Medicina
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Review Comparative Study
[Peculiarities of anesthesia for patients with valvular heart disease during non-cardiac surgery].
A careful preview history of disease and thorough physical examination of patients having valvular heart disease using modern instrumental investigation methods are important in assessing preoperative risk. Important factor in the preoperative decision process and the risk assessment is the nature of surgical procedure also. ⋯ Efforts should be joint to avoid these complications, involving both surgeon and cardiologist, anesthesiologist and general practitioner. Survey of available literature provides variable pathophysiological features of cardiac lesions, which are of paramount in importance while choosing methods of anesthesiological management during non-cardiac operations and use of anesthetics and vasoactive drugs as well for patients with aortic and mitral valve diseases.
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Comparative Study
[Treatment of the upper cervical spine injuries with halo vest device].
In the article are described cases, when patients sustained fractures of the first and the second cervical spine vertebrae and were treated with "Halo-vest" device. We performed this investigation in order to establish efficiency of "Halo-vest" immobilization and to establish regression of neurological evaluation, patients feelings and their come back to their usual environment, when 1-2 years passed after fracture and treatment. Investigation was performed in 1999-2001. ⋯ Reposition of fractures in the upper cervical spine can be achieved with "Halo-vest" device. If close fractures repositions failed, then spondylodesis must be performed and alignment during operation can be maintained with "Halo-vest" device. After these injuries and treatment with "Halo-vest" device about 69% patients came back to their usual environment.
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Commotio cordis due to blunt trauma to the precordium is a rare cause of death in young athletes, occurring less frequently than all of the other athletics-related deaths. Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation, which is often resistant to resuscitative therapy. In this article we discussed this catastrophic event, its historical development, epidemiology and clinical presentation, mechanisms for sudden death in commotio cordis, limitations of evidence using animal models, autopsy findings, resuscitation and preventive measures.
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Quality and adequacy of specialized first aid for patients affected by high energy trauma is extremely important factor in order to reduce postraumatic disability and mortality of polytrauma patients. Treatment strategies for high energy trauma management are in early stages of development. Adequate aid can be rendered only in a few centers of Lithuania. ⋯ Averaged injury severity score, according to ISS, was 21.3, mortality rate was 34%. It was established long duration of pre-hospital and early hospital stage of management (accordingly 34+/-6.5 and 50+/-17.2 minutes), extremely rare monitoring of vital signs in pre-hospital stage (breathing was evaluated for 1.9% of patients, heart rate for 26.4% of patients). Fluid therapy as a part of complex treatment was applied for 7.5% of patients in pre-hospital stage and 3.8% in very early hospital stage.
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Comparative Study
[The immunological parameters and risk factors for pollen-induced allergic rhinitis and asthma].
Naturally occurring exposure to pollen allergens causes symptoms of allergic rhinitis, conjunctivitis and asthma in susceptible individuals. It is, however, unknown why some subjects develop only an allergic rhinitis while others develop asthma as well. The aim of this study was to investigate the difference of immunological parameters in patients with pollen-induced seasonal allergic rhinitis (SAR) and asthma and to determine the risk factors for pollinosis with asthma. We evaluated the demographic and clinical characteristics of the patients, sensitisation pattern to tree-, grass- and weed-pollen and perennial inhalant allergens according to skin prick tests, allergic inflammation parameters (blood and nasal eosinophil count, serum IgE, eosinophil cationic protein levels) in and out of the pollinosis season. Logistic regression analysis was used to rate the effect of covariates on risk for pollinosis and asthma. One hundred and one patients (52 men and 49 women) aged 16-63 years (median 24 yrs.) with pollinosis symptoms were investigated. All patients suffered from moderate-severe seasonal allergic rhinitis, 96% from concomitant allergic conjunctivitis, 23.8% had seasonal asthma. The significant clinical and demographic risk factors for pollinosis with asthma were smoking (OR=15.4, p=0.003) and pollinosis season lasting more than 14 weeks (OR=5.6, p=0.02). The patients with seasonal allergic rhinitis alone were significantly more frequently sensitized to orchard grass (p=0.005), ragweed (p=0.02), lamb's quarter (p=0.05) allergens. During the season the blood eosinophil count raised in all patients (p<0.01). It was shown statistically that there were no differences between groups in blood and nasal eosinophil count, serum eosinophil cationic protein level. The patients with seasonal allergic rhinitis and asthma had higher levels of serum IgE during the season (p=0.05) and out of it (p=0.01). More than two times elevated serum IgE in acute and symptom-free period of pollinosis was considered as a significant risk factor for pollinosis with asthma (OR=3.5, p=0.04 and OR=3.4, p=0.03). ⋯ Pollinosis presented with seasonal asthma in 23.8% of cases. Our data indicate that patients with seasonal allergic rhinitis and asthma differ from the patients with seasonal allergic rhinitis alone according to higher serum IgE levels. Prolonged pollinosis season, smoking and high IgE levels increase the risk for seasonal asthma in pollen-induced allergic rhinitis subjects.