RESUMO
The number of obese people is over one billion worldwide, and the trend is increasing. Frequent failure of conservative approach has been observed. Therefore, various surgical techniques, such as bariatric surgery, are accepted today as a safe and effective treatment of morbid obese condition, and are associated with low perioperative morbidity and mortality rates. The most popular and commonly performed procedures are those related to minimum complications and adequate weight loss: laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Since major and minor complications occur in the perioperative, early and late postoperative period, we discuss most frequent complications and importance of early recognition as well as adequate interventions.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Derivação Gástrica , Humanos , Laparoscopia , Complicações Pós-Operatórias/terapiaRESUMO
Incisional hernias occur primarily as a result of high tension and inadequate healing of a previous incision, the latter of which is frequently related to infection at the surgical site. Despite recent advances in operative techniques, the recurrence rate remains unacceptably high. To evaluate the impact of different predisposing factors for the recurrence of incisional hernia, we reviewed retrospectively the medical records of 297 patients who had undergone incisional herniorrhaphy (188 tissue repairs, 109 mesh repairs) in our hospital. Demographic data (age and gender), type of repair, body mass index, hernia size, presence of chronic illnesses and wound complications were evaluated in a univariate and multivariate manner analysis. The overall recurrence rate was 30.3%, with the recurrence rate in patients who underwent tissue repair being 39.4% and that in patients following prosthetic repair 14.6%. The recurrence rate was significantly influenced by type of repair, obesity, hernia size, wound healing disorders and some chronic comorbidities. We conclude that it is necessary to become familiar with the risk factors for recurrence of incisional hernia in order to eliminate or decrease their effect on the positive outcome of incisional herniorrhaphy.
Assuntos
Herniorrafia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Hérnia/complicações , Hérnia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
We report a case of glomangioma of the esophagus in a 28-year-old woman who presented with a 3-year history of vague discomfort, pain and heat in the neck. At initial gross examination, the tumor mimicked an esophageal papilloma. The resected esophageal specimen contained a polypoid, whitish-gray mass, which measured 3 cm in maximum diameter. Microscopically the tumor consisted of loose fibrovascular stroma heavily infiltrated with mononuclear inflammatory cells and covered with focally hyperkeratotic, parakeratotic and acanthotic squamous epithelium without atypia. In the deeper area immediately above the true muscular layer of the esophageal wall, microscopical examination revealed the neoplasm consisting of numerous, small-to-medium branched vessels covered by regular endothelium and filled with erythrocytes. The loose stroma around the vessels contained poorly circumscribed nests of small, round to oval cells with a uniform appearance. Immunohistochemically, the tumor cells were immunoreactive for smooth muscle actin and vimentin and non-immunoreactive for CD34, CD117, desmin, pan-cytokeratin, synaptophisin, neuron-specific enolase and S-100 protein. Despite its bland histology, the infiltrative growth pattern was suggestive of aggressive behavior; thus, an appropriate clinical follow-up was recommended. An accurate diagnosis and an understanding of the behavior of these rare tumors, especially in an unusual location, are crucial to their management and clinical outcome.
Assuntos
Neoplasias Esofágicas/diagnóstico , Tumor Glômico/diagnóstico , Papiloma/diagnóstico , Adulto , Diagnóstico Diferencial , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Tumor Glômico/metabolismo , Tumor Glômico/patologia , Tumor Glômico/cirurgia , Humanos , Imuno-HistoquímicaRESUMO
The purpose of this study was to evaluate the basket plate in the treatment of comminuted fractures of the distal pole of the patella (patellar apex fracture). The basket plate was designed by Smiljanic Branimir M.D., Clinical Professor of Surgery, at the Department of Surgery, The University Hospital Sestre milosrdnice, Zagreb, Croatia. In the period from 1988 to 2003, more than 100 patients with comminuted patellar apex fractures had been treated with basket plate osteosynthesis in the Department of Surgery. Only 51 patients were subsequently available for knee examination. For evaluation of the knee, we used a modified Cincinnati knee rating system, using a manual dynamometer in the evaluation of the knee extension. The results were excellent in 30 patients, good in 16 and satisfactory in 5 patients; no poor results were observed. The stability of the osteosynthesis by basket plate allows osseous consolidation if the fracture and permits loading the leg with full body weight early in the postoperative period.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Patela/lesões , Adulto , Idoso , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Patela/cirurgiaRESUMO
INTRODUCTION: Morbid obesity is a growing medical problem that has become of epidemic proportions. Various dietary and pharmaceutical approaches do not obtain acceptable long-term results. Surgery, however, especially gastric restriction, represents a viable therapeutic solution. Individuals with a body mass index (BMI) >40 kg/m2 or >35 kg/m2 with at least one severe comorbidity are considered morbidly obese and generally qualify for weightloss surgery. Laparoscopic adjustable gastric banding (LAGB) is currently the most commonly performed procedure, because it is minimally invasive, does not cause metabolic complications, is completely reversible, and is adjustable. In Croatia, the first LAGB was performed in May 2004 at Clinical Hospital "Sestre Milosrdnice." The aim of this report is to illustrate a newly performed surgical treatment and its results for morbid obesity in Croatia. METHODS: Within a 12-month period, the adjustable gastric band was implanted in 15 morbidly obese patients (female, 8; male, 7; mean age, 46.67 years; range, 26-59 years). The so-called "pars flaccida" technique was used. RESULTS: One operation required conversion to laparotomy due to a gastric lesion, and 1 laparoscopy operation was terminated due to massive postoperative adhesions. The average duration of surgery was 90+/-30 minutes. Mean length of stay was 4.9 days (range, 3-9). An average BMI at the time of surgery was 52.21 kg/m2 (range, 45.29 to 61.59; mean body weight was 155.58 kg (range, 127 to 204). Throughout 1-, 3-, 6-, 9-, and 12-month follow-ups, an average of 18.71%, 25.06%, 34.37%, 41.23%, and 47.32% of excessive weight loss (EWL) was observed. Good tolerance and a low complication rate were noted. CONCLUSION: LAGB resulted in good early results and a low complication rate. LAGB appears to be a quality surgical procedure for the management of morbid obesity.
Assuntos
Gastroplastia/métodos , Laparoscopia , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Croácia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
INTRODUCTION: N-terminal prohormone of atrial natriuretic peptide ((proANP(1-98)) has been extensively analyzed in patients with chronic renal failure. It has been found to be closely related to the renal function and to interdialytic hydration status. The clinical relevance of proANP(1-98) and cystatin C, a novel marker of glomerular filtration, has not been investigated in the subgroup of critically ill septic patients with no history of chronic renal impairment. METHODS: We measured plasma level ofproANP(1-98) and cystatin C in 29 critically ill septic patients on admittance to the surgical intensive care unit and correlated it with the occurrence of acute renal failure. RESULTS: The proANP(1-98) plasma level was significantly higher in the group of patients who developed renal failure (12,722 +/- 12,421 vs. 2,801+/- 2,023 fmol/ml, p < 0.05). Multiple regression analysis shows that proANP(1-98) on the first day in the intensive care unit has a superior predictive value for the occurrence of renal failure to diuresis, calculated creatinine clearance or cystatin C (r = 0.42, p < 0.039). proANP(1-98) is also higher in non-survivors (9,303.8 +/- 11,053 vs. 2,448.5 +/- 1,803 fmol/ml, p < 0.018). CONCLUSION: proANP(1-98) is possibly a better predictor of acute renal failure to calculated creatinine clearance or diuresis among critically ill septic patients. Cystatin C was not correlated with occurrence of acute renal failure in this subgroup of patients.
Assuntos
Injúria Renal Aguda/etiologia , Fator Natriurético Atrial/sangue , Cistatinas/sangue , Fragmentos de Peptídeos/sangue , Sepse/sangue , Injúria Renal Aguda/sangue , Adolescente , Adulto , Idoso , Biomarcadores , Estado Terminal , Cistatina C , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/sangue , Peritonite/complicações , Valor Preditivo dos Testes , Estudos Prospectivos , Sepse/complicações , Sepse/mortalidadeRESUMO
N-terminal pro-atrial natriuretic peptide [proANP(1-98)] has been extensively investigated in patients with chronic heart failure and ishemic heart disease. It is found to be a better marker of cardiac dysfunction than atrial natriuretic peptide (ANP). The possible involvement of proANP(1-98) in cardiac depression caused by sepsis has not been studied yet. Therefore, we analyzed atrial plasma concentration of proANP(1-98) in 17 septic patients with hemodynamic variables measured or calculated using pulmonary artery catheter. The results of altogether 96 measurements show a significant negative correlation of proANP(1-98) and cardiac index (p<0.024), oxygen delivery (p<0.03) and oxygen consumption (p<0.03). There is also a positive correlation with pulmonary vascular resistance (p<0.03). ProANP(1-98) is significantly higher in patients who developed acute respiratory distress syndrome (ARDS) (p<0.001). This study implies that proANP(1-98) is a possible novel hormone marker of cardiac depression caused by sepsis that could be used for prediction of ARDS.
Assuntos
Acidose/fisiopatologia , Débito Cardíaco/fisiologia , Hemodinâmica/fisiologia , Hipóxia/fisiopatologia , Animais , Gasometria , Pressão Sanguínea/fisiologia , Cães , Feminino , Masculino , Circulação Pulmonar/fisiologia , Termodiluição , Função Ventricular Direita/fisiologiaRESUMO
BACKGROUND/AIMS: Study of acceptance of simultaneous laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography for treatment of cholelithiasis with choledocholithiasis. METHODOLOGY: There were 25 patients. Ten patients had acute pancreatitis of biliary etiology, accompanied by transitory icterus. In 15 patients, choledocholithiasis was suspected preoperatively both on ultrasonography and i.v. cholangiography. In all patients laparoscopic cholecystectomy with perioperative endoscopic retrograde cholangiopancreatography and sphincterotomy were performed for the treatment of cholelithiasis and choledocholithiasis. RESULTS: Simultaneous laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography was successfully done in all patients. The patients were discharged home on the 4th day after the surgery. Concerning early complications, there where 3 early complications, e.g., prolonged hemorrhage after papillotomy in a patient with choledocholithiasis with stenotic papillitis. Conservative therapy (fresh frozen plasma, local hemostats) was used in this patient. In 4 patients with choledocholithiasis, transitory hyperamylasemia was observed, with no clinical symptoms of pancreatitis. The symptoms disappeared with conservative therapy 3 days after the beginning of treatment. CONCLUSIONS: Simultaneous laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography for treatment of cholelithiasis and choledocholithiasis is a safe and acceptable treatment.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Cálculos Biliares/cirurgia , Ampola Hepatopancreática/cirurgia , Colelitíase/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Totally extraperitoneal laparoscopic hernia repair is an efficient but technically demanding procedure. As mechanisms of hernia recurrence may be related to these technical difficulties, we have modified a previously described double-mesh technique in an effort to simplify the procedure. Extraperitoneal laparoscopic hernia repairs were performed in 82 male and 17 female patients having inguinal, femoral, and recurrent bilateral hernias. A standard propylene mesh measuring 15 x 15 cm was cut into two pieces of 4 x 15 cm and 11 x 15 cm. The smaller mesh was placed over both inguinal rings without splitting. The larger mesh was then inserted over the first mesh and stapled to low-risk zones, reinforcing the large-vessel area and the nerve transition zone. The mean procedure duration was 60 minutes for unilateral and 100 minutes for bilateral hernia repair. Patients were discharged from the hospital within 48 hours. The mean postoperative follow-up was 22 months, with no recurrences, neuralgia, or bleeding complications. Over a 2-year period, this technique was found to be satisfactory without recurrences or significant complications. In our hands, this technique was easier to perform: it allows for a less than perfect positioning of the meshes and avoids most of the stapling to crucial zones.
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Telas Cirúrgicas , Adulto , Idoso , Alcenos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterectomy (EST). In addition, serum pancreatic enzymes increase without clinical symptoms in up to 75% of patients undergoing endoscopic procedures. The aim of this trial was to investigate the effects of octreotide in the prevention of these possible complications in patients undergoing therapeutic ERCP. The study was carried out in 209 subjects who were randomly allocated to two groups (A and B). Group A received 0.5 mg of octreotide-acetate subcutaneously one hour prior to ERCP; group B was given placebo. Serum amylase and lipase values were measured before premedication and 1.5, 2, 6 and 24 hours following endoscopy. Following ERCP, the increase in both amylase and lipase values was significantly greater in the control (placebo) group, but this significance disappeared 24 hours following the procedure. Symptoms of acute pancreatitis developed in 4 (3.85%) patients who were given octreotide-acetate, compared to 10 (9.52%) patients in the control group. The results obtained in our study seem to indicate that octreotide could prevent the increase in serum pancreatic enzymes, but no significant difference was observed in the prevention of post-ERCP pancreatitis.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Fármacos Gastrointestinais/uso terapêutico , Octreotida/uso terapêutico , Pancreatite/prevenção & controle , Doença Aguda , Amilases/sangue , Método Duplo-Cego , Feminino , Humanos , Lipase/sangue , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Esfinterotomia EndoscópicaRESUMO
BACKGROUND/AIM: The occurrence of apoptotic cells was analyzed in human normal gastric mucosa, polyps and adenocarcinomas. METHODOLOGY: Histological classification was carried out on hematoxylin and eosin stained slides. The tissue was classified as follows: Normal gastric mucosa or adenomatous polyps. Gastric carcinoma specimens were histologically classified according to Lauren's classification into: A: Diffuse adenocarcinoma without metastasis, B: Diffuse adenocarcinoma with metastasis, C: Intestinal adenocarcinoma without metastasis, D: Intestinal adenocarcinoma with metastasis, E: Mixed adenocarcinoma without metastasis and mixed adenocarcinoma with metastasis. The counting of apoptotic cells was performed using the 40X objective with a calibrated eyepiece Weibel's multi-purpose M 42 stereological test system. Each group was evaluated stereologically, determining numeric density of apoptotic cells. RESULTS: The results show the progressive and statistically significant increase of apoptotic numeric densities from normal gastric epithelium to adenomatous polyp and finally to cancer, which contained the highest number of apoptotic cells. Comparing gastric carcinoma with and without metastasis in intestinal and diffuse adenocarcinoma there was statistically significant difference. In these two groups, carcinomas with metastasis contained higher number of apoptotic cells than without metastasis. Gastric cancer according to numeric densities of apoptotic cells can be separated in tree statistically different groups: A: Intestinal type gastric cancer with metastasis (the highest number of apoptotic cells), B: Intestinal type gastric cancer without metastasis and diffuse gastric cancer with metastasis (medium number), C: Diffuse type gastric cancer without metastasis, mixed gastric cancer with and without metastasis (the lowest number of apoptotic cells). CONCLUSION: These results suggest that numeric densities of apoptotic cells are associated with tumor progression in human gastric carcinogenesis and can be used as prognostic mark.
Assuntos
Adenocarcinoma/patologia , Apoptose , Pólipos/patologia , Neoplasias Gástricas/patologia , Idoso , Feminino , Mucosa Gástrica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Organization of the first war hospital (War Hospital Dakovo) in the 1991/1992 war in Croatia is presented. During the 13-month period 15123 patients were examined, among them 747 wounded. Complete treatment in the hospital was provided for 334 wounded. Only 23 wounded died immediately after admission, or later on in other hospitals. Most wounds were single and caused by shrapnel. Among the wounded, 75.8 per cent were Croatian soldiers, 22 per cent civilians and 2.2 per cent enemy soldiers.
Assuntos
Hospitais Militares/organização & administração , Guerra , Ferimentos e Lesões/epidemiologia , Adulto , Croácia/epidemiologia , Humanos , Índices de Gravidade do Trauma , Triagem , Ferimentos e Lesões/terapia , Ferimentos Penetrantes/epidemiologiaRESUMO
Stump cancer is the most severe late complication of stomach resection due to peptic disease. Recent clinical studies show an increase in the incidence of gastric carcinoma in patients who underwent stomach resection, in comparison to the general population. Cancers detected within the first four years following resection are considered a consequence of false pathological diagnosis. The etiologic factors which contribute to the development of "late" gastric carcinomas (20-40 years after initial operation) remain unknown. In this retrospective study, we have analysed the incidence of stomach cancer in the whole population of patients operated for peptic disease (stomach resection methods and vagotomy) in our Department over the "1973 to 1993" period. A total of 1343 patients were operated on for malignant diseases of the stomach, and 4531 patients underwent surgery for peptic disease. Gastric stump cancer surgery was performed in 35 (0.8%) patients following resection of the stomach for peptic disease. Their mean age was 63.5 years. An average of 21.4 years elapsed from the initial surgery to the diagnosis and reoperation of the stump cancer. Results of the study point to the importance of a systematic follow-up of patients who underwent stomach surgery due to peptic disease regardless of the surgery applied. Early detection of stomach cancer in previously operated patients is the most important factor contributing to their successful treatment.
Assuntos
Adenocarcinoma/etiologia , Coto Gástrico , Úlcera Péptica/cirurgia , Neoplasias Gástricas/etiologia , Idoso , Feminino , Seguimentos , Gastrectomia , Gastroenterostomia , Humanos , Masculino , Estudos Retrospectivos , Fatores de TempoRESUMO
We are of the opinion that it is less important whether a large mental hospital is regionalized or not, but whether it is possible to realize the principle of universal psychiatric protection as a "unity of responsibilities of all subjects who take part in the protection of mental health and the society in the whole" by improvement and advancement of the existing system. We accept the opinion that the internal organization of mental hospitals has to be changed by organizing hospitals wards with 30-50 beds. We consider that in a perspective organization of psychiatric protection of all institutions (large hospitals, clinic, psychiatric wards of general hospitals, dispensaries and health centers) have their role and that the achieved level of the protection greatly depends on socio-economic level and possibilities.
Assuntos
Hospitais Psiquiátricos/tendências , Previsões , Hospitais Psiquiátricos/organização & administraçãoRESUMO
Fifty-two severely wounded patients, admitted directly from a battlefield or after surgical treatment in a war hospital, were treated in the Surgical Intensive Care Unit of the 'Sisters of Mercy' University Hospital in Zagreb during the 1991 war in Croatia. Considering the severity of the wounds, blood loss was not as severe as expected. This can be attributed to the nature of the injuries as most of the patients were wounded by fragments of explosive devices which cause less tissue destruction than military bullets. Low serum potassium levels, metabolic acidosis, low total protein levels and consequently low serum calcium levels correlated with wound severity. Low serum potassium levels were caused by its redistribution. Reperfusion liver injury was also present. Consumption coagulopathy was one of the characteristic disturbances in this type of injury. There was a relatively big difference between fluid input and output caused by fluid loss through drain sites and large open wound surfaces. The low mortality of the severely wounded was due to their young age and the well-organized military medical service which was developed from the civilian medical service in a short time.
Assuntos
Cuidados Críticos/métodos , Guerra , Ferimentos e Lesões/terapia , Acidose/etiologia , Adulto , Croácia/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar , Hospitais Universitários , Humanos , Concentração de Íons de Hidrogênio , Escala de Gravidade do Ferimento , Masculino , Militares , Potássio/sangue , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidadeRESUMO
In 10 wounded Croatian Army soldiers and in 10 civilians with accidental musculosceletal traumatisation, blood concentrations of the 3 acute phase proteins: fibrinogen, alpha-1-antitrypsin and alpha-2-macroglobulin on the 1st, 5th and 10th postoperative day were assessed. On the 5th day after injury, increased concentrations of all 3 acute phase proteins (APP) were found in all patients. The rise of the fibrinogen concentrations in the wounded soldiers was the steepest. On the 10th day after wounding, fibrinogen concentrations in the gorup of wounded soldiers were significantly lower than those in the group of injured civilians. On the 10th day after wounding there were no differences between the 2 groups in the concentrations of alpha-1-antitrypsin and of alpha-2-macroglobulin. The lower fibrinogen concentrations in the wounded soldiers could be explained by the modulation of the general reactivity of the organism to injury, proposed by Woloski, which is induced by stress and microtrauma on battlefield before the wounding.
Assuntos
Nível de Alerta/fisiologia , Fibrinogênio/metabolismo , Militares , Fraturas da Tíbia/sangue , Guerra , Ferimentos por Arma de Fogo/sangue , alfa 1-Antitripsina/metabolismo , alfa-Macroglobulinas/metabolismo , Adulto , Traumatismos do Braço/sangue , Croácia , Humanos , Traumatismos da Perna/sangue , Masculino , Cicatrização/fisiologiaRESUMO
A group of 1592 male Croatian soldiers (average age 32 +/- 9, ranging from 19 to 54) were examined by an internist at the war hospital. Elevated blood pressure was found in 80 men (5%); 61 of them had no history of hypertension (Group A), while in 19 patients hypertensive disease had been diagnosed before (Group B). In group A, systolic blood pressure (BPS in mm Hg), diastolic blood pressure (BPD in mm Hg) and heart rate (HR) were 182 +/- 13, 111 +/- 10, and 115 +/- 9; in group B, the values were 184 +/- 12, 108 +/- 8, 85 +/- 11. Electrocardiograms (ECG) and thorax roentgenograms of group A did not reveal any hypertension-caused signs, neither did the examination of the fundus, nor the serum creatinine values yield any abnormal results. The ECG test showed sinus tachycardia (heart rate > 100/min) but an otherwise normal function in group A. In group B, at least one of the laboratory examinations confirmed the previously diagnosed hypertension. Group A was treated with the cardioselective beta-blocker Atenolol (100 mg daily), while in group B, the previous antihypertensive medication was modified and/or increased. All patients were sent back to the front-line. Three days later, blood pressure and heart rate in group A were: BPS 139 +/- 9, BPD 87 +/- 6 and HR 77 +/- 8; and in group B: 156 +/- 11, 95 +/- 8, 75 +/- 7. A significant decrease in systolic and diastolic blood pressure (p < 0.0001) was found in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Nível de Alerta/fisiologia , Hipertensão/fisiopatologia , Militares , Receptores Adrenérgicos beta/fisiologia , Guerra , Adulto , Nível de Alerta/efeitos dos fármacos , Atenolol/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Croácia , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Receptores Adrenérgicos beta/efeitos dos fármacos , Síndrome , Taquicardia Sinusal/tratamento farmacológico , Taquicardia Sinusal/fisiopatologiaRESUMO
We presented four patients with hepatolenticular degeneration--Wilson or hepatocerebral dystrophy-Wilson-Konovalov by soviet authors. Our cases were nervous variable of this disease or pseudosclerose (Westphal-Strumphell). The first three patients showed rigid--trembling and one trembling form of disease. All, patients were male. We think that it is very important early identification of this disease, to reduce time from acute manifestation to make a diagnosis and to apply appropriate therapy. This time period in our cases lasted from 0 to 4 years. Except use d- penicillamine (to 900 mg/daily) we think that is also very important use the acidum ascorbicum (to 4.5 gr/daily). This acidum shows less consumption of d- penicillamine and has low complication. Recurrent working ability begins with disappearance of neurological phenomenology and with rehabilitation of psychic status. All our patients we examined by ergometric and psychological tests and we obtained in results working ability population. In our experience and from therapeutic results to make this diagnosis does not mean a priori definite working ability.