Medicinski pregled
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Congenital adrenal hyperplasia is generally considered to be a rare disease; however, the incidence of severe forms of CAH is probably greater than 1 in 10,000 people and the incidence of milder forms is probably 10 times higher. It is a group of autosomal recessive disorders of adrenal steroidogenesis caused by a genetic disorder in one of the steroidogenic enzymes. These disorders impair cortisol synthesis, resulting in stimulation of pituitary proopiomelanocortin and hypersecretion of adrenocorticotropin, which in turn causes adrenal growth. ⋯ In "classic" form, affected newborns present with symptoms and sings of adrenal insufficiency of varying degree and ambiguous genitalia in both sexes. The "late onset" form is a mild type of disorder. It has been described in women with hirsutism and menstrual abnormalities and may be quite common. (ABSTRACT TRUN
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Preemptive analgesia given before noxious stimulation prevents or reduces subsequent pain. Pain associated with central sensitization is called pathological pain. Preemptive analgesia could be defined as analgesia that prevents the development of pathological pain. The clinical significance of central sensitization lies in prediction that preemptive analgesia may prevent the establishment of central sensitization and reduce pain experienced following peripheral injury. Various pharmacological agents and methods have a potential in prevention of acute postoperative pain by blocking the somatosensory system and abolishing hypersensitivity. But the role of preemptive analgesia in postoperative pain is still controversial. The goal of the present study was to examine whether pethidine administration before skin incision is more effective in reducing postoperative pain than the same dose of pethidine given intraoperatively. ⋯ The results of this study did not demonstrate a preemptive effect of pethidine. (ABSTRACT TRUNCATED)
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This paper deals with basic rational antiepileptic therapeutic procedures in children with special consideration of numerous specificities which occur in childhood: difficulties in establishing correct syndrome diagnosis, predominantly after the first or first few seizures which makes it difficult to decide about appropriate syndrome-specific therapy in regard to efficacy, mechanism of action and range of antiepileptic action; difficulties in assessment of subjective factors (their adverse effects and recognition of seizures with subjective symptoms), children's vulnerability in regard to drug toxicity; age-specific pharmacokinetics of these drugs. ⋯ Only a complex approach to child suffering from epilepsy may provide optimal development, quality of life improvement and complete social integration. Rational therapy of epilepsy in children requires good knowledge not only of age-specific syndromes, clinical pharmacology of anticonvulsants, their efficacy and range of action, but also specificity of their metabolism in children, profile of adverse effects as well as facing numerous nonmedical problems.
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Review
[Physical medicine in the diagnosis and treatment of functional disorders of the spinal column].
Manual (Physical) Medicine is concerned with physiology, pathophysiology, diagnosis and therapy of the musculoskeletal system functional disorders. Functional disorders are caused by direct or indirect injury (muscular spasm), inflammation, sudden movements etc. Functional disorders in regard to decreased joint volume are also called segmental or peripheral joint dysfunction, somatic dysfunction and function blocking. Blocking means: reversible disorder with decreased functional joint movement; muscular spasms caused by neurophysiological changes including decreased movement; pain and functional disorder of internal organs and tissues being part of the joint. Intervertebral joints, intervertebral discs, muscles and their nerve control belong to such control circles which are integrated within an organism. The basic principles of Manual (Physical) Medicine are good knowledge of functional anatomy and three-dimensional imaging of biochemical functions of the spine. The most important functions of the spinal column are as follows: it is an organ of axis with a protective and supportive function and it enables normal walk and balance. The basic functional unit in the architecture of the vertebral column is the dynamic spinal segment. Its basic function is movement, posture maintenance and protection of spinal nerve roots. The functional disorder of one part of the dynamic segment cannot be isolated from other parts. Thus functional blocks within the fascial joints, abnormalities within intervertebral discs, changes within the ligament apparatus, and muscular disorders may be both causes and consequences at the same time. The dynamic segment is thus included into a mechanical functional circle. Its mechanical function is tightly connected with the statics of the whole body. Different leg length, severe abnormalities of great leg joints may cause blocks within the fascial joints. The vertebral dynamic segment is also a part of the nervous, functional reflex circle. Clinical symptoms associated with functional disorders within intervertebral joints are as follows: restricted joint mobility and nervous reflex disorders (local segmental and peripheral segmental injuries). ⋯ Manual (Physical) therapy comprises numerous techniques and is used in various indications. (ABSTRACT TRUNCATED)
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For more than a century classical cholecystectomy has been a method of choice in surgical management of gallbladder diseases. At the end of eighties and at the beginning of nineties of this century, laparoscopic cholecystectomy has been introduced gradually taking the place of classical. Numerous studies deal with complications associated with this surgical procedure. ⋯ In spite of numerous advantages and better comfort for patients, this method may have complications, whereas incidence of bile ducts injuries seems to be higher than in the classical procedure. The more laparoscopic cholecystectomies are performed, the more bile ducts injuries occur. Out of 500 laparoscopic cholecystectomies performed at the Surgery Department of the hospital in Senta, 3.2% of mild complications were registered with 1 case needing reoperation, while in 1 case (0.2%) it was probably type A bile duct injury.