Medicinski pregled
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High thoracic epidural anesthesia and analgesia are being increasingly used for coronary artery bypass graft surgery. The reasons for this include excellent perioperative pain control with advantage of early tracheal extubation, improved postoperative pulmonary function, and cardiac protection due to sympthatetic blockade. ⋯ There is strong evidence for beneficial effects of high thoracic epidural anesthesia in patients undergoing surgical myocardial revascularization. However, it is still underutilized in current clinical practice.
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Review
[Erythropoietin-beta in the treatment of anemia in patients with chronic renal insufficiency].
Anemia is an early sign of chronic renal failure (CRF). Although multifactorial in origin, insufficient erythropoietin (EPO) synthesis is one of the most important factors. Other causes are: decreased erythrocyte survival (from 120 days to 70-80 days), chronic blood loss (mainly gastrointestinal and gynecological), inhibitors of erythropoiesis, inflammatory cytokines (IL-1, TNF-alpha, IFN-gamma) and malnutrition (folic acid, L-carnitine and vitamin B12 deficiency). Chronic blood loss may cause iron deficiency in about 25% of patients. Correlation between EPO level and glomerular filtration rate (GFR) is well preserved, but negative feed-back loop between hemoglobin and EPO is disturbed in patients with CRF. ⋯ The reasons for inadequate erythropoietin response are unrecognized bleeding, iron deficiency and infection/inflammation. Adverse events are very rare and predictable; they can be avoided with careful dosage and follow-up of patients. In conclusion, EPO-therapy is well established and efficient for renal anemia in dialysis and pre-dialysis patients.
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Acute postoperative pain and its therapy is a great challenge for all health-care providers in operative medicine today. Despite development of new analgesic drugs and different therapeutic modalities in pain treatment, acute postoperative pain represents a negative experience for many surgical patients. ⋯ Anesthesiologists have a central role in perioperative treatment of surgical patients (from the preoperative preparation through anesthesia and intraoperative monitoring to postoperative treatment and monitoring at the department of the intensive care and at the department of postanesthetic care). Due to abovementioned and familiarity with many therapeutic modalities, like spinal/epidural application of analgesics, regional anesthesia/analgesia many clinicians and pain specialists consider anesthesiologists are those who can organize and supervise teams for acute postoperative pain services.
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Review
[Prevention of multiple organ dysfunction syndrome in severely injured patients--current approach].
Multiple organ dysfunction syndrome (MODS) is frequent after trauma. Predisposing factors for MODS after trauma are: hypovolemic shock, massive volume replacement, time of resuscitation before hospitalization, systemic inflammatory response syndrome, infection, sepsis. Prevention of tissue hypoxia is a priority in prevention of MODS. ⋯ Tissue hypoxia and oxygen debt in injured patients are major factors which determine development of MODS. Prevention of MODS starts with respiratory and circulatory resuscitation and monitoring of tissue oxygenation prehospitally and hospitally. The first line therapy, "goal directed therapy" is not obligatory. Nutritional support, antibiotic therapy, analgesia, sedation and other therapeutic modalities contribute the ability of injured patients to survive and decrease the incidence of MODS.
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ETIOLOGY OF ONYCHOMYCOSES: Onychomycoses can be caused by dermatophytes, molds and yeasts. However, dermatophytes appear to be the chief organisms capable of a primary attack on the nail. By far the most frequent dermatophytes isolated from nails are Trichophyton rubrum, T. mentagrophytes var. interdigitale and Epidermophyton floccosum. ⋯ Histological examination is a routine technique useful for defining the nature and localization of fungi in the nail plate. Immunohistochemistry applied to onychomycosis is an experimental approach bringing prominent information about identification of fungi. In vivo confocal microscopy represents a technique of the future.