Folia medica Cracoviensia
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Hernia (Greek kele/hernios--bud or offshoot) was present in the human history from its very beginning. The role of surgery was restricted to the treatment of huge umbilical and groin hernias and life-threatening incarcerated hernias. The treatment of groin hernia can be divided into five eras. ⋯ Later such methods like TAPP and TEP were introduced. The disadvantages of laparoscopic approach were: high cost and risk connected with general anesthesia. In conclusion it may be stated that history of groin hernia repair evolved from life-saving procedures in case of incarcerated hernias to elective operations performed within the limits of 1 day surgery.
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Folia medica Cracoviensia · Jan 2006
[Pain versus activity and fatigue in adolescents hospitalized because of cancer and rheumatoid diseases].
Chronic disease in adolescence is followed by many negative effects of somatic and psychosocial nature. These effects can be observed especially in oncological and rheumatologic diseases. This is due not only to the character of the disease, its chronic course, but also aggressive treatment. The objective of this work was to evaluate relationship between pain experience and sleep, fatigue and physical, social and intellectual functioning of teenage patients. ⋯ Pain, fatigue and sleep disruption account for important factors in rheumatologic and oncological diseases. They also cause decrease in physical, social and mental functioning of teenage patients. Results show that there is a significant relationship between outcomes of disease, its treatment and impact on functioning and developmental course of adolescents. Care delivered to those patients must be integrated and involve multidisciplinary factors.
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Folia medica Cracoviensia · Jan 2005
[The role of melanocortin peptides in the cardiovascular regulation in haemorrhagic shock].
The central neuronal systems associated with cardiovascular regulation in haemorrhagic shock can be functionally divided into two groups. The first one includes opioid peptides, which inhibit the activity of cardiovascular centre neurones and initiate the sympathoinhibitory phase of regulation in hypovolaemia. The second group consists of non-opioid systems demonstrating anti-shock properties, such as the melanocortinergic. cholecystokininergic, thyreoliberinergic, cholinergic and histaminergic systems. ⋯ The mechanisms of their action include centrally mediated activation of the sympathetic nervous system and the "cholinergic anti-inflammatory pathway". which leads to an increase in the peripheral resistance and suppression of the transcription nuclear factor appaB-dependent systemic inflammatory response. respectively. Moreover, acting peripherally, the melanocortins stimulate secretion of glucocorticoids, normalise the blood levels of nitric oxide and inhibit free radical generation in haemorrhagic shock. Further clinical studies are needed to confirm the usefulness of the melanocortins in the treatment of haemorrhagic shock in humans.
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Folia medica Cracoviensia · Jan 2002
Randomized Controlled Trial Clinical TrialInfluence of different pressures of pneumoperitoneum on the autonomic system function during laparoscopy.
The effects of different pressure values of pneumoperitoneum on the activity of the autonomic nervous system (ANS) have not been investigated in detail. In this prospective study, 20 patients qualified for laparoscopic cholecystectomy were randomised to either low-pressure (LP = 7 mmHg) or standard-pressure (SP = 12 mmHg) pneumoperitoneum groups, 10 patients each. The anesthesia was induced with fentanyl and thiopental and maintained with isoflurane. Ventilation was mechanically controlled (18 breaths per minute, end-tidal CO2 30-35 mmHg, instant capnometer monitoring). Intraabdominal pressure was maintained automatically by a CO2 insufflator. Patient were kept in a horizontal position. The ANS was evaluated by heart rate variability (HRV) analysis (POSTER ECG 2002 System) measured intraoperatively in three recordings of 5 minutes each: in awake patient, after induction of general anesthesia, and after creation of pneumoperitoneum. Power spectral analysis of HRV was applied, the low-frequency (LF = 0.05-0.15 Hz) and high frequency (HF = 0.15-0.45 Hz) spectral density of the HRV were analysed using the Fast Fourier Transform algorithm. The appropriate statistical analysis of data was performed. LF density decreased at the anesthetized stage and increased at the insufflated stage in both groups (p < 0.01). LP resulted in lower sympathetic activation than SP pneumoperitoneum (LF: 68.12 +/- 6.56 nu vs. 78.26 +/- 5.43 nu, p < 0.01; HF: 24 +/- 2.48 nu vs. 15.56 +/- 2.54 nu, p < 0.05). ⋯ pneumoperitoneum leads to sympathetic activation of the ANS. LP in comparison to SP pneumoperitoneum with carbon dioxide results in significantly decreased sympathetic activation during laparoscopy.
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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.