Medicina
-
Comparative Study
[Evaluation of diagnostic criteria for metabolic syndrome to identify insulin resistance].
The aim of study was to evaluate the possibilities of different diagnostic criteria for metabolic syndrome in identifying subjects with insulin resistance and to assess the prevalence of metabolic syndrome according to gender in one Lithuanian district. ⋯ The highest prevalence of metabolic syndrome was determined according to the International Diabetes Federation criteria. According to the National Cholesterol Education Program and International Diabetes Federation criteria metabolic syndrome was observed more frequently in women. The highest prevalence of insulin resistance was determined in metabolic syndrome group based on World Health Organization criteria. Using the World Health Organization and International Diabetes Federation criteria for metabolic syndrome provides more opportunities to identify subjects with insulin resistance.
-
The aim of this study was to analyze the effects of the various traumas on mother and fetus and to present the solutions of trauma management. ⋯ A review of data archive of Kaunas University of Medicine Hospital and articles published during the last 13 years (1990-2003) and selected by computerized Medline search. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma: 84% of women had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The success of pregnancy is associated with severity of maternal trauma. The survival of the fetus after trauma depends on the mother's condition in regard to respiratory passage, oxygenation, and hypovolemia. During 1990-2003, six pregnant patients with severe trauma were treated at Kaunas University of Medicine Hospital. Traumatic separation of placenta was observed in two cases. Three women and three fetuses died.
-
Radical cystectomy is the standard of treatment for muscle-invasive transitional cell carcinoma of the bladder in European Union and in United States. During the last few decades, several clinical trials were performed with the aim to evaluate new treatment methods as an alternative to radical cystectomy for selected patient groups. ⋯ Incorporation of chemotherapeutic agents such as gemcitabine or taxanes in bladder-sparing protocols improves the results of conservative treatment of locally advanced bladder cancer. Pretreatment selection criteria and the most important prognostic factors are macroscopically complete transurethral resection of bladder tumor, absence of hydronephrosis, and lower T stage.
-
Review Comparative Study
[An update on multiple insulin injection therapy in type 1 and 2 diabetes].
Achieving and maintaining glycemic control (glycated hemoglobin--HbA(1c)< or =7.0% according to American Diabetes Association and < or =6.5% according to International Diabetes Federation) is the primary goal in treating diabetes, which lowers the risk for diabetes-related complications. Insulin therapy is essential for type 1 diabetes treatment. Insulin therapy in type 2 diabetes is initiated when glycemic control is inadequate despite the combination of antihyperglycemic drugs. ⋯ Basal insulins include intermediate-acting human insulins (neutral protamine Hagedorn) and long-acting insulin analogs (insulin glargine, insulin detemir). The latter are the optimal choice covering basal insulin requirement. Compared to neutral protamine Hagedorn insulin, long-acting insulin analogs have no pronounced concentration peak and reduce nocturnal hypoglycemia risk and weight gain.
-
This article presents a review of current literature on impact of thoracic epidural anesthesia on functions of organs and systems. Its role in anesthetic management of pulmonary resection is discussed. Thoracotomy is one of the most painful surgical procedures followed by intense, acute, and chronic pain associated with post-thoracotomy. ⋯ Sympathetic blockade during thoracic epidural anesthesia reduces the rate of perioperative myocardial ischemia and cardiac mortality. It also reduces the number of thromboembolic and gastrointestinal complications and has a positive effect on immune function. Due to numerous benefits, thoracic epidural anesthesia can be recommended as a standard in pulmonary resection surgery.