Medical science monitor : international medical journal of experimental and clinical research
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Case Reports
The use of drotrecogin alfa (activated) in severe sepsis during acute pancreatitis - two case studies.
Twenty-five percent of patients with diagnosed acute pancreatitis (AP) present a severe form of it. One of the most widespread complications of such a form is severe sepsis or septic shock, in which mortality can reach 80%. A complication of this state is multiple organ failure, which requires multi-directional treatment in an intensive care unit (ICU). Among the standard therapies are: control of the source of infection, supportive treatment of failed organ function, and others (e.g. dietary therapy, pain management, and physiotherapy). It is also now possible to use recombinant human activated protein C [drotrecogin alfa (activated); Xigris, Eli Lilly, USA] in the treatment of severe sepsis. ⋯ Both the cases presented indicate that drotrecogin alfa (activated) interrupts the developmental cascade of severe sepsis. Proofs of the efficacy of the treatment were improvements in the functions of organs previously insufficient during the course of sepsis. The rapid elimination of the drug allowed planning therapy strategies (the possibility of conducting surgical operations and smaller therapeutic interventions) without the risk of increased bleeding. The decision to use Xigris in severe sepsis during AP should always include consideration of the risk of bleeding in connection with the local status within the pancreas.
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Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal (GI) disorder, affecting about 20% of the world's population. Chronic abdominal pain or discomfort relieved by defecation and associated with altered bowel habits are the mainstay in diagnosis. The pathophysiology of IBS remains unknown. ⋯ Novel approaches include visceral analgesics and serotonin agonists and antagonists. In patients with severe diarrhea, 5-HT3 receptor antagonists (e.g. alosetron) and selective M3-type anticholinergics are indicated, in constipation 5-HT4 agonists (e.g. tegaserod), and in pain alfa2-adrenergics (e.g. clonidine), cholecystokinin antagonists, kappa-opioid agonists (e.g. fedotozine), and neurokinin antagonists; some of these agents are still being investigated. Understanding the brain-gut axis is crucial in the development of effective therapies for IBS.
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The x-ray examination is one of the fundamental diagnostic modalities in patients with low-back-pain. The aim of study was to establish relation between radiological findings and herniation type and its localization. As well, we looked for relation between radiological findings and progression of disc degeneration. ⋯ Classic x-ray examination presents low value in diagnostics of lumbar disc degeneration and its herniation. There is no relation between radiological picture and intensity of degenerative changes within the lumbar discs.
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MR proton spectroscopy (1H MRS) enables early detection of metabolic changes, which occur in the course of AIDS Dementia Complex Syndrome (ADC). The goal of the study was the evaluation of highly active antiretroviral therapy (HAART) and its influence on the character and intensity of metabolic changes in brain 1H MRS spectra in clinically asymptomatic HIV-infected patients as well as search for correlation between the treatment and 1H MR spectroscopy results and immune deficit degree. ⋯ The therapy with HAART affects normalization of metabolite levels in the central nervous system in clinically asymptomatic HIV+ patients and diminishes the risk of ADC occurrence. Myoinositol and choline levels estimated in 1H MRS might be the indices for antiretroviral treatment efficacy.
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To evaluate the role of computed tomography (CT) -guided needle biopsy and sodium iodide fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in the investigation of solitary pulmonary nodules (SPN), which are discovered on screening chest radiographs, and to determine the cost-effectiveness of these modalities. ⋯ The introduction of CT-guided needle biopsy and FDG-PET for the evaluation of SPNs, which are discovered on screening chest radiograph, is potentially cost-effective in Japan with high accuracy.