Medicina
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The second type of multiple endocrine neoplasia syndromes can be described as rare syndromes, heritable in autosomal dominant manner and linking medullary thyroid carcinoma to different tumors of endocrine organ system and endocrinopathies. This syndrome is divided into multiple endocrine neoplasia syndrome type 2A (MEN 2A), characterized with combination of medullary thyroid carcinoma, pheochromocytoma and primary hyperparathyroidism; type 2B (MEN 2B), characterized with combination of medullary thyroid carcinoma, pheochromocytoma, marfanoid habitus and ganglioneuromatosis, and familial medullary thyroid carcinoma syndrome, characterized with the only indication, which is hereditary medullary thyroid carcinoma. Though type 2 multiple endocrine neoplasia syndrome has been known since 1961, yet, the cause of the syndrome, which is germline mutations of c-ret protooncogene, was detected just a decade ago and syndrome pathogenesis with its characterized endocrine neoplasia carcinogenesis machinery were detected. ⋯ Stated genotype link to phenotype helps to prognosticate possible combinations of endocrine neoplasia and endocrinopathies, and to choose purposeful patient observation. Genetic screening of the inheritors of multiple endocrine neoplasia type 2 syndrome enabled purposeful researches and observations of patients with a huge risk of uprising endocrine neoplasia, it also enabled application of effective prophylaxis methods, avoidance or early diagnostic of malignant tumors and life prognosis improvement for patients with malignant tumors while practicing well-timed treatment adaptation. This literature review contains the newest data on multiple endocrine neoplasia syndrome type 2 and its pathogenesis, diagnostics, patient observation, endocrine cancer prophylaxis and methods of treatment, which are characteristic for syndrome and which are being chosen according to biochemical endocrine neoplasia symptoms and genetic diagnosis.
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Asthma is a chronic airway disease that is a growing problem of public health. The current consensus is based on the Global Initiative for Asthma (GINA) and other guidelines for asthma, and adapted for Lithuania. This Consensus provides physicians with recommendations for asthma management in children and adults.
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Randomized Controlled Trial Comparative Study
[Postoperative analgesia with intraarticular local anesthetic bupivacaine and alpha2-agonist clonidine after arthroscopic knee surgery].
To evaluate the efficacy of intraarticular 0.5% 20 ml bupivacaine and compound of bupivacaine with alpha2-agonist clonidine for postoperative analgesia after arthroscopic knee surgery. A total of 48 patients, scheduled for knee arthroscopy, were enrolled in the study. Patients were randomly assigned to three different groups: placebo (group C), and two experimental groups that received one of the following double-blinded intraarticular solutions: 0.5% 20 ml of bupivacaine (group B) and 0.5% 20 ml of bupivacaine with l microg/kg of clonidine (group B+C). Patients were asked to evaluate on a visual analogy scale (VAS) the intensity of pain at rest and during motion, satisfaction with postoperative analgesia. Side effects and requirements for supplemental analgetics were recorded at the same time. ⋯ The compound of intraarticular bupivacaine and clonidine suppresses pain better than intraarticular injection of bupivacaine or use of usual systemic analgetics (p<0.05). Intraarticular analgesia assures satisfaction with anesthesiologic procedure.
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Review Comparative Study
Transcranial magnetic stimulation in clinical practice.
Transcranial magnetic stimulation allows a non-invasive and painless stimulation of the human brain and cranial nerves. The method is in use since 1985. Transcranial magnetic stimulation can use single stimuli, pairs of stimuli separated by different intervals (to the same or to several brain areas), or trains of repetitive stimuli at various frequencies. ⋯ Repetitive transcranial magnetic stimulation can modify excitability of cerebral cortex. Repetitive transcranial magnetic stimulation has opened a new field of investigation of the neural circuitry, and is developing into a therapeutic tool. This general review considers basic principles of transcranial magnetic stimulation, discusses methodological aspects and techniques, and analyses their utility in clinical practice.
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Review Comparative Study
[Intra-abdominal hypertension and multiple organ dysfunction syndrome].
In clinical practice, intra-abdominal pressure is usually measured indirectly via the urinary bladder using Foley catheter. This technique is minimally invasive, safe, simple and accurate. Intra-abdominal hypertension is defined as an intra-abdominal pressure above 12 mmHg. ⋯ Intra-abdominal hypertension causes visceral organ hypoperfusion, intestinal ischemia and may also lead to bacterial translocation, release of cytokines and production of free oxygen radicals. All these factors may contribute to the development of multiple organ failure in the critically ill patients. Intravascular fluid replacement and abdominal decompression are the standards of treatment for abdominal compartment syndrome.