Medicina
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For years, smoking induced inflammatory reaction, comprised mainly of neutrophils and macrophages, has been accepted to be the major component in pathogenesis of chronic obstructive pulmonary disease. New developments in molecular and cell biology have provided scientists with new knowledge and understanding of inflammatory processes in lung. Recent reports have underlined the role of autoimmunity and T lymphocytes as a potential important factor, which takes place in the pathogenesis of chronic obstructive pulmonary disease. This article reviews potential mechanism of T cell mediated immune response in chronic obstructive pulmonary disease.
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In 2000-2003 surgeons performed 616 surgeries on arterio-venous access formation, more than 30% of them were radiocephalic. In 36.9% of cases of radiocephalic fistula early thrombotic complications developed (during the first month after operation) and a new access creation was needed. Various factors that indicate early thrombotic complications in radiocephalic fistula were assessed. 146 case records were analyzed retrospectively and all patients were divided into two groups. ⋯ Comparison of the groups showed that the main disease, patients age, gender and technique of operation (all surgeries were performed using microsurgical technique, but accesses were formed "end to end" or "end to side" using 7/0 or 8/0 sutures), did not influence the development of early thrombotic complications in radiocephalic fistula. The shorter time of maturation of new access was associated with more frequent early thrombotic complications: the mean time of new vascular access maturation was 15.45+/-2.56 days in the first group, and 12.5+/-2.42 days in the second group (p<0.05). A marked tendency of more frequent early thrombotic complications was noticed in patients older than 60 years and in patients with ischemic heart disease.
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Hypovolemia is common among surgical, trauma, and intensive care unit patients. It can occur in the absence of obvious fluid loss secondary to vasodilatation or during generalized alterations of the endothelial barrier resulting in increased capillary permeability. ⋯ Important characteristics for these products are molecular weight, their concentration, the degree of molar substitution, and the substitution pattern. In this review article a large variety of hydroxyethyl starch solutions, their physical and chemical characteristics, pharmacokinetics and metabolism, the main route of elimination, mechanism of action, effect on blood plasma volume, safety, tolerability and side effects (the risk of adverse effects on hemostasis, platelet function, frequency of pruritus, anaphylactoid reaction, incidence of rise in serum amylase) are presented.
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Hypertension is one of the most common medical problems affecting approximately 1 billion individuals worldwide. Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis. Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies. ⋯ Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury. Blood pressure can be lowered less rapidly in this condition. In this review article it is discussed about clinical assessment of patients under these conditions, evaluating neurological, cardiovascular, renal end-organ damage; how much blood pressure should be lowered, which medication should be used to lower blood pressure, treating hypertensive emergencies and urgencies; and management of specific conditions (acute intracranial events, acute left ventricular dysfunction etc).
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Comparative Study
[Coronary reoperations: recurrence of angina and clinical outcome].
To evaluate the features of coronary artery bypass reoperations and to reduce the influence of the factors affecting postoperative morbidity and mortality. ⋯ According to our data mortality after coronary reoperations remains higher comparing to primary coronary artery bypass grafting, however, it does not differ significantly. We observed an increasing number of elderly patients in coronary reoperations. We think that it is related to the demographical changes within our country and increased use of arterial conduits during primary coronary artery bypass grafting operations. Arterial conduits are patent at least 10 years; it means that the time period until recurrent angina and reoperation is delayed. However, progression of arterial atherosclerosis remains the main reason for coronary artery bypass grafting reoperation.