Acta clinica Croatica
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Diabetes is a chronic disease that requires continual medical care and patient self-management education in order to prevent acute complications and to reduce the risk of long-term complications. Diabetes is the leading known cause of neuropathy in developed countries, and neuropathy is the most common complication and the leading source of morbidity and mortality in diabetes patients. Diabetic polyneuropathy is primarily symmetric sensory neuropathy, initially affecting distal lower extremities. ⋯ Diagnosis of diabetic neuropathy should be established according to clinical manifestations of the disease, laboratory findings (altered glucose metabolism) and results of electrophysiological examinations. Treatment of painful diabetic polyneuropathy rests on a two-pronged approach: modification of the underlying disease and control of pain symptoms. The goals of painful diabetic polyneuropathy pharmacotherapy should be reduction of pain for maximum relief commensurate with acceptable side effects and restoration/ improvement in functional measures and quality of life.
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Acta clinica Croatica · Jun 2011
Case ReportsBenign angiopathy of the central nervous system or reversible cerebral vasoconstriction syndrome.
Benign angiopathy of the central nervous system is a subset of primary angiitis of the central nervous system characterized by "benign" course. It means that changes of cerebral vessels are reversible after treatment with corticosteroids and calcium channel blockers, so these abnormalities are believed to reflect vasospasm rather than true vasculitis. ⋯ We present a young man with acute onset of headache and neurologic impairment secondary to ischemic stroke with intracerebral and subarachnoid hemorrhage. Cerebral angiography showed characteristic findings of diffuse vasculitis but good response to treatment with corticosteroids and calcium channel blockers distinguish this benign angiopathy from the more aggressive form of the central nervous system vasculitis.
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Acta clinica Croatica · Jun 2011
Comparative StudyConstant cardiac output monitoring using the PiCCO and LiDCO methods versus PAK in septic patients: when to do calibration?
The accuracy of cardiac output measurement by two most widely used methods of less invasive hemodynamic monitoring and by the standard technique of thermodilution with pulmonary catheter was assessed. The measurements were carried out in septic surgical patients immediately after and between system calibrations. Study results showed satisfactory compatibility of measurements performed by the two methods and by pulmonary catheter in both phases, thus system calibration being recommendable in hemodynamically unstable septic patients.
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Acta clinica Croatica · Jun 2011
Clinical and electrophysiological signs of diabetic polyneuropathy -- effect of glycemia and duration of diabetes mellitus.
Diabetic polyneuropathy occurs in around 50% of diabetic patients. Its pathophysiological mechanism is not completely clarified and major occurrences boil down to the change in neural phenotype and vasa nervorum. As glucose neurotoxicity has been suggested by plenty of evidence, the aim of the study was to assess the effect of glycemia on the severity of diabetic polyneuropathy. ⋯ Diabetes duration was associated with a growing number of sensory symptoms, among which the sensation of pain similar to electric shock was present in 63% of patients. In addition, it also had negative impact on the sensory and motor nerve conduction velocity. HbA1c influenced the whole range of electrophysiological indicators of diabetic polyneuropathy.
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Acta clinica Croatica · Dec 2010
Case ReportsDRESS syndrome with mild manifestations as a diagnostic and therapeutic problem: case report.
The group of severe cutaneous drug reactions with systemic symptoms includes several syndromes: toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS). These reactions occur several days to six weeks after introducing the incriminating drug. The skin and internal organs (liver, kidneys, lungs, etc.) are usually involved. ⋯ After ten days, the patient came back with worsening condition, general inflammatory response, skin changes, liver and kidney damage, and eosinophilia. DRESS syndrome was diagnosed based on clinical and other findings. The diagnosis and treatment of severe drug reactions with cutaneous and systemic symptoms pose a medical challenge.