Przegla̧d lekarski
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The aim of the study was to define the frequency of atrial fibrillation early after coronary artery bypass grafting (CABG) and clinical risk factors for the development of atrial fibrillation in the post-operative course. The study population consisted of 1578 patients (1283 men and 295 women ranging in age from 25 to 85 years, mean age 59.373 +/- 8.686 years) undergoing isolated coronary artery bypass grafting in extracorporeal circulation between 1.01.1998 and 21.12.1999. The patients were divided into two groups: group 1 with atrial fibrillation after CABG (193 patients, mean age 62.399 +/- 7.097 years) and group 2 without atrial fibrillation in the postoperative course (1385 patients, mean age 58.952 +/- 9.009 years). Both groups were compared with respect to pre-, intra- and postoperative parameters. Additionally in group 1 the following aspects were taken into account: timing of atrial fibrillation and its relapses in relation to the surgical procedure, serum potassium level, type and efficacy of antiarrhythmic treatment. ⋯ (1) Atrial fibrillation is an important clinical problem early after coronary artery bypass grafting. It is poorly tolerated and shows a tendency to recur. (2) Atrial fibrillation after CABG is most strongly correlated with age over 60 years, arterial hypertension and perioperative withdrawal of beta adrenolytics.
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The lesions of the trachea resulting from intubation are scarce. Each laceration of the tracheal wall threatens the patient's life. ⋯ In all the patients the lacerated wall of the trachea was sewn up. Our observations indicate that leaving the patients on his own breathing after sewing up of the lacerated tracheal wall supports the healing of the impaired site.
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Historical Article
[The history of tobacco consumption and nicotine addiction in Europe until the middle of the XXth century].
Tobacco, a plant unknown in the Mediterranean civilization, has made a world-wide carreer in the social and economic areas for the last 500 years. The cultivation of tobacco, although originally taking place mostly in North and South America, quickly spread to the other continents, mainly to Europe and Africa. The huge profit from the cultivation of tobacco, based also on the ruthless exploitation of black slaves brought from Africa, founded the welth of such American states, as Virginia, North Caroline and Louisiana. ⋯ The aforementioned factors created the raising supply of tobacco, which reached its the apogee in the XXth century. On the other hand, the demand for tobacco was the function of unreasonable beliefs in its therapeutic properties, religious prejudices, fashions and social rituals, and most of all by gradually increasing tobacco addiction. The purpose of this study is to analize different factors influencing the consumption of tobacco until the middle of the XXth century.
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Urapidil was administered in 69 patients aged between 46-79 age (average 62.7 +/- 8.4 age) to control intra-operative increase in arterial blood pressure accompanying endotracheal intubation, extubation, wakening of the patients, incision of abdominal integument and clamping of abdominal aorta. In presented group 47 patients suffered from arterial hypertension and 22 patients did not. Patients underwent various surgical procedures in general anesthesia and in 13 patients implantation of aortal prosthesis in result of abdominal aortic aneurysm (7 patients) and Leriche syndrome (5 patients) was performed. ⋯ Urapidil administered during monotherapy turned out to be efficacious in 81.1% of treated patients. Other 18.9% required an additional infusion of nitroglycerine, but these were patients operated on due to abdominal aorta. Average dosage of urapidil applied during monotherapy amounted to 26.3 +/- 2.4 mg. Intraoperative administration of urapidil did not result in acceleration of heart rate, and urapidil turned out to be a safe medicine to reduce intraoperative increase in arterial blood pressure also in patients who were previously diagnosed as suffering from arterial hypertension.
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The aim of this study was to determine relations between the clinical state and the severity of liver damage comparing to the amount of ingested paracetamol, time since ingestion and serum concentration of paracetamol with patients after acute intoxication with this drug. A retrospective analysis of medical records of 95 patients hospitalized in the Toxicology Department in Kraków or treated in the Toxicological Admission Room in 2002-2004 years because of acute paracetamol intoxication was performed. The general clinical state connected with intoxication and the severity of liver damage were determined using the Poisoning Severity Score (PSS). ⋯ A positive correlation between time since ingestion of paracetamol to hospitalization and the gravity of poisoning according to PSS scale was also statistically significant. A paracetamol concentration measured during admission to the hospital had no influence on neither the clinical state of patient nor the severity of liver damage. We conclude that the therapeutical approach should consider possibly shortening of the time since drug ingestion to hospitalization and institution of specific treatment (N-acetylcysteine) as well as minimalization of the paracetamol dose, which could be absorbed, by different methods of elimination from the GI tract (eg., gastric lavage, activated charcoal laxatives).