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Grgić D, Prijić R, Romić I, Augustin G, Markoš P, Korša L, Marušić Z, Rustemović N, Krznarić Ž. A Single Small Bowel Hemangioma Detected by Video Capsule Endoscopy in a Patient Presenting with Iron-deficiency Anemia - Two Case Reports. Prague Med Rep 2020; 120:138-143. [PMID: 31935349 DOI: 10.14712/23362936.2019.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hemangioma of the small intestine is a rare vascular malformation which mostly presents as occult gastrointestinal bleeding and iron-deficiency anemia. Patients are often asymptomatic except of fatigue due to anemia. Hemangiomas can arise anywhere in the luminal gastrointestinal tract, with jejunum as the most commonly involved site. They are very hard to recognize mostly due to their localization. Video capsule endoscopy and balloon-assisted enteroscopy have very much improved preoperative diagnostics and made major contribution to establishing the diagnosis - which was very difficult in the past and almost all cases were diagnosed during or after the operation. Surgical resection is still the conventional treatment modality, although with the improvement of endoscopic therapeutic interventions (endoscopic mucosal resection, argon-plasma coagulation) there are more therapeutic possibilities.
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Affiliation(s)
- Dora Grgić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Radovan Prijić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Romić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pave Markoš
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lea Korša
- Deparment of Pathology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zlatko Marušić
- Deparment of Pathology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nadan Rustemović
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Željko Krznarić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Valori R, Cortas G, de Lange T, Balfaqih OS, de Pater M, Eisendrath P, Falt P, Koruk I, Ono A, Rustemović N, Schoon E, Veitch A, Senore C, Bellisario C, Minozzi S, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Spada C, Bisschops R, Rutter M. Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50:1186-1204. [PMID: 30423593 DOI: 10.1055/a-0755-7515] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.
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Affiliation(s)
- Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - George Cortas
- University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Thomas de Lange
- Department of Transplantation, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Omer Salem Balfaqih
- Thamar University, Medical College, Dhamar; and Hadramout University, Medical College, Mukalla, Yemen
| | - Marjon de Pater
- Department of Gastroenterology Endoscopy, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Pierre Eisendrath
- Hepatogastroenterology department, CHU Saint-Pierre, Université libre de Bruxelles, Brussels, Belgium
| | - Premysl Falt
- University Hospital Olomouc, and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Irfan Koruk
- Department of Gastroenterology, Istanbul Bilim University Medical School, Istanbul, Turkey
| | - Akiko Ono
- Unidad de Endoscopia Digestiva, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Nadan Rustemović
- GI Endoscopy Unit, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cathy Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education and Department of Gastroenterological Oncology; and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center, and Institute of Oncology, Warsaw, Poland; and Department of Health Management and Health Economics, University of Oslo, Norway
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia; and Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology. University Hospital Leuven, Leuven, Belgium
| | - Mathew Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK.,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
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Valori R, Cortas G, de Lange T, Salem Balfaqih O, de Pater M, Eisendrath P, Falt P, Koruk I, Ono A, Rustemović N, Schoon E, Veitch A, Senore C, Bellisario C, Minozzi S, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Spada C, Bisschops R, Rutter M. Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2018; 7:21-44. [PMID: 30788114 DOI: 10.1177/2050640618810242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 12/18/2022] Open
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.
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Affiliation(s)
- Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - George Cortas
- University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Thomas de Lange
- Department of Transplantation, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Omer Salem Balfaqih
- Thamar University, Medical College, Dhamar; and Hadramout University, Medical College, Mukalla, Yemen
| | - Marjon de Pater
- Dept. of Gastroenterology Endoscopy, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Pierre Eisendrath
- Hepato-Gastroenterology department, CHU Saint-Pierre, Université libre de Bruxelles, Brussels, Belgium
| | - Premysl Falt
- University Hospital Olomouc, and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Irfan Koruk
- Department of Gastroenterology, Istanbul Bilim University Medical School, Istanbul, Turkey
| | - Akiko Ono
- Unidad de Endoscopia Digestiva, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Nadan Rustemović
- GI Endoscopy Unit, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cathy Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland, Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education and Department of Gastroenterological Oncology; and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center, and Institute of Oncology, Warsaw, Poland; and Department of Health Management and Health Economics, University of Oslo, Norway
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia; and Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Mathew Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK.,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
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Patrun J, Okreša L, Iveković H, Rustemović N. Diagnostic Accuracy of NICE Classification System for Optical Recognition of Predictive Morphology of Colorectal Polyps. Gastroenterol Res Pract 2018; 2018:7531368. [PMID: 29725349 PMCID: PMC5872609 DOI: 10.1155/2018/7531368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/08/2018] [Indexed: 12/19/2022] Open
Abstract
The NICE classification is an international endoscopic classification of colorectal neoplasia through a narrowband spectrum that on the basis of lesion colors, vascular pattern, and structure of the surface of the mucous membrane classifies colorectal neoplasms in three categories: type 1 as hyperplastic lesions, type 2 as adenomas, and type 3 as invasive tumors. The aim of this study was to verify diagnostic accuracy of the NICE classification system compared to the reference standard: histopathological analysis. This retrospective study was conducted by ten physicians on a sequential sample of 418 patients and 735 polyps. The total diagnostic accuracy of the NICE classification system is found to be 76.7%. Optical recognition is significantly better with larger polyps, high-risk lesions (HGIEN), and neoplastic lesions. This research has shown that the NICE classification system is at the moment inferior to histopathological analysis. However, it is noticed that some physicians achieve significantly better results, with the accuracy of diagnosis ranging from 59.5% to 84.2%. These results show that with proper training of physicians and the use of endoscope enhancements to improve image quality, the NICE classification system could in the future potentially replace the histopathological diagnosis process.
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Affiliation(s)
- Josipa Patrun
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lucija Okreša
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hrvoje Iveković
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nadan Rustemović
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
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Majerović M, Jelaković M, Premužić M, Štromar IK, Radić D, Mance M, Pleština S, Ostojić R, Rustemović N, Krznarić Z. Hepatocellular Carcinoma Surveillance-Experience from Croatian Referral Centre for Chronic Liver Diseases. J Gastrointest Cancer 2017; 50:48-53. [PMID: 29127665 DOI: 10.1007/s12029-017-0011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE For patients at high-risk of developing hepatocellular carcinoma (HCC), biannual ultrasound surveillance has long been recommended, in order to detect the tumor in the early, potentially curative stages. However, globally reported HCC surveillance rates vary greatly, ranging from as low as 1.7 to as high as 80%. Our aim was to assess the utilization of surveillance with biannual ultrasound in high-risk Croatian patients and to identify the factors that impact the implementation of the recommended protocol. METHODS This retrospective study included 145 newly diagnosed HCC patients in the period from January 2010 to September 2015. We identified low-risk and high-risk patients. The latter were further subdivided into the regular biannual ultrasound surveillance group and the non-surveillance group. The groups were compared according to demographic characteristics and BCLC stage at the time of HCC diagnosis. RESULTS Among 145 patients, 80 patients were classified as high-risk according to EASL criteria. During the relevant period, 28.7% underwent regular surveillance, while 71.25% did not. Younger patients were more likely to undergo surveillance (OR 0.935 CI 0.874-0.999; p = 0.05). The patients who underwent regular surveillance had a higher chance of being diagnosed at a curative stage (BCLC 0 or A) (OR 3.701 CI 1.279-10.710; p < 0.05).Gender was not a predictor of participation in the regular surveillance protocol. Among the high-risk patients who did not undergo regular surveillance, 56.1% were not aware of the chronic liver disease prior to the HCC diagnosis. CONCLUSION HCC surveillance is still underutilized in high-risk Croatian patients despite its obvious benefits possibly due to the untimely diagnosis of the chronic liver disease.
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Affiliation(s)
- Matea Majerović
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Mislav Jelaković
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Marina Premužić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Ivana Knežević Štromar
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Radić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Marko Mance
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepko Pleština
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Rajko Ostojić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Nadan Rustemović
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Zeljko Krznarić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
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Ćuti EĆ, Rustemović N, Perkov D. Erratum to: 12th WINFOCUS world congress on ultrasound in emergency and critical care. Crit Ultrasound J 2016; 8:13. [PMID: 27778305 PMCID: PMC5078117 DOI: 10.1186/s13089-016-0050-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 12/04/2022] Open
Affiliation(s)
- Edina Ćatić Ćuti
- General Hospital Zabok and Hospital of Croatian Veterans, Zabok, Croatia.
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Acar Y, Tezel O, Salman N, Cevik E, Algaba-Montes M, Oviedo-García A, Patricio-Bordomás M, Mahmoud MZ, Sulieman A, Ali A, Mustafa A, Abdelrahman I, Bahar M, Ali O, Lester Kirchner H, Prosen G, Anzic A, Leeson P, Bahreini M, Rasooli F, Hosseinnejad H, Blecher G, Meek R, Egerton-Warburton D, Ćuti EĆ, Belina S, Vančina T, Kovačević I, Rustemović N, Chang I, Lee JH, Kwak YH, Kim DK, Cheng CY, Pan HY, Kung CT, Ćurčić E, Pritišanac E, Planinc I, Medić MG, Radonić R, Fasina A, Dean AJ, Panebianco NL, Henwood PS, Fochi O, Favarato M, Bonanomi E, Tomić I, Ha Y, Toh H, Harmon E, Chan W, Baston C, Morrison G, Shofer F, Hua A, Kim S, Tsung J, Gunaydin I, Kekec Z, Ay MO, Kim J, Kim J, Choi G, Shim D, Lee JH, Ambrozic J, Prokselj K, Lucovnik M, Simenc GB, Mačiulienė A, Maleckas A, Kriščiukaitis A, Mačiulis V, Macas A, Mohite S, Narancsik Z, Možina H, Nikolić S, Hansel J, Petrovčič R, Mršić U, Orlob S, Lerchbaumer M, Schönegger N, Kaufmann R, Pan CI, Wu CH, Pasquale S, Doniger SJ, Yellin S, Chiricolo G, Potisek M, Drnovšek B, Leskovar B, Robinson K, Kraft C, Moser B, Davis S, Layman S, Sayeed Y, Minardi J, Pasic IS, Dzananovic A, Pasic A, Zubovic SV, Hauptman AG, Brajkovic AV, Babel J, Peklic M, Radonic V, Bielen L, Ming PW, Yezid NH, Mohammed FL, Huda ZA, Ismail WNW, Isa WYHW, Fauzi H, Seeva P, Mazlan MZ. 12th WINFOCUS world congress on ultrasound in emergency and critical care. Crit Ultrasound J 2016; 8:12. [PMID: 27604617 PMCID: PMC5014769 DOI: 10.1186/s13089-016-0046-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
TABLE OF CONTENTS A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MožinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovšek, Boštjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.
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Affiliation(s)
- Yahya Acar
- Department of Emergency Medicine, Etimesgut Military Hospital, Ankara, Turkey.
| | - Onur Tezel
- Department of Emergency Medicine, Etimesgut Military Hospital, Ankara, Turkey
| | - Necati Salman
- Department of Emergency Medicine, Etimesgut Military Hospital, Ankara, Turkey
| | - Erdem Cevik
- Department of Emergency Medicine, Van Military Hospital, Van, Turkey
| | | | | | | | - Mustafa Z Mahmoud
- Radiology and Medical Imaging Department, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdelmoneim Sulieman
- Radiology and Medical Imaging Department, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abbas Ali
- Critical Care Medicine, Geisinger Medical Center, Danville, USA.
| | - Alrayah Mustafa
- Department of Radiology, Medical Specialization board, University of Khartoum, Khartoum, Sudan
| | | | - Mustafa Bahar
- Department of Surgery, University of Khartoum, Khartoum, Sudan
| | - Osama Ali
- Emergency Medicine, The Academic Teaching Hospital, Khartoum, Sudan
| | | | - Gregor Prosen
- Department of Emergency Medicine, University Clinical Center Maribor, Maribor, Slovenia
| | - Ajda Anzic
- University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Paul Leeson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Maryam Bahreini
- Department of Emergency, Sinai Hospital, Tehran, Iran. .,Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Rasooli
- Department of Emergency, Sinai Hospital, Tehran, Iran. .,Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Gabriel Blecher
- Monash Emergency Research Collaborative, Monash University, Clayton, Australia. .,Emergency Program, Monash Health, Monash Medical Centre, Clayton, Australia.
| | - Robert Meek
- Monash Emergency Research Collaborative, Monash University, Clayton, Australia.,Emergency Program, Monash Health, Monash Medical Centre, Clayton, Australia
| | - Diana Egerton-Warburton
- Monash Emergency Research Collaborative, Monash University, Clayton, Australia.,Emergency Program, Monash Health, Monash Medical Centre, Clayton, Australia
| | - Edina Ćatić Ćuti
- General Hospital Zabok and Hospital of Croatian Veterans, Zabok, Croatia.
| | - Stanko Belina
- General Hospital Zabok and Hospital of Croatian Veterans, Zabok, Croatia
| | - Tihomir Vančina
- General Hospital Zabok and Hospital of Croatian Veterans, Zabok, Croatia
| | - Idriz Kovačević
- Department of Veterans Affairs, Treatment Center, Miami, USA
| | | | - Ikwan Chang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chi-Yung Cheng
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
| | - Hsiu-Yung Pan
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
| | - Chia-Te Kung
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Ela Ćurčić
- Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Ena Pritišanac
- Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivo Planinc
- Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijana Grgić Medić
- University Hospital Zagreb, Zagreb, Croatia. .,Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia. .,Division of Intensive Care Medicine, KBC Zagreb, Zagreb, Croatia.
| | - Radovan Radonić
- University Hospital Zagreb, Zagreb, Croatia.,Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Abiola Fasina
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Anthony J Dean
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Department of Internal Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Nova L Panebianco
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Internal Medicine, University of Pennsylvania, Philadelphia, USA
| | - Patricia S Henwood
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Oliviero Fochi
- Pediatric intensive care, Ospedale papa giovanni XXIII, Bergamo, Italy.
| | - Moreno Favarato
- Pediatric intensive care, Ospedale papa giovanni XXIII, Bergamo, Italy
| | - Ezio Bonanomi
- Pediatric intensive care, Ospedale papa giovanni XXIII, Bergamo, Italy
| | - Ivan Tomić
- University Hospital Zagreb, Zagreb, Croatia.,Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,Division of Intensive Care Medicine, KBC Zagreb, Zagreb, Croatia
| | - Youngrock Ha
- Department of EM, Bundang Jesaeng Hospital, Seongnam, Korea.
| | - Hongchuen Toh
- Acute and Emergency Care Center, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Elizabeth Harmon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Wilma Chan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Emergency Medicine, University of Pennsylvania, Philadelphia, USA
| | - Cameron Baston
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Internal Medicine, University of Pennsylvania, Philadelphia, USA
| | - Gail Morrison
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Frances Shofer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Internal Medicine, University of Pennsylvania, Philadelphia, USA
| | - Angela Hua
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA. .,Department of Emergency Medicine, Northwell Health, New Hyde Park, USA.
| | - Sharon Kim
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - James Tsung
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Isa Gunaydin
- Department of Emergency Medicine, School of Medicine, Cukurova University, Adana, Turkey
| | - Zeynep Kekec
- Department of Emergency Medicine, School of Medicine, Cukurova University, Adana, Turkey
| | - Mehmet Oguzhan Ay
- Department of Emergency, Corum Education and Research Hospital, Hitit University, Corum, Turkey
| | - Jinjoo Kim
- Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Jinhyun Kim
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Gyoosung Choi
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Dowon Shim
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Ji-Han Lee
- Chungbuk National University Hospital, Cheong-Ju, South Korea
| | - Jana Ambrozic
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Katja Prokselj
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - Gabrijela Brzan Simenc
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Asta Mačiulienė
- Department of Anaesthesiology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Almantas Maleckas
- Department of General Surgery, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Algimantas Kriščiukaitis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytautas Mačiulis
- Department of Anaesthesiology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Andrius Macas
- Department of Anaesthesiology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania.
| | - Sharad Mohite
- Department of Paediatrics, Children's Emergency, National University Hospital, Singapore, Singapore
| | - Zoltan Narancsik
- Emergency Medical Unit, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Hugon Možina
- Emergency Medical Unit, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Nikolić
- Faculty of Medicine, University of Maribor, Maribor, Slovenia.
| | - Jan Hansel
- Landspítali University Hospital, Reykjavík, Iceland
| | - Rok Petrovčič
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Una Mršić
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | | | | | - Niklas Schönegger
- Medical University Graz, Graz, Austria.,Sono4You Graz, Graz, Austria
| | - Reinhard Kaufmann
- Medical University Graz, Graz, Austria.,Sono4You Graz, Graz, Austria
| | - Chun-I Pan
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
| | - Chien-Hung Wu
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | | | | | - Sharon Yellin
- New York Methodist Hospital, Brooklyn, New York, USA
| | | | - Maja Potisek
- Internal Medicine Department, General Hospital Trbovlje, Trbovlje, Slovenia.
| | - Borut Drnovšek
- Internal Medicine Department, General Hospital Trbovlje, Trbovlje, Slovenia
| | - Boštjan Leskovar
- Internal Medicine Department, General Hospital Trbovlje, Trbovlje, Slovenia
| | - Kristine Robinson
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Clara Kraft
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Benjamin Moser
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Stephen Davis
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Shelley Layman
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Yusef Sayeed
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.,Department of Occupational Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Joseph Minardi
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Irmina Sefic Pasic
- Radiology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
| | - Amra Dzananovic
- Radiology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Anes Pasic
- Oncology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sandra Vegar Zubovic
- Radiology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ana Godan Hauptman
- Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Jaksa Babel
- Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marina Peklic
- Division of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Luka Bielen
- Division of Intensive Care Medicine, KBC Zagreb, Zagreb, Croatia
| | - Peh Wee Ming
- Singapore General Hospital, Singapore, Singapore
| | | | | | - Zainal Abidin Huda
- Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia.
| | | | - W Yus Haniff W Isa
- Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia
| | - Hashairi Fauzi
- Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia
| | - Praveena Seeva
- Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia
| | - Mohd Zulfakar Mazlan
- Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia
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8
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Bišof V, Juretić A, Stančić-Rokotov D, Rustemović N, Miletić D, Boban M, Omrčen T, Razumović JJ, Pavlović I, Fröbe A, Čonkaš M, Rakušić Z, Gugić D. [CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCERS]. Lijec Vjesn 2016; 138:233-239. [PMID: 30148543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Esophageal and esophagogastric junction cancers comprise histologically and biologically different malignant tumors in which the progress in the understanding of the disease has not been followed by the improvement in the survival. Diagnosis is set by tumor biopsy during endoscopy. Multimodal approaches containing surgery, radiotherapy and chemotherapy are frequently applied in the treatment of locoregionally advanced disease. However, the optimal sequence of the treatment options is still the issue of numerous clinical trials and meta-analyzes. Metastatic disease is treated with palliative chemotherapy and best supportive care. Treatment decisions should be individualized according to patients’ characteristics and made after multidisciplinary team discussion. The following text presents the clinical guidelines in order to standardize the diagnostic procedures, treatment and monitoring of patients with esophageal and esophagogastric junction cancers in the Republic of Croatia.
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9
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Majerović M, Boban A, Premužić M, Radić D, Knežević-Štromar I, Ladić A, Krznarić Ž, Rustemović N, Ostojić R. [ABNORMALITIES OF HEMOSTASIS IN PATIENTS WITH LIVER CIRRHOSIS]. Lijec Vjesn 2016; 138:272-281. [PMID: 30148556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Until the beginning of the 90ies, it was believed that patients with liver cirrhosis were auto-anticoagulated and thus protected from thromboembolic events. However, new discoveries have broken the longstanding paradigm. In deranged hepatic function there is a reduced synthesis of procoagulants and endogenous anticoagulants, however, extrahepatally synthesized hemostatic and fibrinolytic factors are disproportionately affected. In stable disease hemostatic system is ”rebalanced’’ but fragile, therefore, even a minimal stress can promote bleeding or thrombosis. Also, there are many concomitant factors, such as hemodynamic changes, other organ affection, namely kidney, and predisposition to infection, that shift the balance towards either bleeding or thrombosis. Conventional laboratory tests are not sufficient for evaluation of the bleeding risk, prothrombotic risk factors are not clearly identified, and safety profile of antithrombotic drugs is not precisely evaluated since cirrhotic patients are mainly excluded from big clinical trials. For all that is said, the diagnostic and therapeutic approach in this context is complex and requires teamwork of a hepatologist, hematologist and in a phase of operative treatment, the anesthesiologist. In this review article, we will discuss mechanisms of hemostatic and fibrinolytic abnormalities of liver cirrhosis, the incidence of thromboembolic events as well as prophylactic and therapeutic options in the setting of conservative treatment.
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10
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Iveković H, Brljak J, Bilić B, Markoš P, Pulanić R, Ostojić R, Rustemović N. THE OVER-THE-SCOPE-CLIP FOR THE TREATMENT OF THE DIGESTIVE TUBE LEAKS AND TEARS: A CASE-SERIES. Lijec Vjesn 2016; 138:79-84. [PMID: 30146853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Digestive tube damages represent a therapeutic challenge for the gastrointestinal endoscopists. Recenty, a novel device – the-over-the-scope clip (OTSC) – has been introduced for non-surgical treatment of gastrointestinal perforations, fi stula, anastomotic leaks and refractory gastrointestinal bleeds. This study aimed to evaluate the therapeutic effi cacy of OTSC in our case series. A total of nine patients were included (six males, medain age 72 years, range 58-86). The indications were upper gastrointestinal bleeding (refractory to standard endoscopic treatment: fi ve patients, a vessel with a large caliber: one patient), fi stula in two patients, and iatrogenic perforation of the sigmoid colon in one patient. Atraumatic and traumatic versions of OTSCs with twin graspers were used. All of the patients were treated with only one OTSC, and none of the patients required additional endoscopic treatment. The OTSC procedure had 100% technical success. In a subgroup of patients with perforation and fi stulae, the clinical success was 67%, whereas in those with the bleedings it was 50%. The median follow-up was 34 days (range: 3-452). OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic effi cacy was subopimal in patients with the upper gastrointestinal bleedings possibly due to the application of the sharp-teeth OTSC.
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11
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Brljak J, Iveković H, Bilić B, Kovačić I, Markoš P, Brkić T, Ostojić R, Rustemović N. [PREDICTORS OF POOR BOWEL PREPARATION FOR COLONOSCOPY: A SINGLE-CENTRE PROSPECTIVE STUDY]. Lijec Vjesn 2015; 137:156-162. [PMID: 26380473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adequate bowel preparation is the key of a successful colonoscopy. The aim of the study was to analyze sociodemographic and clinical characteristics in our population of patients referred for colonoscopy. Bowel cleanness was evaluated using the Boston Bowel Preparation Scale (BBPS) where values 7 were considered a criterion of successful bowel preparation. The study involved 286 subjects (61.5% male, median 61 years, interquartile range 50-71). BBPS score 7 was found in 145 subjects (50.7%). Multivariate analysis indicated that subjects with severe comorbidity (ASA status 3, OR = 0,29; 95% CI: 0.12-0.72; p = 0,008) represented a risk factor for poor bowel preparation. Regimens with polyethyleneglycol (PEG) were superior compared with other protocols (OR = 2.54; 95% CI: 1.27-5.10; p = 0.008). Timing of the colonoscopy also contributed to better bowel preparation (OR = 5.50; 95% CI: 2.07-14.67; p = 0.001). This study confirms that presence of comorbidity and non-use of PEG regimens are predictors of poor bowel preparation in our population of patients referred for colonoscopy.
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12
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Iveković MP, Radulović B, Brčić I, Jakic Razumović J, Rustemović N, Iveković H. [COLONIC MUCO-SUBMUCOSAL ELONGATED POLYP: A CASE REPORT AND LITERATURE REVIEW]. Lijec Vjesn 2015; 137:168-170. [PMID: 26380475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Recently a new entity has been described--a colonic muco-submucosal elongated polyp (CMSEP)--that did not fall into traditional classification of colorectal polyps. The CMSEP is endoscopically characterised by elongated, worm-like appearance with a normal overlying mucosa. Histologic characteristics of the CMSEP comprise mucosa and expanded submucosa with dilated vasculature and lymphatics. Herein, we report a case of CMSEP, that to the best of our knowledge, has not been previously described in our literature. With regard to the on-going National colorectal cancer screening programme, our intention is to draw attention of gastrointestinal pathologists and endoscopists to this distinctive and very rare phenomenon.
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13
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Opačić D, Rustemović N, Kalauz M, Markoš P, Ostojić Z, Majerović M, Ledinsky I, Višnjić A, Krznarić J, Opačić M. Endoscopic ultrasound elastography strain histograms in the evaluation of patients with pancreatic masses. World J Gastroenterol 2015; 21:4014-4019. [PMID: 25852289 PMCID: PMC4385551 DOI: 10.3748/wjg.v21.i13.4014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the accuracy of the strain histogram endoscopic ultrasound (EUS)-based method for the diagnostic differentiation of patients with pancreatic masses.
METHODS: In a prospective single center study, 149 patients were analyzed, 105 with pancreatic masses and 44 controls. Elastography images were recorded using commercially available ultrasound equipment in combination with EUS linear probes. Strain histograms (SHs) were calculated by machine integrated software in regions of interest and mean values of the strain histograms were expressed as Mode 1 (over the mass) and Mode 2 (over an adjacent part of pancreatic tissue, representing the reference area). The ratio between Mode 2 and Mode 1 was calculated later, representing a new variable, the strain histogram ratio. After the final diagnosis was established, two groups of patients were formed: a pancreatic cancer group with positive cytology achieved by fine needle aspiration puncture or histology after surgery (58 patients), and a mass-forming pancreatitis group with negative cytology and follow-up after 3 and 6 mo (47 patients). All statistical analyses were conducted in SPSS 14.0 (SPSS Inc., Chicago, IL, United States).
RESULTS: Results were obtained with software for strain histograms with reversed hue scale (0 represents the hardest tissue structure and 255 the softest). Based on the receiver operating characteristics (ROC) curve coordinates, the cut-off point for Mode 1 was set at the value of 86. Values under the cut-off point indicated the presence of pancreatic malignancy. Mode 1 reached 100% sensitivity and 45% specificity with overall accuracy of 66% (95%CI: 61%-66%) in detection of pancreatic malignant tumors among the patients with pancreatic masses. The positive and negative predictive values were 54% and 100%, respectively. The cut-off for the new calculated variable, the SH ratio, was set at the value 1.153 based on the ROC curve coordinates. Values equal or above the cut-off value were indicative of pancreatic malignancy. The SH ratio reached 98% sensitivity, 50% specificity and an overall accuracy of 69% (95%CI: 63%-70%). The positive and negative predictive values were 92% and 100%, respectively.
CONCLUSION: SH showed high sensitivity in pancreatic malignant tumor detection but disappointingly low specificity. Slight improvements in specificity and accuracy were achieved using the SH ratio.
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14
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Iveković H, Prijić R, Radulović B, Markoš P, Brkić T, Ostojić R, Rustemović N. [Clinical characteristics of patients with a double pylori]. Lijec Vjesn 2015; 137:30-33. [PMID: 25906546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Double pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008-2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive.
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15
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Rustemović N, Krznarić Z, Bender DV, Ostojić R, Cavka SC, Milić S, Anić B, Ljubicić N, Mesarić J, Stimac D. [Croatian guidelines for the management of pancreatic exocrine insufficiency]. Lijec Vjesn 2012; 134:141-147. [PMID: 22930931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pancreatic exocrine insufficiency is a major consequence of pancreatic diseases (e. g. chronic pancreatitis and cystic fibrosis), extrapancreatic diseases like celiac disease and Crohn's disease, and gastrointestinal and pancreatic surgical resections. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function should be assessed by measuring levels of faecal elastase-1. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. Administration of enzymes in form of enteric-coated minimicrospheres avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. In adults, the initial recommended dose of pancreatic enzymes is 25.000 units of lipase per meal, titrating up to a maximum of 80000 units of lipase per meal. Large meals require 25.000 - 80.000 units of lipase per meal while snacks require 10.000 - 40.000 units of lipase per meal. Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. Adjunct therapy with acid-suppressing agents may be useful in patients who continue to experience symptoms of PEI despite high-dose enzyme therapy. Patients with PEI should be encouraged to consume small, frequent meals and to abstain from alcohol. Dietary fat restriction is not recommended for patients with PEI.
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16
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Iveković H, Rustemović N, Opacić M, Deban O, Romic B, Razumović JJ, Ostojić R, Pulanić R, Vucelić B. [Intraductal papillary mucinous neoplasm of the pancreas: case report and review of the literature]. Lijec Vjesn 2012; 134:25-28. [PMID: 22519250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively rare clinical entity with a main characteristic being mucus production. Extension of IPMN along pancretic ducts and mucus production lead to ductal obstruction and dilatation, resulting in recurrent episodes of acute pancreatitis. Molecular background of IPMN-a comprises several aberrations, with the K-ras gene mutation being the likely trigger that initiates further genetic changes. Due to its indolent nature, IPMN is most commonly diagnosed in the 7th decade of life. Depending on the histology type, IPMN has a malignant potential. Therefore, surgical therapy remains a "gold standard" of treatment. Insidious, slow progression of the disease and absence of symptoms in a certain number of patients makes diagnostic approach to this entity difficult. In this paper we present a patient with IPMN of the pancreas, in whom the episodes of acute pancreatitis had been present for 22 years.
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Affiliation(s)
- Hrvoje Iveković
- Zavod za gastroenterologiju i hepatologiju, Klinika za unutrainje bolesti Medicinskog fakulteta Sveucilista u Zagrebu, KBC Zagreb
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17
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Markos P, Brkić T, Pulanić R, Jakić-Razumović J, Iveković H, Premuzić M, Kalauz M, Opacić M, Rustemović N, Vucelić B. [Endoscopic mucosal resection of sessile polypoid colorectal lesions: a two-year retrospective study, technique description, indications and complications]. Lijec Vjesn 2011; 133:322-326. [PMID: 22165081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Endoscopic mucosal resection (EMR) is a therapeutic method for removal of sesile premalignant lesions and intramucosal carcinoma of the gastrointestinal tract. No reports on EMR data in Croatia have been published yet. MATERIALS AND METHODS All patients included in the study were managed at the University Hospital Centre Zagreb between December 2006 and December 2008. EMR was performed using strip technique with submucosal injection of epinephrine (dilution with saline 1:5000-10000). RESULTS EMR of sessile polypoid colorectal lesions was performed in 95 patients. The most common localisation of the disease was rectum (52 pts - 54.7%). In most patient size of the lesion was between 16-25 mm (43 pts - 45%). En-bloc resection was performed in 75 patients and piecemeal resection in the rest. Bleeding occurred immediately during the EMR in 5 pts (5.3%). Patohistological diagnosis revealed tubulovillous adenoma in 67 pts (70%). Invasive carcinoma was observed in 6 pts (6.3%) and intramucosal carcinoma in 20 pts (21%). On follow up, 73 pts (77%) did not show and sign of disease recurrence. Surgery was needed in 6 pts (6.3%) due to the diagnosis of invasive carcinoma. CONCLUSION EMR is safe and reliable method with low risk of serious complications and acceptable recurrence rate.
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Affiliation(s)
- Pave Markos
- Zavod za gastroenterologiju i hepatologiju, Klinika za unutrasnje bolesti Medicinskog fakulteta Sveucilista u Zagrebu, KBC Zagreb
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18
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Rustemović N, Jakić-Razumović J, Belev B, Petricević B, Skegro M, Kinda E, Augustin G, Hrstić I, Ostojić R, Stern-Padovan R, Vrbanec D. [Consensus guidelines for diagnosis, treatment and follow-up of patients with gastrointestinal stromal tumors]. Lijec Vjesn 2011; 133:170-176. [PMID: 21888081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gastrointestinal stromal tumors are the most common mesenchymal tumors in gastrointestinal tract. They are often asymptomatic and discovered incidentally during endoscopic or barium studies. About 80% GISTs have a KIT (CD 117 antigen) gene mutation. Most affect exon 11, less commonly exon 9,13 or 17, that results in uncontrolled KIT signaling. This led to effective systemic therapies in the form of small molecule inhibitors of the receptor tyrosine kinase such as imatinib mesylat. With the purpose of providing standardized approach to rational and effective diagnostic and treatment algorithm in Croatia, a multidisciplinary session was organized. Results of the session are given in the form of Consensus guidelines.
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Affiliation(s)
- Nadan Rustemović
- Zavod za gastroenterologiju i hepatologiju, Klinika za unutarnje bolesti, Medicinski fakultet, Sveuriliite u Zagreb.
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19
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Rustemović N, Berković MC, Zjacić-Rotkvić V, Ostojić R, Hrabar D, Sertić J, Jakić-Razumović J, Kruslin B, Stern-Padovan R, Tezak S, Kovacić K, Vrbanec D, Belev B, Skegro M. [Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic neuroendocrine tumors]. Lijec Vjesn 2010; 132:127-133. [PMID: 20677617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pancreatic neuroendocrine tumors (PETs) are increasingly recognized. In order to assure an optimal treatment of patients and to propose an efficient diagnostic algorithm we were prompted to organize meetings, with participating experts, specialists in different fields of expertise. The idea for the meetings was to try to give a standardized approach, which would in future help in stratification of PET patients. Results of meetings are given in a form of Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic neuroendocrine tumors.
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Affiliation(s)
- Nadan Rustemović
- Zavod za gastroenterologiju i hepatologiju, Klinika za unutarnje bolesti Medicinskog fakulteta Sveucilista u Zagrebu, KBC Zagreb.
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20
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Rustemović N, Opacić M, Cuković-Cavka S. [Endoscopic ultrasonography elastography in gastroenterology]. Acta Med Croatica 2009; 63 Suppl 3:49-50. [PMID: 20235372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Endoscopic ultrasonography (EUS) elastography is a new technique for detecting the elastic properties of examined tissues during real time ultrasonography. The method is a very valuable tool for the diagnosis and evaluation of pathologic processes affecting the gastrointestinal tract and its adjacent organs. It represents a major advance in the diagnosis and staging of gastrointestinal malignancies, especially pancreatic carcinoma. EUS also provides guidance for fine needle aspiration (FNA) of undiagnosed masses and lymph nodes. Establishing the diagnosis of Crohn's disease or ulcerative colitis is sometimes very difficult. When inflammatory bowel disease (IBD) is confined to the colon, there is a lack of diagnostic tools for distinction between Crohn's colitis and ulcerative colitis, which is especially important in definitive phenotyping before surgical decision. Our ongoing studies emphasize the role of EUS elastography in the diagnosis of inflammatory bowel disease phenotype and primary sclerosing cholangitis. As there are no literature data on this issue, we recommend further investigations in this promising new area of research.
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Affiliation(s)
- Nadan Rustemović
- Zavod za gastroenterologiju i hepatologiju, Klinika za unutrasnje bolesti, Klinicki bolnici centar Zagreb, Zagreb, Hrvatska.
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21
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Rustemović N, Opacić M, Bates T, Ostojić R, Stern Padovan R, Pulanić R, Vucelić B. Endoscopic ultrasound-guided drainage of an intra-abdominal abscess: a new therapeutic window to the left subphrenic space. Endoscopy 2008; 38 Suppl 2:E17-8. [PMID: 17366386 DOI: 10.1055/s-2006-944635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- N Rustemović
- Dept. of Gastroenterology, Zagreb University Hospital Center, Zagreb, Croatia
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22
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Kujundzić M, Vogl TJ, Stimac D, Rustemović N, Hsi RA, Roh M, Katicić M, Cuenca R, Lustig RA, Wang S. A Phase II safety and effect on time to tumor progression study of intratumoral light infusion technology using talaporfin sodium in patients with metastatic colorectal cancer. J Surg Oncol 2007; 96:518-24. [PMID: 17671969 DOI: 10.1002/jso.20832] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Twenty-seven patients with refractory liver metastases from colorectal cancer took part in a Phase II study of the light infusion technology (Litx) light-activated drug/device system to assess safety and evaluate time to tumor progression (TTP). METHODS Litx consists of the light-activated drug, talaporfin sodium (LS11), activated intratumorally by a catheter-like array of light-emitting diodes (LEDs). After placement of the array via ultrasound or computed tomography (CT) guidance, LS11 was administered intravenously, followed 15-60 min later by light infusion for 2.8 hr. Patients were assessed for adverse events and tumor response using physical examination, laboratory values, and CT scan evaluation over a period of 60 days. RESULTS The observed occurrence of Litx treatment-related adverse events was minimal and cumulative toxicity did not occur when combined with chemotherapy. Assessment of TTP and tumor response rate, although statistically non-robust, suggest potential improvement. CONCLUSIONS The Litx system was shown to be safe for treating liver metastases from colorectal cancer and there was no cumulative toxicity when combined with standard systemic therapy. Preliminary assessments of TTP and tumor response rate justify further evaluation in a Phase III follow-up study.
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Affiliation(s)
- M Kujundzić
- Department of Medicine, Division of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
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23
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Gasparović S, Rustemović N, Opacić M, Premuzić M, Korusić A, Bozikov J, Bates T. Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures: A three year prospective study. World J Gastroenterol 2006; 12:327-30. [PMID: 16482639 PMCID: PMC4066048 DOI: 10.3748/wjg.v12.i2.327] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy.
METHODS: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.5-1.5 mg/kg). Arterial blood pressure (BP) was monitored at 3 min intervals and heart rate and oxygen saturation (SpO2) were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure.
RESULTS: A statistically significant reduction in mean arterial pressure was demonstrated (P <0.001) when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60 mmHg, was noted in only 5 patients (0.5%). Oxygen saturation decreased from 96.5% to 94.4 % (P<0.001). A critical decrease in oxygen saturation (<90%) was documented in 27 patients (2.4%).
CONCLUSION: Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effects if carefully titrated. All the patients (and especially ASA III group) require monitoring and care of an anesthesiologist.
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Margan A, Rustemović N, Loncarić S. [Virtual polyclinic--consultant health service for rural areas and islands]. Acta Med Croatica 2005; 59:169-78. [PMID: 16095188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The development of medical sciences and digital revolution in health care have made possible the creation of new models for hospital care and primary health care. Health care management usually does not follow all possible solutions of new computer technology. Croatian health system is based on large hospital centers in the mainland and small, poorly equipped remote medical units. The possibility of sharing medical information using telematic technologies brings all knowledge of the large, powerful hospital centers close to remote medical units. Working in a small, remote consultation office on the island Cres, the author A. M. became part of medical periphery far from the security of hospital on the mainland. After five years of the work on telemedicine projects for the islands, we have introduced a new medical practice concept of communication between remote medical units and clinical hospital centers in the mainland. The pilot project Virtual Polyclinic-Medical Consultation System for the Islands and Remote Areas is a good example of the possible new models in health care structure. Our experience indicates that organization of health care in remote areas depends not only on advanced technical solutions but also on team work and medical professionals.
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25
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Rustemović N, Vucelić B, Opacić M, Ostojić R, Pulanić R, Petrovecki M, Radanović B, Marinić J, Pulanić D. Palliative treatment of hepatocellular carcinoma with percutaneous ethanol injection using tumor's feeding artery occlusion under the ultrasonic color Doppler guidance. Coll Antropol 2004; 28:781-91. [PMID: 15666612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We evaluate the efficacy of PEIT in patients with HCC using duplex color Doppler US. The study included 27 HCC patients admitted to the University Hospital Centre Zagreb, between 1993 and 1997. PEIT was performed for ablation of tumor supplying vessels in HCCs of < 5 cm in diameter, and as a palliative measure for tumor feeding vessel obliteration in larger tumors. The efficacy of PEIT was evaluated with duplex color Doppler US, and controlled by dynamic CT scan (16 patients) or selective angiography of hepatic artery (11 patients). All patients had well vascularized tumors before PEIT, and after therapy 25 of them showed absent or minimal tumor vascularization. Recanalization of the tumor feeding vessel was detected with Doppler US within 9 months after therapy. Study results suggested that duplex color Doppler US should be the method of choice in the evaluation of PEIT as well as in the follow-up of HCC patients after PEIT.
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Affiliation(s)
- Nadan Rustemović
- University Hospital Centre Zagreb, Department of Internal Medicine, Croatia.
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26
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Brkić T, Pulanić R, Krznarić Z, Opacić M, Rustemović N, Vegar V, Vucelić B, Hrstić I, Cavka SC, Premuzić M, Ostojić R, Kalauz M. [Percutaneous endoscopic gastrostomy: 5-year experience at out center (1997-2002)]. Lijec Vjesn 2003; 125:292-5. [PMID: 15209023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Gauderer and Ponsky first described percutaneous endoscopic gastrostomy (PEG) in 1979. It was introduced as a routine method in the Division of Gastroenterology, University Hospital Rebro, Zagreb, in 1995. Over the years the number of PEG insertions has increased significantly. We reviewed the available literature and compared the results with our experience according to indications, complications and efficacy of the procedure. We inserted PEG in 86 patients from January 1, 1997 until January 31, 2002. There were 40 females and 46 males. The most frequent indication for PEG insertion was a neurological condition (60/86). There were no deaths directly related to the procedure. One patient had a leakage of PEG feeding into the peritoneal cavity that caused severe peritonitis and required urgent laparatomy within 24 hours of the PEG insertion. Two patients had local infection and the tube had to be removed. The antibiotic prophylaxis has been given to 65 patients. Our experience confirms that PEG is a relatively safe and well tolerated procedure.
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Affiliation(s)
- Tomislav Brkić
- Centar za intervencijsku gastroenterologiju, Zavod za gastroenterologiju, Klinika za internu medicinu, Klinićki bolnićki centar Rebro, Kispatićeva 12, 10 000 Zagreb
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27
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Opacić M, Rustemović N, Ostojić R, Pulanić R. [Linear endoscopic ultrasound in the diagnosis of diseases of the digestive system]. Med Arh 2003; 57:17-22. [PMID: 12827960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
This article reviews the recent literature on the role of endoscopic ultrasonography (EUS) as diagnostic and therapeutic tool, defines it's place in the algorithm of diagnostic procedures and informs how to treat gastroenterologic patients evaluated by EUS. Endoscopic ultrasonography utilizes the technology of endoscopy to introduce high-frequency ultrasound probes in the upper or lower part of gastrointestinal tract to visualize gastrointestinal wall and adjacent structures. Longitudinal endoscopic probe is different, compared to radial probe, and advantage is use of Doppler technique. This method has came out as an important modality for the diagnosis and staging of benign and malignant lesions of the gut wall and surrounding structures of the mediastinum, abdomen and pelvis. It is also used as a diagnostic tool for the evaluation of submucosal masses of the upper gastrointestinal tract and the rectosigmoid, for locating pancreatic endocrine tumors, and for the assessment of vascular disease. The widest application of EUS is, however, in the diagnosis and staging of esophageal, gastric, rectal, and pancreaticobiliary carcinoma. EUS has been shown to change the approach to clinical management in a significant proportion of patients to a less costly, risky, or invasive strategy.
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Affiliation(s)
- Milorad Opacić
- Centar za intervencijsku gastroenterologiju, referalni centar Ministarstva zdravstva RH Zavod za gastroenterologiju, Klinika za unutrasnje bolesti Rebro, Klinicki bolnicki centar Zagreb
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28
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Hrstić I, Ostojić R, Rustemović N, Opacić M, Cuković-Cavka S, Barbarić-Babić V. [Primary sclerosing cholangitis: case report of a young patient with an atypical diagnostic process in complications of the disease]. Med Arh 2003; 57:29-32. [PMID: 12827963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The primary sclerotic colangitis is the chronic disease of the liver which in its finish very often requires the liver transplantation. The disease gets diagnosed mainly in males of middle age and is often joined with the inflammation disease of the intestines. The course of the disease not rarely is complicated by the stenosis of the liver ducts or by the occurrence of the concrements. In the presented case it is the word about the young patient in which the is the diagnosis made with the atypical way primarily from the reason that the biopsy of the liver is performed too early and the patohystologic changes were non specific. Immediately after the graft is being developed the biliary peritonitis because of the injury of the gallbladder so is done the cholecystectomy. Only in the later course is performed the endoscopic retrograde colangiography, during which are getting the typical changes of the biliary trunk for the primary sclerotic colangitis. The underlying disease in the demonstrated patient is complicated by the recidivens occurrence of the concrements of the choledokus and stenoses of the bladder ducts primarily for the left slice what, up to new, always successfully was treated by the extraction of the concrements and the dilatation of the liver ducts by endoscopic way.
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Affiliation(s)
- Irena Hrstić
- Zavod za gastroenterologiju, Klinika za unutrasnje bolesti, Zavod za radiologiju, KBC Rebro, Zagreb
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29
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Rustemović N, Opacić M, Ostojić R, Kvarantan M. [Liner interventional endoscopic ultrasound in diseases of the digestive system]. Med Arh 2003; 57:23-6. [PMID: 12827961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The evident advantages of the endoscopic ultrasound, upon the complementary imaging methods, as are transabdominal ultrasound, the spiral CT, the nuclear magnet resonance, potentioned by the development of the techniques for the taking of biopsies, and the possibilities of the microinvasive surgical approach to the environment organs and tissues. Besides the standard achievement of the material for the cytologic and pathohistologic analysis is opened the possibility of the therapeutic application of the medicaments, that is the drainage collection in the abdomen and by "stapler" technique of the establishing of the anastomoza.
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Affiliation(s)
- Nadan Rustemović
- Centar za intervencijsku gastroenterologiju, referalni centar Ministarstva zdravstva RH Zavod za gastroenterologiju, Klinika za unutrasnje bolesti Rebro
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30
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Opacić M, Rustemović N. [Endoscopic ultrasonography and diagnostic algorithms in diseases of the gastrointestinal tract]. Lijec Vjesn 2003; 125:192-9. [PMID: 14692094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This article reviews the recent literature on the role of endoscopic ultrasonography (EUS) as diagnostic and therapeutic tool, defines its place in the algorithm of diagnostic procedures and informs how to treat some patients evaluated by EUS. Endoscopic ultrasonography utilizes the technology of endoscopy to introduce high frequency ultrasound probes in the upper or lower part of gastrointestinal tract to visualize gastrointestinal wall and adjacent structures. This method has come out as an important modality for the diagnosis and staging of benign and malignant lesions of the gut wall and surrounding structures of the mediastinum, abdomen and pelvis. It is also used as a diagnostic tool for the evaluation of submucosal masses of the upper gastrointestinal tract and the rectosigmoid, for locating pancreatic endocrine tumors, and for the assessment of vascular disease. Interventional applications, such as EUS-guided fine-needle aspiration (EUS-FNA) for obtaining tissue/fluid samples, for pseudocyst drainage, and also for delivery of local therapy will likely enhance the clinical utility and cost-effectiveness of this imaging modality. The widest application of EUS is, however, in the diagnosis and staging of esophageal, gastric, rectal, and pancreaticobiliary carcinoma. EUS has been shown to change the approach to clinical management in a significant proportion of patients to a less costly, risky, or invasive strategy.
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Affiliation(s)
- Milorad Opacić
- Centar za intervencijsku gastroenterologiju, referalni centar Ministarstva zdravstva RH, Zavod za gastroenterologiju, Klinika za unutrasnje bolesti Rebro, Klinicki bolnicki centar Zagreb
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31
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Gasparović S, Rustemović N, Opacić M, Bates M, Petrovecki M. Comparison of colonoscopies performed under sedation with propofol or with midazolam or without sedation. Acta Med Austriaca 2003; 30:13-6. [PMID: 12558560 DOI: 10.1046/j.1563-2571.2003.02050.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous studies have shown that some patients are not able to tolerate colonoscopy without sedation because of low pain threshold, anxiety, colonic sensitivity and anatomical variations. Benzodiazepines are most commonly used, often in combination with pethidine. Our study compares sedation with propofol to midazolam and colonoscopy without sedation. METHODS In this study 147 patients were examined. The patients were divided into three groups: The first group included patients in whom propofol was used for sedation, the second group included patients sedated with midazolam, and the third group was comprised of patients who received no sedation. Oxygen saturation and heart rate were recorded continuously by pulse oxymetry. Arterial blood pressure (BP) was monitored at 3-min intervals. RESULTS A decrease in blood pressure and heart rate was documented in the first two groups (P < 0.001), whereas in group 3 we found an increase in both BP and heart rate (P < 0.001). Oxygen saturation dropped below 90 % in 11/102 patients sedated with propofol and in 9/23 sedated with midazolam. Two of 22 patients in whom no sedation was used were found to have oxygen saturation below 90 %. The recovery time was shorter (7 min) in group 1 (propofol) than in group 2 (midazolam), in which it was found to be 20 min. CONCLUSIONS Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant haemodynamic side effects.
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Rosandić M, Skegro M, Paar V, Paar D, Sćukanec-Spoljar M, Juricić M, Vucelić B, Pulanić R, Rustemović N, Ostojić R, Ljubojević N. Quantitative tissue carcinoembryonic antigen (T CEA) assay as a screening test for severe dysplasia in colorectal adenomas. Acta Med Austriaca 1999; 26:89-92. [PMID: 10520376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Relationship between the serum (S CEA) and the tissue (T CEA) carcinoembryonic antigen concentrations with regard to the degree of dysplasia in colorectal adenomas was investigated. Our study included 56 single or multiple colorectal adenomas in 46 patients. The measurements of T CEA concentrations were performed using the quantitative CEA-EIA method (Abbott) modified for wet tissue, obtained from heads of the adenomas. As a control point the mucosa near adenoma and the rectal mucosa were used. Our results suggest that the T CEA concentrations from the head of the adenoma demonstrate a highly significant difference between mild and severe dysplasia (P < 0.001), between mild dysplasia and invasive adenocarcinoma (P < 0.001) and a significant difference between mild and moderate dysplasia (P < 0.05). On the other hand, the S CEA concentrations corresponding to these cases showed no such differences. In conclusion, we suggest the quantitative measurement of T CEA concentrations as a screening test for severe dysplasia in colorectal adenomas.
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Affiliation(s)
- M Rosandić
- Department of Internal Medicine, University Hospital Rebro, Zagreb, Croatia
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33
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Pulanić R, Cavka S, Brkić T, Rustemović N, Dumić E, Babić V, Opacić M, Vucelić B, Rosandić M, Krznarić Z, Ostojić R. [Palliative treatment of malignant esophageal obstruction with a new endoscopically administered self-expanding nitinol stent: case report]. Lijec Vjesn 1997; 119:206-9. [PMID: 9471480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The endoscopic methods of palliative treatment in malignant esophageal stenoses caused by neoplasm which have been performed so far unfortunately do not provide permanently satisfying results. The implantation of self-expanding stents with the purpose of removing malignant esophageal obstructions has recently become the most acceptable method of treatment. By using that method it is possible to reduce or even completely remove difficulties in swallowing. In that way a significant improvement in life quality of patients with inoperable esophageal cancer is possible. The various types of metal endoprostheses used for the palliative treatment of esophageal malignant stenoses are described in this paper. Here is also presented a case of nitinol stent implantation in a 50 year old woman suffering from esophageal cancer. This type of therapeutic treatment has been applied in Croatia for first time.
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Affiliation(s)
- R Pulanić
- Klinika za unutarnje bolesti Medicinskog fakulteta u Zagrebu
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34
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Rustemović N, Brkić T, Dumić E, Opacić M, Pulanić R, Vucelić B, Cuković-Cavka S. [Treatment of malignant bile duct obstruction with a metal stent. Case report]. Lijec Vjesn 1997; 119:151-4. [PMID: 9379822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the case report we describe endoscopic implantation of endoprosthesis in the periampullar area in a 87 year old female patient with obstructive jaundice and cholangitis caused by pancreatic tumour. This is the first time that this procedure was successfully performed in Croatia.
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Affiliation(s)
- N Rustemović
- Zavod za gastroenterologiju, Klinika za unutarnje bolesti Rebro, KBC Zagreb
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35
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Abstract
PURPOSE The aim of the study was to evaluate percutaneous pancreatography as an alternative method for pancreatic duct visualisation in patients with pancreatic disease. MATERIAL AND METHODS In 21 patients with pancreatic disease and previously unsuccessful ERCP, puncture of the pancreatic duct was carried out under ultrasonographic guidance with an 0.7-mm Chiba needle, and contrast injection was made under fluoroscopic control in the pancreatic duct. RESULTS The procedure was successful in 18 patients (86%). In 10 patients, chronic pancreatitis was found, and in 8 patients, pancreatic carcinoma. CONCLUSION Percutaneous pancreatography is a good alternative method for visualisation of the pancreatic duct in patients with pancreatic disease and previously unsuccessful ERCP.
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Affiliation(s)
- M Opacić
- Department of Gastroenterology, University Hospital Rebro, Zagreb, Croatia
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Opačic M, Rustemović N, Pulanić R, Vucelić B, Frković M, Mandić A. Percutaneous Pancreatography under Ultrasonographic Guidance. Acta Radiol 1996. [DOI: 10.1080/02841859609174363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pulanić R, Vucelić B, Rosandić M, Opacić M, Rustemović N, Krznarić Z, Brkić T, Jokić-Begić N. Comparison of injection sclerotherapy and laser photocoagulation for bleeding peptic ulcers. Endoscopy 1995; 27:291-7. [PMID: 7555933 DOI: 10.1055/s-2007-1005695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND STUDY AIMS The most widely used endoscopic procedures in the management of patients with bleeding peptic ulcer are at present sclerotherapy and thermal methods. In an attempt to assess the most effective method of achieving hemostasis, we compared injection sclerotherapy and laser photocoagulation in terms of the efficacy of initial hemostasis, rebleeding, need for surgery, mortality, and the appearance of the ulcer after the hemostatic procedure. PATIENTS AND METHODS In this prospective, randomized trial, 160 patients were treated with injection sclerotherapy (1% polidocanol), and 155 patients with laser photocoagulation (Nd:YAG laser) in cases of Forrest I, Forrest IIa, and Forrest IIb hemorrhage. The bleeding activity was classified according to the modified Forrest criteria. Polidocanol injection and Nd:YAG laser photocoagulation were not preceded by epinephrine administration. RESULTS There were no significant overall differences between the groups in the outcome in terms of definitive hemostasis, rebleeding, urgent surgery, and death (p = 0.487). In the case of the subgroup with Forrest I lesions, laser photocoagulation was more efficacious than sclerotherapy (p = 0.0078). In the Forrest IIa and Forrest IIb subgroups, the two methods were equally effective (p = 0.202 and 0.513 respectively). In the sclerotherapy patients, definitive initial hemostasis in Forrest IIa was achieved in 100%, whereas in the laser group this rate was 92%, with 28% of patients initially developing hemorrhage after one or two laser pulses. Ulcer healing was slower following sclerotherapy than after photocoagulation. CONCLUSION Injection sclerotherapy and laser photocoagulation are equally effective in achieving definitive hemostasis in bleeding peptic ulcers. Laser photocoagulation is more efficacious in patients with active bleeding, whereas injection sclerotherapy is more effective in patients with a nonbleeding visible vessel.
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Affiliation(s)
- R Pulanić
- Department of Internal Medicine, University Hospital Rebro, Zagreb, Croatia
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Pulanić R, Vrhovac B, Jokić N, Rosandić-Pilas M, Salamon V, Opacić M, Rustemović N, Korać B, Vucelić B. Prophylactic administration of ranitidine after sclerotherapy of esophageal varices. Int J Clin Pharmacol Ther Toxicol 1991; 29:347-51. [PMID: 1937995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The present trial was carried out to determine the usefulness of H2-receptor antagonist drug therapy for the prevention of esophageal bleeding and esophageal varices in patients who underwent sclerotherapy. According to randomization, out of the 58 patients, 28 received, along with the usual standard therapy, ranitidine and 30 received placebo. Ranitidine, 50 mg, was administered intravenously over a period of 3 days every 8 hours, and then 150 mg of ranitidine was given per os in the evening for one month. For improvement of hemostasis and during the elective sclerotherapies, 1% polidocanol was used as the sclerosant. During each puncture, 2 ml was injected. Injections were paravasal and intravasal. After sclerotherapy, endoscopic examinations were carried out on the third day and one month later. Necrosis was noted in 42% of the patients and esophageal mucosal inflammation in 26%. Esophageal ulcers did not occur. There was no statistically significant difference between the two groups in terms of age, sex ratio, cause of liver cirrhosis, and the Child's classification. The size of the esophageal varices had no effect on the development of esophageal mucosal changes in correlation with the quantity of sclerosant. The comparison of the two groups of patients, sclerosed for hemorrhage and sclerosed electively, showed no statistically significant difference regarding esophageal mucosal changes. No differences between the ranitidine and placebo groups of patients were observed in this indication. It can be concluded that esophageal mucosal changes probably arise as a consequence of the sclerosant, its concentration, quantity and mode of application.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Pulanić
- Department of Internal Medicine, University Hospital Rebro, Zagreb, Croatia, Yugoslavia
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