Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%. An increase in the incidence of shoulder dystocia has been recorded over the last 20 years, probably just because it has now been regularly registered at maternity wards as an obstetric complication. The risk factors for shoulder dystocia include fetal macrosomia, fetal malformations and tumors, maternal adiposity, excessive weight gain during pregnancy, diabetes mellitus, pathologic pelvis, multiparity, short maternal stature, advanced maternal age, postterm pregnancy, so-called midforceps delivery or vacuum extraction, prolonged delivery stage II, oxytocin labor induction, premature fetal expression according to Kristeller, and previous shoulder dystocia in macrosomatic children. ⋯ McRoberts' maneuver (or Gaskin maneuver) is recommended as the initial procedure for shoulder release in case of shoulder dystocia. If it fails, other obstetric procedures such as Resnik's suprapubic pressure and Woods' grip with posteriorly placed arm release should be used, always with gross lateral episiotomy. The performance of all these obstetric procedures requires skilfull and highly experienced obstetrician and obstetric team as a whole.
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Randomized Controlled Trial Clinical Trial
Pilocarpine in the prevention of postirradiation xerostomia.
During radiation therapy to the head and neck region, salivary gland hypofunction commonly develops. The aim of our study was to evaluate whether the sialogogue pilocarpine given during radiation therapy may reduce the severity of xerostomia and salivary dysfunction. ⋯ No drug effect was observed in the glands that were completely irradiated. Thus, pilocarpine appeared to stimulate salivary tissues outside the radiation field.
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To obtain data on mesothelioma incidence in Central and Eastern Europe, a short questionnaire was sent to 83 researchers from 19 countries. The questions referred to the approximate number of mesotheliomas diagnosed per year in the country, degree of asbestos consumption, and percentage of lung carcinomas attributable to asbestos. Answers were received from 12 countries. ⋯ Data on the percentage of asbestos-related lung carcinomas are lacking. The knowledge about asbestos related cancer in Central and Eastern Europe remains fragmentary. Further investigations in this relevant area of public health should be encouraged.
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Endotoxic shock with multiorgan dysfunction syndrome (MODS) is fatal in more than 80% of cases and is the leading cause of death in patients admitted to intensive care units. The incidence has increased to more then 100% in the last 10 years and there has been no significant decreases in its morbidity and mortality. The systemic inflammatory response to infection, e.g. sepsis, develops when the endotoxins activate various cascade systems. ⋯ When more than 3 organs are involved, the risk of fatal outcome exceeds 80%. The use of plasma exchange may be a beneficial adjunct to therapy during a progressive septic shock with MODS, when the patient does not respond to classical intensive care unit therapy. The beneficial effect, recently reported for plasma exchange procedures in patients with sepsis, may be due to the removal of various toxins and waste products from the blood, and administration of plasma from healthy subjects.
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Owing to its technical possibilities, bronchoscopy has also come into frequent use in the treatment of trauma patients, not only for diagnostic but also for therapeutic purposes. It has become a mandatory procedure in the treatment of chest injuries. Following discussion of its history, possibilities and scope, the authors present the results of treatment over the last two years at the University Hospital of Traumatology Zagreb, Croatia. ⋯ According to indications for bronchoscopy, patients were classified into four groups: (a) patients with atelectasis (N = 51), with a total of 68 bronchoscopic procedures (1.33 per patient; (b) patients who developed infiltrates (N = 48) with 162 bronchoscopies (3.37 per patient); (c) patients with excessive secretions (N = 42) with 153 bronchoscopies (3.64 per patient); and (d) patients who developed respiratory insufficiency in the course of treatment (N = 16) with 24 bronchoscopic procedures (1.5 per patient). The best results were achieved in the atelectasis patients--in 74.47% of them there was no need of additional bronchoscopies, whereas in the group with excessive secretions or infiltrates bronchoscopy had to be repeated several times. It may be concluded that today, bronchoscopy is a routine diagnostic and therapeutic method in the treatment of chest injuries.