Wiadomości lekarskie (Warsaw, Poland : 1960)
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Review Comparative Study Historical Article
[Thoracic paravertebral blockade--history or present time?].
This article discusses thoracic paravertebral blockade (TPVB)--a popular in early XX-th century method of local anaesthesia used also for diagnosis and treatment--being revitalized lately. Authors present modem indications for TPVB comparing it to other methods of regional anaesthesia.
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Remifentanil is a new, ultra-short acting opioid, which may be applied in several branches of anaesthesia. Data concerning pharmacokinetics and pharmacodynamics as well as review of references regarding practical use, combining this drug with other anaesthetics agents and side effects are given. Particular attention is paid to the usefulness of remifentanil to provide good control of haemodynamics and stress response during surgical procedures. Remifentanil also seems to be very effective in the intensive care setting and for pain control during various medical procedures.
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The authors present an analysis of literature data regarding correlations between health-related quality of life (HRQL), quality of anesthesia, quality assurance and pharmaco-economic factors in the context of patient-based individual perception of a life threatening situation in the perioperative period. The main attention was given to the quantification of HRQL as a new clinical parameter and methodological problems were emphasized.
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Comparative Study
[Permanent local nerve injuries after carotid endarterectomy].
Functional assessment of nerves, especially motor rami of cranial nerves, in patients at postoperative period after carotid endarterectomy (CEA), is particularly important in case of necessity of contralateral carotid artery surgery. Bilateral damage to recurrent laryngeal or hypoglossal nerve is a potentially life-threatening complication. Sensory disturbances due to intraoperative injuries of cervical plexus branches may cause residual discomfort in numerous patients. The aim of this study was the assessment and comparison of frequency of persistent (for more than 12 months postoperatively) manifestations of cranial and cervical nerves injuries in patients after CEA performed either in the standard or eversion technique. A prospective study evaluating cranial and cervical nerves dysfunction after carotid endarterectomies in 144 out of 193 patients operated on from January 1999 until June 2001 was undertaken at the Department of General and Vascular Surgery, Pomeranian Medical University in Szczecin, Poland. CEA was performed in the standard way (i.e. by primary closure) in 92 patients, while 52 others were operated on by eversion technique. Neurological examination with careful functional assessment of cranial nerves: V, VII, IX, X, XII and cervical plexus, was performed according to a standard protocol within two follow-up periods: 3 to 6 and 12 to 18 months after discharge from the hospital. ⋯ 1. Permanent damage of cranial nerves refers to small group of patients after carotid endarterectomy and concern predominantly recurrent laryngeal nerve and hypoglossal nerve. 2. Majority of local neurological complications are injuries to cervical plexus branches. 3. Eversion carotid endarterectomy is not related to higher incidence of local neurological deficits compared to standard procedure.
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Hypersensitivity to poppy seeds is rare and it may develop due to immune (allergy) and non-immune reactions of fulminant course. Two cases of hypersensitivity to poppy seeds are presented: in a 21-year-old woman and 32-year-old man in whom life-threatening symptoms and signs of anaphylaxis (SSA) developed after consumption of poppy seeds in various situations, e.g in the street after consumption of a roll with poppy seeds or a cake prepared on a moulding board on which poppy seeds were previously squeezed. In the case of the woman, history data pointed to familial and individual occurrence of atopy, and positive cutaneous prick tests with allergens of grass/crop and weed pollen and tree pollen (birch, hazel) as well as hazelnuts. In the man the anamnesis and skin prick tests were negative. Serum concentrations of allergen-specific IgE (asIgE) for poppy seeds and, additionally, for food allergens, which, according to patients, also could be the cause of SSA: celery, pineapple, mixture of spices and nuts were determined. In the woman elevated concentrations of asIgE for celery (class 2) and nut mixture (class 2) with negative result for poppy were noted, whereas in the man elevated concentrations of asIgE for poppy (class 2) and nut mixture (class 2) were found. Additionally, in the male patient skin tests were performed with topical anesthetics and narcotic analgesics derived from poppy (morphine, codeine) finding positive reactions to xylocaine and codeine. ⋯ The two presented cases illustrate that hypersensitivity to poppy seeds may occur in IgE-dependent or non-immune mechanisms and the presence of atopy is not decisive of its mechanism.