Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
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Pol. Merkur. Lekarski · Jun 2004
Clinical Trial Controlled Clinical Trial[Effectiveness of extrameningeally administered opioids in patients with aortic prosthesis].
The examination was carried out in 60 men at the age of 56 to 78 (mean age 65.3 years) treated by suturing of vascular prosthesis due to aneurysm of abdominal part of aorta, in which postoperative analgesia was done with the use of bupivacaine with opioids administered extradurally. Patients were divided into two groups consisting of 30 individuals each. In group I, patients were given 0.25% bupivacaine with phentanyl, while in group II--bupivacaine appropriate for the need of the patient. ⋯ Twenty-four hour long dose of bupivacaine to 210+/-20.5 mg in group I and 145+/-11.5 mg, while morphine 5.1+/-1.2 mg. Fluctuation of the chosen haemodynamic and gasometric parameters were of no clinical importance. 7 patients suffered from nausea and vomiting, these patients included 2 patients from group I and in 5 patients from group II. On this basis of results, one may confirm that both methods of analgesia are equally effective, although it was possible to reduce the twenty-four hour long dose of bupivacaine, thus limiting the risk of depressive effect on heart muscle.
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Pol. Merkur. Lekarski · May 2004
Review[Adjuvant and salvage radiotherapy after radical prostatectomy].
Currently radical prostatectomy remains the standard mode of treatment for patients with locally and localized stage of prostate cancer. On the other hand, after radical prostatectomy approximately 50% of patients have postoperative positive margin. Therefore implementation of effective mode of adjuvant radiotherapy treatment after radical prostatectomy plays important role in clinic. ⋯ Still remain questions about the following issues: timing of radiotherapy, optimal dose, treatment technique, involved target for radiotherapy, and the role of adjuvant hormonal therapy. The last issue now is evaluating in the randomized clinical trial. In summary, currently until outcomes from well conducted randomized trials will available patients after radical prostatectomy with adverse significant factors for local recurrence or/and increased level of PSA should be considered for postoperative radiotherapy.
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The coadministration of long-acting inhaled beta2-agonists and inhaled corticosteroids is the most effective treatment for persistent asthma. It is often assumed that there is synergy between these medications. ⋯ The combination has a logical role in the treatment of moderate-to-severe asthma, offering the advantage of increased convenience and possibly improved compliance. In addition to improvements in lung function, symptom scores and quality of life, the combination therapy reduces exacerbation rates, an outcome that contributes to favorable cost-effectiveness.
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Pol. Merkur. Lekarski · May 2004
Review[Transplant coronary artery disease--treatment with statins].
Hypercholesterolemia is a common disorder after heart transplantation and my be associated with the development of transplant coronary artery disease. 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors (HMG CoA) are the most effective drugs to lower cholesterol level in transplant patients. However, interaction of immunosuppressants with HMG CoA inhibitors, which are metabolized by cytochrome P 450, increase incidence of skeletal muscle myopathy and rhabdomyolysis.
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Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability in many countries over the world. Prevalence of COPD is difficult to evaluate because of clinical similarity to bronchial asthma, and changes in diagnostic standards. ⋯ In Poland this problem was described only in some regional trials. For this reason the program for prevalence of COPD has to be established according to contemporary diagnostic and therapeutic standards.