Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
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Pol. Merkur. Lekarski · Jul 2007
[Estimation of medical protocol correctness in the light of opinions issued as ordered by the judiciary or prosecution authorities].
Medical personnel, most commonly physicians, are held responsible for situations in which in the course of medical treatment some adverse effects develop that endanger the patient's health and life. Such effects generally include death, a severe damage to patient's health as well as the exposing of patients to the danger of such effects developing in them. The effects of the kind result either from some medical malpractice or from medical personnel's negligence. The aim of the paper was to analyse medico-legal expertises issued as ordered by the Polish Judiciary and Prosecution Authorities in cases of alleged medical malpractice that had been issued by the Chair and Department of Forensic Medicine, Medical University of Gdańsk, and to compare the results with those from similar studies done by Chairs and Departments of Forensic Medicine at the Medical Universities of Katowice, Kraków, and Wrocław. ⋯ Legal proceedings were generally conducted by the Public Prosecutor's Office, less frequently by the police, and only in 7.2% were such cases subject to the civil law procedure. Most frequently assessed health care facilities included hospitals (66.1%), clinics of medical universities (16.6%), and ambulance service (13.4%). Seldom were the charges of medical malpractice brought against basic health care facilities (9.4%) or private practices (3.5%). As revealed in the analyzed material, adverse health effects of a disease or injury included death--70.5%, a severe damage to patient's health--9.1%, and the endangering of patients with development of such effects--0.4%. In 60.8% of the cases analyzed, medical protocol implemented by medical personnel was assessed as proper. Medical malpractice were found in 18.5% of the cases, including diagnostic malpractice--1.8% therapeutic malpractice--2.7%, and those of logistic nature--4%. Similar results were obtained by the above mentioned Departments of Forensic Medicine. Negligence in the rendering of health care was found in 13.4 of the medico-legal expertises analyzed. Conclusions. In the material subjected to this analysis criminal cases are predominant. Medical personnel, including medical practitioners, are more and more frequently charged with exposing patients to the immediate danger of loss of life or a severe damage to their health (Art. 160 of the Polish Penal Code). There are more and more cases in which the adverse effects endangering patient's health or life result from negligence rather than from some medical malpractice.
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Pol. Merkur. Lekarski · May 2007
Review[The use of endoscopic method in treatment of strictures of biliary tree].
The strictures of bilitary tree may occur as a result of benign and malignant pathologies of liver and pancreas. The benign stricture of biliary tree are usually results of the surgery and if it is possible the endoscopic methods should be implemented in this group of patients. In case of the stricture of biliary tree in the course of the chronic pancreatitis a surgery should be chosen, because the widening and endoscopic stenting don't allow the long term removal of stricture. ⋯ In most cases they do have character of urgent or palliative treatment. The study shows some of the treatment methods and the combination of different techniques, which may be used in case of bile flow obstruction because of the stricture of biliary tree. The final choice of treatment method is based on the clinical condition of a patient and the availability of the method and experience at using it.
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Pol. Merkur. Lekarski · May 2007
Case Reports[Accidental ingestion of two magnets--aggresive or prolonged approach?].
Accidental ingestion of foreign bodies is a common pediatric problem. Non-sharp items like coins, jewelry, pieces of toys are most frequently found among swallowed objects. They usually pass through a child's digestive system without health consequences (40-90% of reported cases). ⋯ Patient has been discharged home with no complaints in general and local good condition. Ingestion of more than one magnets is an strong indication for an immediate endoscopic intervention. Such an algorithm is strongly advocated to prevent of lesion formation in the soft tissues located between two objects with paramagnetic properties which may cause ischemic necrosis and perforation of the GI tract wall.
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Pol. Merkur. Lekarski · May 2007
[Bilateral posterior thoracoscopic splanchnicectomy in a face-down position in the management of chronic pancreatic pain].
Abdominal pain is the primary symptom in most patients with chronic pancreatic diseases. Many authors have reported that thoracoscopic splanchnicectomy is a effective and recognize method for relief of chronic pain due to pancreatic cancer and chronic pancreatitis. Time ago only few authors used bilateral toracoscopic splanchnicectomy in one session because they observed side effects as transient orthostatic hypotension and/or diarrhea. The aim of this study was retrospective analysis of two methods of the bilateral thoracoscopy splanchnicectomy at one session. We comparsion operation's time, intraoperative and postoperative complication, hospitalization and evaluate pain intensity in patients with intractable pain due to advanced pancreatic cancer and chronic pancreatitis. ⋯ Posterior thoracoscopic splanchnicectomy approach with the patient in a face-down position is a save, minimally invasive and reduce operation time procedure.
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Sarcoidosis is a multisystemic disease of unknown pathogenesis. Its characteristic feature is formation of noncaseating granuloma in involved organs. ⋯ The variations in prevalence and incidence of this disease in individuals from different ethnic, racial groups or families show, that the genetic factors are also involved in sarcoidosis etiology. Although there is a clear genetic influence on the risk of sarcoidosis, the relation between clinical course of the disease is an area for further exploration in the future.