Przegla̧d lekarski
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Controlled Clinical Trial
[Influence of visual stimulation on cerebral blood flow and visual evoked potentials in children with migraine with visual aura].
Visual aura is the most common type of migrainous aura. It may occur as a single symptom or precede sensory or speech disturbances. Aura symptoms and order of their appearance may result from propagation of spreading depression phenomenon. Vascular disorders observed during migraine with aura attacks are probably secondary to neuronal changes. Simultaneous registration of cerebral bioelectric activation and changes evoked in cerebral circulation enables their objective estimation, detection of correlation and better understanding of migraine with aura pathogenesis. Studies with transcranial Doppler revealed impaired cerebrovascular response to various stimulations in migraine, especially migraine with aura patients. Combination of Doppler examination with registration of visual evoked potentials (VEP) enables estimation on neurovascular coupling. ⋯ Visual stimulation has significant influence on cerebral blood flow velocities in both migraine with aura patients and controls and these changes are most often observed direct after the beginning of the stimulation. However, no differences in vascular response to visual stimulation between the groups were observed. On the other hand positive correlation between visually evoked changes in cerebral blood flow velocities and VEP amplitudes was found in migraine with aura patients suggesting increased neurovascular coupling in this group when compared with controls.
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Gelastic epilepsy is usually symptomatic and most often associated with hypothalamic hamartoma. Usually, in the course of this epilepsy different seizure types develop, partial and generalized as well. Moreover, progressive behavioral disorders are observed. Pharmacological treatment is usually ineffective and surgical resection of the lesion is the only chance of clinical improvement. ⋯ Diagnosis of gelastic epilepsy is often delayed due to untypical character of the seizures, treated as non-epileptic behavioral disorders. Drug resistance in this type of epilepsy cause search of better and better surgical techniques and establishment of criteria enabling to choose optimal method for every patient.
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Acute methanol poisoning may cause heart dysfunction accompanied by various electrocardiographic abnormalities. In such cases heart damage is usually secondary to metabolic acidosis and reversible. In this paper the case of fatal methanol poisoning complicated with acute coronary syndrome in a 52-year-old alcohol abuser is presented. The main cause of the myocardial ischaemia was the subtotal stenosis of the anterior interventricular branch of the left coronary artery, whereas metabolic disorders in the course of methanol poisoning probably intensified the ischaemia in the area supplied by that artery.
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Case Reports
[Acute poisoning due to chemical substances inducing methemoglobinemia--two cases report].
Methemoglobin is an oxidized derivative of hemoglobin. It is generated by oxidization the ferrous form of iron (Fe2+) in the heme molecule to the ferric form (Fe3+). A molecule of methemoglobin is incapable of binding and carrying of oxygen. ⋯ The other case concerns a 49-year-old man who developed methemoglobinemia of 42.7% after suicidal ingestion of an urea-substituted herbicide containing linuron. We observed hemolysis in both of these cases. They were treated symptomatically and with a specific antidote--methylene blue.
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Comparative Study
[An economic consideration of the lower respiratory tract infection treatment in children with severe neurodegradative diseases under the hospice care].
Congenital and acquired neurodegradative diseases are always the reason for prolonged stay in hospital, at the beginning of the establishment of diagnosis and treatment and afterwards for stabilizing all functional adaptation to an existence with the severe disability. Also infections of the lower respiratory tract accompanying the later course of the disease are usually directed to hospital treatment. The aim of the study was to delineate the role of hospice care of patients staying at home, in economical approach to the medical care of severly and incurably ill children. ⋯ The median estimated cost of treatment of the lower airways infection in hospital for one child equaled 4942 zl. The expenses of home treatment of the lower airways infections under the hospice care were twice lower than the costs of the therapy in hospital. Apart from the obvious psychological and social benefits, also economic aspect contributes to the promotion of the hospice care of staying-at-home patient in the improvement of medical care for children with severe neurodegradative diseases.