Srp Ark Celok Lek
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The fracture of the external condyle is the most common fracture of the distal end of the humerus. This is an intraarticular fracture, which, if not properly treated, can cause serious complications, difficult to treat. ⋯ The initial width of the fracture crack is important for the evaluation of the fracture stability, the evaluation of the risk for the creation of secondary dislocations and for the choice of treatment. The upper limit of the fracture crack width which influenced the selection of the method of treatment was 2.5 mm.
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Organ injury caused by ischaemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35 degrees C) is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC). ⋯ In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v.) fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia,will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal "therapeutic window" for gene therapy.
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Exentheresis pelvis totalis due to locally advanced pelvic malignancies is an extensive surgical procedure. The operation is commonly associated with anticipated perioperative haemorrhage requiring a large volume of haemoproducts. Sometimes, the intervention can result in unexpected massive and uncontrolled haemorrhage that is frequently a combination of surgical and coagulopathic bleeding. Attempts to arrest massive bleeding by conventional means may fail. ⋯ RFVIIa can be a treatment option in patients suffering from intractable coagulopathic bleeding when standard therapy has failed.
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Modern pharmacological reperfusion in ST segment elevation acute myocardial infarction means the application of fibrin specific thrombolytics combined with modern antiplatelets therapy--dual antiplateles therapy, acetylsalicylic acid and clopidogrel, and enoxaparin. The contribution of each agent has been widely examined in large clinical studies, but not sufficiently has been known about the effects of a combined approach, where the early angiography and percutaneous coronary intervention is added during hospitalization, if necessary. ⋯ Alteplase with modern adjuvant therapy of ST segment elevation acute myocardial infarction shows the earlier achievement of coronary perfusion as well as better coronary flow compared to streptokinase. There is no statistically significant difference in the frequency of reperfusion arrhythmias, degree of residual stenosis at the"culprit"artery and the frequency of new coronary events in the 6-month-follow-up period after acute myocardial infarction.
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Case Reports
[Intraoperative use of recombinant activated factor VII in traumatic unpenetrating liver injury--case report].
Uncontrolled massive bleeding is often the cause of death of polytraumatized patients. Massive haemorrhage in polytrauma is the consequence of severe tissue and blood vessel damage or the development of posttraumatic coagulopathy. Most often, it is the combination of the two causes. Coagulopathy arises in early stages of trauma and it is an independent predictor of mortality of polytraumatized patients, however, its timely correction can significantly result in the reduction of mortality rate in trauma. ⋯ Until today, there are numerous references about successful application of rFVIIa in uncontrolled bleedings in trauma when previously applied conventional methods of haemostasis were not sufficient. We are presenting a case of successful use of rFVIIa in our hospital accompanied by usual surgical measures and reanimation of a severely injured patient with massive bleeding. Based on our experience and available references, in case of timely diagnosis and adequate therapy, such as conventional treatment methods and the use of rFVIIa, uncontrolled bleedings in polytrauma have better prognosis.