Przegla̧d lekarski
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Calcium channel inhibitors have been extensively used to treat arterial hypertension, ischaemic heart disease and supraventricular rhythm irregularities. The poisonings by that category of drugs are extremely dangerous, particularly when accompanied by intoxication with other drugs affecting the circulatory function. This paper reports 3 cases of poisonings with calcium channel inhibitors (verapamil and diltiazem) in combination with angiotensin convertase inhibitors and nonselective beta-adrenolytics. ⋯ The persisting hypotonia combined with heart rhythm disturbances could not be prevented by the typical conservative treatment involving intravenous administration of infusion fluids, calcium formulations, catecholamines and atropin. The application of 4-amino-pyridine (Pymadin) caused that arterial tension and heart rate were higher, and the heart rhythm disturbances disappeared. The reported cases suggest a beneficial effect of 4-aminopyridine used to treat cases of poisonings by calcium channel inhibitors; however, up to the present time, no detailed procedures have been determined for 4-aminopyridine administration in cases like those reported above. 4-aminopyridine has not been included in the list of the antidotes approved by the WHO and, therefore, broader tests and more clinical observations are required to confirm its therapeutic value.
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Pediatric abdominal pain is one of the most common symptom of children brought to attention of primary care physicians and pediatric surgeons. In many children clinical symptoms may be uncharacteristic and may lead to diagnostic difficulties. ⋯ 1. Appendicitis is the most frequent surgical etiology of the right lower quadrant pediatric abdominal pain. 2. Despite new diagnostic imagines there are no definite criteria to recognize appendicitis, in most cases physical examination and very carefull evaluation of abdominal pain are the most important. 3. All children with periappendipected of Crohn's disease. 4. All children with equivocal presentations of appendicitis and with normal appendix during operation should undergo further diagnostic evaluation.
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Fever in infants and children frequently causes considerable concern for parents and physicians. It is one of the most common reasons that parents seek medical attention for their children, accounting for 1/3 of pediatric office and emergency department visits. ⋯ This article reviews the evaluation and management of children with fever which is the only alarming symptom of infection. A cautious approach should still be taken based on the potential for adverse consequences of unrecognized and untreated serious bacterial infection.
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Despite of the constant progress in the imaging of vessels, cerebral angiography characterises with the best specificity and sensitivity in detection of arterial, arteriovenous malformations and aneurysms. ⋯ Cerebral angiography allowed to exclude vascular pathology in 75% of children, in whom previous neuroradiological examinations suggested such pathology. It was important for their quality of life. In 25% of patients angiography confirmed results of previous neuroradiological tests detecting vascular pathology. MR with contrast medium is more sensitive than angiography in detection of venous angiomas.