Medicina
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The dangers of opioid overdose have been recognized for as long as the use of opium itself. When used correctly for medical purposes, opioids are remarkably safe and effective agents. ⋯ In a number of countries the use of heroin and other opioids in nonmedical contexts in associated with on increasing rate of overdose and often of fatal opioid overdose. This review article discusses opioid-receptor pharmacology, which is necessary for understanding of the signs and symptoms of opioid ingestion and management principles, clinical and toxic effects mediated with the opioids, the diagnosis and management guidelines in opioid intoxication, a clinical prediction rule to identify patients who can be safely discharge from hospital, the problems of the significant morbidity and mortality associated with opioid overdose.
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Severe acute adrenocortical insufficiency or adrenal crisis are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or ineffectively treated. Although more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are far the most abundant and physiologically active. In primary adrenocortical insufficiency, glucocorticoid and mineral-corticoid properties are lost; however, in secondary adrenocortical insufficiency (i.e., secondary to disease or suppression of the hypothalamic-pituitary axis), mineralocorticoid function is preserved. ⋯ The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, occasionally, laboratory findings. Delay in treatment while attempting to confirm this diagnosis can result in poor patient outcomes. This article review data about physiology, pathophysiology of the adrenal cortex, physiologic effects of glucocorticoids, aldosterone, causes of primary and secondary adrenal insufficiency, frequency, clinical picture, laboratory and imaging studies of adrenal crisis, laboratory evaluation of adrenal function and emergency therapy, replacement therapy, mortality/morbidity of this pathology.
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From January 1974 trough August 2002 184 neonates with congenital heart disease underwent surgical repair in Heart Surgery Clinic of Vilnius University. It came to 3.8% of all 4813 procedures of congenital heart diseases performed. Number of neonates operations considerably increased in the latter's years, because special Department with proper technique was established. ⋯ Unsatisfactory results of neonates operations with cardiopulmonary bypass, especially such as left heart hypoplasia syndrome is the main problems. The group of specialists performing repair of congenital heart diseases is working actively in the heart Surgery Clinic of Vilnius University. Improvement of surgery methods and results, following the best Heart Surgery Clinics of the world, is the main purpose of this group.
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During 1987-2000, in Clinic of Thoracic Surgery, Kaunas Medical University Hospital 30 patients with cardiac injuries and foreign bodies in the heart were treated. Average age of patients--37 years. ⋯ Two patients had foreign bodies in the heart (one--needles, one--bullet). We present two rare cases of foreign bodies in the heart.
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Objective was to evaluate sensitivity, specificity and diagnostic accuracy of brain computed tomography (CTA) in patients with subarachnoid hemorrhage (SAH). ⋯ CTA is a quick, noninvasive method to be performed in outpatient and inpatient basis. It gives information about vessels and surrounding tissues. In some cases it can replace DSA. CTA must not be considered as replacement of DSA, instead, it should be considered as method providing more additional information.