Przegla̧d lekarski
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Congenital spine and thorax deformities are an interdisciplinary clinical problem. Apart from trunk deformity they may lead to respiratory or cardiovascular insufficiency. Surgical treatment should be implimented as soon as possible in order to improve posture, balance and further development. This treatment should not impair further growth of the young spine. This is possible with the VEPTR device. ⋯ VEPTR device is indicated in treatment of severe congenital deformities of the spine and thoracic cage. It improves patients' posture, changes the shape of thorax wall and consecutively improves respiratory function and further development.
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For several years now, with the introduction of the health care sector reform we have been observing a considerable drop in the number of postmortem examinations performed in patients who died in hospitals. The decrease amounts to as much as 50 to 70%. This is undoubtedly a consequence of financial restrictions imposed on the management of these inpatient facilities. ⋯ The result of a postmortem examination is practically the only basis for a factual evaluation of a given case. When no autopsy has been performed, the experts are virtually helpless, and in the majority of such instances, they are forced to refuse passing an expert opinion. The report presents basic principles of medico-legal opinionating in criminal cases (including proceedings pertaining to medical errors), the rules governing the medical error assessment, as well as problems encountered in evaluating the appropriate course of treatment when a post mortem examination has been waived.
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Humans are highly adapted to consuming probiotics. Trehalose ("mushroom" sugar) is probably an important reserve compound and stress-responsible metabolite (increases bile and gastric acid resistance) of probiotic bacteria's and trehalase activity, in contrast to lactase activity, is preserved in all human populations, even those not consuming mushrooms. Among traditional Melanesian horticulturists, of whom 4/5 are daily smokers, the diet is rich in pre- and probiotics and there is absence of cancer and cardiovascular disease. ⋯ In one study it was observed that a diet supplemented with Lactobacillus plantarum could be also useful in the prevention of cardiovascular disease in smokers. There is no sufficient data from clinical trials to recommend the routine use of probiotics in prevention of smoking-related diseases. More research is needed to investigate the role of probiotics in this area.
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Transcranial Doppler enables dynamic assessment of cerebral blood flow and is particular important in migraine, associated with impaired vasoreactivity. Majority of studies revealed disturbed mechanisms of autoregulation in patients with migraine with aura in predominance. Visual aura and increased photosensitivity in migraine patients suggest disorders of visual pathway and visually evoked potentials (VEP) enable to detect even subclinical pathologic changes in its course. ⋯ Simultaneous recording of cerebrovascular response to visual stimulation and VEP revealed increase of cerebral blood flow velocity over 10 cml s in 6/15 patients and in 5 of them also amplitudes N75/ P100 or also P100/N145 over 20 mV were recorded. However, analysis of the results did not allow to identify characteristic changes for each type of headache. In order to establish the role of doppler examination in childhood migraine diagnostics further study in this area is needed.
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Case Reports
[A rare case of the extensive Fournier's gangrene developed in the course of a perianal abscess].
Fournier's gangrene is a rare necrotising fascitis of the perineum and genitals caused by mixture of aerobic and anaerobic microorganism. Despite appropriate therapy mortality in this disease is still high. ⋯ Treatment involves extensive soft tissue debridement and broad-spectrum antibiotic therapy. The clinical applicability of the so called Fournier's gangrene severity index score (FGSIS) was discussed.