Medicina
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Randomized Controlled Trial
Preliminary results of randomized controlled study on decompressive craniectomy in treatment of malignant middle cerebral artery stroke.
Studies on decompressive craniectomy (DCE) after a malignant middle cerebral artery (MCA) stroke in selected population show an increased probability of survival without increasing the number of very severely disabled. Cerebral infarct volume (CIV) as a triage criterion for performing surgery has not been discussed in literature. The aim of this study was to investigate the value of CIV and initial National Institutes of Health Stroke Scale (NIHHS) and Glasgow Coma Scale (GCS) scores as possible triage criteria in the surgical treatment of patients with "malignant" MCA stroke. ⋯ Decompressive surgery in the selected patients is likely to increase the probability of survival with a favorable outcome without increasing the number of severely disabled survivors. Patients with CIV of more than 390 cm(3) may be bad candidates for DCE, and the prognosis is likely to be bad regardless the treatment strategy. The initial NIHHS and GCS scores did not prove any prognostic value in outcome.
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Pregnancy in a woman with pulmonary hypertension carries a prohibitively high risk of maternal mortality, and pregnancy is contraindicated in such patients. Some women decide to continue with their pregnancy despite being aware of possible fatal maternal outcome. The management of pulmonary hypertension in pregnancy is a challenge and requires a multiprofessional approach. We report the case of a patient with severe pulmonary hypertension, who successfully underwent elective cesarean section under epidural anesthesia at 38 weeks of gestation and discuss major issues associated with the obstetric and anesthetic management of pregnant patients with pulmonary hypertension.
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Case Reports
Referral pattern, management, and long-term results of laparoscopic bile duct injuries: a case series of 44 patients.
The incidence of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is higher than after open cholecystectomy, and the management of these lesions is still controversial. This study analyzed diagnostic and management strategies as well as long-term outcomes after BDI. ⋯ Minor BDIs are best served by endoscopy, while surgical repair may be an efficient option when injury is diagnosed intraoperatively. The timing of reconstruction after major BDIs does not portend a different outcome; consequently, every attempt to achieve infection control should be warranted. Referral to a tertiary care center should be encouraged to facilitate a proper classification of preoperative injuries and multidisciplinary approach.
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The aim of this study was to determine the prevalence of burnout among Lithuanian cardiac surgeons and cardiac anesthesiologists, and associations between burnout and the personal and professional characteristics of physicians. ⋯ Burnout was found to be prevalent among Lithuanian cardiac surgeons and cardiac anesthesiologists. Some personal and professional characteristics were significantly related to burnout. Burnout relief measures should be developed in order to prevent a further increase of burnout syndrome among Lithuanian cardiac surgeons and cardiac anesthesiologists.
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Bacterial sepsis with no bacterial isolates can be a difficult clinical conundrum, where other markers like C-reactive protein (CRP), white cell count (WCC), and neutrophilia are helpful to arrive at a diagnosis. Procalcitonin (PCT) has been shown to be a useful biomarker in bacterial sepsis. The aim of the study was to look at the association of PCT with bacterial cultures and compare this to currently used markers of bacterial sepsis. ⋯ PCT has a better association with bacterial sepsis and is superior to currently available biomarkers in the clinical setting. The rapid pharmacodynamics of PCT can serve as an early predictor of the diagnosis of bacterial sepsis while awaiting the bacterial culture results avoiding undue delay in the institution of antibiotics, hence, potentially improving the prognosis of patients with bacterial sepsis.