Medicina
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The aim of our study was to evaluate patients survival, changes of functional status after repair of ischemic mitral insufficiency and coronary artery bypass grafting in acute period of myocardial infarction. In the Clinic of Cardiosurgery of Kaunas University of Medicine (since January 2001 till July 2003) 82 patients with acute myocardial infarction underwent surgery. Patients were operated on the 1(st)-21(st) day after myocardial infarction. Among 82 operated patients with acute myocardial infarction, 64 (78%) underwent coronary artery bypass grafting and 18 (22%) - coronary artery bypass grafting with mitral valve repair. Ten patients (55.6%) were in NYHA functional class II and 44.4% - in NYHA functional class III. Before myocardial infarction ischemic heart disease was diagnosed in 12 (66.7%) patients; 8 (44.4%) patients had a history of myocardial infarction. Patients were not operated during the first 24 hours of myocardial infarction. All patients were evaluated by means of 2 Doppler-echocardiography and transesophageal echocardiography before, during and a few days after operation. Eighteen patients underwent mitral valve repair: in 9 (50%) - annulocompression (original technique), in 7 (39%) - annulocompression with shortening of papillary muscles, in 1 case - Kay valvuloplasty was performed. One patient needed mechanical mitral valve prosthesis due to rheumatic mitral valve disease. After correction of ischemic mitral incompetence improvement of left ventricular function was observed. Medial-lateral mitral valve ring diameter was reduced from 36.8+/-2.6 mm to 23.9+/-0.56 mm (p<0.01) resulting in decrease of degree of mitral incompetence - 2.9+/-0.2 to 0.7+/-0.8, mean LVEDD - 53.3+/-6 to 50+/-4.1 mm, improvement of LVEF - 35.9+/-6.3 to 38.4+/-9.5, LVWSI from 2.61+/-0.22 to 1.81+/-0.43. ⋯ 1. Patients suffering acute myocardial infarction with >II degrees mitral valve incompetence, should receive coronary artery bypass grafting with mitral valve repair. 2. Repair of ischemic mitral incompetence should consist of annulocompression with/without papillary muscle shortening. 3. Early results surgery in patients with acute myocardial infarction and mitral valve incompetence are similar to the results of surgery on stable ischemic heart disease with mitral valve incompetence if operation is performed on the 3(rd) day of acute myocardial infarction.
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Review Comparative Study
[Health in the United Nations Convention on the Rights of the Child].
The United Nations Convention on the Rights of the Child is a document that secures the fundamental minimum needs of the child. It takes great consideration to support the perspective of the child in every respect. Most important of them are those, which influence the social process and fullness of child development: right to live, right to education and right to care. ⋯ Lithuania joined the Convention in 1992. The review of literature on the United Nations Convention on the Rights of the Child is given. The perspectives and problems of implementation of Convention in Lithuania are discussed.
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S. aureus causative agent is relatively pathogenic to humans and is found on the skin and mucosa of up to 40% of all population. Burn injuries are infected with S. aureus in 30% of cases; however, in many cases the injuries heal without the antibiotic therapy, solely by applying dressing with antiseptic solutions, early removal of necrotic masses and covering the injury with a skin graft. ⋯ The study included 100 patients who had S. aureus grown in the samples of their injuries. The article compares the severity of the trauma and the results of treatment in groups of patients with methicillin-resistant S. aureus and methicillin-sensitive S. aureus.
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Review Comparative Study
[Current treatment options for acute bronchiolitis in children].
Bronchiolitis is the most common lower respiratory tract infection in infants and is responsible for the majority of pediatric hospital admissions in winter. Respiratory syncytial virus has been identified as the main causative agent, causing 50-90% of the cases of bronchiolitis. ⋯ This paper reviews current treatment options for bronchiolitis, including the use of bronchodilators, epinephrine, steroids and ribavirin. Most recent advances, including immunotherapy and intensive care, are discussed.
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Acute respiratory distress syndrome (ARDS) - is a life-threatening acute clinical syndrome of pulmonary insufficiency with high mortality. The causes of the syndrome are of every description - from crustacean poisoning to cardiopulmonary bypass. The rate of ARDS is not clear, because of diagnostical variety of ARDS and acute pulmonary dysfunction. ⋯ Though some authors state that recently the ARDS mortality decreased, but most of the authors did not notice any improvement during the last 20 years. The prognosis is determinated not only by pulmonary insufficiency itself (the cause of death in 5% of patients), but by the ARDS predisposing factor (the worst is sepsis and septic shock), multiple organ dysfunction syndrome, difficult physical state of the patient, sepsis as a cause or as a complication of ARDS, nosocomial pneumonia, progressive fibroproliferation in the lung. Considering the actuality of ARDS, the diagnostical criteria of ARDS, pathogenesis, clinical course and new treatment methods are reviewed in the publication.