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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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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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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Comparative Study
The prevalence, course and clinical features of post-concussion syndrome in children.
To investigate the clinical features and the prevalence of symptoms of post-concussion syndrome in children with mild traumatic brain injury, and to evaluate their changes over time. ⋯ More than one year after the trauma, the prevalence of the symptoms of the post-concussion syndrome is not significant higher in children with mild traumatic brain injury, compared to children with other mild body injuries, and is comparable by the changes over time.
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Comparative Study
Prevalence, clinical features and accompanying signs of post-traumatic headache in children.
The aim of the study was to investigate the prevalence and clinical features of headaches and their accompanying signs in children with mild traumatic brain injury, as well as to evaluate their changes over time. ⋯ Headaches are not more prevalent in children with mild traumatic brain injury, compared to children with other mild body injuries. The frequency of headaches, as well as the prevalence of dizziness in children with mild traumatic brain injury decreases with time.