Lijec̆nic̆ki vjesnik
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The prime goal of this paper is to offer an overview of main scientific points in epidemiology, genetics, pathogenesis, clinical course and therapeutic strategies in stiff person syndrome (SPS). This syndrome is characterized by progressive muscle rigidity and painful muscle spasms. Three major forms of SPS are described, according to the pathophysiologic basis, autoimmune, paraneoplastic and idiopathic SPS. ⋯ The therapeutic approaches are focused on symptomatic therapy managing the muscle spasm and on possible immunomodulatory procedures to attenuate an autoimmune reaction. Two cases of SPS are reported in the Republic Croatia since 2005. Although it is a rare medical condition, SPS is of clinical importance, especially because it may be the first sign of an underlying undiagnosed malignant disease or if the anesthesia is necessary in SPS patient.
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Lijec̆nic̆ki vjesnik · Jan 2010
Review[Lipopeptides and oxazolidinones--novel antibiotics in MRSA infection treatment].
Last few years vancomycin-intermediate S. aureus and vancomycin-resistent S. aureus have emerged, giving us a task to reevaluate susceptiblity to vancomycin in treatment of methicillin-resistent S. aureus (MRSA) infections. It is also oportunity to review necessity for new generation of antibiotics in treatment of MRSA infections. Efficacy of vancomycin treatment in MRSA bacteriemia is associated with minimal inhibitory concentration (MIC) and speed of killing colonies. ⋯ That's one of the reasons why there is novel antibiotic therapy for MRSA investigated, especially daptomycin and linezolid. Daptomycin is lipopeptide and an important optional antibiotic in MRSA infections treatment: bacteremia and endocarditis, even the tricuspidal valve endocarditis. Linezolid, as novel oxazolidinon, has shown good activity against gram-positive bacteria, especially in treatment of nosocomial pneumonia and complicated skin and soft tissue infections caused by MRSA.
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Crystalloid solutions are considered a good choice for lower scale blood loss (up to 20%). The usage of colloids facilitates faster and more durable blood volume substitution. ⋯ It is therefore important to know that HES 130/04, a new generation colloid solution, is linked to a lower frequency of side effects. Nonetheless, it seems that the individual approach and procedure-specific choices are more important than other factors.
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Careful assessment of fluid balance is required in the perioperative period since appropriate fluid therapy is essential for successful patient outcomes. Volume status is frequently assessed by different hemodynamic variables that could be targeted as endpoints for fluid therapy and resuscitation. Goal directed fluid therapy is a method for correction of fluid status in individual patients that includes invasive hemodynamic monitoring and aggressive perioperative correction of hemodynamics. ⋯ It is associated with a variety of patophysiological disturbances, hydro-electrolyte balance disorders and compensatory mechanisms. Heart failure indicates careful assessment of fluid balance in perioperative period. The aim of this article is to describe actual techniques of hemodynamic measurements as well as main principles of fluid therapy to maintain hydro-electrolyte balance in patients with heart failure.
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Preload assessment and optimization is the basic hemodynamic intervention in critically ill. Beside clinical assessment, non-invasive or invasive assessment by measurement of various pressure or volume hemodynamic variables, are helpful for estimation of preload and fluid responsiveness. ⋯ In patients with inadequate preload, fluid responsiveness and inadequate flow, treatment with crystalloids or colloids is mandatory. When rapid hemodynamic response is necessary colloids are preferred.