluation of high risk patients to see if there are no postoperative bacterial complications as a prognostic indicator.
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The dangers of opioid overdose have been recognized for as long as the use of opium itself. When used correctly for medical purposes, opioids are remarkably safe and effective agents. ⋯ In a number of countries the use of heroin and other opioids in nonmedical contexts in associated with on increasing rate of overdose and often of fatal opioid overdose. This review article discusses opioid-receptor pharmacology, which is necessary for understanding of the signs and symptoms of opioid ingestion and management principles, clinical and toxic effects mediated with the opioids, the diagnosis and management guidelines in opioid intoxication, a clinical prediction rule to identify patients who can be safely discharge from hospital, the problems of the significant morbidity and mortality associated with opioid overdose.