Srp Ark Celok Lek
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Case Reports
[Neurotoxicity during induction treatment of childhood acute lymphoblastic leukaemia--two case reports].
During chemotherapy of acute lymphoblastic leukaemia (ALL), children sometimes exhibit neurological disturbances. Chemiotherapeutic regimens include methotrexate, administered either intravenously or via intrathecal route. Although multiple drugs are used in addition to methotrexate, the acute neurotoxicity reported in patients is usually attributed to methotrexate. The acute neurotoxicity usually results in stroke-like symptoms such as aphasia, weakness, sensory deficits, ataxia and seizures. ⋯ The neurotoxicity in patients with ALL can be combined with significant structural changes of the brain, but also morphological changes can be absent. Several questions concerning aetiology and treatment of neurological events are raised.
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Comparative Study
[Bernard Organ Failure Score in estimation of most severe forms of acute pancreatitis].
Despite intensive research, efforts and clinical investigations on pathogenesis of acute pancreatitis (AP) and system morbidity during the illness onset, mortality is still very high in the group of severe forms. A significantly high number of patients show moderate, self-limited forms of illness, with a minimal degree of systemic or local complications, with full recovery. However, some of them have a severe form, followed by a high percent of morbidity and mortality, and system organ failure. The distinction between mild and severe forms of AP within 24-48 hours of hospital admission is very important for the treatment of these patients. The usage of multifactorial scoring systems holds a lot of promise, reaching reliability in the disease severity estimation of approximately 70-80%. ⋯ The concept of the BOFS score has more advantages than the APACHE II score in the patients with severe forms of AP with organ dysfunction.
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The fracture of the external condyle is the most common fracture of the distal end of the humerus. This is an intraarticular fracture, which, if not properly treated, can cause serious complications, difficult to treat. ⋯ The initial width of the fracture crack is important for the evaluation of the fracture stability, the evaluation of the risk for the creation of secondary dislocations and for the choice of treatment. The upper limit of the fracture crack width which influenced the selection of the method of treatment was 2.5 mm.
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Organ injury caused by ischaemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35 degrees C) is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC). ⋯ In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v.) fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia,will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal "therapeutic window" for gene therapy.
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Exentheresis pelvis totalis due to locally advanced pelvic malignancies is an extensive surgical procedure. The operation is commonly associated with anticipated perioperative haemorrhage requiring a large volume of haemoproducts. Sometimes, the intervention can result in unexpected massive and uncontrolled haemorrhage that is frequently a combination of surgical and coagulopathic bleeding. Attempts to arrest massive bleeding by conventional means may fail. ⋯ RFVIIa can be a treatment option in patients suffering from intractable coagulopathic bleeding when standard therapy has failed.