Medicina
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Review Case Reports
[The importance of left bundle branch block in the diagnosis of acute myocardial infarction].
Electrocardiographic (ECG) evidence of cardiac ischemia or infarction is difficult to detect in the presence of left bundle branch block (LBBB). Traditional ECG indicators of ischemia, such as ST- segment elevation, are common in LBBB and may not indicate acute ischemia. Proper evaluation of the initial ECG is crucial in selecting candidates for early thrombolysis, because the earlier reperfusion treatment is administred, the better are the results. ⋯ In the absence of definitive diagnosis of AMI doctors withhold from decision to administer thrombolytic treatment because of risk of haemorrhagic complications. There are not perfect diagnostic tools allowing early diagnostic of AMI in patients having LBBB. Currently the best justified strategy is to follow AHA/ACC recommended guidelines to administer thrombolysis to all patients with LBBB presenting with chest pain, particularly if serum biomarkers are elevated.
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Venous air embolism is the entry of air into the venous system as a consequence of trauma or iatrogenic complications (especially central venous cannulation or pressurized intravenous infusion systems). It also can occur following the surgical procedures. Venous air embolism results in right ventricular dysfunction and pulmonary injury. In this review article various causes, frequency, pathophysiology, clinical features, diagnosis, treatment, outcome and prevention of venous air embolism are discussed.
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Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. In the case of the expanded process, still more numerous interventions are performed with general anesthesia. The objective of research is to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia caused by nitroglycerin and captopril when performing endoscopic operations of accessory nasal sinuses. ⋯ The visibility of the operative field was by one point, on the average, better than in Group H. No anesthetic complications were observed during investigation. In summary, it is possible to state that the controlled arterial hypotension caused by captopril and nitroglycerin reduced significantly intraoperative hemorrhage and improved the visibility of the operative field in endoscopic rhinosurgery.
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In the world five-year overall survival of patients with pancreatic cancer is low, i.e. about 5-6%. Patients without treatment live few months. Patients with pancreatic cancer are treated with combined treatment modalities. ⋯ In the article we review chemotherapeutic agents that are used in everyday practice like fluorouracil and it's use in combination with other chemotherapeutic agents, and also, new drugs like gemcitabine, taxanes, capecitabine and other. Effectivity of the treatment with these agents, results of survival, toxicity and particularities of intraarterial chemotherapy are discussed. New perspectives in the treatment of patients with pancreatic cancer and methods of new chemotherapeutic strategies are analyzed.
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Comparative Study
[The impact of antibiotic use on hospital-acquired pneumonia: data of etiology tests].
To investigate most common pathogens isolated from the hospital-acquired pneumonia patients bronchoalveolar lavage fluid in Kaunas University of Medicine Hospital according to the previous antibiotic use and to estimate pathogens antibacterial susceptibility. ⋯ Previous antibiotic treatment has an impact on pneumonia etiology testing. H. influenzae strains are more common isolated hospital-acquired pneumonia etiologic agents in previously untreated patients. The low antibacterial resistance was found enabling the use of aminopenicillins for treatment if H. influenzae infection suggested. The use of antibacterials increases non-fermenters isolation rates and combined antipseudomonal treatment is reasonable in these patients.