Khirurgii͡a
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Between 1988 and 2000 a total of 33 patients with traumatic tracheobronchial lesions were diagnosed and treated. The trauma was penetrating in 7 (stab and gun-shot), blunt in 10 (car accidents, compression and falling from heights) and iatrogenic in 16 of them (postintubational--15, after foreign body extraction--1). The main clinical and radiological features were subcutaneous emphysema, hemoptysis, respiratory insufficiency, pneumomediastinum and pneumothorax. ⋯ The operative mortality was 9%. The cause of death in these 3 patients were associated brain and spinal cord injuries. In the rest of patients the early and long-term postoperative results were considered very good.
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This study describes the methods of anesthesia and analgesia used in 296 limb amputations for vascular disease over a fifteen year period (1986-2000). The main type of anesthesia was general in 55%, epidural in 29% and spinal in 14%: there were no significant differences for ASA grade, age, or amputation level, nor any statistical differences in mortality for each method of anesthesia. ⋯ Thirty-seven percent of patients were prescribed pethidine for phantom pain. There have been substantial changes in postoperative analgesia following amputation, and epidurals are now common practice, despite the controversy about their role in preventing phantom pain.
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The technique of coracoid block described by Whiffler has been improved by use of neurostimulator (Stimuplex--B. Braun) and changing the angle of insertion of the neurostimulation needle (Stimuplex needle A150, 0.90 x 150 mm). ⋯ The acquired results of the alteration of the sensitivity and motor function prove an effective block within all the regions distally of the upper brachium in 91.4 of the patients and no complications. The proposed technique of coracoid block is a safe and easily performed method for regional anesthesia routinely applied in planned, urgent and outpatient surgery of the upper extremity.
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A technique is described which combines the advantages of interscalene (IS) and supraclavicular block (SCB) and avoids their disadvantages due to complications such as pneumothorax, high spinal and epidural block, cervical plexus block, puncture of a. subclavia and a. vertebralis. The technique has been applied on 110 patients with I-II degree of ASA functional status and indicated for surgical or plysiotherapeutic treatment at the region of the shoulder and upper extremity. ⋯ The effectiveness, security and ability for control through the proposed technique of the brachial plexus anesthesia are investigated. The results we obtained prove an effective block in 93% of the patients together with a low incidence of complications, which determines the technique as a method of choice in the planned, urgent and outpatient surgery.
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Over the period 1994-1998, five patients presenting coagulation status impairment in the course of sintrom treatment are hospitalized in the Clinic of Emergency Neurology and Neurosurgery. Three of them are with craniocerebral trauma (2 severe forms--score 5 by the Glasgow Coma Rating scale, and one mild form--score 15), one has spontaneous intracerebral hematoma, and one--acute hydrocephalus against the background of ruptured aneurysm of the basilar artery (score 4). ⋯ One female patient presenting serious craniocerebral trauma is not operated (refusal by the relatives) and dies. The therapeutic approach to this contingent of patients is comprehensively discussed.