Annales Academiae Medicae Stetinensis
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Ann Acad Med Stetin · Jan 2013
Case Reports[Mesenteric infarction of the small bowel in the course of portal vein thrombosis - a case report].
Portal vein thrombosis is a rare entity, usually concomitant with hepatic cirrhosis and malignancies. Spontaneous disease occurs very rarely, and it presents with venous small bowel mesenteric infarction, causing intestinal ischaemia extremely rarely. ⋯ The correct diagnosis, mesenteric infarction of the small bowel in the course of portal vein thrombosis, was made after performing an abdominal computer tomography scan a week after surgery. The course of the treatment, complications, and data from the literature are presented about this very rare condition, which may constitute a difficult diagnostic problem for a surgeon.
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During the last decade there has been a striking growth in interest in ethical issues arising from the development of neurosciences. It was as late as 2002 that the new discipline, called neuroethics, started. It was intended to be a new area of interdisciplinary discourse on moral dilemmas connected with recent advances in, broadly understood, neurosciences. ⋯ Although there are some reasons for distinguishing several branches or sub-disciplines of bioethics (genethics, neuroethics, nanoethics, etc.), there are sound arguments against such a tendency for the proliferation of biomedical ethics. The second approach to neuroethics (neuroscience of ethics), which aims at studying neuronal correlates of the well-known ethical concepts (e.g. free-will, moral responsibility, etc.), seems to be much more promising. Neuroethics understood in this way (and only in this way) can be considered as a truly new opportunity for collaboration between neuroscientists and ethicists.
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The development of techniques applied in cardiac surgery changed the profile of operated patients. Patients with small lesions within the cardiovascular system are treated using invasive cardiology. The occurrence of infections is directly related to the type of surgery and the implanted material. Many hospitals, even in the developed countries, contend with hospital infections, which are the source of serious clinical and economic problems. Paradoxically, problems associated with hospital infections have grown worse along with advances in medicine and the implementation of new invasive diagnostic methods. Cardiac surgery wards are specialist units, where infections among patients are quite common. Hospital infections are dangerous for patients' health and even life. They also contribute to the failure of therapy. Therefore, the awareness of infections and their reasons, which may help to control and eliminate this problem, is so important. The aim of this study was an annual forward-looking analysis of hospital infections in the cardiac surgery ward, which included: patients' profiles, clinical forms of infections, aetiological factors and infection risk factors in patients with various types of cardiac surgical procedures. ⋯ 1. Infections were detected in 7.2% of patients. 2. Death rates among patients with infections was higher in women than in men (46.2% vs 33.3%). 3. The most common clinical forms of infection were pneumonia (44.4%), sepsis (42.0%) and surgical site infection (33.3%), however every infected patient had 1-4 clinical forms. 4. The most common aetiological factors of infection, irrespective of a clinical form, were Gram-negative rods with the prevalence of Enterobacter cloacae and Pseudomonas aeruginosa. 5. Patient-related infection risk factors included overweight and womens' age > 72, while a statistically significant increase in the incidence of infections was found in patients who had not received anti-thrombosis treatment. 6. Infection risk factors associated with treatment and specificity of the cardiac surgery ward were mainly: artificial ventilation > 24 h, the necessity for reoperation, a blood transfusion, pressor administration, treatment complications, as well as not using extracorporeal circulation and surgical site drainage. 7. Risk factors related to treatment complications included mainly: circulatory problems, renal insufficiency, respiratory insufficiency, low cardiac output syndrome and ischaemic cerebral stroke. 8. There were no correlations between infections and the course of surgery, the type of a prosthesis (mechanical/biological) or catheterization of vessels and the bladder. 9. The presented results enable the analysis of procedures used in cardiac surgery wards so far and the offer of optimal prevention measures.
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Ann Acad Med Stetin · Jan 2012
Case Reports[Macrophage activation syndrome: report on three cases].
The macrophage activation syndrome (MAS) is a rare and potentially fatal disease. This syndrome is founded on congenital or acquired dysfunction of NK cells resulting in secondary activation and proliferation of macrophages with excessive cytokine production and organ infiltration. Causes of acquired MAS include viral infections (chiefly EBV and CMV), malignancies, and autoimmune diseases. ⋯ Treatment also includes elimination of the triggering infection and high-dose glucocorticosteroids. Second-line therapy is based on cyclosporin, intravenous immunoglobulins, and etoposide. The present work focuses on diagnostic and therapeutic difficulties in three patients with the macrophage activation syndrome.
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Ann Acad Med Stetin · Jan 2012
Case Reports[Heart involvement in systemic sclerosis: analysis of four cases].
Systemic sclerosis (SSc) is an autoimmune disease characterized by multisystem involvement. Heart involvement occurs in 80-100% of cases and represents one of the more common risk factors of death. Myocardial fibrosis and vascular microangiopathy lead to arrhythmias and impaired contractility with secondary left and right heart failure. Pulmonary arterial hypertension in some patients with systemic sclerosis results in right heart failure and low output syndrome during the end-stage of the disease. The aim of the present study was to analyze four cases of systemic sclerosis with severe cardiovascular complications and a fatal outcome. ⋯ Lung and heart involvement is the most common reason for poor prognosis in systemic sclerosis. Arrhythmias, usually latent clinically, and right heart failure associated with cardiomyopathy or pulmonary hypertension are the main reasons of cardiac death in SSc patients. Severe and fatal cardiovascular complications occur more often in dcSSc, particularly during the first few years after diagnosis. Early detection of cardiovascular manifestations should be a priority in systemic sclerosis.