Przegla̧d lekarski
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Comparative Study
[Acute appendicitis--open or laparoscopic surgery?].
Laparoscopy is used more and more frequently in the treatment of abdominal emergencies including acute appendicitis. This technique has a lot of advantages especially in the group of the young female patients, where the differential diagnosis between gynecological diseases and appendicitis is difficult. ⋯ Laparoscopy allows for the precise diagnosis and final treatment in most patients with the suspected acute appendicitis. Some patients also avoid laparotomy. Hospital stay is significantly shorter and complication rate is markedly lower among patients operated laparoscopically.
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Cardiotoxicity is a rare but very serious side effect of 5-fluorouracil (5-FU) treatment. Many theories have been suggested to explain the mechanism of this problem. Most commonly, coronary artery spasm is considered responsible in cardiovascular toxicity. ⋯ In the late phase of 5-FU administration, the patient developed anginal pain with transitional ST segment elevation in ECG. Patient, after coronary angiography, was successfully treated with percutaneous coronary intervention. Interventional methods, most of all stent implantation, seem to be the best treatment of 5-FU-related acute coronary syndromes.
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Comparative Study
[Endovascular coiling and microsurgery of the cerebral arteriovenous malformations. Assessment of criteria of treatment and outcome].
Three available methods of therapy of arteriovenous malformations (AVM) i.e. microsurgical resection, intravascular embolization and stereotactic radiosurgery, make possible definitive treatment in the majority of patients. During qualification to these procedures the risk of complications and efficacy of each method should be considered. ⋯ 1. Spetzler-Martin scale is very useful in evaluation of operative risk of AVM operations but, in our opinion, before operation there should be considered also such factors like number and diameter of feeding arteries, exact localization of AVM and initial condition of the patient. 2. Although intravascular embolization is less invasive than neurosurgical operation, the risk of hemorrhagic and ischemic complications is present. 3. Complete AVM embolization is possible in the minority of patients. The remaining group require follow up and control radiological examinations to establish indications for further treatment.
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In the period from 1990 to 2002, 201 patients with suicidal antihypertensive drugs poisoning were treated, including 138 women and 63 men from 15 to 84 (mean 36) years old. The main causes of suicides were various kinds of depression (63%) as well as psychopathy and/or sociopathy (16%) and schizophrenia (10%). Twenty eight patients attempted repeatedly to commit suicide. ⋯ In the examined group three patients died of cardiogenic shock, electromechanical dissociation and secondary acute respiratory failure resistant to therapy. The drugs used in these cases were propranolol, amlodipine, theophylline, captopril, doxepine, propafenone, furosemide, methimazole and alcohol. Mortality rate in antihypertensive drug poisonings was 1.5%.
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Prosthetic valve endocarditis (PVE) occurred from 1 to 9% of patient after heart valve replacement. The aim of the present study was to assess the long term outcome of the treatment of PVE and to analyze the recurrence of infective endocarditis (IE). ⋯ 1. Mean survival after 4 years was 69%, 2. Total mortality was 31%, 22% hospital, 9% in late observation (decreased from 8% in first 2 years to 1% mean 4 years after cure, 3. Recurrence of IE was observed in 17% of episodes, most cases (88%) were caused by the same bacteria as in the primary infection.