Acta chirurgica Iugoslavica
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This article explains the most frequent psychiatric disorders such as co-morbidity in the acute surgical treatment, along with its position and importance for the surgical procedure. Besides basic features of these disorders, epidemiology and clinical expression, this article holds the latest therapeutic approach, side effects, toxicity and drug interactions, during the surgical procedure. Frequent postoperative problems, delirium, and postoperative cognitive disorders are noted in these patients. To avoid these complications, it is recommended to use a mini-mental score examination to re-evaluate the decision and indication for high risk surgery patient.
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In patients with respiratory pathology changes in respiratory physiology may lead to clinical problems during the conduct of anesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anesthesiologist to account for the potential complications of these conditions and manage the anesthetic accordingly. ⋯ A thorough medical history, physical examination and some functional tests are the keys in decision-making in preparation for anesthesia and surgery. The burden of respiratory disease is reviewed, and some important areas of current interest are highlighted.
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Cardiomyopathies are myocardial diseases in which there is structural and functional disorder of the heart muscle, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease. Cardiomyopathies are grouped into specific morphological and functional phenotypes: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and unclassified cardiomyopathies. Patients with dilated and hypertrophic cardiomypathy are prone to the development of congestive heart failure in the perioperative period. ⋯ Drug therapy should be optimized and continued preoperatively. Surgery should be delayed (unless urgent) in patients with decompensated or untreated cardiomyopathy. Preoperative evaluation requires integrated multidisciplinary approach of anesthesiologists, cardiologist and surgeons.
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Intra-abdominal compartment syndrome (ACS) are increasingly recognised to be a contributing cause of organ dysfunction and mortality in critically ill patients. The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra abdominal pressure (IAP). This syndrome is most commonly observed in the setting of severe abdominal trauma. ⋯ Preventing ACS by the identification of patients at risk and early diagnosis is paramount to its successful management. Because of the frequency of this condition, routine measurement of intra abdominal pressure should be performed in high risk patients in the intensive care unit. Surgical decompression is definitive treatment of fully developed abdominal compartment syndrome, but nonsurgical measures can often effectively affect lesser degrees of IAH and ACS.
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Originally the main idea was to obtain a stable patella, i.e., to stabilize the "slipping patella". In the past many conditions like patella alta, ligamentous laxity, PF bone hypoplasia, weakness of the quadriceps muscle, genu valgum or genu recurvatum were thought to predispose to patellar instability. For a long period muscle exercises were instituted to strengthen the weak m.vastus medialis and to make vastus lateralis stronger. ⋯ Muscle imbalance as well as anatomical abnormalities are the basis both for patellar instabilities and reasonable surgical procedures were: proximal extensor mechanism realignment, proximal capsular reefing, patellar tendon splitting and its medial transfer. On the other hand bone procedures on the hypoplastic lateral femoral condyle were also performed by Albee, as well as tibial tubercle transfer and trochleoplasty by deepening of the trochlea (Dejour). An understanding of the pathoanatomic basis is the corner stone for