Medicina
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Amniotic fluid embolism is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the maternal circulation. Amniotic fluid embolism is an incompletely understood obstetric complication unique to pregnancy presenting with the acute onset of hypoxia, hypotension and severe coagulopathy. ⋯ It cannot be predicted nor prevented. The epidemiology of amniotic fluid embolism, frequency, pathophysiology, clinical presentation, histologic findings, diagnosis, differential diagnosis, possible treatment, mortality rate, neonatal survival are discussed in this review article.
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Focal cerebral contusions can be dynamic and expansive, leading to a delayed neurological deterioration. In head--injured patients, the rise in intracranial pressure (ICP), subsequent to uncontrollable swelling, is the only and the most frequent cause of death. Studies show that brain swelling, after traumatic brain injury (TBI), is caused by brain edema rather than cerebral blood volume (CBV). ⋯ Histologically the loss of CA3 pyramidal cells in the hippocampus was observed ipsilaterally in the cortical contusion and bilaterally in diffuse axonal injury. Aggressive, early hyperventilation after TBI augments neuronal death in CA3 hippocampus. Due to high mortality associated with such cerebral contusions, a standard practice has evolved into evacuating contusions in patients who had deterioration in the level of consciousness, lesions more than 30 sec and CT suggestion of raised ICP.
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Comparative Study
[Autotransfusion of red blood cell from cardiopulmonary bypass circuit blood after cardiac surgery].
The aim of this study was to evaluate the effect of autologous centrifuged residual cardiopulmonary bypass blood on patients' hematocryte value, donor blood product requirements, postoperative blood loss, hospitalization time and the development of infective complications. ⋯ We found that autologous centrifuged residual cardiopulmonary bypass blood was useful in avoiding infective complications, decreasing need of donor blood product requirement and postoperative length of stay in the hospital. This method increases hematocryte value after 12 hours postoperatively.
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Comparative Study
[Stair climbing test in prediction of postoperative complications after lung cancer surgery].
Preoperative physical state of a patient is very important for adaptation of the patient after lung resections. Purpose of this work is to evaluate an information factor of a stair-climbing test while predicting of postoperative complications after lung cancer surgery. Fifty two patients were examined, who passed lung surgery of different volume. ⋯ Postoperative course was normal for those patients (n=11) who were able to climb five or more flights of stairs. It was noticed that duration of postoperative period has an inverse proportion to a number of the climbed up footsteps. The stair-climbing test is a simple, safe, cheap and informative enough for prediction of postoperative cardiopulmonary complications after lung cancer surgery.
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Evaluate efficacy of videothoracoscopic operations in diagnosis and treatment of lung and pleural diseases. In 1997-2001 186 operations were performed using videothoracoscopic devices in the Department of Thoracic Surgery, Institute of Oncology, Vilnius University. Fourty eight resections were performed: 4 (8%) lobectomies, 1 (2%) pericardial cystectomy, 3 (6%) simpatectomies, 3 (6%) intrathoracal lipomectomies, 1 (2%) removing calcificate, 3 (6%) resections of pericardium, 15 (30%) removing metastases, 12 (25%) hamartomas, 6 (13%) wedge resections of lungs tissue due to I(st) stage NSCLC performed for the elderly. One hundred thirty eight diagnostic procedures were performed in pts with various lung and pleura diseases: 66 (48%) biopsies of lungs tissue and 72 (52%) biopsies with chemopleurodesis. From oncological point of view videothoracoscopic operations are confirmed. These operations shortens hospitalization and combined treatment starts quicker. Middle period of hospitalization - 5 days. We had complications: 22 pts (12%) postoperative pneumonia, 4 pts (2%) - short duration pneumothorax, 1 pts (0.5%) - pleural empiema 1 pts (0.5%) - drop of the lung 1 pts (0.5%) - bleeding. After resections margins were free of tumor invasion. ⋯ 1. Video-assisted thoracic surgery (VATS) surgery is effective safe method of treatment for lung and pleural diseases. 2. In some cases VATS surgery is the only way to remove tumours, and it shortens hospital stay till 5 days. 3. VATS surgery is very effective in elderly patients with concomitant diseases. 4. Chemopleurodesis is very useful in treatment of pleural fluid.