Przegla̧d lekarski
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Clinical Trial
[Research from the Palliative Care Department in Poznań on treatment of neoplasm pain with Durogesic (transdermal fentanyl)].
Transdermal Fentanyl (TF, Durogesic) is a strong opioid analgesic which is used in the treatment of cancer pain. In this article we described basic properties and dosing guidelines for TF and our own experience with use of Durogesic in the treatment of cancer pain. In this open study TF was administered in 16 pts aged of 30-88 (mean 62 +/- 17) years with advanced cancer who suffered from strong cancer pain and who had previously been treated with morphine (11 pts), buprenorphine (1 pt), tramadol (2 pts) and non-opioid analgesics (2 pts). ⋯ The treatment was well tolerated and the most frequent adverse reactions were constipation in 10 pts (63%) and drowsiness in 4 pts (25%). During the therapy with TF we didn't encounter serious side-effects which would cause cessation of the treatment. Results of our study confirmed that TF was an effective analgesic most commonly used in pts with stable nociceptive pain especially when opioid analgesics could not be administered orally.
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Systemic lupus erythematosus is a disease in which inflammatory process provoked by different antibodies affects many organs and systems. The circulatory system is one of them. In patients with systemic lupus erythematosus cardiac disorders are generally known and well proved. ⋯ In studied group of children echocardiographic global indices of left ventricular systolic function were normal. The subclinical impairment of diastolic left ventricle function was found in 8 children with increased left atrium-aorta index. Both the theoretical knowledge and the results of the studies suggest that the offsprings of mothers suffering from SLE need a careful cardiological observation.
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Isolated injury of gall bladder as a result of blunt abdominal trauma is very rare. We report a case of 39 year old man, who was admitted to our Clinic during emergency. He presented upper right quadrant abdominal pain, increasing on palpation and guarding. ⋯ Disruption of the neck of the gall bladder was found during laparotomy. Cholecystectomy was performed. Patient was discharged from hospital five days after the operation.
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Life saving surgery is the surgery which has to be performed during the acute or reanimation period (1 to 3 h) and during the primary or stabilisation period (first day surgery). During the reanimation period lifethreatening conditions are identified and management is begun simultaneously. Many trauma surgeons talk about the first "golden hours" as the time interval starting immediately after the injury when rapid intervention will save lives and a lack of intervention will result in life loss. ⋯ This period consists of further diagnostic procedures and treatment of injuries that are not directly life-threatening, but which may become life endangering or severely disabling if not treated promptly. The priorities of the surgical treatment are: brain injuries, eye- and facial injuries, progressive compression of the spinal cord, visceral injuries, musculoskeletal injuries. By improving prehospital care, rapid transport and last but not least immediate life saving surgical treatment preventable deaths can be reduced from 20-30% to 2-9% (5).
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We present a review of our recent experience of operating on infants below 2500 g suffering from congenital heart disease. A retrospective review was performed in 73 children who had undergone cardiac operations at our institution from 1990 to 1999. There were 43 (59%) females and 30 (41%) males; the mean age at operation was 28 days (range 4 to 92). ⋯ A higher mortality rate was noted in premature children and in children who had undergone palliative procedures. At a 1-116-month follow-up (mean 39 months), of 57 (93.4%) patients, 46 (80.7%) were in NYHA class I and 11 (19.3%) in NYHA class II. In conclusion the authors believe that early intervention can be performed in infants below 2500 g, and the associated mortality and morbidity rates are low.