Medicina
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Comparative Study
Lethal outcomes in patients with symptomatic heart failure developed after Q-wave myocardial infarction.
The article analyses clinical characteristics and mortality of patients with symptomatic chronic heart failure following Q-wave myocardial infarction. During the study 224 patients (mean age 64.1+/-9.7) with symptomatic chronic heart failure and left ventricular ejection fraction <40% were followed-up for 1-5 years (on the average, 2.6+/-2.0 years). The majority of the studied patients had had anterior or anterior-lower Q-wave myocardial infarction (61.6% and 25.9%, respectively) and an identified Canadian function class II-IV angina pectoris (74.6%), and one-fifth of the patients (19.6%) had unstable angina pectoris. ⋯ The evaluation of Kaplan-Meier curves showed that total mortality resulting from the development of chronic heart failure symptoms and indications of chronic heart failure during the 1st year was 21.0%, during the 2nd year -40%, during the 3rd year -55.0%, during the 4th year -61.0%, and during the 5th year -65.0% the highest mortality was observed when left ventricular ejection fraction < or =20%, and age >75. The development of severe chronic heart failure resulted, on the average, after 1.5+/-1.1 years. It is obvious that symptomatic chronic heart failure caused by ischemic cardiomyopathy and marked left ventricular systolic dysfunction following Q-wave myocardial infarction is a rapidly progressing process conditioning high risk of lethal outcome within the period of several years.
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Gliomas are the most common type of primary intracerebral neoplasm. They carry a dismal prognosis. ⋯ This paper reviews different morphological, genetic, molecular factors and their association with survival. Tumor associated morphological features such as predominant cell type, cellularity, cytological atypia, proliferation activity, microvascular proliferation, necrosis and apoptosis are discussed in some detail.
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Peripheral, especially central venous catheters, are used with increasing frequency in the intensive care unit and in general medical wards to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor hemodynamic status. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay. ⋯ Reducing catheter infections rates requires a multiple-strategy approach. Therefore, intensive care units and other locations where catheters are used should implement strict guidelines and protocols for catheter insertion, care, and maintenance.
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The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. ⋯ Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.
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While still relatively uncommon in many countries, esophageal cancer is fatal in the vast majority of cases. In the USA, estimated 13,100 of new cases were diagnosed in 2002. In Lithuania, 163 new cases were diagnosed in 2001. ⋯ The superiority of preoperative chemoradiation over surgery alone in esophageal cancer has been demonstrated in a prospective trials. Recently published phase I and II studies have demonstrated moderate response rates to taxanes in esophageal cancer. Taxanes and irinotecan in combinations with platinum compounds and fluoropyrimidines are being tested in regimes with radiation.