Medicina
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Combined oral contraceptives have been known as a well-established contraceptive method already more than 50 years. Unfortunately, this method is not absolutely safe. Combined oral contraceptives include estrogens and progestagens, which may stimulate the blood coagulation and promote the occurrence of deep-vein thrombosis; adverse effects of oral contraceptives are also notably associated with increased risk of stroke and myocardial infarction. The risk of hypercoagulation and venous thrombosis is most likely to be influenced by the dose of estrogens, but recent investigations have showed that the type of progestagens is very important as well.
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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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Review Comparative Study
[Postoperative cognitive dysfunction of older surgical patients].
Light changes in mental function after operation occur in patients of all ages, but more frequent they are observed in older patients. The incidence of early postoperative cognitive dysfunction varies depending on surgical procedure and may be as high as 20-90% in aged patients, and occurs most often in patients undergoing cardiovascular surgery. Early postoperative cognitive dysfunction is a predictor of late postoperative cognitive dysfunction. ⋯ An assessment of cognitive function should be completed as a routine in older patients, and effective prevention requires the identification of risk factors for delirium: advanced age, preexisting dementia and depression, visual and hearing impairment, Parkinson disease, emergency operation, anticholinergic drugs, and others. After operation, elderly patients must be carefully monitored for probable postoperative delirium. It is important to deepen health care professionals' knowledge of postoperative cognitive complications in older surgical patients.
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Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and risk of death. Thorough knowledge of the etiology, pathophysiology, and optimal therapeutic options of major obstetric hemorrhage may help to avoid lethal outcomes. ⋯ The transfusion of each single blood product must be performed only in case of evaluation of expected effect. The need for blood products and for their combination is necessary to estimate for each patient individually in case of obstetric emergencies either. Indications for transfusion of blood components in obstetrics are presented in order to improve the skills of doctors and to optimize therapeutic options in obstetric emergencies.
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Review
New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010.
Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. ⋯ Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.