Przegla̧d lekarski
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Case Reports
[Carbamazepine "CR"--clinical picture of intoxication: the kinetics of extracorporeal elimination].
Carbamazepine (CBZ) intoxication is an important issue in acute poisonings practice. Pathological reflexes, central breathing depression and cardiac disturbances are the characteristic features of carbamazepine poisoning. The clinical picture is variable and does not always correlate with CBZ serum concentration. ⋯ CBZ pharmacokinetics makes the drug move rapidly between the compartments during the HP. This movement may cause a reduction in CBZ concentrations in receptors' vicinity. Probably this mechanism accounts for the improvement of the patients' clinical state despite low kinetic values of the procedure.
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Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation. ⋯ Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.
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The lesions of the trachea resulting from intubation are scarce. Each laceration of the tracheal wall threatens the patient's life. ⋯ In all the patients the lacerated wall of the trachea was sewn up. Our observations indicate that leaving the patients on his own breathing after sewing up of the lacerated tracheal wall supports the healing of the impaired site.
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The development of predictive genetic DNA- tests gives people the choice "to know" or "not to know" a decision with tremendous short-mid- and long-term consequences. Family history of disease can provide information about the increased risk of susceptibility, and these knowledge may have psychosocial implication. The results of studies using genetic testing and their psychological impact are discussed with regard to hereditary cancer (breast, colorectal, prostate) as well as particular neurogenetic disease (e.g. ⋯ Psychological studies on genetic risk concentrating on psychological adjustment, transfer of information within the family and perception of genetic risk in families showed that genetic disease had a considerable impact on family life (e.g. reproductive decisions). Findings showed that people with a family history of cancer (without genetic testing) vary in their illness behaviour, but little is known about the effect of inheredited predisposition to disease (e.g. cancer) on such health related behaviour as smoking, diet, activity level. Genetic information could both increase (strengthening the belief that current behaviour combined with genetic predisposition is putting person at increasing risk of disease) and decrease motivation to change behaviour (weakening belief that changing behaviour will reduce risk of disease because genetic is immutable).
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Between 1994-1997 the Pain and Palliative Care Out-Patient Clinic founded by the Society of Friends of the Sick Hospicium in Kraków undertook hospice home care of 870 cancer patients. Retrospective evaluation of their files revealed that 48.2% of patients on admission were aware of their diagnosis and 61.2% of families did not discuss it with patients. ⋯ During the same time, among the cancer patients not admitted to hospice home care in the city of Kraków, only 23.7% died at home and the rest in institutions. In spite of demonstrated adequate home care, 16.5% of home care patients were admitted to the local hospital, which suggests the need for stationary hospice or palliative care ward cooperation.