Srp Ark Celok Lek
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Case Reports
The role of rotational thromboelastometry in real time assessment of haemostasis in surgical settings.
In the settings of trauma, liver transplantation and major surgery multifactorial coagulopathies are frequently encountered. The treatment of acutely bleeding patients is critically compromised by monitoring with standard available routine coagulation tests. In contrast to conventional tests, rotational thromboelastometry (ROTEM) provides an automated measurement of interactive dynamic haemostatic processes in whole blood starting with initial haemostasis up to and including fibrinolysis at a given time point. Especially fibrinogen, platelet dysfunction and hyperfibrinolysis pose diagnostic gaps. The aim of this report was to highlight the usefulness of ROTEM in making the correct diagnosis and adoption of therapeutic approaches in a timely manner in liver transplantation and trauma. We describe the value of ROTEM in two haemostatically compromised patients. ⋯ In orthotopic liver transplantation and severely injured trauma patients ROTEM enables rapid and accurate detection and the differential diagnosis of multifactorial coagulopathies. Also, it provides the basis of rational approach to the use of blood component therapy and pharmacological interventions.
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The manifestations of autonomic nervous system (ANS) dysfunction in autoimmune diseases have been the subject of many studies. However, the published results pertaining to such research are controversial. Sudden cardiac death due to fatal arrhythmias is frequent in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). ⋯ SLE and RA are associated with severe autonomic dysfunction and the presence of significant risk predictors related to the onset of sudden cardiac death.
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The optimal treatment of pregnancy associated VTE (venous thromboembolism) has not been established yet. ⋯ Nadroparin is both safe and effective for the treatment of DVT during pregnancy and puerperium.
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Unreduced elbow dislocation is every elbow dislocation older than one week. It may be treated non-operatively (with prereduction traction) or surgically. The treatment goals are: to reduce pain, to establish joint stability and movements. There are a lot of techniques described in literature, series are relatively small, mostly case reports. Multicentric studies have not been done. That is why there are no precisely defined therapeutic protocols. Every contribution in the field is valuable. ⋯ The presented method of treatment has been found as very useful, having in mind that it may solve two problems: difficult reduction and redislocation. Reduction may be done without the joint opening, step by step; retention of the reduced joint may be easily done. Physical therapy may be started without Ilizarov device removal, movements of flexion and extension may be improved without any lateral instability. There is no iatrogenic intraarticular damage, so there are no secondary joint degeneration, pains and invalidity.
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Forensic expertise has not specified with certainty any specific injury among fatally injured frontal car-occupants in frontal car collisions. ⋯ The basic mechanism of the injury of thoracic organs is deceleration, as well as anteroposterior compression with caudorostral hyperextension. That is why thoracic organ injuries are mostly concomitant. Fatally injured car-drivers suffered more often of these injuries than other car-occupants. The probability that the fatally injured was the car-driver rises with the number of concomitant injuries of thoracic aorta, heart and pericardium, as well as with the fractured thoracic-cage bones.