The treatment of Meniere's disease

Meniereova bolest je bolest unutrašnjeg uha koja se manifestira karakterističnim trijasom simptoma: vrtoglavicom, fluktuacijom sluha i šumom u uhu. Etiologija bolesti je nejasna. Okidač za nastanak Meniereove bolesti može biti stres, imunološki poremećaj, poremećaj metabolizma vode i elektrolita, vaskularni poremećaji te razna druga stanja. Bolest počinje iznenada, slabljenjem sluha, šumom u uhu i vrtoglavicama koje su često praćene vegetativnim simptomima mučnine i povraćanja. Nakon prestanka napadaja stanje bolesnika se normalizira. U početku bolesti sluh fluktuira, ali ponavljanjem napadaja dolazi do postupnog trajnog oštećenja sluha. Dijagnoza se postavlja na temelju anamneze i kliničke slike. Liječenje Meniereove bolesti može biti konzervativno i kirurško. Konzervativno liječenje se provodi u početnoj fazi bolesti i sastoji se od sedativa, antivertiginoznih lijekova, vazodilatatora, antihistaminika te kortikosteroida. Također, preporuča se smanjen unos soli u organizam. Kad je bolest rezistentna na konzervativnu terapiju, preporuča se kirurško liječenje. Postoje četiri skupine zahvata: lokalna primjena antibiotika u srednje uho, destruktivni i drenažni zahvati te vestibularna neurektomija. Destruktivni zahvat se najčešće izvodi intratimpanalnom aplikacijom ototoksičnog antibiotika. Drenažni zahvati omogućuju otjecanje endolimfe preko endolimfatičkog sakusa u subarahnoidalni prostor. Vestibularna neurektomija se izvodi selektivnom resekcijom vestibularnog živca, najčešće retrosigmoidnim pristupom.Meniere’s disease is a condition of the inner ear manifested by the triad of symptoms: vertigo, fluctuating hearing and tinnitus. The etiology of the disease remains unclear. Stress, immune system disorders, disorders of water and electrolyte metabolism, vascular disorders as well as various other conditions can all trigger Meniere’s disease. The disease starts suddenly with tinnitus and vertigo, often accompanied by symptoms of nausea and vomiting. After such attacks, the patient’s condition tends to stabilize. The disease starts with fluctuating hearing loss, but repeated attacks of Meniere’s result in gradual permanent damage to patient’s hearing. The diagnosis is based on the anamnesis and clinical features. The treatment of Meniere’s disease can be conservative and surgical. Conservative treatment is applied at an early stage of the disease and includes sedation, antivertigo medications, vasodilatators, antihistaminics and corticosteroids. Reducing salt intake is also recommended. When the disease is resistant to conservative therapy, there is a proposed surgical treatment. There are four surgical procedures: local application of antibiotics in the middle ear, destructive and drainage procedure and vestibular neurectomy. A destructive procedure is mostly carried out by intratympanal application of ototoxic antibiotics. Drainage procedure releases endolymph through endolymphatic sac into subarachnoid space. Vestibular neurectomy is carried out by selective resection of the vestibular nerve, usually by the retrosigmoid approach

The treatment of Meniere's disease

Meniereova bolest je bolest unutrašnjeg uha koja se manifestira karakterističnim trijasom simptoma: vrtoglavicom, fluktuacijom sluha i šumom u uhu. Etiologija bolesti je nejasna. Okidač za nastanak Meniereove bolesti može biti stres, imunološki poremećaj, poremećaj metabolizma vode i elektrolita, vaskularni poremećaji te razna druga stanja. Bolest počinje iznenada, slabljenjem sluha, šumom u uhu i vrtoglavicama koje su često praćene vegetativnim simptomima mučnine i povraćanja. Nakon prestanka napadaja stanje bolesnika se normalizira. U početku bolesti sluh fluktuira, ali ponavljanjem napadaja dolazi do postupnog trajnog oštećenja sluha. Dijagnoza se postavlja na temelju anamneze i kliničke slike. Liječenje Meniereove bolesti može biti konzervativno i kirurško. Konzervativno liječenje se provodi u početnoj fazi bolesti i sastoji se od sedativa, antivertiginoznih lijekova, vazodilatatora, antihistaminika te kortikosteroida. Također, preporuča se smanjen unos soli u organizam. Kad je bolest rezistentna na konzervativnu terapiju, preporuča se kirurško liječenje. Postoje četiri skupine zahvata: lokalna primjena antibiotika u srednje uho, destruktivni i drenažni zahvati te vestibularna neurektomija. Destruktivni zahvat se najčešće izvodi intratimpanalnom aplikacijom ototoksičnog antibiotika. Drenažni zahvati omogućuju otjecanje endolimfe preko endolimfatičkog sakusa u subarahnoidalni prostor. Vestibularna neurektomija se izvodi selektivnom resekcijom vestibularnog živca, najčešće retrosigmoidnim pristupom.Meniere’s disease is a condition of the inner ear manifested by the triad of symptoms: vertigo, fluctuating hearing and tinnitus. The etiology of the disease remains unclear. Stress, immune system disorders, disorders of water and electrolyte metabolism, vascular disorders as well as various other conditions can all trigger Meniere’s disease. The disease starts suddenly with tinnitus and vertigo, often accompanied by symptoms of nausea and vomiting. After such attacks, the patient’s condition tends to stabilize. The disease starts with fluctuating hearing loss, but repeated attacks of Meniere’s result in gradual permanent damage to patient’s hearing. The diagnosis is based on the anamnesis and clinical features. The treatment of Meniere’s disease can be conservative and surgical. Conservative treatment is applied at an early stage of the disease and includes sedation, antivertigo medications, vasodilatators, antihistaminics and corticosteroids. Reducing salt intake is also recommended. When the disease is resistant to conservative therapy, there is a proposed surgical treatment. There are four surgical procedures: local application of antibiotics in the middle ear, destructive and drainage procedure and vestibular neurectomy. A destructive procedure is mostly carried out by intratympanal application of ototoxic antibiotics. Drainage procedure releases endolymph through endolymphatic sac into subarachnoid space. Vestibular neurectomy is carried out by selective resection of the vestibular nerve, usually by the retrosigmoid approach

Igra za sve

Uvid prema kojem je igra koja se odvijala u sobi dnevnog boravka imala spolno sterotipan predznak, ponukao je odgajateljicu Ivu Tucić da zajedno s djecom pokuša osmisliti novi vid zajedničkog sudjelovanja u aktivnosti izrade didaktičkog sredstva koje će jednako biti namijenjeno djevojčicama i dječacima i dodatno obogatiti prostor za igru i učenje

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CLINICAL COMPARISON OF INVOS OXYMETRY AND ARTERIAL LACTATE LEVELS AS A PREDICTOR OF PERIPHERAL PERFUSION AND REPERFUSION IN VASCULAR SURGERY PATIENTS

Cilj ovog probnog projekta je evaluacija primjene INVOS oksimetrije za optimalizaciju anesteziološkog postupka kod operacija reperfuzije donjih ekstremiteta u bolesnika s perifernom arterijskom bolešću (PAB). Ispitanici: U probnom projektu evaluirana su 4 bolesnika s kritičnom ishemijom donjih ekstremiteta. Uz elektrodu za indikaciju cerebralne perfuzije (crSO2), drugu INVOS elektrodu za indikaciju periferne perfuzije, postavili smo distalno od vaskularne kleme (prSO2). Dobivene podatke smo koristili kao prediktore periferne perfuzije i nužnosti intervencije, a podatke smo usporedili s koncentracijom laktata arterijske krvi. Rezultati: Početne prosječne crSO2 vrijednosti bile su 62,25 %, a prSO2 53,5 %. Prosječno trajanje arterijske okluzije bilo je 61 min. Pacijenti su primili u prosjeku 1275 mL kristaloida i 500 mL koloida. Najviše izmjerene vrijednosti laktata aterijske krvi bile su 0,7 mmol/L. Postoperacijski crSO2 iznosio je prosječno 73 %, a prSO2 69,75 %. Prosječna hospitalizacija trajala je 19,25 dana, s 30-dnevnim preživljavanjem od 100 %, bez potrebe reoperacije ili amputacije. Rasprava: Pretragom dostupne literature nismo pronašli sličnih kliničkih iskustava primjene optičke spektrometrije kao metode mjerenja intraoperacijske perfuzije ishemičnog ekstremiteta. Koristeći INVOS za poboljšanje perfuzije periferije koristili smo minimalnu vazoaktivnu potporu i restriktivnu bolusnu primjenu intravenskih tekućina uz zadovoljavajući klinički ishod.The aim of this pilot project was to evaluate the use of INVOS oxymetry to optimize anesthesia in lower extremities in patients with peripheral arterial disease (PAD). Four patients with critical ischemia of lower extremities were evaluated. With the electrode indicating cerebral perfusion (crSO2), another INVOS electrode was placed distally from the vascular clamp (prSO2). The data obtained were used as predictors of peripheral perfusion and necessity of intervention. We compared the aforementioned data with the arterial blood lactate levels. The initial mean crSO2 and prSO2 value was 62.25% and 53.5%, respectively. The mean duration of arterial occlusion was 61 minutes. The patients received a mean of 1275 mL crystalloids and 500 mL colloids. The highest measured lactate value was 0.7 mmol/L. Postoperative crSO2 averaged 73% and prSO2 69.75%. The mean length of hospital stay was 19.25 days, with a 30-day survival rate of 100%, without the need of reoperation or amputation. Reviewing the scientific literature available, we found no similar clinical experiences of optical spectrometry used as a method of measuring intraoperative perfusion of the ischemic extremity. Utilizing INVOS data to improve perfusion of periphery, we used minimal vasoactive support and restrictive bolus administration of intravenous fl uids with a satisfactory clinical outcome

The treatment of Meniere's disease

Meniereova bolest je bolest unutrašnjeg uha koja se manifestira karakterističnim trijasom simptoma: vrtoglavicom, fluktuacijom sluha i šumom u uhu. Etiologija bolesti je nejasna. Okidač za nastanak Meniereove bolesti može biti stres, imunološki poremećaj, poremećaj metabolizma vode i elektrolita, vaskularni poremećaji te razna druga stanja. Bolest počinje iznenada, slabljenjem sluha, šumom u uhu i vrtoglavicama koje su često praćene vegetativnim simptomima mučnine i povraćanja. Nakon prestanka napadaja stanje bolesnika se normalizira. U početku bolesti sluh fluktuira, ali ponavljanjem napadaja dolazi do postupnog trajnog oštećenja sluha. Dijagnoza se postavlja na temelju anamneze i kliničke slike. Liječenje Meniereove bolesti može biti konzervativno i kirurško. Konzervativno liječenje se provodi u početnoj fazi bolesti i sastoji se od sedativa, antivertiginoznih lijekova, vazodilatatora, antihistaminika te kortikosteroida. Također, preporuča se smanjen unos soli u organizam. Kad je bolest rezistentna na konzervativnu terapiju, preporuča se kirurško liječenje. Postoje četiri skupine zahvata: lokalna primjena antibiotika u srednje uho, destruktivni i drenažni zahvati te vestibularna neurektomija. Destruktivni zahvat se najčešće izvodi intratimpanalnom aplikacijom ototoksičnog antibiotika. Drenažni zahvati omogućuju otjecanje endolimfe preko endolimfatičkog sakusa u subarahnoidalni prostor. Vestibularna neurektomija se izvodi selektivnom resekcijom vestibularnog živca, najčešće retrosigmoidnim pristupom.Meniere’s disease is a condition of the inner ear manifested by the triad of symptoms: vertigo, fluctuating hearing and tinnitus. The etiology of the disease remains unclear. Stress, immune system disorders, disorders of water and electrolyte metabolism, vascular disorders as well as various other conditions can all trigger Meniere’s disease. The disease starts suddenly with tinnitus and vertigo, often accompanied by symptoms of nausea and vomiting. After such attacks, the patient’s condition tends to stabilize. The disease starts with fluctuating hearing loss, but repeated attacks of Meniere’s result in gradual permanent damage to patient’s hearing. The diagnosis is based on the anamnesis and clinical features. The treatment of Meniere’s disease can be conservative and surgical. Conservative treatment is applied at an early stage of the disease and includes sedation, antivertigo medications, vasodilatators, antihistaminics and corticosteroids. Reducing salt intake is also recommended. When the disease is resistant to conservative therapy, there is a proposed surgical treatment. There are four surgical procedures: local application of antibiotics in the middle ear, destructive and drainage procedure and vestibular neurectomy. A destructive procedure is mostly carried out by intratympanal application of ototoxic antibiotics. Drainage procedure releases endolymph through endolymphatic sac into subarachnoid space. Vestibular neurectomy is carried out by selective resection of the vestibular nerve, usually by the retrosigmoid approach

Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients from 29 Countries

Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. Results: Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%. Conclusions and Relevance: In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events - in particular cardiovascular instability - were observed frequently