Srp Ark Celok Lek
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Randomized Controlled Trial Comparative Study
[Reverse Trendelenburg's position vs. supine-horizontal position for induction of general anesthesia in obese neurosurgical patients].
The induction of general endotracheal anesthesia (GETA) is associated with variable period of apnea. Obese patients have reduced oxygen supply during period of apnea. Hypoxemia and subsequent hypercarbia, during period of apnea, are strong stimuli of cerebral blood flow and intracranial pressure increase. ⋯ 30 degree reverse Trendelenburg's position provides longer SAP when compared with horizontal-supine positions. This extra time may preclude adverse sequelae resulting from hypoxemia during induction of obese neurosurgical patients.
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The basic ethical principles in science are internationally recognised in all disciplines of science. The first among these is honesty--both towards oneself and towards others. The betrayal of this principle can be seen as deviant behaviour, which may result in the most serious violation of the high ethical standards of science--scientific fraud. ⋯ In this article, several high profile cases of scientific fraud--involving falsification, fabrication of data, and plagiarism--are described. The damaging effect they had on both science and the scientific community led to the codification of the concept of Good Scientific Practice (GSP)--an international quality standard for designing, conducting, recording, and reporting research. The concept of GSP sets internationally valid benchmarks for quality assurance, and also provides safeguards against scientific dishonesty and fraud.
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This is a case report of 26-year old, advanced university student of the Faculty of Science, Department of Mathematics, single. He has never been a psychiatric patient, but being unable to suppress the gambling impulse, he presented for treatment, on his own initiative, to the outpatient department. Patient met the criteria for diagnosis of pathological gambler, over the period of two years (International Classification of Diseases -ICD X, WHO, 1992). ⋯ Progression of the applied therapy was presented in four phases. Observations of the patient concerning the control over impulse disorder were described in his own words. Data on neurobiological concepts as well as phychopharmaceuticals which, according to our knowledge so far, have been used in therapy of pathological gambling were discussed in our study.
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Review
[Basic principles of aggressive rehabilitation after anterior cruciate ligament reconstruction].
Rehabilitation after ACL (anterior cruciate ligament) reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. ⋯ The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.
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Randomized Controlled Trial
[Effect of infusion of hypertonic-hyperoncotic solution on cardiovascular function in surgery of the abdominal aorta during the perioperative period].
When blood flow is decreased, as in prolonged hypovolaemia and hypotension, or in the course of transversal clamping of the aorta during aortic reconstruction, nutritive tissue perfusion can also fall below the critical level. ⋯ Cardiac output increased from 5.67 +/- 2.95 to 7.05 +/- 3.39 L min(-1) in the study group, in comparison to the controls, where it increased from 4.98 +/- 2.06 to 5.99 +/- 3.02 L min(-1) (p = 0.004). Central venous pressure increased from 8.75 +/- 3.67 to 9.30 +/- 2.77 mm Hg in the study group, in comparison to the controls, where the values decreased from 6.84 +/- 2.73 to 6.45 +/- 2.50 mm Hg (p = 0.022). Diastolic pulmonary artery pressure increased from 15.92 +/- 5.61 to 16.65 +/- 6.53 mm Hg in the study group, in comparison to the controls, where it decreased from 12.65 +/- 4.28 to 11.85 +/- 3.91 mm Hg (p = 0.021). The amount of given crystalloids 24 hours after the removal of the aortic clamp totalled 2562.5 +/- 485.82 mL in the study group, versus 3350 +/- 727.29 mL in the control group (p = 0.000). The amount of given human albumins 24 hours after the removal of the aortic clamp totalled 30 +/- 49.74 mL in the study group versus 100 +/- 4.34 mL in the control group (p = 0.001). CONCLUSION Haemodynamic stability of patients and adequate organ perfusion during surgery are achieved through the infusion of hypertonic-hyperoncotic solution, which maintains optimal values of: cardiac output, mixed venous oxygen saturation, and delivery of oxygen, while reducing alveolo-arterial oxygen difference. The balance of fluids, 24 hours after the removal of the aortic clamp, was maintained with the aid of hypertonic-hyperoncotic solution, while isotonic solution produced an excess of over 1000 mL of fluid in the control patients. Hypertonic-hyperoncotic solution increases cardiac output considerably more than does isotonic solution, and its application significantly reduces the accumulation of crystalloid solutions and human albumins.