Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Case Reports
A life-threatening complication of extreme hyperkalemia in a patient on maintenance hemodialysis.
A 68-year-old female on two-year chronic hemodialysis for chronic renal failure due to chronic pyelonephritis, was admitted to hospital for weakness, dulled sensorium and dizziness. On examination the patient was in a state of circulatory collapse, the electrocardiogram showed an accelerated idioventricular rhythm and laboratory analysis revealed extreme hyperkalemia (K+ 10.1 mmol/l). ⋯ At the end of the hemodialysis session, the patient was in a clinically good condition, blood pressure was 160/90 mm Hg and the serum K+ concentration was normal. The case appeared to suggest that extreme hyperkalemia may have direct effects on vascular resistance, causing hypotension and shock.
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Fourteen casualties with penetrating injuries to the colon caused by firearms in combat zones have been treated according to the principles accepted today for the treatment of such injuries acquired in civilian violence. The patients were treated by primary resection of the injured part of the intestine, without relieving colostomy, providing that the time interval between the moment of injury and admittance to the hospital was less than six hours. ⋯ Complications related to colon surgery occurred in one patient (7%). Primary resection without relieving colostomy for the colon injuries caused by firearms is a safe procedure providing that the time interval between wounding and surgery does not exceed six hours.
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A prospective study was performed to determine whether the risk factor for hepatitis B, proposed by Centers for Disease Control (CDC), USA, are reliable predictors for the hepatitis B surface antigen (HBsAg) carrier state in an obstetric population. In the period between January 1, 1991 and December 31, 1992, all pregnant women from geographically defined areas of the Istrian and Rijeka districts were routinely screened for hepatitis B surface antigen (HBsAg). Among 10,627 pregnant women, 107 (1%) HBsAg positive cases were registered. ⋯ The other 61 subjects had no recognizable risk factors. The screening of pregnant women for HBsAg only on the basis of the CDC recommended history guidelines, would have left 57% of our HBsAg positive mothers undetected and therefore their children unvaccinated against hepatitis B infection. Our results confirmed the need and value of the new CDC recommendations about routine prenatal screening of all pregnant women for HBsAg until hepatitis B vaccine is included in the scheme of compulsory vaccination of all newborns.