Folia medica Cracoviensia
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Folia medica Cracoviensia · Jan 2001
Review[Biological properties and sensitivity to induction therapy of differentiated cells expressing atypical immunophenotype in acute leukemia of children].
The atypical immunophenotype (expression of determinant from the another cell lines than line of origin) of acute leukaemia blast cells are noted in a part of cases. The characteristics and classification of atypical immunophenotypes are not unified and the clinical significance is not yet fully described. The purpose of the study was: precise description of atypical immunophenotypes and analysis of their frequency in different types of acute leukaemia, analysis of association between expression of atypical immunophenotypes and the level of initial leukocytosis, percentage of blast cells in peripheral blood, expression of CD34, analysis of frequency of multidrug resistance molecule (MDR) expression and association between MDR and immunophenotypes of leukaemia cells, analysis of association between atypical immunophenotypes and proliferation, secretion of cytokines (IL-6, TNF) and spontaneous apoptosis of leukaemia cells, analysis of association between atypical immunophenotypes and sensitivity to induction therapy. ⋯ In AML the combined expression of CD34 and atypical immunophenotype were associated with response to induction therapy by reaching the complete remission, but without any influence on the time of reaching this remission. The results of analysis of cytoreduction time and time of reaching the remission improved the usefulness of these parameters for the estimation of response to the induction therapy. The clinical importance of these observations consist in characterisation of leukaemia cells potentially resistant to the induction therapy what may suggest the modification and individualization of the induction therapy.
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Folia medica Cracoviensia · Jan 2001
Clinical Trial[Experiments in evaluation of brain oxygenation and metabolism based on continuous bilateral SjO2 monitoring and metabolic glucose transformations in patients after severe cranio-cerebral injuries].
The study group consisted of 17 patients after severe cranio-cerebral injuries-in GCS below 8. Saturation in both jugular bulbs was measured by using fiberoptic catheters, the concentration of lactate taken from jugular bulbs was measured too. These values were compared to concentration in peripheral arteries. ⋯ Interdependence between the state of patient in GOS and variability saturation and concentration of lactate was showed. Desaturation occurred before the neurological sings of intracranial hypertension what had influence on way of treatment and diagnostics. Bilateral measurement of the saturation is more useful to make diagnostic unilateral measurement.
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Folia medica Cracoviensia · Jan 2001
[Preparation of the patient for reconstructive surgery of the abdominal aorta as an element in prevention of perioperative complications].
The tasks of an anesthetist in preoperative preparation of the patients submitted for reconstructive surgery of the abdominal aorta have been the subject of this paper. These tasks thought as an element of prevention of perioperative complications have been preceded by the description of characteristic of this steadily increasing population of patients with aortic abdominal aneurysm, or obliterative atheromatosis of the abdominal aorta (syndrome Leriche). There is a justified need for elective surgery in this population of patients because of the following premises: a substantial minor perioperative mortality (about 3% now) in the cases of aortic aneurysms, the steady high mortality in emergency operations and difficulty to foresee the dynamics in enlarging of aortic aneurysms, as well as the risk of their rupture. ⋯ The peculiar task in this team belongs to the cardiologist, whose experience should also embrace the problems of surgical patients. The tasks of an anesthetic team in emergency concerning aortic surgery have been exposed in this paper. A proper understanding by anaesthetist of his/her role as an integrator of interdisciplinary team in perioperative stage of surgical disease is a new task for young doctors as well as for their teachers.
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Folia medica Cracoviensia · Jan 2001
[Reasons for optimizing perioperative anesthesia methods in neurosurgical patients--personal observations and innovations].
Own observations and experiments in neuroanaesthesia were presented, some of them controversial and in present day even historical, other put into practice for safety and comfort of patients and neurosurgical team.
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The day surgery, known also as an office based practice, is a major change in the clinical medicine of the last two decades. In some countries (for instance in Austria) exists a clear difference between the ambulatory and the day surgery. While the ambulatory patient does not need a hospital bed at all, the day surgery patient occupies a bed for at least few hours, but never stays in the unit overnight. ⋯ There is no clear definition of the magnitude of the operation, which can be performed in the settings of day surgery, it varies according to organisation of such units and from the proximity of the hospital in its background. Generally from the day surgery programs should be excluded patients with the risk class above ASA 2, operations lasting more then 90 minutes, all intracranial and intrathoracic operations and all procedures requiring blood transfusion. Day surgery is generally free from mortality and major complications like myocardial infarction, pulmonary embolism or neurological consequences, therefore the assessment of outcome should include minor morbidity, pain relief and satisfaction of the patient.