30 yaşında erkek hastanın boyun bölgesinin sol tarafı yaralı olarak acil servise getirildi. Ağır kanamaya bir camın neden olduğu gözlendi. Hastada serebral koma ve hemorojik şok meydana geldi. ...Gözbebekleri operasyon sırası ve sonrasında izokor kaldı. Hasta acil olarak ameliyathaneye alındı. Kanama dış basıyla durduruldu. Sol boyun damarlarında gerçekleşen bu durum sol karotik arter ve internal jugular ven yaralanması olarak ortaya çıkmıştır. Karotik artere geçici Pruitt- Inahara Şantı konularak yaralı ven ligature edildi. Sol karotik arter dikişi için Prolen 6-0 kullanıldı. Operasyondan sonra hasta yoğun bakım ünitesine alındı. İki saat sonra hastanın bilinci açıldı. Operasyondan sonraki ikinci günde sol göğüs drenajı uygulandı. Hasta on dört gün sonra hastaneden taburcu edildi. Sağ yüz parazisi ve orta düzey sol hemiparazisi devam etti. Olaydan iki ay sonra hastada kalıcı hiçbir nörolojik hasar gözlenmedi.
Hundreds of Kurdish villagers were forced to flee their homes in the semi-autonomous Kurdistan region of Iraq due to Turkish bombing - and are being replaced by jihadists imported from Syria.
Amaç Bu çalışmada; Kafa travması nedeniyle acil servise başvuran hastaların demografik verilerini geniş bir olgu sayısıyla değerlendirmeyi, bölgesel faktörleri belirlemeyi ve ülkemizdeki eksik olan ...epidemiyolojik veri tabanının oluşturulmasına katkı sağlamayı amaçladık.Gereç ve Yöntemler: Ocak 2008-Aralık.2009 tarihleri arasında, 2602 hastanın kayıtları geriye dönük olarak araştırılarak kafa travmalı olgular belirlendi. Kafa travması olan 531 hastanın demografik, radyolojik ve klinik bulguları ile kafa travması etyolojisi, eşlik eden yaralanmaları ve Yaralanma Ciddiyet Skoru’na göre değerlendirilerek bölgesel epidemiyolojik veriler belirlendi. Hastalar Glaskow Koma Skoruna (GKS) göre gruplandırılarak morbitide ve mortaliteye etki eden faktörler analiz edildi.Bulgular: Kafa travması sıklığı % 20,4 (n=531) olarak tespit edildi. .Etyolojik olarak en sık araç içi trafik kazalarının ve yüksekten düşmenin (sırasıyla %29 ve %24,4) akut kafa travmasına sebep olduğu belirlendi. Akut kafa travmalı hastalar GKS skorlarına göre: Hafif (n= 296;%55,8), orta (n=170;%32) ve ağır (n=65;%12,2) olarak gruplandırıldı. Ortalama ISS puanı 12 (1-38) olarak tespit edilmiştir. Düşük GKS skorlu hastalar mortalite daha fazlaydı.Sonuç: Doğu Anadolu Bölgesi’nde çok sayıda olguyla yapılan bu çalışmanın sonuçları; kafa travmalı olgularda bölgesel faktörlerin epidemiyolojik verilerde etkili olabileceğini göstermektedir. Bu çalışma, Ülkemizin diğer bölgelerinde geniş serilerle yapılacak çalışmalarla birlikte ulusal epidemiyolojik verilerimiz ortaya konmasına katkıda bulunabilir.
The use of medications that improve the physical performance of an individual represents a very serious worldwide health problem. The abuse of these medications is increasing. Herein, we describe a ...patient, at the age of 20, who was hospitalized due to loss of consciousness and difficulty breathing. At admission, the patient was unconsciousness, tahi-dyspnoic, and had a pale complexion and an athletic build. In gas analyses, extremely low saturation was observed, followed by acidosis, heavy hypoxia with normocapnia, higher lactates, hypocalcaemia and severe hypoglycaemia. The patient was treated with a hypertonic solution of glucose and intubated, with the aspiration of sanious content from the respiratory tract. After treatment, the patient woke from coma but was very confused. In the first 6 hours of hospitalization, severe hypoglycaemia occurred several times, despite the continuous administration of glucose. Due to the growth of inflammatory syndrome since the first day of hospitalization, the patient was kept in the hospital for treatment along with the administration of antibiotic treatment. On the fourth day of hospitalization, the patient stated that for the last year, he had been taking testosterone at a dose of 1 g a week, as well as tamoxifen pills and 15 i.j. of fast-acting human insulin (Actrapid
) daily for their combined anabolic effect. Hypoglycaemic coma, caused by the abuse of insulin, represents a severe complication in patients, which can be followed by confusion, a slowed thinking process, the weakening of cognitive functions and even death. It is necessary to invest great efforts into the prevention of the purchase of these medications via the Internet or on the black market for purposes of abuse in order to prevent such serious and life-threatening complications.
Latar Belakang dan Tujuan:Prevalensi stroke di Indonesia berdasarkan data dari Kementerian Kesehatan RI tahun 2013 yang terdiagnosis tenaga kesehatan atau bergejala sebesar 12,1 per mil. Jawa barat ...menempati posisi ke-13 dari 33 provinsi dengan prevalensi pasien stroke 6,6 0/00. PIS spontan dapat sangat merusak dengan kematian yang tinggidalam 30 hari pertama pascaserangan. Pasien koma (GCS 9) dengan PIS merupakan suatu keadaan yang khusus karena angka mortalitas yang sangat tinggi dan tindakan terapi yang belum tepat.Tujuan penelitian ini adalah untuk menganalisis perbandingan tindakan dekompresi hemikraniektomi evakuasi dibandingkan kraniotomi evakuasi pada pasienPIS dengan GCS 9. Subjek dan Metode:Dilakukan penelitian ini selama bulan February-Juli 2016. Penelitian ini merupakan penelitian Kohort analitik dengan rancangan penelitian analitik komparatif. Analisis statistik akan menggunakan uji-t tidak berpasangan jika sebaran data nomal, dilanjutkan dengan Man Whitney jika sebaran data tidak normal dengan menggunakan SPSS 17. Hasil: Didapatkan 16 sampel yang memenuhi kriteria inklusi penelitian. Didapatkan hasil perbandingan skor NIHS post operasi yang dilakukan dekompresi hemikraniektomi dengan kraniotomi yang memberikan hasil signifikan dengan p = 0,021 (p 0,05). Sedangkan untuk midline shift post operasi dan mortalitas 30 hari tidak memberikan perbedaan yang signifikan dengan p = 0.328 dan p = 1,00. Simpulan:Tindakan dekompresi hemikraniektomi evakuasi memberikan hasil luaran yang lebih baik dibandingkan kraniotomi evakuasi pada pasien PIS spontan di ganglia basal dengan GCS 9dengan tolak ukur skor NIHS Comparison of Outcome between Evacuative Decompressive Hemicraniectomy and Craniotomy Evacuation Spontaneous Intracerebral Hemorraghe Patients with Glasgow Coma Scale 9 Background and Objective:Indonesian stroke prevalence based upon 2013 Indonesian Health Ministry database that was diagnosed by health professionals was 12.1/mil. West Java was ranked 13 out of 33 provinces with a stroke prevalence of 6.6%. Coma patients with ICH are a special condition because of the high mortality rate and improper therapy. The aim of this study was to analyze the comparison between evacuative hemicraniectomy decompression and craniotomy evacuation upon spontaneous ICH patients with GCS 9. Subject and Method:This research was done during February-July 2016. The research used analytical cohort study with comparative analysis design. Employed statistical analysis was unpaired t-test with normal distribution or Mann Whitney if it was abnormal using SPSS ver. 17. Result:There were 16 samples that met research inclusion criteria. The results of postoperative NIHS score comparison between decompressive hemicraniectomy and craniotomy showed significant difference with p = 0.021 (p0.05). Meanwhile for postoperative midline shift and less than 30 days mortality didn’t demonstrate significant difference with respective were p = 0.328 and p = 1.00. Conclusion: Evacuative hemicraniectomy decompression gave better outcome compared with craniotomy evacuation upon spontaneous basal ganglia ICH patients with GCS 9 using NIHS score assessment.
The Middle Awash study area of Ethiopia's Afar rift has yielded abundant vertebrate fossils ( 10,000), including several hominid taxa. The study area contains a long sedimentary record spanning Late ...Miocene (5.3-11.2 Myr ago) to Holocene times. Exposed in a unique tectonic and volcanic transition zone between the main Ethiopian rift (MER) and the Afar rift, sediments along the western Afar rift margin in the Middle Awash provide a unique window on the Late Miocene of Ethiopia. These deposits have now yielded the earliest hominids, described in an accompanying paper and dated here to between 5.54 and 5.77 Myr. These geological and palaeobiological data from the Middle Awash provide fresh perspectives on hominid origins and early evolution. Here we show that these earliest hominids derive from relatively wet and wooded environments that were modulated by tectonic, volcanic, climatic and geomorphic processes. A similar wooded habitat also has been suggested for the 6.0 Myr hominoid fossils recently recovered from Lukeino, Kenya. These findings require fundamental reassessment of models that invoke a significant role for global climatic change and/or savannah habitat in the origin of hominids.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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