Vojnosanit Pregl
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Randomized Controlled Trial Clinical Trial
[Total intravenous anesthesia with propofol with midazolam coinduction--the anesthesia of choice in cataract surgery].
Comparative clinical investigation was performed in 80 ASA I/II patients undergoing cataract surgery on one eye. Patients were randomly divided in to four groups, according to the method of anesthesia. Intraoperatively (T0-T6), decreasing of intraocular pressure (IOP) to the optimal values at the start of the operation (T3), and the hemodynamic stability of patients after the induction (T1) were evaluated. ⋯ Fast recovery rate was noticed in the first and the second groups (13.9 +/- 1.1 and 14.4 +/- 0.8 min). Vomiting was noticed in 5% patients in the first group, 15% in the third group, and in 20% in the 4th group. The authors have concluded that TIVA fourth propofol and coinduction with midazolam is anesthesia of choice in the cataract surgery.
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The specificity of the lower leg is in sparse collateral blood flow of the skin cover in the middle and distal part, reduced subcutaneous tissue and the prominence of the front side of tibia immediately under the skin. These characteristics of the lower leg make the application of the standard plastic reconstructive principles, which have been applied in the other regions of the body to a certain degree impossible. ⋯ The aim of this study was to show the available reconstructive methods in the treatment of the lower leg soft tissue and to analyze its application in the management of war wounds in the injured from the civil war in the former Yugoslavia. On the basis of our experiences in the management of war wounds, especially of the lower leg with the tissue defects, we would like to point on the existence of the clear indications for the application of certain reconstructive methods depending on the size, localization and tissue defect structure, as well as the advantages and disadvantages of the available reconstructive procedures.
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The retrospective analysis of 1,514 cases treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy in the period between 1991 and 1995, established that the percentage of the injuries caused by gunshots and those caused by explosives during the conflict in former Yugoslavia, was more or less the same. The injuries caused by gunshot more often occurred on the head, neck, arms and trunk. The injuries of the legs caused by the explosives were more frequent, and they occurred in 83% of the cases. ⋯ Free skin, myocutaneous or complex microvascular flaps were applied in cases of more extensive defects or if a more suitable solution could not be found. Our experience in surgical treatment of war injuries with skin defects during the civil war in former Yugoslavia has shown that over 50% of all the injured patients required the treatment of a plastic surgeon in a definite surgical treatment of a war injury. A multidisciplinary approach is necessary in the majority of the injured, and the surgical team is composed according to the affected area and the extent of the injury.
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Sepsis and its complications are severe clinical syndrome that is caused by systemic inflammatory response of the host to infection. Despite the use of common and numerous new therapeutic protocols, mortality from this severe disease is still very high. In the study are presented 155 patients (111 males, 44 females) of average age 49.6 years with mean septic score 12.9 (2-40). ⋯ Concentrations of fibrinogen and urea in the blood at the admission in the patients with sepsis were very good prognostic factors of the disease outcome, and leukopenia, leukocytosis and neutropenia were associated with the increased mortality. Negative correlation existed between fibrinogen concentration and mortality (p < 0.001), while positive correlation (p < 0.001) existed between urea concentration and mortality. In the absence of more efficacious therapeutic protocols, fast recognition of the sepsis, evaluation of its severity, knowledge of the risk factors for its poor outcome and aggressive use of antibiotic and existing supportive therapy can significantly decrease high mortality of this too severe clinical syndrome.