Przegla̧d lekarski
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Systemic lupus erythematosus is a disease in which inflammatory process provoked by different antibodies affects many organs and systems. The circulatory system is one of them. In patients with systemic lupus erythematosus cardiac disorders are generally known and well proved. ⋯ In studied group of children echocardiographic global indices of left ventricular systolic function were normal. The subclinical impairment of diastolic left ventricle function was found in 8 children with increased left atrium-aorta index. Both the theoretical knowledge and the results of the studies suggest that the offsprings of mothers suffering from SLE need a careful cardiological observation.
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Isolated injury of gall bladder as a result of blunt abdominal trauma is very rare. We report a case of 39 year old man, who was admitted to our Clinic during emergency. He presented upper right quadrant abdominal pain, increasing on palpation and guarding. ⋯ Disruption of the neck of the gall bladder was found during laparotomy. Cholecystectomy was performed. Patient was discharged from hospital five days after the operation.
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Life saving surgery is the surgery which has to be performed during the acute or reanimation period (1 to 3 h) and during the primary or stabilisation period (first day surgery). During the reanimation period lifethreatening conditions are identified and management is begun simultaneously. Many trauma surgeons talk about the first "golden hours" as the time interval starting immediately after the injury when rapid intervention will save lives and a lack of intervention will result in life loss. ⋯ This period consists of further diagnostic procedures and treatment of injuries that are not directly life-threatening, but which may become life endangering or severely disabling if not treated promptly. The priorities of the surgical treatment are: brain injuries, eye- and facial injuries, progressive compression of the spinal cord, visceral injuries, musculoskeletal injuries. By improving prehospital care, rapid transport and last but not least immediate life saving surgical treatment preventable deaths can be reduced from 20-30% to 2-9% (5).
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We present a review of our recent experience of operating on infants below 2500 g suffering from congenital heart disease. A retrospective review was performed in 73 children who had undergone cardiac operations at our institution from 1990 to 1999. There were 43 (59%) females and 30 (41%) males; the mean age at operation was 28 days (range 4 to 92). ⋯ A higher mortality rate was noted in premature children and in children who had undergone palliative procedures. At a 1-116-month follow-up (mean 39 months), of 57 (93.4%) patients, 46 (80.7%) were in NYHA class I and 11 (19.3%) in NYHA class II. In conclusion the authors believe that early intervention can be performed in infants below 2500 g, and the associated mortality and morbidity rates are low.
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In recent years there has been much progress in the understanding of the pathophysiology of acute pain and analgesic pharmacology. The most important role in postoperative pain management is still played by opioids administered through various modes, including spinal and local ones. ⋯ Paracetamol, owing to its safe therapeutical profile, should be the primary postoperative pain management tool in a majority of surgical procedures. A combination of opioids, NSAIDs and paracetamol in order to relieve pain allows both for a significant reduction in the dosage of respective drugs, fewer side effects and an improved pain relief.