Difficulties and complications during surgical treatment of otosclerosis

Orthostatic intolerance can present a very serious limitation to astronauts attempting any functions requiring the upright position. Vasovagal syncope is a common cause of fainting characterized by paradoxic bradycardia and vasodilation in the presence of decreasing arterial pressure. Several mechanisms have been proposed to mediate vasovagal syncope and it seems likely that redundant mechanisms exist both centrally and peripherally which can mediate these responses. Spaceflight alters reflex control of cardiovascular function in several ways which may influence susceptibility to vasovagal syncope provoked by the Bezold-Jarisch reflex.     

Efficacy of lomefloxacin in treatment of nonspecific inflammatory diseases and in prophylaxis of postoperative complications in urology

Clinical and bacteriological efficacies of lomefloxacin and ofloxacin were comparatively estimated in the treatment of 104 urologic patients with nonspecific inflammatory diseases and in 36 urologic patients for prophylaxis of inflammatory complications after surgical interventions. The majority of the urinary tract pathogens i.e. Enterobacteriaceae spp. and gramnegative nonfermenting bacteria were highly susceptible to both the fluoroquinolones. The clinical and bacteriological efficacies of lomefloxacin amounted to 94.4 and 80.7 per cent and those of ofloxacin to 92 and 79.2 per cent respectively. The prophylactic use of lomefloxacin and ofloxacin was efficient in 94.7 and 94.1 per cent of the cases respectively. The antibacterial prophylaxis in urologic patients should be applied not only at the period of surgical interventions but also during the early postoperative period.     

Acupuncture in treatment of inflammatory rheumatic diseases

Seventeen studies were examined with regard to efficacy and scientific quality of acupuncture in rheumatoid arthritis, spondarthropathy, lupus erythematosus, local and progressive systemic scleroderma. Acupuncture cannot be recommended for treatment of these diseases. By far, the most studies examined failed to show sufficient quality.     

Oral complications during treatment of malignant diseases in childhood: effects of tooth brushing

During anticancer treatment, oral lesions considerably aggravate the child's clinical condition and increase the risk of infection. This prospective study evaluated the incidence, nature and chronology of oral complications arising during the first 6 weeks of chemotherapy. 131 children were included in this study, and their oral and dental health evaluated on enrolment. Each child was observed once a week, for 6 weeks. Fifty-two per cent (68/131) of the children presented with at least one oral lesion. Two oral healthcare regimens (with or without tooth brushing) were evaluated. Tooth brushing significantly reduced the number of children affected. Standardised multicentre studies should permit the definition of oral care regimens which would eliminate pain and reduce the risk of infection in children hospitalised for cancer.     

Immunopathogenesis of gastrointestinal and hepatobiliary diseases

The largest lymphoid organ in the body is the gut and the gut-associated lymphoid tissue. The mucosal immune system faces many challenges in protecting the body from microbial invasion. Its chief function is to maintain a diverse population of mature lymphocytes capable of responding to foreign antigens. This task is accomplished with a variety of unique features that distinguish the mucosal from the systemic immune system. In addition, the mucosal immune system plays a role in inflammatory bowel disease, Whipple disease, autoimmune gastritis, Helicobacter pylori infection, immunoproliferative small intestinal disease, hepatitis A, B, C, D, E, F, and G, autoimmune hepatitis, primary biliary cirrhosis, progressive sclerosing cholangitis, and vanishing bile duct syndrome.     

Clinical-statistical prognosis of gastroduodenal erosion and ulcer incidence after surgical treatment of inflammatory disease of hepato-biliary tract]

The challenges the prospective payment system (PPS) pose to managers in postacute care are enormous. Managers need to learn not only how to prepare their facilities and staff for PPS but also, and more important, how to provide the leadership to carry out a strategic plan for survival. In effect, this new reimbursement system, based on 44 resource utilization groups (RUGS III)--each with a distinct payment level--will necessitate a reexamination of managerial competencies.     

Videothoracoscopy for diagnosis and treatment of respiratory tract diseases

Orthopaedic nurses often are well-educated in dealing with patients' physical and psychologic needs but lack education in caring for the spiritual needs of man. Nurses must realize they, themselves, have spiritual needs and must invest in clarifying their own values and beliefs as well as their patients. To perform a complete spiritual assessment, nurses need to become familiar with the concept of spirituality and what it means in the care of patients. Providing spiritual care is individualized and often complex. The nursing process enables the nurse to plan patient care. Providing spiritual care is a challenge orthopaedic nurses must recognize and assume responsibility for.     

Clinical significance of fungal and microbial associations and antibacterial therapy for treatment of chronic inflammatory respiratory tract diseases in children

Microbiological examination applied to 270 children with chronic inflammatory and relapsing respiratory tract diseases revealed that by the frequency of the etiologically significant organisms the main pathogens isolated from the bronchial secretion belonged to Haemophilus influenzae, then followed Streptococcus pneumoniae and the less frequent isolates belonged to Branhamella catarrhalis characterized by high susceptibility to the 2nd and 3rd generation cephalosporins, erythromycin and azithromycin. Mycological investigation of the oral mucus and sputum from the patients revealed high frequency of Candida, mainly C.albicans. The fungi were most frequent and abundant in the children with chronic pulmonary diseases and congenital immune deficiency and in the children with bronchial asthma and asthmatic bronchitis, as well as in the children with exacerbation of the chronic disease, especially with bronchial obstruction. The antibacterial therapy with semisynthetic penicillins, cephalosporins and macrolides led to an increase in the number of the Candida carriers and in the biological material contamination level. The fungal contamination of the host was mainly observed after the use of the penicillins and cephalosporins. Chronic Candida carriers were detected among the patients with chronic inflammatory diseases of the lungs. The diseases in such patients were particularly severe. There were also detected children with colonization resistance to Candida. In the latter cases the chronic process was more favourable. The data made it possible to recommend a more differential use of the antibacterial and antimycotic drugs in the treatment of children with chronic inflammatory diseases of the bronchopulmonary system.     

Popliteal aneurysm: surgical treatment is mandatory before complications occur

Between 1972 and 1995, surgical repair was undertaken for 94 popliteal aneurysms diagnosed in 71 patients (69 men and 2 women) with a mean age of 66 years. Ninety-one femoropopliteal bypasses, 2 lumbar sympathectomies and one primary amputation were performed. Postoperative results of 28 elective bypasses performed for asymptomatic aneurysms (AA) were compared with 63 revascularisations needed for symptomatic aneurysms (SA) secondary to thrombosis (31%), embolization (30%), venous or nerve compression (13%), or rupture (2.1%). Occlusion of at least one tibial vessel was documented angiographically in 40% of the asymptomatic aneurysms and in 80% of the symptomatic aneurysms. No significant difference was observed between 5-year graft-patency of asymptomatic aneurysms (64%, mean followup 30 months +/- 37.2) and symptomatic aneurysms (50%, mean followup 39 months +/- 40.9). Furthermore, 5-year graft patency was not influenced by the number of patent tibial vessels in either of these populations. No statistically significant difference between these two groups was observed with respect to morbidity (AA: 10.7%, SA: 19%), or early reintervention (AA: 7.1%, SA: 9.5%). However, 12 secondary amputations were needed, all of which were performed after repair of a symptomatic aneurysm (19%, p < 0.05). No postoperative mortality was observed after an elective bypass while 3 patients (4.8%) with symptomatic aneurysms died after an emergency surgery. Ischemic symptoms persisted in 56% of patients who were initially symptomatic. Surgical correction should therefore be performed once the diagnosis of a popliteal aneurysm has been established in order to prevent amputation and late sequelae.     

The surgical treatment of hepatic echinococcosis and of its biliary complications

The authors report the experience of 47 patients submitted to surgery for hepatic hydatidosis. Results from different therapeutic procedures are then compared. Finally, possible biliary complications of the hepatic echinococcosis and their surgical treatment are discussed.     

Surgical treatment of postop abdominal hernia in elderly and geriatric patients

The results were summarized on surgical treatment of 56 patients, ageing 60-85 years, for femoral hernia using two methods--according to Bassini and original one stipulated for femoral ring strengthening using implant made of poliuretane in hernial sac tunic fixed without tension to inguinal and public ligaments. Recurrence of hernia in the late follow-up period have occurred in 13.6% of patients operated on according to Bassini and was never observed after operation performed using original method.