Medicina
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Randomized Controlled Trial Comparative Study
[Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study].
The aim of the study was to find minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery. ⋯ Groups were comparable in demographics. No case of failure was registered but 4 patients (10.5%) in the group 3 received supplemental i/v fentanyl to treat tension in the abdomen intraoperatively. Level of sensory block in groups 1, 2, 3 was 10.4+/-1.7, 7.013+/-2.2, 6.7+/-1.9 dermatomes, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=1.0 group 2 vs 3, Bonferroni). Extent of motor block was 2-3 scores according to the Bromage scale in 70.5% of group 1 cases, compared to 0-1 score in 97.3% of group 2 and 92.1% of group 3 cases. Median (range) duration of motor block in groups 1, 2, 3 was 90 (0-120), 0 (0-90), and 0 (0-60) min, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=0.13 group 2 vs 3, Bonferroni). Time of ambulation was 181.5+/-41.5, 136.6+/-32.2 and 123.0+/-45.9 min, respectively (p<0.0001 ANOVA; p<0.001 group 1 vs 2, p<0.00001 group 1 vs 3, p=0.43 group 2 vs 3, Bonferroni). There was no significant intergroup difference in time to urinate; retention developed in 20.4% of total cases. No difference was found in morphine consumption, 64.5% of cases did not require rescue analgesics. Quality of anesthesia was stated as excellent by the anesthesiologist and surgeon in all groups. However, quality was rated as excellent by patient in the operating room in groups 1, 2, 3: 58.8, 94.7, and 86.8%, respectively (p=0.003), on day 1 postoperatively: 76.5, 92.1, and 97.4%, respectively (p=0.023); by nursing staff: 82.4, 100, and 97.4%, respectively (p=0.019). Lower rates in group 1 were due to extensive motor block. In conclusion, a minimal recommended dose of spinal hyperbaric bupivacaine for anorectal surgery is 4-5 mg; a dose of 7.5 mg is excessive due to prolonged sensory and motor block.
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The aim of the study was to evaluate influence of preoperative treatment with aspirin or heparin on platelet function and intensity of postoperative blood loss in early period after coronary artery bypass grafting (CABG). ⋯ Our investigation shows that preoperative treatment with aspirin or heparin had no remarkable influence on dynamics of platelet function in early period after CABG. The least blood loss was observed in patients with heparin pretreatment.
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The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Injuries to this area include occipital condyle fractures, occipitoatlantal dislocations, subluxations and dislocations of the atlantoaxial articulation, atlas fractures, odontoid fractures, and fractures of the arch of the axis. ⋯ The complex regional anatomy and overlying structures make plain radiographic images difficult to interpret. Delayed recognition can result in significant disability. A thorough understanding of the clinical presentation, radiographic assessment, and mechanisms of injury can minimize morbidity and enhance treatment effectiveness for the more common upper cervical ligamentous and bony injuries.
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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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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.