Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Hypoperfusion of peripheral tissues and splanchnic organs during cardiac surgery in extracorporeal circulation may lead to the origin of serious complications. The aim of the study was to monitor metabolism and blood pressure in interstital peripheral tissue, skeletal muscle, during the operation on the patient with extracorporeal circulation (ECC) in an early post-operation period by means of microdialysis. ⋯ The results of the microdialysis study demonstrated dynamic changes in interstitial concentrations of the observed compounds (glucose, urea, glycerol and lactate) related to the phase of operation on the heart in extracorporeal circulation and in early post-operation period. A higher perfusion of skeletal muscle was documented in patients operated on under normothermia. It became obvious that the dynamism in the changes of the compounds observed in the interstitium of skeletal muscle was determined by metabolic activity of the tissue as well as by blood flow in the muscle interstitium.
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The cost of providing intensive care is enormous. This resource consumption is focused on a relatively small number of patients. Over the past 30 years, despite new technologies and escalating costs, mortality rates for major disease conditions treated in the intensive care units remain unchanged. ⋯ In contrast, the closed system involves transfer of the patient to the exclusive care of a team of intensivists upon admission to the intensive care unit. The closed system typically provides formal triage, and consistent control, and mandated care by the intensivist team. Significant reductions in mortality rates and improvements in resource efficiency are seen with use of intensivist teams, a closed intensive care unit model and systematic triage.
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Postoperative pulmonary complications are of clinical importance: they prolong the hospitalization, increase the costs of treatment and contribute to the perioperative mortality. Respiratory insufficiency--inability to maintain adequate exchange of gases in the lungs--is its most severe form. Early diagnostics is essential and it is possible only during continuous and meticulous surveillance of the patient. ⋯ The cornerstones of adequate postoperative care are oxygen therapy, sufficient analgesia, physiotherapy. At the earliest signs of respiratory insufficiency the commencement of respiratory support is mandatory. Artificial ventilation can be used as a preemptive measure preventing the development of pulmonary complications.
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Stab injuries of the heart belong into the category of fatal injuries. Along with the increased crime rate also the number of these injuries increased and they must be tackled unexpectedly by the surgeon who frequently lacks specialization in cardiosurgery. The authors present the case histories of three patients whom they treated successfully in 2001. ⋯ The postoperative course was uncomplicated and the patients were discharged into domiciliary care on the 7th and 8th day after surgery resp. Consistent with quoted authors, favourable prognostic factors in penetrating stab wounds of the heart include the following: younger age, early transport to the emergency centre, presence of cardiac tamponade and early surgical revision by a competent surgeon without the necessity of specialization in cardiosurgery. The authors emphasize the rule which pushes examination methods into the background: stab wound in the cardiac area + unstable circulation = surgical revision.
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The case-history describes successful resuscitation of a young man who was found after 15 hours following attempted suicide (intoxication with carbamazepine) in deep hypothermia (19 degrees C) with cardiac arrest. For rewarming the patient extracorporeal circulation was used. The patient was successfully disconnected from the extracorporeal circulation, relieved of the shock incl. severe rhabdomyolysis and intoxication with carbamazepine and discharged to domiciliary treatment without suffering from a neurological deficiency.