Przegla̧d lekarski
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Traumatic injuries have been described as the largest epidemic of the 20th century. In view of the number of victims and the associated costs, they have been also called the most severe and longest war of the contemporary world. According to Lipiński, every year every tenth Pole is involved in an accident and every one hundred-thirteenth Polish citizen requires specialist medical care. ⋯ The third life threatening cause is acute respiratory insufficiency after thoracic trauma. The "golden hour" procedures are particularly described as a prehospital time period (ABC ... system), emergency room period (ATLS system), damage control period and other life saving operations period. The general conception of these standards is minimalization of the effects of shock, respiratory insufficiency and intracranial hypertension in multitrauma patients.
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The authors present their experience in surgical treatment of children with supravalvular aortic stenosis (SAS). A retrospective analysis was carried out on 20 patients operated in the years 1980-1999. The group included 12 boys and 8 girls aged 0.9 to 14.5 years (mean 7.8 +/- 3.4 years). ⋯ In the follow up the mean systolic pressure gradient between the left ventricle and ascending aorta revealed by echocardiography in 19 (95%) children to be 8 +/- 2 mmHg (range from 0 to 28 mmHg). Eighteen children are now in NYHA class I (New York Heart Association) and develop normally. Supravalvular aortic stenosis is a rare complex anomaly, which, because of life-threatening complications and low operative risk, should be fully repaired as soon as possible.
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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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Comparative Study
[Postprandial hypotension and gastric emptying in longstanding diabetes mellitus].
Postprandial hypotension is commonly defined as a decrease in systolic blood pressure of 20 mmHg and more within 2 hours after meal ingestion. It was described in autonomic nervous system failure of different origin, among others in diabetes mellitus. Pathomechanism of postprandial hypotension is not entirely understood. The rol of gastric emptying disorders is considered as an important factor. The aim of the study was to evaluate the concordance between gastric emptying and postprandial blood pressure changes in diabetic patients. The study involved 67 subjects (26 males, 41 females, mean age: 47.5 +/- 16.2 years) diagnosed either with diabetes mellitus type 1 or 2 (disease duration: 13.3 +/- 8.8 years) and treated with diet and insulin injections. Postprandial hypotension was recognised based on results of automatic blood pressure recordings within 90 minutes after test meal ingestion, according to the criterion mentioned above. Gastric emptying was assessed scintigraphically. The parameters evaluated were: gastric half emptying time (T1/2 max) and residual activity registered over stomach area at 45 minute of the study. Both blood pressure monitoring and gastric emptying were assessed concurrently. In investigated patients mean fall in systolic blood pressure of 17.7 +/- 11.7 mm Hg was recorded at 48.0 +/- 13.7 min of the study. Based on systolic blood pressure monitoring results patients were divided into two groups: group A of 39 patients (58.2%) without postprandial hypotension, and group B of 28 patients (41.8%) with pathological reaction of systolic blood pressure to meal. The average decrease in systolic blood pressure was 8.9 +/- 4.4 mm Hg in group A and 30.0 +/- 6.2 mmHg in group B, the difference was statistically significant (p < 0.001). Gastric emptying parameters in both groups did not differ significantly (T1/2 max: group A 68.4 +/- 31.1; group B 70.8 +/- 39.1 min, p = 0.96; residual activity over stomach area at 45 min of the study: 64.5 +/- 18.6% and 62.6 +/- 24.3% accordingly, p = 0.80). No statistically significant correlation between gastric emptying half time (T1/2 max) and magnitude of postprandial systolic blood pressure fall was noted (Spearman's correlation co-efficient R: -0.041, p = 0.74). Statistically significant correlation was found between T1/2 max value and time in which systolic blood pressure reached its nadir (Spearman's correlation co-efficient: 0.527, p < 0.0001). ⋯ Gastric emptying was not recognised as an important factor influencing the magnitude of postprandial hypotension in diabetic patients, however it may significantly change the dynamics of postprandial blood pressure decrease.