Medicina
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Passive smoking has been shown to be a risk factor for respiratory diseases in children. Some authors reported reduced lung function of children exposed to passive smoking. The purpose of the study was to assess the prevalence of exposure to passive smoking and its relation to respiratory health of Kaunas children. ⋯ Multiple regression analysis that included variables such as passive smoking, family history of allergy, smoked mother during pregnancy, gas stove and pets in child's room showed that FEF25 and FEF50 in girls were related to passive smoking. Our data show that more than two fifth of children are exposed to passive smoking which is associated with increased prevalence of chronic cough, wheezing, running nose and sneezing without cold. Passive smoking is also related to decreased lung function, especially for small airway flows.
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Randomized Controlled Trial Comparative Study
[Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study].
The aim of the study was to find minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery. ⋯ Groups were comparable in demographics. No case of failure was registered but 4 patients (10.5%) in the group 3 received supplemental i/v fentanyl to treat tension in the abdomen intraoperatively. Level of sensory block in groups 1, 2, 3 was 10.4+/-1.7, 7.013+/-2.2, 6.7+/-1.9 dermatomes, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=1.0 group 2 vs 3, Bonferroni). Extent of motor block was 2-3 scores according to the Bromage scale in 70.5% of group 1 cases, compared to 0-1 score in 97.3% of group 2 and 92.1% of group 3 cases. Median (range) duration of motor block in groups 1, 2, 3 was 90 (0-120), 0 (0-90), and 0 (0-60) min, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=0.13 group 2 vs 3, Bonferroni). Time of ambulation was 181.5+/-41.5, 136.6+/-32.2 and 123.0+/-45.9 min, respectively (p<0.0001 ANOVA; p<0.001 group 1 vs 2, p<0.00001 group 1 vs 3, p=0.43 group 2 vs 3, Bonferroni). There was no significant intergroup difference in time to urinate; retention developed in 20.4% of total cases. No difference was found in morphine consumption, 64.5% of cases did not require rescue analgesics. Quality of anesthesia was stated as excellent by the anesthesiologist and surgeon in all groups. However, quality was rated as excellent by patient in the operating room in groups 1, 2, 3: 58.8, 94.7, and 86.8%, respectively (p=0.003), on day 1 postoperatively: 76.5, 92.1, and 97.4%, respectively (p=0.023); by nursing staff: 82.4, 100, and 97.4%, respectively (p=0.019). Lower rates in group 1 were due to extensive motor block. In conclusion, a minimal recommended dose of spinal hyperbaric bupivacaine for anorectal surgery is 4-5 mg; a dose of 7.5 mg is excessive due to prolonged sensory and motor block.
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The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Injuries to this area include occipital condyle fractures, occipitoatlantal dislocations, subluxations and dislocations of the atlantoaxial articulation, atlas fractures, odontoid fractures, and fractures of the arch of the axis. ⋯ The complex regional anatomy and overlying structures make plain radiographic images difficult to interpret. Delayed recognition can result in significant disability. A thorough understanding of the clinical presentation, radiographic assessment, and mechanisms of injury can minimize morbidity and enhance treatment effectiveness for the more common upper cervical ligamentous and bony injuries.
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The aim of the study was to evaluate influence of preoperative treatment with aspirin or heparin on platelet function and intensity of postoperative blood loss in early period after coronary artery bypass grafting (CABG). ⋯ Our investigation shows that preoperative treatment with aspirin or heparin had no remarkable influence on dynamics of platelet function in early period after CABG. The least blood loss was observed in patients with heparin pretreatment.
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For years, smoking induced inflammatory reaction, comprised mainly of neutrophils and macrophages, has been accepted to be the major component in pathogenesis of chronic obstructive pulmonary disease. New developments in molecular and cell biology have provided scientists with new knowledge and understanding of inflammatory processes in lung. Recent reports have underlined the role of autoimmunity and T lymphocytes as a potential important factor, which takes place in the pathogenesis of chronic obstructive pulmonary disease. This article reviews potential mechanism of T cell mediated immune response in chronic obstructive pulmonary disease.