Przegla̧d lekarski
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Case Reports
[A rare case of the extensive Fournier's gangrene developed in the course of a perianal abscess].
Fournier's gangrene is a rare necrotising fascitis of the perineum and genitals caused by mixture of aerobic and anaerobic microorganism. Despite appropriate therapy mortality in this disease is still high. ⋯ Treatment involves extensive soft tissue debridement and broad-spectrum antibiotic therapy. The clinical applicability of the so called Fournier's gangrene severity index score (FGSIS) was discussed.
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Congenital spine and thorax deformities are an interdisciplinary clinical problem. Apart from trunk deformity they may lead to respiratory or cardiovascular insufficiency. Surgical treatment should be implimented as soon as possible in order to improve posture, balance and further development. This treatment should not impair further growth of the young spine. This is possible with the VEPTR device. ⋯ VEPTR device is indicated in treatment of severe congenital deformities of the spine and thoracic cage. It improves patients' posture, changes the shape of thorax wall and consecutively improves respiratory function and further development.
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The kidneys are the critical organs in the case of a long-term occupational or environmental exposure to heavy metals and tobacco smoke. In diagnostics of renal damage useful are the methods which determine the activity of renal enzymes, quantify in urine (e.g. beta-glucuronidase, N-acetyl-beta-D-glucosaminidase). N-acetyl-beta-D-glucosaminidase (NAG) is one of the most often determined factors of tubular damage, since its activity increases in early stages of renal injury, ahead of appearance of excretory dysfunction. ⋯ About 3-times increase of total NAG's activity was observed in urine of smoking founders and 4-times increase of non-smoking founders in comparison with smoking and non-smoking control group. The highest activity of NAG-B was observed in urine of smoking founders (11.35 +/- 7.85 U/g creatinine), then non-smoking founders (9.7 +/- 8.75 U/ g creatinine). It was confirmed, that the activity of N-acetyl-beta-D-glucosaminidase is a good factor in the assessment of occupational exposure to heavy metals like arsenic, cadmium and lead.
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Smoking cessation in the perioperative period allows a substantial reduction of a number of anesthetic and surgical complications. They primarily include pathology and adverse reactions of respiratory, cardiovascular and nervous systems and also alterations in wound and bone healing. There is no doubt that long-term (several months) tobacco abstinence reduces the complication risk; however, the significance of short-term smoking cessation is being discussed. ⋯ Interventions for preoperative smoking cessation effectively change smoking behavior and should be widely offered to surgical patients. Oral recommendations should possibly be supported by pharmacotherapy. Nicotine replacement therapy and bupropion proved to be effective and safe in the perioperative period.
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For several years now, with the introduction of the health care sector reform we have been observing a considerable drop in the number of postmortem examinations performed in patients who died in hospitals. The decrease amounts to as much as 50 to 70%. This is undoubtedly a consequence of financial restrictions imposed on the management of these inpatient facilities. ⋯ The result of a postmortem examination is practically the only basis for a factual evaluation of a given case. When no autopsy has been performed, the experts are virtually helpless, and in the majority of such instances, they are forced to refuse passing an expert opinion. The report presents basic principles of medico-legal opinionating in criminal cases (including proceedings pertaining to medical errors), the rules governing the medical error assessment, as well as problems encountered in evaluating the appropriate course of treatment when a post mortem examination has been waived.