Przegla̧d lekarski
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Approximately one third of adults report difficulty sleeping, and 10% to 15% have the clinical disorder of insomnia. Among primary care patients, approximately half have sleep difficulties, but these difficulties often are undetected. Sleep disorders, especially chronic insomnia, results in impaired occupational performance and diminished quality of life. ⋯ Insomnia is also a risk factor for a number of other medical and psychiatric disorders, such as depression, hypertension. This presentation describes different sleep disorders (insomnia, hypersomnia, obstructive sleep apnea, sleep related movement disorders, circadian rhythms sleep disorders, parasomnias), diagnostic methods available in sleep medicine. The various treatment options for these sleep disorders are also identified.
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Case Reports
[Methaemoglobinaemia and respiratory tract irritation connected with poppers inhalation].
"Poppers" is the street name for volatile nitrites offered by online shops and sex-shops for their aphrodisiac and euphoric properties. Although nitrites have been abused since the late 1960s, recently they became popular in Poland. Recreational poppers using was associated with homosexual men at first. ⋯ This article presents the case of 44-years old male hospitalized three times in Toxicology Department after history of poppers abusing. Methaemoglobinaemia (26.4%) and tracheobronchial irritation were the main symptoms observed. Patient was given specific therapy with methylene blue.
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Until recently chemotherapy was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (uveal extension, orbital extension, neoplastic infiltrates of the optic nerve at resection line, intracranial metastasis, generalized disease). Recent experience has proved that use of chemotherapy for intraocular retinoblastoma before local treatment (so called "chemoreduction") has allowed not only to decrease number of enucleations and indications for external beam irradiation or limit the extension of local therapy, but also increase chances for vision preservation and decrease the risk of severe complications. Seventy five children (with 106 involved eyes) aged 0.2 - 106 months with intraocular retinoblastoma diagnosed between January 1996 and June 2009 were the subject of this study. ⋯ Out of 84 eyes treated by combined methods eye enucleation could be avoided in 47 (67%), including 18 (90%), 13 (87%) and 16 (46%) qualified to R-E group I-II, III-IV and V, respectively. First-line chemotherapy combined with the local treatment should be standard treatment for intraocular retinoblastoma groups I - IV. More effective therapy is required for R-E eye group V cases.
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Neurosurgery in functionally relevant brain structures carries a high risk for surgery induced post-operative neurological deficits. Functional magnetic resonance imaging (fMRI) is one of the most commonly used functional neuroimaging techniques for pre-surgical brain mapping. Preoperative fMRI is optimal method to localize specific functions of the human brain that govern motor, sensory or language functions. fMRI facilitates the selection of the safest treatment and is very helpful to plane and to perform function preserving surgery in patients with brain tumors. This kind of examination is feasible for clinical routine neuroimaging and provides important diagnostic information noninvasively that is otherwise unavailable. fMRI examinations require also advanced software for data analysis.
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Smoking tobacco still remains one of the basic health and social-economic issues, both in Poland and around the world. Popularity of smoking, dissemination of this habit, and continually high levels of its social acceptance make physicians feel helpless, and often relieved from the obligation of counteracting the phenomenon. ⋯ Additionally, a pattern of psychological assistance or intervention actions has been developed which has proved to be extremely successful within a truly short time span, called minimum (anti-nicotine) intervention. The goal of this article is to popularise those methods and invite physicians to become familiar with the new ideas, in view of their future application to working with the patient.