Browsing by Author "Krstić, M. (35341982900)"

One year prospective study of 25 cirrhotic patients with portal systemic encephalopathy (PSE) admitted to the Emergency Care Centre in Belgrade was performed in order to investigate the significance of clinical, biochemical and electroencephalographic (EEG) parameters and blood ammonia in the diagnosis, differential diagnosis and prognosis of PSE. 15 cirrhotic patients without PSE (of comparable age, sex, duration and etiology of liver cirrhosis) constituted the control group. Ammonia levels were elevated in 84% of patients with PSE (112 +/- 72 mumol/l) and reached normal range within 3 +/- 0.44 days, but with no correlation to clinical improvement (p greater than 0.1). Ammonia levels correlated with the severity of PSE (p less than 0.05), but not with other biochemical parameters (prothrombin time, bilirubin, albumin, urea, creatinine, potassium). Overall mortality was 44% and was strongly correlated (p less than 0.01) to the severity of PSE. In addition, the mortality in patients with gastrointestinal bleeding and PSE was higher (p less than 0.05), than in PSE precipitated by other conditions. We concluded that the ammonia may be a primary diagnostic parameter for PSE in the absence of the most important diagnostical methods (EEG, psychometric tests). Secondly, ammonia are of great diagnostic importance in patients with coma of unknown origin and can help in deciding admission priorities. The ammonia levels do not appear to be a useful prognostic factor.

INTRODUCTION: Medical practice is under continual public scrutiny. There are increasing concerns on medical malpractice and its consequences - further deterioration of health and death. Public criticism of medical practice very often outrageous, but sometimes medical negligence is obvious. AIM OF THE STUDY: We are presenting basic medicolegal analysis of causation in cases of medical malpractice with subsequent fatal outcome. CASE STUDY: We are reporting on two cases from archives of Institute of Forensic Medicine. The selected cases (biliary ileus and pseudomembranous colitis subsequent to elective cholecistectomy) may reflect common gastroenterological pathology. The analysis of medical practice and its consequences, i.e. analyse of causation has been presented and commented in regard to the pertinent legislation. CONCLUSION: Doctors ought to be familiar with medicolegal aspects of their practice. This might affect them to improve the quality of health care, and to increase protection, both of health care personal and patients.