Medicina
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Commotio cordis due to blunt trauma to the precordium is a rare cause of death in young athletes, occurring less frequently than all of the other athletics-related deaths. Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation, which is often resistant to resuscitative therapy. In this article we discussed this catastrophic event, its historical development, epidemiology and clinical presentation, mechanisms for sudden death in commotio cordis, limitations of evidence using animal models, autopsy findings, resuscitation and preventive measures.
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Quality and adequacy of specialized first aid for patients affected by high energy trauma is extremely important factor in order to reduce postraumatic disability and mortality of polytrauma patients. Treatment strategies for high energy trauma management are in early stages of development. Adequate aid can be rendered only in a few centers of Lithuania. ⋯ Averaged injury severity score, according to ISS, was 21.3, mortality rate was 34%. It was established long duration of pre-hospital and early hospital stage of management (accordingly 34+/-6.5 and 50+/-17.2 minutes), extremely rare monitoring of vital signs in pre-hospital stage (breathing was evaluated for 1.9% of patients, heart rate for 26.4% of patients). Fluid therapy as a part of complex treatment was applied for 7.5% of patients in pre-hospital stage and 3.8% in very early hospital stage.
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Comparative Study
[The immunological parameters and risk factors for pollen-induced allergic rhinitis and asthma].
Naturally occurring exposure to pollen allergens causes symptoms of allergic rhinitis, conjunctivitis and asthma in susceptible individuals. It is, however, unknown why some subjects develop only an allergic rhinitis while others develop asthma as well. The aim of this study was to investigate the difference of immunological parameters in patients with pollen-induced seasonal allergic rhinitis (SAR) and asthma and to determine the risk factors for pollinosis with asthma. We evaluated the demographic and clinical characteristics of the patients, sensitisation pattern to tree-, grass- and weed-pollen and perennial inhalant allergens according to skin prick tests, allergic inflammation parameters (blood and nasal eosinophil count, serum IgE, eosinophil cationic protein levels) in and out of the pollinosis season. Logistic regression analysis was used to rate the effect of covariates on risk for pollinosis and asthma. One hundred and one patients (52 men and 49 women) aged 16-63 years (median 24 yrs.) with pollinosis symptoms were investigated. All patients suffered from moderate-severe seasonal allergic rhinitis, 96% from concomitant allergic conjunctivitis, 23.8% had seasonal asthma. The significant clinical and demographic risk factors for pollinosis with asthma were smoking (OR=15.4, p=0.003) and pollinosis season lasting more than 14 weeks (OR=5.6, p=0.02). The patients with seasonal allergic rhinitis alone were significantly more frequently sensitized to orchard grass (p=0.005), ragweed (p=0.02), lamb's quarter (p=0.05) allergens. During the season the blood eosinophil count raised in all patients (p<0.01). It was shown statistically that there were no differences between groups in blood and nasal eosinophil count, serum eosinophil cationic protein level. The patients with seasonal allergic rhinitis and asthma had higher levels of serum IgE during the season (p=0.05) and out of it (p=0.01). More than two times elevated serum IgE in acute and symptom-free period of pollinosis was considered as a significant risk factor for pollinosis with asthma (OR=3.5, p=0.04 and OR=3.4, p=0.03). ⋯ Pollinosis presented with seasonal asthma in 23.8% of cases. Our data indicate that patients with seasonal allergic rhinitis and asthma differ from the patients with seasonal allergic rhinitis alone according to higher serum IgE levels. Prolonged pollinosis season, smoking and high IgE levels increase the risk for seasonal asthma in pollen-induced allergic rhinitis subjects.
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Comparative Study
[Treatment of supracondylar humerus fractures in children, according to Gartland classification].
Supracondylar fractures are the most common fractures in the area of elbow in children. The purpose of this study was to review and analyze the treatment patterns of supracondylar humerus fractures in childhood. There were 93 children with supracondylar humerus fractures treated in the Department of Pediatric Orthopedics within the period from March 2000 till November 2002. ⋯ Type III displaced fractures should be treated with closed reduction and percutaneous pinning with K-wires under the fluoroscope guidance. It is believed to be a safe, reliable and efficient method for treatment of this difficult fracture. Indications for open reduction and internal fixation includes open fractures, fractures complicated by vascular injury, unsatisfactory closed reduction due to unstable fracture.
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One of the life-threatening complications of hyperemesis gravidarum is Wernicke's encephalopathy, the main etiological factor of which is a lack of thiamine (vitamin B1). Most frequently Wernicke's encephalopathy is found among persons suffering from excessive drinking. ⋯ The course of the disease, clinical signs, diagnostics, treatment and its results are presented. Also a review of the literature on Wernicke's encephalopathy secondary to hyperemesis gravidarum is introduced.