Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences
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Acute kidney injury (AKI) is encountered in a variety of settings (e.g., hospitalized and outpatient, non-intensive and intensive care unit patients, pediatric, adult, and elderly), with varied clinical manifestations ranging from a minimal elevation of serum creatinine (SCr) to anuric renal failure and/or multi organ failure (MOF), and a wide variation in causes, risk factors and comorbiditis. There is no hard and fast rule as to when renal replacement therapy (RRT) should be initiated, but is clearly not sensible to wait until an obvious uremic complication arises. Modern practice is to initiate RRT sooner rather than later, for example, when the SCr concentration reaches 500-700 micromol/L, perhaps even earlier, unless there is clear evidence that renal function is about to recover. ⋯ Hybrid therapies using a variety of machines are safe and convenient, providing excellent control of electrolytes and fluid balance, and offers several advantages over CRRT, including less cumbersome technique, patient mobility, and decreased requirements for anticoagulation, while providing similar hemodynamic stability and volume control. Currently, it has been found no difference in mortality or renal recovery between hybrid RRT, CRRT or IHD for critically ill patients with AKI. However, future investigations should collect detailed information on long-term costs and the relative likelihood of renal recovery associated with dialysis modality.
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The optimal time for lumbar discectomy due to sciatica is still under discussion. We examined a group of 177 consecutive patients with lumbar disc herniation, who underwent lumbar discectomy. According to the duration of the sciatica, patients were divided into 3 groups: 31 (17.5%) patient with a duration of sciatica from 0 to 3 months, 82 (46.3%) patients with a duration from 4 to 10 months, and 64 (36.2%) with a duration longer than 10 months. ⋯ There was also a significant difference between the patients operated on in the period from 4-10 months and those operated > 10 months (p < 0.001). This goes in favour of achieving the best results in patients with a duration of sciatica from 0 to 3 months. The worst results were obtained in those with a duration of sciatica > 10 months.