Vŭtreshni bolesti
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In a previous paper (Balanova, Surcheva and Ichev, 2001) we have proposed a scheme about pathophysiological mechanisms involved in dyspnea. Some of the clinical problems in dyspnea were discussed in this paper on the base of that scheme, as well as clinical observations on the patients with dyspnea. Two groups of symptoms were considered--subjective and objective, and their significance for the diagnosis of the dyspnea and of the disease that provokes dyspnea were evaluated. A critical analysis of the different forms of dyspnea has been made, and suggestions about the treatment of the subjective symptoms in dyspnea were proposed.
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An analytical review was made on the pathophysiological mechanisms suspected to be involved in dyspnea, accepting that the sensation of shortness of breathing, and the subjective signs (exertion, anxiety and fear) are essential for the diagnosis of this condition. Bearing in mind the anatomical relations in the central nervous system between the structures involved in the control and regulation of the respiration, and these involved in the emotions, a scheme was presented of the pathophysiological mechanisms, which determine the essential signs of the dyspnea. Three neuronal circuits were assumed for the explanation of the manifestations in dyspnea: subjective signs, symptoms of the thoraco-pulmonary and cardio-vascular systems, and these of the voluntary muscular system that accompanied dyspnea.
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Adult respiratory distress syndrome (ARDS) represents an excessively dangerous acute respiratory failure, as result of diffuse damage of alveolocapillary membranes in stiff noncompliant lungs. ARDS is a widely disseminated syndrome caused by severe etiologic factors. ARDS usually appears within 12 to 72 hours of an identifiable clinical event and progresses through three phases: 1. exudative phase; 2. alveolar membrane damage and pulmonary surfactant systems; and 3. proliferative phase. ⋯ ARDS progresses through three clinical phases: 1. basis respiratory failure; 2. progressive respiratory failure; and 3. total respiratory failure. The therapy of ARDS is complex. It consists of: 1. background general therapy of ARDS; 2. background supportive therapy of ARDS; 3. definitive therapy to interrupt mechanisms of inflammation and pulmonary injury; 4. new pharmacologic supportive therapy.
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Comparative Study
[Effect of age and the duration of the peptic ulcer on reflux changes of the esophageal mucosa].
446 patients with an active peptic ulcer were examined. In 81.2% of them gastroesophageal reflux was found. In 220 patients the changes in the esophageal mucosa were studied morphologically. ⋯ In 70.3% of the patients with a history of peptic ulcer over 15 years a reflux esophagitis was found and in 34.5% of the patients it was well expressed while in only 39% of the patients with a 5 year history of the disease a reflux esophagitis was found histologically and it was well expressed in 8.1% of them. Gastroesophageal reflux and reflux esophagitis are more frequent in patients over 40 years of age and in these patients the more severe forms prevail. The longer is the duration of the disease the greater is the number of cases with well expressed destructive changes.