Przegla̧d lekarski
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Case Reports
[Carbamazepine "CR"--clinical picture of intoxication: the kinetics of extracorporeal elimination].
Carbamazepine (CBZ) intoxication is an important issue in acute poisonings practice. Pathological reflexes, central breathing depression and cardiac disturbances are the characteristic features of carbamazepine poisoning. The clinical picture is variable and does not always correlate with CBZ serum concentration. ⋯ CBZ pharmacokinetics makes the drug move rapidly between the compartments during the HP. This movement may cause a reduction in CBZ concentrations in receptors' vicinity. Probably this mechanism accounts for the improvement of the patients' clinical state despite low kinetic values of the procedure.
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Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation. ⋯ Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.
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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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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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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.