Przegla̧d lekarski
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The case of a 67-year-old patient, treated for melanoma, who was given a toxic dose of doxorubicin (600 mg/m2), was described. The haemoperfusion was performed a short time after intoxication. No toxic effects were seen during the observation for three weeks. The catheter was removed from the sitting patient by an oncologist. The patient abruptly lost consciousness, there were also cyanosis, loss of muscle tone and apnea. The reanimation was unsuccessful. The air embolism was probably the cause of death. The diagnosis was confirmed by the sudden attack, wide duct after the removal of catheter, sitting position of the patient and the presence of foramen ovale found during autopsy. ⋯ Cannulation as well as decannulation of the central vessels should be performed by experienced doctors. Decannulation should always be done in the Trendelenburg position.
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Bacterial meningitis is still associated with high mortality rate and severe neurological sequels. The aim of the study was to assess correlation between concentration of proinflammatory cytokines (TNF-alpha, IL-1 beta, IL-8) in the cerebrospinal fluid (CSF) and patient condition described on the basis of Glasgow Coma Scale (GCS), changes in the CSF (pleocytosis, protein and glucose level), mortality rate and occurrence of neurological complications. 42 patients with bacterial meningitis have been analysed. Control group consisted of 25 patients with viral meningitis and 23 patients without meningitis. ⋯ Our investigation confirm that TNF alpha, IL-1 beta, IL-8 are useful in differential diagnosis of neuroinfections. Assessment of patients with bacterial meningitis on the basis of GCS is helpful to establish prognosis, and CGS seems to correlate with the intensity of inflammation in the CSF. High concentration of TNF-alpha, and IL-1 beta in the CSF are associated with the risk of patient death during the course of bacterial meningitis, but IL-1 beta has been the better prognostic marker.
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The aim of the study was to analyze seasonality and temporal fluctuations in suicide attempts by persons living in Krakow and hospitalized in the Department of Clinical Toxicology CMUJ in the years 2000-2002. The research focussed on the frequency of suicide attempts in relation to the time of the day, day of the week, and month of the year. Temporal fluctuations in the frequency of suicide attempts have been assessed on the basis of the data from medical documentation concerning 2757 suicide attempts by individuals ranging in age from 14 to 90 years. ⋯ This finding seems to be of particular importance for suicide prevention--it can contribute to the increase in the effectiveness of the organization of work in the Crisis Intervention Centres and make therapists and patients' families aware of the existence of periods of an increased suicide risk. The research has been conducted owing to the cooperation between the department of Clinical Toxicology, CMUJ and the Department of Adult Clinical Psychiatry, CMUJ in Kraków. The results obtained, together with the results of the research conducted by the centres participating in WHO/EURO are vital for suicide prevention and treatment.
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The precise estimation of the hydration status of the human body has a great meaning in the assessment of dry weight in end-stage renal disease patients treated by hemodialysis. The bioimpedance technique (BIS) is postulated as easy in use and as a non-invasive method in monitoring the size of hydrate space such as total body water (TBW) and extracellular volume (ECV). However, the precision of the method (Whole Body Bioimpedance Technique) has been questioned in several research papers. ⋯ At the time after hemodialysis the sum of segmental ECV volume measurement was of 11.42 +/- 1.28 L in comparison to 14.84 +/- 1.31 (p < 0.001) from WBIS the whole body technique (WBIS) and changes in electrical resistance Re was of 674 +/- 67 W as calculated from the sum of segments versus 677 +/- 64 (p < 0.05) W respectively. The observed difference between the identical electrical resistance Re as measured by WBIS in comparison to the sum of segment measurements and important difference between ECV volume as measured by WBIS versus sum of segment ECV measurements can be partly explain by non-cylindric nature of human body composition. However, the segmental bio-impedance technique is a method which gives us more accurate data about the extracellular volume taken from each segment in the hemodialysis patient but the accuracy of trunk water assessment is still a problem.
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Left ventricular diastolic dysfunction plays an important role in the pathogenesis of symptoms in patients with hypertrophic cardiomyopathy (HCM). Theoretically abnormal LV filling should lead to left atrium (LA) enlargement and abnormal emptying. Our study was performed in 27 pts with hypertrophic cardiomyopathy (mean ventricular septum thickness 2.4 +/- 0.73 cm, mean posterior wall thickness 1.23 +/- 0.42 cm and mean LV wall thickness measured at 10 segments 1.93 +/- 0.37 cm) and 38 healthy volunteers. Transmitral Doppler flow parameters (Emax, Amax, t decE, Emax/Amax) did not differ in both groups. We used 2D echocardiographic automatic borderline detection method to assess the following LA volumes during its emptying: maximal volume (LAVmax), volumes at the end of rapid emptying (LAV-RE), before atrial contraction--P wave on ECG (LAV-P) and minimal LA volume after atrial contraction (LAVmin). We also calculated total LA emptying fraction (%LAEF), absolute volume changes during LA early emptying (delta LAV-RE) and atrial contraction (delta LAV-AC) and their ratio (delta LAV-RE/delta LAV-AC). 11 pts had mitral regurgitation. The mitral regurgitation fraction was calculated as the ratio of the area of mitral regurgitation to LA area. ⋯ LV hypertrophy in hypertrophic cardiomyopathy leads to LA enlargement and changes in its emptying. We found larger the following LA volumes: maximal volume, volume after early emptying, before atrial contraction and minimal volume and greater LA volume change during active emptying. Total LA emptying fraction, volume change during early/passive emptying and passive/active emptying volumes ratio were similar in both groups. No correlation existed between the degree of LV hypertrophy and LA volume and emptying parameters. We observed negative relation between mitral regurgitation fraction and LA total emptying fraction, but because of small group of pts with mitral regurgitation, further studies are needed.