Folia medica
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Salmonellosis in humans is most often manifested as a self-limiting gastroenteritis. Antimicrobial therapy is superfluous in the milder forms of the disease and in Salmonella carriage but can be life saving for patients with septic salmonellosis and patients at risk of extraintestinal dissemination of the infection. The therapeutic approach is based on the clinical course of the disease and the patient's immune reactivity. ⋯ Alternative treatment may use azithromycin and imipenem in life-threatening systemic Salmonella infections. Aminoglycosides are considered ineffective in gastrointestinal salmonelloses. The emerging resistance to fluoroquinolones, production of extended-spectrum beta-lactamases, and the increase of multidrug resistant Salmonella strains are major problems in the search for efficient antimicrobial therapy of Salmonella infection.
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Tracheomalacia is a potentially life-threatening clinical problem. The expandable Palmaz stent can be used for the treatment of tracheomalacia. We describe a female infant with tracheomalacia who showed respiratory distress the day after birth. ⋯ However, in bronchoscopic examination carried out two years later, we detected invasion of the Palmaz stent to the trachea and development of granulation tissue. We think that expandable metallic stent placement should be considered in patients who show intractable respiratory symptoms caused by tracheomalacia in the earlier stages of the treatment. But long-term complications of this procedure are crucial.
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Previous studies focusing on the changes of heart rate, systolic blood pressure and dyspnea caused by the six-minute (6MWT) and shuttle walking distance tests (ISWT) have produced conflicting data. The present study aims at comparing the cardiovascular and dyspnea responses to 6MWT and ISWT in patients with chronic obstructive pulmonary disease (COPD). Twenty patients with clinically stable COPD (age, 56 +/- 9 yrs; BMI, 27.8 +/- 7.7 kg.m(-2); FEV1%pred, 42 +/- 19%; mean +/- Sx) performed three 6MWTs and two ISWTs using standardised protocols. The distances walked in the third 6MWT and second ISWT were 458 +/- 105 and 365 +/- 116 m, respectively. There was a significant correlation between the distances covered in the two tests (r = 0.87; p < 0.001). The 6MWT and ISWT showed similar correlation coefficients with the Baseline Dyspnea Index (r = 0.86; p < 0.001 and r = 0.76; p < 0.001), the Clinical Symptom Scale (r= -0.72; p < 0.001 and r= -0.55; p = 0.011), FEV1 L (r = 0.36; NS and r = 0.30; NS), PImax (r = 0.59; p < 0.008 and r = 0.60; p = 0.001) and the mean pulmonary artery pressure, Doppler echocardiography (r= -0.51; p < 0.029 and r = -0.51; p = 0.032). Although the response to ISWT tended to be greater, we found no statistically significant differences between the two tests in the changes of heart rate (HR), systolic blood pressure (SBP) and dyspnea (Borg) (deltaHR, 17.9 +/- 13.4 vs 23.8 +/- 15.4; deltaSBP, 7.7 +/- 14.6 vs 13.0 +/- 17.0 and deltaBorg, 1.7 +/- 1.1 vs 2.2 +/- 0.9; NS). ⋯ The cardiovascular and dyspnea response caused by ISWT is greater (but statistically not significant) than that generated by 6MWT. The more limited the functional capacity of COPD patients the more similar the response generated by 6MWT and ISWT.
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Clinical Trial
Treatment of knee osteoarthritis by arthroscopic synovectomy and debridement of cartilage lesions--late results.
Osteoarthritis (OA) is accompanied by degeneration and destruction of the articular cartilage, development of inflammatory process in the synovial membrane and periarticular tissues. Despite the introduction of new modern medications, the articular inflammatory changes often progress and therapy gives only a transitory improvement. Arthroscopic synovectomy (AS) in knee OA combined with resection of the cartilage lesions is a mild operative procedure and is not associated with postoperative joint stiffness and necessity of continuous rehabilitation. ⋯ The patients were examined before the arthroscopy and followed-up in 1, 3 and 5 years after AS. For the clinical assessment the WOMAC test was used. The WOMAC functional index shows statistically significant improvement at 1 and 3 years (p < 0.0001), as well as at 5 years (p < 0.001) after AS. The WOMAC pain index was significantly reduced in the arthroscopic joint at 1 and 3 years (p < 0.0001). The good therapeutic result was maintained for 5 years (p < 0.001). The WOMAC joint stiffness index was improved to the greatest extent 1 and 3 years after AS (p < 0.0001). In the 5th year a favourable statistically significant improvement was preserved. The total WOMAC index showed a durable general functional improvement including 3 years after the AS. The AS was performed in advanced OA of the knee joint accompanied with a chronic synovitis, resistant to medical therapy and topical management. The functional therapeutic results from AS were very good and lasting even 5 years after the AS.
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The incidence of injury of the recurrent laryngeal nerve (RLN) in various types of surgery is reported to be as high as 12%. By monitoring the recurrent laryngeal nerve intraoperatively we can identify it and preserve it even in atypical positions or in operations for processes involving the nerve. These types of surgery give rise to some specific problems facing the anaesthesiologist and the method of anaesthesia used. ⋯ The authors consider as a method of choice the general inhalational anaesthesia supplemented with non-depolarizing myorelaxants and permanent intraoperative monitoring of the level of relaxation in surgery with intraoperative monitoring of the cranial nerve and recurrent laryngeal nerve.