Przegla̧d lekarski
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Obesity--an important problem in modern societies--is caused by energy balance dysregulation and produces numerous adverse effects on health. Recently a particular attention has been paid to molecular and physiological mechanisms in the development of obesity and to the signalling role of adipose tissue in energy stores maintenance on the hypothalamic level. Leptin, the obese gene product discovered in 1995, may play a key role in the feedback system between adipose tissue and the ventromedial nucleus of the hypothalamus (satiety centre). ⋯ Defining of the role of leptin in the regulation of satiety and energy expenditure will undoubtedly contribute to a better understanding of the pathogenesis of obesity and its related metabolic complications and may lead to a new treatment approach to human obesity based on leptin or its analogues. At present research work focuses on leptin receptor studies and on ob gene polymorphism and its expression in feeding disorders including obesity and anorexia nervosa. The ob gene is one of a few genes involved in energy balance, however, very promising one.
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The internal jugular vein cannulation is a commonly used route for access to the central venous system for therapeutic and diagnostic purposes. Although the great majority of this venous puncture are successfully performed using anatomic landmark technique, serious complication such as pneumothorax, arterial puncture or hemothorax can occur during this procedure, particularly under difficult clinical condition. ⋯ Ultrasound guidance reduces the number of passes needed to puncture the vein, increases the success rate of venous puncture, and minimizes complications. Ultrasound guidance is usually successful in allowing performance of internal jugular vein cannulation when landmark technique fail.
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The National Poisons Control Centre of the National Institute of Public Health and the Environment in the Netherlands conducted a prospective study on acute poisoning arising from exposure to pesticides in agricultural workers. The study was performed to determine the extent and severity of acute pesticide poisoning in the Netherlands and the working conditions that lead to these poisonings. All cases of potential acute occupational intoxication by pesticides in which the Poisons Control Centre was consulted in 1991 were thoroughly studied by an occupational hygienist and a specialist in internal medicine. ⋯ In most accidents (74%) imperfect technical design or technical defects were important risk factors for exposure. Although most workers were aware of the risk of using pesticides, they were still careless in taking adequate protective measures. Especially during preparatory and reparations activities the wearing of protective clothing has to be emphasized.
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The present paper described and analyses various strategies of coping with professional stress. The paper is based on investigations of 55 physicians. ⋯ Valuable and useful for physicians in their everyday practice is intellectual way of coping. Social support for doctors is the most important to return to inner equilibrium.
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We present evaluation and methods of treatment for "tic douloureux" (trigeminal neuralgia). Angio-Magnetic Resonance seems to be essential in establishment of neuro-vascular compression pathology. ⋯ In patients with contraindications for general surgery other techniques are being used to decrease pain sensation: RF thermocoagulation with the help of stereotactic procedure, percutaneous microcompression of the trigeminal ganglion, radiosurgery, electrical stimulation of the Gasserian ganglion. Current methods of imaging and new therapeutical achievements allow to dramatically reduce pain and discomfort in first days of trigeminal neuralgia.