Przegla̧d lekarski
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Urological complications constitute significant problem following renal transplantation. Incidence ranges from 4 to 14% in graft recipients. The most important aspects concerning these complications are early diagnosis and prompt treatment, any delay in diagnosis and management may lead to deterioration of renal graft function or graft loss. ⋯ Subsequently percutaneous nephrostomy was performed which lead to immediate diuresis. Next, distal ureter stenosis (located by the urinary bladder) was surgically removed and reimplantation of the ureter was carried out. Due to early diagnosis and surgical reconstruction of the transplanted ureter, renal graft function returned to normal requiring only one hemo-dialysis session.
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Case Reports
[Severe carbon monoxide poisoning: different clinical course--the same source of exposure].
The different course of acute carbon monoxide poisoning in two young people exposed to the same Carbon monoxide source are reported in the study. The pulmonary edema was diagnosed in the man, but not in the woman. ⋯ MRI detected the brain changes invisible in CT scans and seems be more useful for evaluation CNS abnormalities. The neuropsychological examination, of the brain functional changes is also necessary for proper evaluation of the CNS damage.
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The pulmonary endothelium synthesizes many bioactive compounds and their activation or injury may cause release these substances into the blood. We determined the influence of trauma severity for endothelium activation/injury by measurement of specific endothelial cell markers--soluble E-selectin (sES) and von Willebrand factor antigen (vWF:Ag). Thirty six severely traumatized patients were stratified according to an Injury Severity Score (ISS). ⋯ Significant correlation between plasma vWF:Ag and serum sES concentration was also observed (Rs = 0.501, p < 0.001). In conclusion, severe trauma patients manifest endothelial cell activation/injury. Plasma vWF:Ag concentration seems to be an important, early marker of trauma severity, while serum sE-selectin level may serve as prognostic factor in immediate postinjury period course.
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Shortening the time between the onset of pain and start of the efficacious treatment is an important mean to lower case-fatality in myocardial infarction (MI). The goal of this publication was to assess: 1) current time between the onset of pain and: a) calling medical service by the patient b) first examination by a doctor, and c) first administration of intravenous treatment, 2) reasons of the delay in calling medical service by the patient, 3) whether patients with a diagnosis of ischaemic heart disease (IHD) prior to hospitalization were instructed how to behave in case of chest pain, and 4) whether instructing how to behave in case of chest pain was related with a time between the onset of pain and calling medical service by the patient. Studied group were 515 patients hospitalised in 6 in-patient clinics of cardiology with MI or unstable angina (UA) or hospitalised for first PTCA or CABG, 427 (83%) agreed to participate, out of whom 184 had MI or UA including 110 patients having typical chest pain. ⋯ Patients who earlier received instruction had four times higher chance to call medical service within the first hour after the onset of pain (Odds Ratio = 4.11, 95% confidence interval 1.13-15.0). Only half of all patients hospitalised due to acute episode of IHD or for revascularization procedures received intensive instructions from a doctor. Adopting a detailed instruction on how to behave in case of chest pain as a standard procedure for patients with IHD may be an important mean to lower case-fatality in MI.
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Trauma remains one of the three main causes of death all over the world. In Poland severe trauma is also an important public health problem which should be fully recognised in the changing system of our health service. ⋯ Certain recommendations of treatment of patients following severe trauma have been discussed concerning anti-shock therapy, diagnostic and operative management in polytraumatized patients with major head trauma, thoracic and abdominal trauma and also operative stabilization of fractures of bones. It has been concluded that in our country, especially in bigger cities, patients following major trauma should be treated in specially designed units (centers) integrated with emergency medicine departments providing competent intensive therapy and surgical interventions of well trained trauma teams introducing optimal modern trauma algorithms.