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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In this paper an analysis of poisonings with cardiovascular drugs treated in the II Ward of Internal Diseases and Acute Poisonings in Tarnów, in the years from 1996 to 2001, is presented. In 6 years 66 patients were treated (4.5% of all treated toxicological cases). ⋯ No fatalities were observed. Suicidal poisoning with propafenone in 22-year-old man is presented.
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Clinical Trial Controlled Clinical Trial
[The effect of antiinflammatory therapy with dexamethasone and dexamethasone with pentoxifylline on the course of bacterial meningitis].
Despite of antimicrobial therapy mortality rate in the bacterial meningitis (BM) is high. The aim of the study was to assess the influence of anti-inflammatory treatment with dexamethasone and dexamethasone with pentoxifylline on the course of this disease and concentration of proinflammatory cytokines TNF-alpha, IL-1 beta, II-8 in the cerebrospinal fluid (CSF). 42 patients with the BM were analysed. They were divided into three groups on the basis of applied therapy: A--treated only with antibiotics, A+D--treated with antibiotics and dexamethasone, A+D+P--treated with antibiotics, dexamethasone and pentoxifylline. ⋯ Also in the group A+D decrease of cytokines concentration in the CSF was observed, however was not such significant in all cases. In the group of patients treated only with antibiotics concentration of cytokines in the CSF varied, even increased in some of them. Our investigation indicates that inhibition of cytokines production in central nervous system (CNS) with dexamethasone and pentoxifylline improves the outcome of BM and is associated with the reduction of neurological sequels and deaths.
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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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The targeting and recruitment of inflammatory cells to vascular endothelium in ischaemic heart diseases is mediated by Intercellular Adhesion Molecule-1 (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1) and E-selectin and proinflammatory cytokines. Accumulation of mononuclear cells to the endothelium is one of the earliest events in the formation of an atherosclerotic lesion. The aim of this study was to estimate the serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular adhesion molecule-1 (sVCAM-1), selectin E (sE-selectin) in patients with acute myocardial infarction (Group 1--n = 18 patients: 3 women and 15 men, mean age--60 years), unstable angina pectoris (Grupa 2--n = 31 patients: 8 women and 23 men, mean age--62 years and stable heart disease (Grupa 3--n = 25 patients: 14 women and 11 men, mean age--61 years. ⋯ Furthermore, serum concentrations of adhesion molecules correlated with serum concentrations of acute inflammation parameters and traditional coronary risk factor for example BMI, systolic and diastolic blood pressure and lipid concentration. Additional serum concentration of sICAM-1 was elevated in smoking patients compared to non-smokers. We conclude that evaluation of adhesion molecules (sICAM-1 and sVCAM-1 in patients with heart diseases can be unspecific markers of activity of inflammatory process in coronary vascular endothelium.