Folia medica Cracoviensia
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Folia medica Cracoviensia · Jan 2001
Clinical Trial[Levels of troponin I, tropoinin T, isoenzyme MB creatine kinase and myoglobins in blood serum for perioperative diagnosis of myocardial infarction in patients after coronary artery bypass graft surgery with extracorporeal circulation].
We studied plasma levels of troponin I (cTnI), troponin T (cTnT), creatine kinase MB (CKMBmass) and myoglobin (MB) in patients undergoing coronary artery bypass surgery with extracorporeal circulation and cardioplegia. In group 1 (25 patients without perioperative myocardial infarction) plasma levels of all markers studied were elevated after operation. In group 2 (24 patients with perioperative myocardial infarction) plasma concentrations of all markers exceeded several times levels observed in patients without myocardial infarction with maximal value for MB at 12 hours after operation; for cTnI and CKMBmass at 16 hours after surgery and for cTnT at 32 hours after the end of operation. ROC curves show cut-off value for CKMBmass 20.3 ng/ml (sensitivity 79% and specificity 89%); for cTnI cut-off value was 0.8 ng/ml (sensitivity 80% and specificity 94%) for cTnT the cut-off value was 0.41 ng/ml (sensitivity 86% and specificity 88%) and for MB the cut-off value was 419 ng/ml (sensitivity 85% and specificity 70%). ⋯ All markers studied are reliable biochemical tests for perioperative myocardial infarction, however, the analysis of ROC curves suggested that cTnI and cTnT might be more useful for diagnosis of perioperative myocardial infarction after conventional coronary artery bypass surgery.
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Folia medica Cracoviensia · Jan 2001
Clinical Trial Controlled Clinical Trial[Mivacurium--use for complications of facial-cranial surgery--personal experience].
The aim of this study was to evaluate the effectiveness of mivacurium (Mivacron--GlaxoWellcome) during combined general anaesthesia in the operations on the facial cranium, after tracheal intubation performed using suxamethonium chloride (Chlorsuccillin--Polfa PL). We examined 20 patients, 17-65 years old, who were underwent operations due to facial and neck neoplasms or trauma. Patients were divided into two 10-person groups. ⋯ By 4 patient with heart failure prolongation of the activity time of Mivacurium was observed. The dose of 0.1 mg/kg, is efficient to maintain of the neuromuscular block on the stabile level. This allows the reduction of the total dose, and the decrease of the costs of the operation.
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Folia medica Cracoviensia · Jan 2001
ReviewEvaluation on the effectiveness of perioperative nutritional therapy.
In the last three decade very important advances in venous access, enteral feeding techniques and parenteral and enteral nutrient formulations have made it possible to provide sufficient nutritional support to almost all patients. The clinical nutritional therapy became a progressive medical subspecialty. Despite the widespread use of nutritional management of different patient groups, many fields of nutritional support remain controversial. ⋯ The historical background and development of perioperative artificial nutritional therapy are cited. Whenever possible, prospective randomised clinical trials (PRCTs) are evaluated because this is the most reliable method for evaluating clinical efficacy of a treatment. The incidence of postoperative complications, the length of postoperative hospitalisation and the mortality are considered good general indicator of effectiveness of perioperative nutritional therapy.
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Folia medica Cracoviensia · Jan 2001
Review Comparative Study[Point systems for evaluating coma in patients with injuries of the central nervous system (CNS)].
Paper reviews various coma scales which are used to monitor consciousness after sustaining severe injuries of CNS. Glasgow Coma Scale, at present the most frequently used, was compared to recently developed scales, which are more useful for monitoring persistent comas, allows to evaluate discrete changes in patient's state more precisely and to predict the outcome. The necessity of evoked potentials' measurements, such as Trigeminal-Auditory Glasgow (Coma Scale) has been stressed.
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Folia medica Cracoviensia · Jan 2001
Clinical Trial Controlled Clinical Trial[Does intravenous administration of magnesium have an effect on postoperative analgesia?].
The study involved 67 patients operated for malignant tumours of stomach and of the colon. The patients have been divided into 3 groups: the NORMO group--20 patients in whom the serum magnesium level remained normal during the whole period studied; the HYPO group--22 patients who developed hypomagnesaemia in the postoperative course; the MAG i.v. group--25 patients who on the day of surgery and on 4 days following surgery, received intravenously daily doses of 2.5 ml of 20% MgSO4 per each 500 ml of transfused fluids. ⋯ In all three groups, the daily amounts of morphine and noramidopirine received by patients was the same. The intravenous administration of daily doses of 8 to 14 mmol magnesium in the postoperative period does not affect the amount of analgesics given to patients.