Przegla̧d lekarski
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The kidneys are the critical organs in the case of a long-term occupational or environmental exposure to heavy metals and tobacco smoke. In diagnostics of renal damage useful are the methods which determine the activity of renal enzymes, quantify in urine (e.g. beta-glucuronidase, N-acetyl-beta-D-glucosaminidase). N-acetyl-beta-D-glucosaminidase (NAG) is one of the most often determined factors of tubular damage, since its activity increases in early stages of renal injury, ahead of appearance of excretory dysfunction. ⋯ About 3-times increase of total NAG's activity was observed in urine of smoking founders and 4-times increase of non-smoking founders in comparison with smoking and non-smoking control group. The highest activity of NAG-B was observed in urine of smoking founders (11.35 +/- 7.85 U/g creatinine), then non-smoking founders (9.7 +/- 8.75 U/ g creatinine). It was confirmed, that the activity of N-acetyl-beta-D-glucosaminidase is a good factor in the assessment of occupational exposure to heavy metals like arsenic, cadmium and lead.
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Posterior shoulder dislocations are diagnosed rarely in every-day practice. Although the methods of radiological imaging have been developing and becoming commonly available, the cases of late diagnosis are still happening. Proper clinical examination and properly conducted and interpretated radiographs allow for identification and implementation of appropriate medical procedures. ⋯ The choice of an appropriate treatment is complicated and requires in-depth theoretical knowledge as well as the knowledge of specific conditions within the shoulder surgery. Based on an algorithm, proposed by Griggs, between 2000-2006 seven patients with locked posterior instability were treated, for all of them defect of the proximal humerus did not exceed 30%. In all these cases the goals of improving stability and range of motion were obtained.
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Less than twenty years ago, a high spinal cord injury accompanied by paralysis of the diaphragm and the resulting apnea and tetraplegia led to certain death within a short time after the trauma, mostly due to respiratory complications associated with ventilatory therapy in hospitals. The objective of this paper is to present the case of a paediatric brain stem trauma with spinal cord injury, consisting of spinal cord rupture in the upper cervical segment. Thanks to appropriate management at all treatment stages (prompt, fully professional assistance in the ambulance, followed by appropriate management at ICU), the child survived. ⋯ As the patient grew, in consequence of uncontrolled sudden increases of muscle tone of the trunk spine. Increased muscle tone was increasingly resistant to pharmacotherapy and negatively affected the effectiveness of home rehabilitation. In consequence, a decision was made to implant an intraspinal baclofen pump.
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Diabetic nephropathy is a leading cause of end-stage renal disease. In this paper the role of renin-angiotensin-aldosterone system (RAA) in the pathogenesis of diabetic nephropathy is discussed and clinical effects of multilevel pharmacological blockade of RAA system by combined treatment with ACE inhibitors, angiotensin receptor blockers (ARB) and aldosterone antagonists is described.
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This paper describes two different cases of acute suicidal arsenic trioxide intoxication. Case no 1. A 38-year-old man, alcohol abuser, who ingested 4-5 g dental paste, which corresponds to 2.2-2.7 g of pure arsenic trioxide, developed gastritis with vomiting and abdominal pain, but without diarrhea. ⋯ Cardiovascular collapse as a result of intravascular volume depletion, vasodilatation and myocardial dysfunction was observed. The patient died on the first day of hospitalization. In both cases treatment included gastric lavage, BAL therapy, haemodialysis and supportive measures.