Medicina
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Visibility in the surgical field reduced by bleeding is one of the most important problems of endoscopic sinus surgery. It causes the risk of serious complications and reduces intervention quality. ⋯ Since general anesthesia may influence surgical bleeding in physiological and pharmacological pathways, the role of an anesthesiologist is extremely important in reducing bleeding. The impact of different anesthesia methods on quality of the surgical field is being investigated, and the most effective medicines are being sought.
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Comparative Study
Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting.
BACKGROUND. The aim of our study was to evaluate the incidence of early postoperative cognitive decline (POCD) and determine perioperative risk factors as well as the impact of asymptomatic cerebral vascular lesion on the development of neurocognitive complications. MATERIALS AND METHODS. ⋯ Age of more than 65 years (OR, 2.7), asymptomatic carotid artery stenosis of more than 50% (OR, 26.89), duration of surgery of more than 4 hours (OR, 4.08), postoperative mechanical ventilation of more than 6 hours (OR, 3.33), and stay in an intensive care unit for more than 3 days (OR, 3.38) were significant independent predictors of cognitive decline. CONCLUSIONS. Increased age, preoperative prevalence of craniocervical atherosclerotic lesions, longer time in surgery, longer stay in an intensive care unit and mechanical ventilation time were found to be the risk factors for developing postoperative cognitive decline.
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Crush injury is defined as compression of extremities or other parts of the body that causes muscle breakdown (traumatic rhabdomyolysis). Systemic consequences of crush injuries are as follows: rhabdomyolysis, electrolyte and acid-base abnormalities, hypovolemia, and acute renal failure. Crush injuries are important injuries in disaster situations: earthquakes, hurricanes, mining and road traffic accidents, war, collapse of buildings, etc. In this review article, there are discussed about epidemiology of crush syndrome, risk factors, pathophysiology (mechanisms of muscle cell injury, release of substances from injured muscles, other consequences of reperfusion), clinical features, differential diagnosis, investigations, complications (acute renal failure, hypovolemic shock, hyperkalemia, infection, compartment syndrome), approach to treatment (adequate rehydration, a forced mannitol-alkaline diuresis, intravenous fluids, management of hyperkalemia, wound care, hyperbaric oxygen, etc.), prognosis, the mortality rate and prevention (timely support may reduce morbidity and mortality).
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Comparative Study
Acute kidney injury in pediatric patients: experience of a single center during an 11-year period.
The aim of our study was to determine the causes of acute kidney injury (AKI) in children, to compare outcomes between two periods--1998-2003 and 2004-2008--and to evaluate the influence of new methods of renal replacement therapy on mortality. ⋯ More than half of patients had secondary acute kidney injury of nonrenal origin. More than two-thirds (69.3%) of patients with AKI were treated in the pediatric intensive care unit. Multiple organ dysfunction syndrome was diagnosed for 40.8% of children with AKI. Renal replacement therapy was indicated for one-third of patients with AKI. A 2.5-fold decrease in mortality was observed in the second period as compared to the first one.
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Comparative Study
The effect of induced sputum and bronchoalveolar lavage fluid from patients with chronic obstructive pulmonary disease on neutrophil migration in vitro.
The aim of study was to investigate a chemotactic effect of induced sputum and bronchoalveolar lavage fluid on blood neutrophils in patients with chronic obstructive pulmonary disease (COPD) and healthy individuals. ⋯ Migration of neutrophils isolated from patients with COPD was more intensive compared to healthy individuals. Induced sputum and bronchoalveolar lavage fluid directly and with addition of interleukin-8 stimulated chemotaxis, and it was higher in neutrophils from COPD patients. Migration of neutrophils did not depend on smoking status.