Srp Ark Celok Lek
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Randomized Controlled Trial Clinical Trial
[Renal protection during surgical procedures on the infrarenal aorta].
Despite the progress in surgical and anaesthetic management, decreased renal function is still observed after abdominal infrarenal aortic surgery and remains an important problem in postoperative period. Although data regarding the efficacy of perioperative renal protection are conflicting, it is widely believed that renal protection before aortic cross-clamping is beneficial and therefore is commonly used. The aim of this study was to evaluate the impact of renal protection in patients undergoing elective infrarenal aortic surgery (1ARS). ⋯ Patients in groups A and B were similar regarding the age (64.32 vs. 62.00), sex (males 35, females vs. males 34, females 6) and preoperative diseases. (Tab. 2) No difference was found between groups regarding any of the parameters (BUN, serum creatinine, electrolytes, volume load, creatinine and free-water clearance, haemodynamic parameters, plasma and urine osmolality). Urinary output was higher in group B during and 2 hours after ACC. (Graph 1.) ACC time was similar in two groups (24.1 min vs 24.5 min). (Graph. 2) Only one patient in group B revealed transitory renal insufficiency, not requiring special treatment. These data indicate that renal protection did not influence renal function. Short ACC time may have impact on the obtained results. Our results suggest that renal protection should not be considered as mandatory for elective infrarenal aortic surgery. Because of the short ACC time observed in this study (in comparison to other studies), further studies of renal protection in patients with longer ACC time are needed.
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Relief of pain after tonsilloadenoidectomy in preschool children is the precondition of good postoperative recovery of that group of patients. The aim of this project is to study, to estimate and to relieve the pain. It focuses on dosage and ways of using medication, and establish the difference between Paracetamol and Ibuprofen i.e. their respective effects after oral, rectal or rectal-oral application. ⋯ In this study Ibuprofen proved to be a stronger, more efficient and longer active drug compared to Paracetamol. There was no irritation in the digestive system and there was a small number of side effects. In conclusion, using Ibuprofen first orally then rectally proved to provide a quick and long painless period of postoperative recovery provided that children do not swallow it.
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Surgical tracheotomy in newborn children is a rare intervention. It is reserved for heavy pathological disorders that cause obstruction of airways. In the Mother and Child Health Institute over the period from 1992 to 2001 we treated 141 children with congenital laryngeal anomaly. ⋯ Tracheotomy was performed in 11 (8%) infants, because their breathing was difficult, and they were at risk from suffocation. In six infants we made successful disannulment and in the others treatment still continues. We decided that surgical tracheotomy must be carried out just in cases with acute respiratory insufficiency, as a step in later treatment.
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The manner of death, i.e. if death is moros or violent, is the most important fact for the court and therefore, the most important part of the finding of autopsy reports [1]. To recognize the manner of death in cases with long outliving period after injury could be difficult for forensic pathologists. In such cases, the dissector should be able to point out the direct relationship between initial injury and death by using his (her) own experience and medical knowledge. Could the deaths provoked by low injuries be prevented? These injuries have score of 3 by Abbreviated Injury Scale (AIS) i.e. 12-20 by injury Severity Score (ISS) [3-5]. ⋯ As long as a direct chain of events can be traced from the injury to the death, then the initial injury must be considered to be the basic cause of death, and this fact may have profound legal implications for both civil compensation and criminal responsibility. Some of the most difficult problems in forensic pathology concern deaths from which posttraumatic complications are disputed as being fatal causative factors. The agony and dying are irreversible dynamic pathophysiological processes. By autopsy only the morphological consequences of these processes could be noted by dissector. The dynamics of dying, direct correlation between initial injury and death, as well as appearance and development of complications provoked by trauma could be established only by clinical medical data. Therefore, medical clinical data are crucial for forensic pathologists and for solving the problems about the mode and manner of death in cases with long outliving period. Microscopical findings have only academic and scientific importance and are less useful in daily practice. The authors suggest that all complications of injury must be generally involved in autopsy reports, and all severe injuries should separately be registered both in medical data and autopsy reports. The finding of cause of death must include all observed severe injuries and not only one of the most severe injuries and its complications.
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Diabetes mellitus is frequently accompanied by cardiac rhythm disorders. On the other hand, atrial fibrillation is the most frequent cardiac arrhythmia in adult population [1, 2]. According to some of the large epidemiological studies diabetes mellitus is among independent risk factors for development and persistence of atrial fibrillation [3]. Both diabetes mellitus and atrial fibrillation independently increase the risk of thromboembolism, especially of stroke [3-5]. It is obvious that rhythm control, i.e. restoration and maintenance of sinus rhythm, may be essential for prevention of thromboembolism in these patients. ⋯ We concluded that diabetes mellitus independently predicts the presence of recurrent atrial fibrillation but does not influence the possibility of sinus rhythm restoration. The relationship between atrial fibrillation and diabetes mellitus needs further investigation.