Panminerva medica
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New techniques of laparoscopy: gasless, open Hasson, optic trocars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alternative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery. ⋯ The introduction of new techniques of laparoscopy: gasless, open Hasson, optic trocars has broadened the application of operative laparoscopy. Gasless technique in lieu of conventional laparoscopy can be performed reliably and safely for most gynaecological indications. The most outstanding benefit of this method is that it can be combined with a vaginal approach which is not possible using a pneumoperitoneum due to gas leakage. The place of gasless laparoscopy will depend on continuing development by instrument manufacturers, in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.
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Randomized Controlled Trial Clinical Trial
Heparin-coated circuits reduce complement activation and inflammatory response to cardiopulmonary bypass.
Clinical procedures involving extracorporeal blood circulation are potentially complicated by the interaction of various blood systems with foreign surfaces. In cardiopulmonary bypass, exposure of blood to synthetic surfaces generally leads to activation of cellular and humoral blood systems with activation of complement cascade. This reaction can be associated with a variety of postoperation clinical complications such as increased pulmonary capillary permeability, anaphylactic reactions and various degrees of organ failure which contributes to mortality in routine cardiac operations. Application of biocompatible materials in an extracorporeal circuit modifies the normal pattern of blood activation, and therefore potentially may reduce clinical complications in routine cardiac surgery. ⋯ In conclusions using the Duraflo II heparin-coated circuit in open heart surgery can reduce the complement activation and inflammatory response to cardiopulmonary bypass.
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Comparative Study Clinical Trial
Clinical validation of an automatic device measuring blood pressure in the fingers.
To assess the agreement between a new automatic device (FS-20D) using a cuff-oscillometric method to measure arterial blood pressure (BP) in the fingers and a standard mercury sphygmomanometer. ⋯ The monitor was proved to be reliable with a good level of precision and accuracy. The FS-20D monitor may be used in self-monitoring of blood pressure of patients with slight to moderate hypertension.
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Review Case Reports
Munchausen's syndrome. A case of factitious hemoptysis.
Factitious hemoptysis is the bleeding type of Munchausen's syndrome, rarely reported in the literature (only seventeen cases). After a careful and detailed literature review, the authors report the case of a 22-year-old working-woman, with a history of asthma, Mediterranean anaemia and recurrent hemoptysis, who was admitted several times to the cardiovascular and Respiratory Sciences Department in the Carlo Forlanini Hospital in 1994 for an asthmatic attack and wheeziness at rest. During the admissions the patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, tuberculin test, cold agglutinins and pneumotropic virus tests) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, bronchography, perfusion and ventilation lung scan), because she continually presented with hemoptysis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when she was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient's history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hemoptysis in Munchausen's syndrome was made.
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In cases of thermal injuries it is always difficult to predict the extent of necrosis to the peripheral ischemic zone. Practically, full-thickness skin burn also affects the underlying muscle, panniculus carnosus, which adheres tightly to the skin. In this proposed model, the muscle which was always partly damaged also covers the ischemic zone of full-thickness burn injury. To evaluate the deeper levels of injury, the status of the micro circulation of thermally affected muscle was evaluated by counting the accumulated radioactive agent, 99mTc methoxyisobutylisonitril (MIBI) in the muscle cells. ⋯ Muscle layer, where just below the burn area and tightly attached to the skin, could be assessed as a representative of the extension of the injury.