Przegla̧d lekarski
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Comparative Study
[Evaluation of surgical treatment results of coarctation of the aorta in neonates and young infants].
The authors present the analysis of surgical results obtained for coarctation of the aorta (CoA) in children less than 1 year of age. The material consisted of 103 infants (62 Males and 41 Females) aged 0.33-10.5 months (x = 3.3 +/- 2.6 months) treated between January 1, 1985 and December 31, 1999. All the patients were subjected to a detailed physical examination, ECG, chest X-ray and comprehensive echocardiography, while 12 children had additional hemodynamic studies and angiocardiography. Two groups were distinguished among the investigated children: Below 3 months of life (Group 1, N = 65) and above 3 months of life (Group 2, N = 38). In 69 infants, (including 55 from Group 1 and 14 from Group 2), the recommendation for surgery was circulatory failure, while in 34 infants (10 from Group 1 and 24 from Group 2), the recommendation for surgery considerable systemic hypertension with absent femoral pulses. In 76 patients, the Waldhausen procedure was performed, while 24 were subjected to aortic isthmus angioplasty using a Gore-Tex patch and 3 were subjected to end-to-end anastomosis. Six patients died, including 5 from Group 1 and 1 from Group 2. The remaining 97 infants (60 from Group 1 and 37 from Group 2) were followed-up for a mean period of 96.2 +/- 48.2 months. Postoperative recoarctation was encountered in 12 patients (12.4%); the condition was more predominant in Group 1 (16.6%) than in Group 2 (5.4%), but, no statistical significance was noted (Chi 2 = 2.677, p = 0.102). Despite the repair of aortic coarctation, systemic hypertension was noted in 17 children (17.5%) and it was equally common in both groups, but, twice as frequent in children with recoarctation. ⋯ 1. CoAo correction in children below 3 months of age is associated with an increased risk of recoarctation. 2. Even when surgical treatment of CoAo is attempted very early in life, the risk of elevated systemic blood pressure is not completely eliminated.
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The article presents most important changes in international guidelines for adult cardiopulmonary resuscitation. In this article guideline changes in basic and advanced life support published in Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--a Consensus on Science are discussed. Major changes in guidelines presented in this article include: pulse check, ventilation technique for rescue breathing, compression technique, abdominal thrust recommendations, precordial thump, universal algorithm changes.
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The authors examined intellectual and socio-emotional functioning of 39 subjects suffering from Duchenne muscular dystrophy. Their school situation, access to rehabilitation and a quality of familial upbringing attitude were characterized, as well. No significant differences concerning I. Q. between sick children and healthy population were found.
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Early epicardial vessel patency and tissue perfusion limit infarct size, improve survival and are crucial for optimum functional recovery of the ischaemic myocardium in patients with acute myocardial infarction (AMI). Coronary angiography has been considered the "gold standard" in assessment of reperfusion. Restoration of coronary patency is not a guarantee of myocardial cellular perfusion. ST-segment elevation resolution observed in electrocardiogram (ECG) early after initiation of primary PTCA could be potentially correlated with reperfusion. ⋯ 1. Presence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are more likely to benefit from the early restoration of flow in the infarct related artery. 2. TIMI measures greatly overestimate the success of primary PTCA; they only assess vessel patency, not myocardial cellular perfusion. 3. "Electrocardiographic reperfusion" provides a real-time physiologic marker of cellular perfusion and is a significant predictor of LV contractility recovery--more useful than angiographic reperfusion. 4. ST-segment monitoring is a reliable, non-invasive and inexpensive method to evaluate myocardial perfusion.