Medicina
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Randomized Controlled Trial Comparative Study
[Combined anesthesia for esophageal resection operations].
To view combined anesthesia benefits versus general anesthesia and to compare postoperative epidural analgesia and patient-controlled analgesia with intravenous morphine. ⋯ Combined anesthesia and epidural analgesia improve overall outcome, provide better postoperative pain relief, shorten the intubation time and intensive care stay in patients undergoing esophageal resection operations.
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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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Penetrating injury of neck is a complicated pathology, and there is more than one opinion of its treatment tactic in nowadays. Our recomendation is to refuse mandatory surgical exploration. ⋯ In cases with possibilities of full investigation of patients (panendoscopy, X-ray investigations, ultrasound investigations, angiography), we suggest the model of active observation. If there are no possibilities of full investigation, we prefer mandatory surgical exploration.
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The problems of diagnosis and treatment of Failed Back Surgery Syndrome are briefly analyzed in this article. Literature overview and analysis is supplemented by the data collected at the Spinal Neurosurgery Department in Kaunas University of Medicine Hospital during the study in which clinical findings and data were analyzed and compared to the answers of patients in the special questionnaires about pain specially designed for the patients with low back pain and the Failed Back Surgery Syndrome. ⋯ The most important clinical aspects of diagnosis and treatment of Failed Back Surgery Syndrome are discussed in this article and compared to the clinical trial in order to point out the real their value, effectiveness and long term results. In addition, the clinical value and use of special pain questionnaires is discussed and their auxiliary role is established.