Lijec̆nic̆ki vjesnik
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Lijec̆nic̆ki vjesnik · Nov 2013
Historical Article[40 years of neurological intensive care in Croatia].
On the 40 year anniversary of the foundation of the first Neurological intensive therapy unit (ICU) in Zagreb, Croatia and in the region, the author recalls circumstances which stipulated its realization. The process lasted several years, from the proposal in 1968, starting working in provisional conditions in 1971--acquiring experience, and normal functioning in the newly adapted rooms in 1974. ⋯ The basic principles of therapy are nowadays the standard in the neurological departments, enabling better recovery from stroke, neurological ailment with high mortality. Positive development brought to the realization of the concept of comprehensive care for cerebrovascular patients, including prevention, early intensive therapy and neurological restoration measures after stroke.
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Severe asthma affects 5-10% of the asthma population. Exact pathophysiology of severe asthma mechanisams is complex and not fully understood. Cellular inflammation of the airways with neutrophils is a characteristic feature and is considered relevant to the pathogenesis of the disease, but all components of the airway wall have been reported to be thickened in severe asthma with or without cellular inflammation. ⋯ Treatment of severe asthma should be started with high doses of inhaled steroids, 2000 microg of beclomethasone or its equivalents in addition to long acting beta 2 agonists, leukotriene receptor antagonists, theophylline and long acting anticholinergic drugs. Due to significant short-term and longterm oral glucocorticoids side effects it is essential to emphasize the importance of alternative therapies in severe asthma: treatment with omalizumab, macrolide antibiotics, tumor necrosis factor alpha inhibitors, cytokine receptors inhibitors and bronchial thermoplasty. Although there is a significant improvement in the treatment of severe asthma, the challenge remains to determine therapeutic strategy for appropriate phenotype in view of the heterogeneity of severe asthma.
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Lijec̆nic̆ki vjesnik · Jan 2013
Review[Piriformis muscle syndrome: etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy].
The term 'piriformis syndrome' (PS), introduced by Robinson in 1947, implies a group of signs and symptoms caused by piriformis muscle (PM) disorders. Since PM disorders lead to irritation/compression of the anatomic structures passing under its belly, the main clinical PS signs and symptoms are actually the clinical signs and symptoms of irritation/ compression of neural and vascular structures passing through the infrapiriform foramen: sciatic nerve/SN, inferior gluteal nerve, posterior femoral cutaneous nerve, pudendal nerve, inferior gluteal artery and vein and inferior pudendal artery and vein. The clinical picture is usually dominated by signs and symptoms of irritation/compression of SN (SN irritation --> low back and buttock pain, sciatica,paresthesias in distribution of SN; SN compression --> low back and buttock pain,sciatica, paresthesias and neurologic deficit in distribution of SN). ⋯ In 5-6% of patients with low back pain and/or unilateral sciatica, the pain is caused by PM disorders. PS diagnosis can be made on the basis of anamnesis, clinical picture, clinical examination, EMNG, perisciatic anesthetic block of PM and radiological exams (pelvis/PM MRI; MR neurography of LS plexus and SN). PS therapy includes medicamentous therapy, physical therapy, kynesitherapy, acupuncture, therapeutic perisciatic blocks, botulinum toxin injections and surgical treatment (tenotomy of PM, neurolysis of SN).
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Lijec̆nic̆ki vjesnik · Jan 2013
Comparative StudyTreating acute kidney injury using continuous and intermittent renal replacement therapy.
Acute kidney injury (AKI) is the sudden kidney excretory function loss. Patient data of patients hospitalized on intensive care unit from 2009 to 2011 and had to undergo one sort of renal replacement therapy (RRT)--continuous or intermittent--was used. 63 patients were in this study, 46 on continuous RRT (CRRT) and 17 on intermittent RRT (IRRT). ⋯ Results have shown that mortality rate was higher at patients on CRRT. However, these patients were haemodynamically unstable compared to patients on IRRT.
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Lijec̆nic̆ki vjesnik · Nov 2012
[How to improve perioperative blood management in patients undergoing total hip or knee replacement surgery?].
Total hip and knee arthroplasty is associated with significant perioperative blood loss, necessitating often blood transfusions. Because of risks and cost of allogenic blood transfusion and elective types of surgery several alternative methods have been developed to reduce allogenic blood use. We prospectively audited 65 consecutive patients undergoing primary total hip (THR; n = 30) or knee replacement (TKR; n = 35) at our Department of Orthopaedic Surgery which did not use autologous blood collection methods. ⋯ However, we reported high transfusion rates with 63.3% of THR and 82.6% of TKR patients receiving allogenic blood. Important steps to reduce allogenic blood use would include implementation of restrictive transfusion protocols with a defined hemoglobin value as a transfusion trigger, correction of preoperative anemia with i.v. iron +/- erythropoietin, use of one or more modalities of autologous transfusion (postoperative autotransfusion, preoperative blood donation), pharmacological agents like tranexamic acid (anti-fibrinolytic) and other complementary procedures. There is sufficient evidence in literature about the cost-benefit of certain methods which makes routine use of allogenic blood in THR and TKR surgery unacceptable even at general orthopaedic surgery departments.