Lijec̆nic̆ki vjesnik
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Lijec̆nic̆ki vjesnik · Sep 2006
Review[Anaphylactic reaction as a side-effect of administration of general anesthetics and neuromuscular blocking agents].
The incidence of anaphylactic reactions during anesthesia is between 1:5000 and 1:25000 anesthetics. During the IgE-mediated anaphylactic reaction mast cells release proteases such as tryptase, histamine and vasoactive mediators. The release of mediators from the mast cells and basophils is responsible for the immediate clinical manifestations of anaphylaxis. ⋯ Airway maintenance, 100% oxygen administration, intravascular volume expansion and epinephrine are essential to treat the hypotension and hypoxia that result from vasodilatation, increased capillary permeability and bronchospasm. As soon as the diagnosis has been made the adrenalin should be given intravenously 1 to 3 ml of 1:10000 aqueous solution (0.1 mg/ml) over 10 minutes. Prevention is possible with methylprednisolone 125 mg i.v. 1 hour before administering of anesthetics and neuromuscular blocking agents with or without antihistaminic chlorpiramine-chloride 1 amp i.v. few minutes before anesthesia.
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Lijec̆nic̆ki vjesnik · Sep 2006
Review[Cervicogenic proprioceptive vertigo: etiopathogenesis, clinical manifestations, diagnosis and therapy with special emphasis on manual therapy].
Cervical proprioceptive system (CPS) consisting of mechanoreceptors of cervical intervertebral joints, mechanoreceptors of neck muscles and ligament's insertions, muscle spindles located in deep short muscles of cervical spine and sensitive fibers connecting neck's proprioceptors with neurons of cornu posteriori of spinal cord, plays an essential part in maintaining bodily balance. CPS, via tractus spinovestibularis, is connected to vestibular nuclei. Clinical and neurophysiological studies have shown that functional disorders and/or organic lesions of CPS cause identical symptoms as vestibular diseases: vertigo, nystagmus and balance disorders. ⋯ Hyperactivity of craniocervical mechanoreceptors also causes disturbances in reflex regulation of postural muscle tonus manifesting as "general instability". Knowledge of CPV as a separate clinical entity is important from diagnostical and therapeutical aspect. As it concerns a peripheral vestibular disorder still unknown to a wider circle of physicians, the article describes etiopathogenesis, clinical manifestations, diagnosis and therapy of CPV with special emphasis on manual therapy.
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Rituximab, a chimeric anti-CD20 monoclonal antibody, has become a part of standard treatment of B-cell non-Hodgkin lymphoma in the last several years. Depleting CD20+ cells by various mechanisms, it is active as a single agent and particularly when combined with chemotherapy. ⋯ Because of different mechanisms of action, adding rituximab to chemotherapy does not cause additional toxicity. Combination of rituximab and chemotherapy improves response rates in indolent lymphomas and survival in aggressive lymphomas.
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Organ transplantation becomes an accepted method of treatment, being closely accompanied with the development of transplantation ethics. Numerous problems and dilemmas occurring in this process can be grouped as problems connected with confirming death, and ethic dilemmas connected with obtaining and distributing organs. ⋯ A difficult question of just organ distribution causes many ethical dilemmas. Solution should be sought in the multidisciplinary approach of bioethics with medicine, politics, legislature and sociology.
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Acute pancreatitis varies from mild to severe fulminant disease. Once the diagnosis of acute pancreatitis is established, the treatment is dependent on the early assessment of disease severity based on objective clinical and laboratory parameters. ⋯ The roles of initial treatment and monitoring, nutritional support, specific therapy and antibiotic prophylaxis are analysed. The therapeutic approach to patients with early and late complications of acute pancreatitis could be medical, endoscopic or surgical and recommendations for relevant management are given.