Medicina
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Comparative Study
[Video-assisted thoracoscopic surgery as an alternative to urgent thoracotomy following open chest trauma in selected cases].
To prove that video-assisted thoracoscopic surgery in selected cases is an alternative to urgent thoracotomy following open chest trauma. ⋯ Video-assisted thoracoscopy is minimally invasive method of thoracic surgery allowing for the evaluation of the pathological changes in the lung, pericardium, diaphragm, mediastinum, thoracic wall and pleura, including the localization of these changes, and the type and severity of the injury. The number of early post-operative complications following video-assisted thoracoscopy is lower. Compared to operations through thoracotomy incision, video assisted thoracoscopies entail the shortening of the duration of drain presence in the pleural cavity and the duration of post-operative treatment. Video-assisted thoracoscopy should be performed on all patients with open chest trauma and stable hemodynamics and the respiration function. Video-assisted thoracoscopy is an informative diagnostic and treatment method allowing for the selection of patients for urgent thoracotomy.
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This study evaluated effectiveness of hypotensive epidural anesthesia in decreasing blood loss, operation and extubation time, opiates use and stay in intensive care unit. ⋯ Hypotensive epidural anesthesia is an effective method to decrease blood loss and blood transfusions in thoracic surgery. It creates better conditions for surgery and reduces stay in intensive care unit. Also there were no serious cardiac, neurological and renal intra-operative and post-operative complications that could be conditioned by the use of hypotension.
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Comparative Study
[Assessment of health care services quality by medical professionals and patients].
The article presents the data of medical professionals and patients' assessment of health care services quality in Jurbarkas hospital. All physicians and nurses, working full time, and patients, treated in the hospital within November-December 2002, were invited to participate in the survey. The response rate among the physicians was 79.5%; while among the nurses and the patients it was 64.5%, and 68.9% correspondingly. ⋯ The physicians and nurses rated their communication with the patients more critically than the patients. The differences between the medical professionals and patients' assessments concerning health care services quality demonstrate, that in order to achieve comprehensive information, it is necessary to organize a universal survey. The information assembled from different sources will allow collecting more objective and comprehensive data about the quality of health care services in hospital.
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This study evaluates the clinical efficacy of interscalene brachial plexus block (according to G. Meier) for shoulder surgery. ⋯ Single injection interscalene brachial plexus block is a reliable anesthetic and effective method of providing postoperative pain relief after shoulder surgery.
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Cancer pain is a major problem for cancer patients, as about 80 percent patients with advanced cancer declare pain as their main symptom. The causes of the pain are very different: due to the main tumor, its metastases, anticancer treatment, debility caused by the cancer or other diseases. The cancer pain relief algorithm is proposed in the article, including determination of the cause, type, intensity of pain, its pharmacological and non-pharmacological management, opioid rotation rules, treatment of adverse drug reactions, etc.