Przegla̧d lekarski
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The aim of the study was to assess the diagnostic yield of transbronchial needle aspiration (TBNA) in mediastinal or hilar adenopathy in: sarcoidosis, tuberculosis and malignancy. Transbronchial needle aspiration was performed in 53 patients, preeceded by computed tomography (CT). In 22 patients (41,5%) TBNA enabled to diagnose 10 cases of sarcoidosis, 12 cases of neoplastic infiltrates of the lung. ⋯ In the remaining 7 patients who were followed-up for a period of one year the diagnosis of sarcoidosis was confirmed by clinical, radiological and cytological (BAL) examinations. Transbronchial needle aspiration was shown to be efficient diagnostic method in mediastinal or hilar adenopathy in sarcoidosis and malignancy except lymphoma. Moreover in approximately 60% of cases this technique doesn't allow to establish a diagnosis and in turn implicates the necessity for further diagnostic procedures like mediastinoscopy, or transbronchial or thoracoscopic lung biopsy.
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The aim of the study was to define the frequency of atrial fibrillation early after coronary artery bypass grafting (CABG) and clinical risk factors for the development of atrial fibrillation in the post-operative course. The study population consisted of 1578 patients (1283 men and 295 women ranging in age from 25 to 85 years, mean age 59.373 +/- 8.686 years) undergoing isolated coronary artery bypass grafting in extracorporeal circulation between 1.01.1998 and 21.12.1999. The patients were divided into two groups: group 1 with atrial fibrillation after CABG (193 patients, mean age 62.399 +/- 7.097 years) and group 2 without atrial fibrillation in the postoperative course (1385 patients, mean age 58.952 +/- 9.009 years). Both groups were compared with respect to pre-, intra- and postoperative parameters. Additionally in group 1 the following aspects were taken into account: timing of atrial fibrillation and its relapses in relation to the surgical procedure, serum potassium level, type and efficacy of antiarrhythmic treatment. ⋯ (1) Atrial fibrillation is an important clinical problem early after coronary artery bypass grafting. It is poorly tolerated and shows a tendency to recur. (2) Atrial fibrillation after CABG is most strongly correlated with age over 60 years, arterial hypertension and perioperative withdrawal of beta adrenolytics.
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Urapidil was administered in 69 patients aged between 46-79 age (average 62.7 +/- 8.4 age) to control intra-operative increase in arterial blood pressure accompanying endotracheal intubation, extubation, wakening of the patients, incision of abdominal integument and clamping of abdominal aorta. In presented group 47 patients suffered from arterial hypertension and 22 patients did not. Patients underwent various surgical procedures in general anesthesia and in 13 patients implantation of aortal prosthesis in result of abdominal aortic aneurysm (7 patients) and Leriche syndrome (5 patients) was performed. ⋯ Urapidil administered during monotherapy turned out to be efficacious in 81.1% of treated patients. Other 18.9% required an additional infusion of nitroglycerine, but these were patients operated on due to abdominal aorta. Average dosage of urapidil applied during monotherapy amounted to 26.3 +/- 2.4 mg. Intraoperative administration of urapidil did not result in acceleration of heart rate, and urapidil turned out to be a safe medicine to reduce intraoperative increase in arterial blood pressure also in patients who were previously diagnosed as suffering from arterial hypertension.
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Surgical treatment for Rathke cleft cysts--Intrasellar and suprasellar cysts are often lesions observed in the neuroradiological examinations. The majority of them (craniopharyngioma, cystic pituitary adenoma) are histologically neoplasmic. The others originate from the remnants of the embryonic diverticulum which arise from the roof of the stomodeum. ⋯ Histological examination confirmed Rathke cleft cyst. There were no serious complications in our group. Follow-up examination comprises periodic endocrinological and radiological investigations.
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The aim of this study was to determine relations between the clinical state and the severity of liver damage comparing to the amount of ingested paracetamol, time since ingestion and serum concentration of paracetamol with patients after acute intoxication with this drug. A retrospective analysis of medical records of 95 patients hospitalized in the Toxicology Department in Kraków or treated in the Toxicological Admission Room in 2002-2004 years because of acute paracetamol intoxication was performed. The general clinical state connected with intoxication and the severity of liver damage were determined using the Poisoning Severity Score (PSS). ⋯ A positive correlation between time since ingestion of paracetamol to hospitalization and the gravity of poisoning according to PSS scale was also statistically significant. A paracetamol concentration measured during admission to the hospital had no influence on neither the clinical state of patient nor the severity of liver damage. We conclude that the therapeutical approach should consider possibly shortening of the time since drug ingestion to hospitalization and institution of specific treatment (N-acetylcysteine) as well as minimalization of the paracetamol dose, which could be absorbed, by different methods of elimination from the GI tract (eg., gastric lavage, activated charcoal laxatives).