Przegla̧d lekarski
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Case Reports
[Severe nonfatal poisoning after intravenous abuse of transdermal fentanyl--a case report].
Fentanyl is a potent synthetic opioid with short-acting analgesic activity after intravenous or subcutaneous administration. The potency and lipid solubility of fentanyl make it suitable for delivery via the transdermal therapeutic system in the treatment of chronic pain. ⋯ The present case demonstrates the possibility of intravenous abuse of transdermal patches and the risk of severe intoxication. In the cases of suspected fentanyl overdose specific assays should be utilized for the detection of fentanyl because it may not be detected by the routine opiate screening procedure.
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Electrophysiological examinations still play an important role in initial diagnostics of neuromuscular disorders and monitoring of the disease progress or recovery process. ⋯ Electromyographic examination remains important diagnostic tool of neuromuscular disorders. In order to limit extension of differential diagnostics EMG should be performed in its early stage.
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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.