Medicina
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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.
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Comparative Study
[Treatment of supracondylar humerus fractures in children, according to Gartland classification].
Supracondylar fractures are the most common fractures in the area of elbow in children. The purpose of this study was to review and analyze the treatment patterns of supracondylar humerus fractures in childhood. There were 93 children with supracondylar humerus fractures treated in the Department of Pediatric Orthopedics within the period from March 2000 till November 2002. ⋯ Type III displaced fractures should be treated with closed reduction and percutaneous pinning with K-wires under the fluoroscope guidance. It is believed to be a safe, reliable and efficient method for treatment of this difficult fracture. Indications for open reduction and internal fixation includes open fractures, fractures complicated by vascular injury, unsatisfactory closed reduction due to unstable fracture.
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One of the life-threatening complications of hyperemesis gravidarum is Wernicke's encephalopathy, the main etiological factor of which is a lack of thiamine (vitamin B1). Most frequently Wernicke's encephalopathy is found among persons suffering from excessive drinking. ⋯ The course of the disease, clinical signs, diagnostics, treatment and its results are presented. Also a review of the literature on Wernicke's encephalopathy secondary to hyperemesis gravidarum is introduced.
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Angioneurotic edema is a rare (0.1-0.2%) but potentially life-threatening side effect of angiotensin-converting enzyme inhibitors. It can result in serious respiratory distress, airway obstruction and death. Angiotensin-converting enzyme inhibitors associated angioedema is clinically poorly recognized and frequently underestimated condition. ⋯ Pharmacological action of angiotensin-converting enzyme inhibitors on bradykinin and substance P, immunological mechanisms and disarrangements in complement system are discussed. Treatment includes immediate withdrawal of angiotensin-converting enzyme inhibitors and acute therapy with epinephrine 0.3-0.5 ml subcutaneous, 50 mg diphenhydramine s/c or i/v, 40-50 mg methylprednisolone. Future treatment with angiotensin-converting enzyme inhibitors is contraindicated.
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This review explores the effects of central neural blockade on cardiovascular system in healthy patients and for patients with common cardiovascular disease (ischemic heart disease, rheumatic valve disorders, cardiomyopathy). Central regional blockade poses these patients at some extent of risk due to possible hemodynamic instability because of effects of blockade on peripheral vessels and heart. ⋯ It increases diameter of epicardial coronary stenosis, reduces the ST segment depression, provides pain relief for patients with unstable angina, does not affect myocardial contractility. Recommendations are made about applying the central regional anesthesia for these patients; prevention and treatment of hypotension are discussed; and peculiarities of central regional anesthesia for patients taking anticoagulants are highlighted.