Medicina
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Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called noninsulin-dependent diabetes mellitus) is not as rare as was once thought. ⋯ The review discusses diagnostic procedures, laboratory evaluation, differential diagnosis and treatment: replacement of fluid and electrolytes, low-dose insulin therapy and recommendations for use of bicarbonate. A discussion of complications management of diabetic ketoacidosis (hypoglycemia, hypokalemia, cerebral edema, hyperchloremic metabolic acidosis, pulmonary edema, adult respiratory distress syndrome), mortality rate and prevention are included in this review.
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Focal cerebral contusions can be dynamic and expansive, leading to a delayed neurological deterioration. In head--injured patients, the rise in intracranial pressure (ICP), subsequent to uncontrollable swelling, is the only and the most frequent cause of death. Studies show that brain swelling, after traumatic brain injury (TBI), is caused by brain edema rather than cerebral blood volume (CBV). ⋯ Histologically the loss of CA3 pyramidal cells in the hippocampus was observed ipsilaterally in the cortical contusion and bilaterally in diffuse axonal injury. Aggressive, early hyperventilation after TBI augments neuronal death in CA3 hippocampus. Due to high mortality associated with such cerebral contusions, a standard practice has evolved into evacuating contusions in patients who had deterioration in the level of consciousness, lesions more than 30 sec and CT suggestion of raised ICP.
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Comparative Study
[Autotransfusion of red blood cell from cardiopulmonary bypass circuit blood after cardiac surgery].
The aim of this study was to evaluate the effect of autologous centrifuged residual cardiopulmonary bypass blood on patients' hematocryte value, donor blood product requirements, postoperative blood loss, hospitalization time and the development of infective complications. ⋯ We found that autologous centrifuged residual cardiopulmonary bypass blood was useful in avoiding infective complications, decreasing need of donor blood product requirement and postoperative length of stay in the hospital. This method increases hematocryte value after 12 hours postoperatively.
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Evaluate efficacy of videothoracoscopic operations in diagnosis and treatment of lung and pleural diseases. In 1997-2001 186 operations were performed using videothoracoscopic devices in the Department of Thoracic Surgery, Institute of Oncology, Vilnius University. Fourty eight resections were performed: 4 (8%) lobectomies, 1 (2%) pericardial cystectomy, 3 (6%) simpatectomies, 3 (6%) intrathoracal lipomectomies, 1 (2%) removing calcificate, 3 (6%) resections of pericardium, 15 (30%) removing metastases, 12 (25%) hamartomas, 6 (13%) wedge resections of lungs tissue due to I(st) stage NSCLC performed for the elderly. One hundred thirty eight diagnostic procedures were performed in pts with various lung and pleura diseases: 66 (48%) biopsies of lungs tissue and 72 (52%) biopsies with chemopleurodesis. From oncological point of view videothoracoscopic operations are confirmed. These operations shortens hospitalization and combined treatment starts quicker. Middle period of hospitalization - 5 days. We had complications: 22 pts (12%) postoperative pneumonia, 4 pts (2%) - short duration pneumothorax, 1 pts (0.5%) - pleural empiema 1 pts (0.5%) - drop of the lung 1 pts (0.5%) - bleeding. After resections margins were free of tumor invasion. ⋯ 1. Video-assisted thoracic surgery (VATS) surgery is effective safe method of treatment for lung and pleural diseases. 2. In some cases VATS surgery is the only way to remove tumours, and it shortens hospital stay till 5 days. 3. VATS surgery is very effective in elderly patients with concomitant diseases. 4. Chemopleurodesis is very useful in treatment of pleural fluid.
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Comparative Study
[Patient-controlled analgesia in the treatment of postoperative pain in children and adolescents].
We aimed to evaluate the efficacy, morphine requirements and side effects in patients managed with patient-controlled analgesia postoperatively. ⋯ In the majority of patients patient-controlled analgesia was effective and used doses of morphine were low. Though nausea/vomiting was the most common side effect, decreased respiratory rate was observed in some patients. Regular patient evaluation for vital signs and side effects is recommended.