Medicina
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There are still many discussions among physicians how heart failure should be defined. Despite many suggested traditional classifications, majority of definitions circulating in clinical practice and their appropriate usage remain unclear. ⋯ Diagnostic strategy of acute heart failure as well as recommendations for prehospital and inpatient treatment of its forms (pulmonary edema and cardiogenic shock) are presented in the article. Application of new medications, recently introduced to the clinical practice for treatment of acute heart failure, is discussed.
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Review Comparative Study
[The new aspects of treatment of severe sepsis and septic shock].
The mortality rate of infection-induced organ dysfunction or hypoperfusion abnormalities due to severe sepsis and septic shock remains unacceptably high. The adequacy and speed of treatment administered in the first hours after syndrome develops influence outcome. Initial resuscitation, appropriate antimicrobial treatment, selection of optimal control methods, properties of fluid therapy, use of vasopressors and inotropic therapy, proper corticosteroid administration, value of the use of recombinant human activated protein C, and glucose control are the most important points newly evaluated for severe and septic shock management.
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Comparative Study
Impedance cardiography for aortic balloon counterpulsation impact assessment on patients hemodynamics during acute myocardial infarction.
The evaluation of hemodynamics in patients with acute myocardial infarction is crucial. Intra-aortic balloon pumping or counterpulsation in patients with cardiogenic shock is supposed to be monitored exceptionally by invasive methods for assessment of hemodynamics. However, noninvasive methods might have place in monitoring these patients. The objective of the study was to evaluate the possibility of applying noninvasive methods for evaluation of hemodynamics during acute myocardial infarction complicated by cardiogenic shock and managed by intra-aortic balloon pumping. ⋯ Significant correlation of cardiac output values was observed between the impedance cardiography and intermittent thermodilution techniques during intra-aortic balloon counterpulsation. Noninvasive evaluation of hemodynamic indices by continuous monitoring of impedance cardiography during acute myocardial infarction, complicated by cardiogenic shock and managed by intra-aortic balloon counterpulsation is a reliable method for further application.
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Comparative Study
Experience of treatment of moyamoya disease at the Clinic of Neurosurgery of Kaunas University of Medicine.
Moyamoya disease was first described in Japan and represents characteristic appearance on cerebral angiography an abnormal network ("puff of smoke") of collaterals around stenotic arteries. This disease is characterized by progressive intracranial vascular obliterations of the circle of Willis, resulting in successive ischemic or hemorrhagic events. Moyamoya disease primarily occurs among orient people (Japanese, Koreans, Caucasians) and is very rare in Lithuania. ⋯ Cerebral angiography is the main diagnostic procedure which confirms the diagnosis of moyamoya disease. Cerebral hypoperfusion on single photon emission computed tomography is the main criterion for selection of patients for cerebral revascularization. Extra-intracranial anastomosis is an effective procedure for preventing both ischemic and hemorrhagic events in moyamoya patients.
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To evaluate initial (prehospital) assessment and management of high-energy blunt polytrauma patients. ⋯ Initial assessment of high-energy blunt polytrauma patients reached 14% and management reached 10.6% of that recommended by Advanced Trauma Life Support.