Wiadomości lekarskie (Warsaw, Poland : 1960)
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Case Reports
[Lance-Adams syndrome in patient with anoxic encephalopathy in the course of bronchial asthma].
Lance-Adams syndrome, described in 1963, is caused by anoxia of central nervous system, generally in the course of primary respiratory failure. It is characterized mainly by action myoclonus, associated cerebellar ataxia and very mild intellectual deficit. Occurrence of Lance-Adams syndrome is rare; about 100 cases have been described yet. ⋯ CT of the brain was normal. Action myoclonus responded appropriately to sodium valproate. The authors indicate the importance of the correct diagnosis and proper treatment.
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Ornithine transcarbamylase deficiency is the most common inherited urea cycle disorder. Its clinical manifestations as lethargy, vomites, coma and cerebral edema are the effect of the higher concentration of the ammonia in plasma. Hyperammonemia, caused by mutation in ornithine transcarbamylase gene, is often considered as a reason of coma by pediatricians but skipped by internist, although it is the third reason of hepatic coma in adults. This article is the recapitulation of published studies and their implication on everyday clinical practice.
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Transvenous pacemaker lead malposition in the left ventricle is a rare complication of pacemaker implantation however, at the moment of diagnosis poses the serious therapeutic problem. The usual morphology for paced events originating from the right ventricle has a left bundle branch block pattern, but sometimes right bundle branch block (RBBB) configuration is identified. The report describes two cases of RBBB configuration in the electrocardiogram (ECG) after pacemaker implantation. ⋯ The following algorithm of procedures during pacemaker implantation is proposed to avoid the lead malposition in the left ventricle. First, obligatory perform 12-lead ECG in pace mode during surgery or immediately after it. Second, in case of RBBB pattern in post implant ECG, make ECHO for precise lead position description.
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Comparative Study
[Analysis of labour and perinatal complications in case of foetus weight over 4000 g].
The fetal macrosomia occurs in 3-15% pregnancies. It is recognized when foetus weight exceeds 4000 g in any period of pregnancy. Macrosomia can also be determined in case of foetus weight over 90 percentyl for the appropriate pregnancy period. The most detrimental foetal complications of macrosomia are: shoulder dystocia with Erb's brachial palsy, facial nerve palsy, clavicular and humeral bone fracture. The attempts in order to eliminate these complications lead to increase in the number of caesarean sections and labour inductions. Clinical examination and assessment of risk factors as well as ultrasonographic examination cannot exclude or confirm the possibility of macrosomia with sufficient specificity and sensitivity. On the other hand it is well known that delivery of macrosomic foetus is not always associated with perinatal complications. The aim of the study was to assess the risk of perinatal complication in foetuses with large birth weight. ⋯ Significant increase in the frequency of perinatal complications in foetuses with birth weight over 4500 g indicates the necessity of considering caesarean section as a favourable mode of delivery.
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A risk of haemorrhage in arteriovenous malformations (AVM) of the brain is estimated as 2-4% per year. A mortality rate from this reason is estimated as 1% per year and morbidity 10-20%. The methods of treatment ofAVM are: microsurgical treatment, radiosurgery, endovascular treatment. The aim of this work is presentation of our results of surgical treatment of AVM and comparison with the results of radiosurgical and endovascular treatment presented by other authors in the literature. ⋯ In the conclusion we want to emphasize the advantages of surgical treatment of AVM's of the brain especially these including in I to III score according to Spetzler-Martin scale comparing with the results ofradiosurgical and endovascular methods of treatment.