Przegla̧d lekarski
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The International Classification of Epilepsies and Epileptic Syndromes distinguishes four types of idiopathic generalized epilepsies with typical absences: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME) and epilepsy with generalized grand mal on awakening (EGMA). It is essential in any case when sizures occur to classify the type of epileptic syndrome in order to make prognosis and to choose correct treatment. But it is not always possible to establish diagnosis at the beginning of the disease. Often prolonged observation of the patient and evolution of clinical and EEG features lead to define the epileptic syndrome. The aim of the work was to define the type and frequency of epileptic syndromes and their long-term observation in patients with absences occurred as the first (or the only) type of seizures. ⋯ 5.2% of all subjects were patients with idiopathic epilepsies who experienced absences as a first (or the only) type of seizures when absences occur one should consider first of all childhood absence epilepsy and juvenile absence epilepsy. Recognition of juvenile myoclonic epilepsy and epilepsy with generalized grand mal on awakening is less probable.
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Case Reports
[Severe carbon monoxide poisoning: different clinical course--the same source of exposure].
The different course of acute carbon monoxide poisoning in two young people exposed to the same Carbon monoxide source are reported in the study. The pulmonary edema was diagnosed in the man, but not in the woman. ⋯ MRI detected the brain changes invisible in CT scans and seems be more useful for evaluation CNS abnormalities. The neuropsychological examination, of the brain functional changes is also necessary for proper evaluation of the CNS damage.
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The pulmonary endothelium synthesizes many bioactive compounds and their activation or injury may cause release these substances into the blood. We determined the influence of trauma severity for endothelium activation/injury by measurement of specific endothelial cell markers--soluble E-selectin (sES) and von Willebrand factor antigen (vWF:Ag). Thirty six severely traumatized patients were stratified according to an Injury Severity Score (ISS). ⋯ Significant correlation between plasma vWF:Ag and serum sES concentration was also observed (Rs = 0.501, p < 0.001). In conclusion, severe trauma patients manifest endothelial cell activation/injury. Plasma vWF:Ag concentration seems to be an important, early marker of trauma severity, while serum sE-selectin level may serve as prognostic factor in immediate postinjury period course.
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Shortening the time between the onset of pain and start of the efficacious treatment is an important mean to lower case-fatality in myocardial infarction (MI). The goal of this publication was to assess: 1) current time between the onset of pain and: a) calling medical service by the patient b) first examination by a doctor, and c) first administration of intravenous treatment, 2) reasons of the delay in calling medical service by the patient, 3) whether patients with a diagnosis of ischaemic heart disease (IHD) prior to hospitalization were instructed how to behave in case of chest pain, and 4) whether instructing how to behave in case of chest pain was related with a time between the onset of pain and calling medical service by the patient. Studied group were 515 patients hospitalised in 6 in-patient clinics of cardiology with MI or unstable angina (UA) or hospitalised for first PTCA or CABG, 427 (83%) agreed to participate, out of whom 184 had MI or UA including 110 patients having typical chest pain. ⋯ Patients who earlier received instruction had four times higher chance to call medical service within the first hour after the onset of pain (Odds Ratio = 4.11, 95% confidence interval 1.13-15.0). Only half of all patients hospitalised due to acute episode of IHD or for revascularization procedures received intensive instructions from a doctor. Adopting a detailed instruction on how to behave in case of chest pain as a standard procedure for patients with IHD may be an important mean to lower case-fatality in MI.
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Life saving surgery is the surgery which has to be performed during the acute or reanimation period (1 to 3 h) and during the primary or stabilisation period (first day surgery). During the reanimation period lifethreatening conditions are identified and management is begun simultaneously. Many trauma surgeons talk about the first "golden hours" as the time interval starting immediately after the injury when rapid intervention will save lives and a lack of intervention will result in life loss. ⋯ This period consists of further diagnostic procedures and treatment of injuries that are not directly life-threatening, but which may become life endangering or severely disabling if not treated promptly. The priorities of the surgical treatment are: brain injuries, eye- and facial injuries, progressive compression of the spinal cord, visceral injuries, musculoskeletal injuries. By improving prehospital care, rapid transport and last but not least immediate life saving surgical treatment preventable deaths can be reduced from 20-30% to 2-9% (5).