1
|
P3722Platelet reactivity changes following transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Although recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated.
Purpose
To investigate PR changes during and after TAVI.
Methods
Study included 42 consecutive patients with severe and symptomatic aortic stenosis undergoing TAVI procedure in our institution. Patients' clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses for next three months. PR was measured in six time points: just before induction of anaesthesia (T1), after heparin administration (T2), at the end of procedure (T3), and on 3rd, 6th and 30th postoperative day (T4–6). PR was measured using impedance aggregometer (Multiplate® analyzer, Roche, Munich, Germany) in response to three platelet aggregation agonists: arachidonic acid (ASPItest), ADP (ADPtest) and thrombin receptor activating peptide-6 (TRAPtest).
Results
Mean patient age was 82.1 years with majority of patients being male 57.1% (N=24). Mean valve area and mean transvalvular gradient prior to procedure were 0.71±0.21 cm2 and 49.1±18.7 mmHg, respectively. All patients underwent successful TAVI procedure using either self-expandable (N=25, 59.5%) or balloon-expandable valve. Two patients (4.7%) underwent transapical TAVI, while transfemoral approach was used in all other patients. Mean postimplantation gradient was 10.2±7.1 mmHg.
Mean PR on T1 was 24.3±23.1 U for ASPItest, 41.6±26.5 U for ADPtest and 90.1±33.3 U for TRAPtest. There was no significant difference in PR on T2. However, on T3, ignificant reduction of PR in all 3 tests was observed (ASPI 9.4±10.1 U (p=0.001), ADP 23.1±15.0 U (p<0.001) and TRAP 64.5±27.3 U (p<0.001)). Lowest PR values for all tests were reached on T4, after which incline in PR has been observed. On T5, value of ASPItest reached levels not significantly different to those on T1 (15.1±17.2 U, p=0.13), while ADPtest and TRAPtest remained significantly lower (27.3±18.5 U, p=0.007 and 68.6±33.2 U, p=0.003, respectively). All PR values returned to initial levels on T6 (figure 1).
Conclusions
Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway. These findings add new knowledge in understanding complexed relations in intravascular milieu following TAVI. Further research on a larger number of patients is needed to confirm and asses clinical significance of these results.
Acknowledgement/Funding
Croatian Science Foundation
Collapse
|
2
|
Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
|
3
|
Abstract
Objectives Endemic nephropathy (EN) is a chronic tubulointerstitial renal disease associated with increased incidence of upper urinary tract urothelial cancer (UTUC) occurring predominantly in geographically limited areas in villages along big Danube river. Based on results obtained by the research it is confirmed that aristolochic acid is causative agent of endemic nephropathy (EN). Aim The aim of this study was to determine characteristics of UTUC in two endemic areas and analyze trends in 5-year period. Methods This study included all patients with UTUC with or without synchronous/metachronous urothelial cancer in urinary bladder, from Croatian and Bosnian EN and non-EN regions. We analyzed archival data bases from all patients with UTUC who were admitted and operated in Department for surgery and urology, General Hospital Josip Bencevic Slavonski Brod in the time period between 2005 and 2010. Analyzed groups of patients were divided and compared as EN group (that includes patients from Croatian and Bosnian EN region) and non-EN group (that includes patients from Croatian and Bosnian non-EN region). All surgical specimens were processed according to standardized pathological procedures. Results Comparing patients basic characteristics from Croatian and Bosnian EN region there was no significant difference in gender (females were more frequently affected in both EN regions, p=0.99) or age (p=0.43) of patients. We found higher blood levels of urea and creatinine in group of patients from Croatian EN region when compared with group of patients from Bosnian EN region but the difference was not statistically significant (p=0.79 and p=0.44, respectively). In patients from Croatian EN group Hemoglobin levels were significantly lower than levels from Bosnian EN region patients, p=0.0049. In group of patients from Bosnian EN region ureteral tumors were more frequently observed than in Croatian group of patients, when compared with renal pelvis tumors but the difference was not statistically significant (p=0.258). Conclusion Our data showed some differences in tumor localization between to investigated, relatively nearly situated, EN regions in Croatia and Bosnia. Statistically significant difference in hemoglobin levels between Croatian and Bosnian EN regions that should be further analyzed to give some reasonable explanation.
Collapse
|
4
|
Drug-Eluting Balloons-A New Tool in the Treatment of Cardiac Allograft Vasculopathy: A Case Series. Transplant Proc 2017; 49:1675-1677. [PMID: 28838462 DOI: 10.1016/j.transproceed.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 11/19/2022]
Abstract
Percutaneous coronary intervention in patients with cardiac allograft vasculopathy is burdened with a lot of difficulties. Although they have allowed significant progress in comparison with plain balloon angioplasty and bare metal stents, drug-eluting stents have not fully overcome problems of diffuse lesions and small-vessel disease that are so common in transplant coronary artery disease. There is growing evidence that drug-eluting balloons might be a better choice for patients with small vessel atherosclerotic coronary disease and yet there is no experience with this technology in patients with cardiac allograft vasculopathy. Herein we report a case series of successful percutaneous coronary interventions in patients with cardiac allograft vasculopathy.
Collapse
|
5
|
Impact of Reduced Creatinine Clearance on Early Heart Transplantation Outcomes: A Propensity Score Adjusted Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
HIT Poster session 2P486The effect of short term aerobic exercise and ACE polymorphism on cardiovascular remodeling in healthy sedentary postmenopausal womenP487Are there predictors of malignant progression of aortic stenosis severity?P488Quantitative und semiquantitative parameters in the classification of aortic insufficiency: a 3D-echocardiography and magnet resonance imaging studyP489Vascular indicies surrogate markers for left ventricular dysfunctionP490Left ventricular systolic strain data does not require indexation to cavity size in mitral valve diseasesP491Impact of EACVI grant programme on career progression of grant winnersP492Early predictor of atrial fibrillation recurrence after electrical cardioversion: diastolic parameters come firstP493Echocardiographic diagnosis of arrhythmias in the fetusP4943D echocardiography is a fast-learning and a more reliable method compared with 2D echocardiography for the assessment of left ventricular volumes and ejection fraction in patients with heart failureP495Right ventricular mechanics in functional ischemic mitral regurgitation in acute inferior myocardial infarctionP496Added value of two dimentional strain in assessement of left ventricular systolic function in rheumatic mitral stenosis patients with normal ejection fractionP497Left ventricular myocardial deformation in arterial hypertension with different types of glucose metabolism disordersP498Epicardial to pericardial adipose tissue ratio: predicting myocardial ischemia in patients referred for exercise stress echocardiographyP499Echocardiographic evaluation of the patients with asd after percutaneous closureP500Screening for carotid artery stenosis with the use of pocket-size imaging device equipped with linear probeP501LAD correlates poorly with LAVIP502Predictors associated with the diastolic dysfunction formation in patients with moderate hypertensionP503Assessment of left atrial function by speckle tracking analysis in transthoracic echocardiography for predicting the presence of left atrial appendage thrombus in patients with atrial fibrillationP504can echocardiography detect subclinical myocardial damage in the layers of myocardial wall? (The first study in a large population with known inflammatory disease)P505Epicardial fat thickness and galectin 3 in patients with atrial fibrillation and metabolic syndromeP506Left ventricular reverse remodeling in heart failure: a new obesity paradox?P507Epicardial adipose tissue and carotid intima media thickness in hemodialysis patients; single center experienceP508Echocardiographic parameters of mitral valve remodeling associated with poor clinical outcome in high risk patients with functional mitral regurgitation after Mitraclip implantationP509Prevalence of valve disease in a community population over the age of 60P510Discordance between mitral valve area and mean transmitral pressure gradient in mitral stenosis: Is mean gradient marker of the severity or parameter of tolerance in severe mitral stenosis?P511Ischemic mitral regurgitation is associated with impaired radial and circumferential myocardial deformation in acute inferoposterior myocardial infarctionP512The importance of early left atrial functional changes in predicting long term left ventricular remodeling in patients surviving a ST elevation myocardial infarctionP513Remodeling of myocardial deformation after mitral valve surgeryP514Global longitudinal peak systolic strain is reduced shortly after heart transplantationP515Detailed transthoracic and transesophageal echocardiographic analysis of mitral leaflets in patient undergoing mitral valve repair. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
7
|
Abstract
INTRODUCTION Laparoscopic treatment in general, in recent age has proven that it is well associated with low morbidity, mortality, fast recovery, less pain and sound oncologic outcomes. Recent reports from the National Comprehensive Cancer Network (NCCN) GIST Task Force and the GIST Consensus Conference under the auspices of The European Society for Medical Oncology (ESMO) show that laparoscopic resection may be used for small gastric GISTs (< 2 cm in size). CASE REPORT We report, all the benefits of laparoscopic approach which include short hospitalization, less pain, better cosmetic effect and good oncological outcome, in this case report of 60 year old female patient with gastric GIST larger than 2 cm.
Collapse
|
8
|
Education and Training for Major Incidents Through Medical Response to Major Incidents-MRMI course. Acta Inform Med 2015; 23:169-71. [PMID: 26236085 PMCID: PMC4499290 DOI: 10.5455/aim.2015.23.169-171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/15/2015] [Indexed: 11/05/2022] Open
Abstract
Incidence of major incidents nowadays is in constant growth, especially in last decade. Main goal of all health systems is to minimize and prevent tragic outcomes of major incidents, thus reducing morbidity and mortality and psychological and physical suffering. Lessons learned from Major Incidents throughout the World point out that tragical outcomes could be avoided through adequate preparation and planning. Necessity to plan and to educate to response to Major incident is greater than ever. Finally it is legal obligation that every hospital has plan in case of Major Incident. Effective planning must incorporate: identification of risks, methods of prevention, identification of all recourses, anticipation of errors and detailed protocol of response for each participant. Knowledge and skills needed for Major incident situations must be adopted through interactive training and practical exercise („learning by doing„). That can be achieved by field exercises and by simulation model. Simulation model has many advantages and enables simultaneous education and training of all participants; scene, transport, hospitals, communication and command which than can be evaluated through objective outcomes. The goal is to train medical staff in real time, on position they are assigned to, with available resources in conditions of Major incident.
Collapse
|
9
|
Impact Of Pharmacoeconomic Guidelines on the Reimbursement Process of Medicines In Serbia In 2014. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A407. [PMID: 27200990 DOI: 10.1016/j.jval.2014.08.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
10
|
Pricing and Reimbursement Analysis of Bacillus Calmette-Guérin (BCG) Immunotherapy for Bladder Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A654. [PMID: 27202366 DOI: 10.1016/j.jval.2014.08.2385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
11
|
EPA-1779 – Acute and chronic effects of neurosteroid dehydroepiandrosterone on rat behavior in the foced swim test. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
12
|
Management of heparin-induced thrombocytopenia with fondaparinux in a patient with left ventricular assist device. Int J Organ Transplant Med 2014; 5:83-6. [PMID: 25013684 PMCID: PMC4089335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Heparin-induced thrombocytopenia is an immune-mediated serious adverse effect of heparin therapy. It is a relatively frequent complication among patients with mechanical circulatory support. Herein, we present a patient with severe heart failure and sepsis who developed heparin-induced thrombocytopenia shortly after implantation of left ventricular assist device as a bridge to transplantation and who was successfully treated with fondaparinux.
Collapse
|
13
|
Lyme disease as a cause of transient disorder in myocardial conductive function. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Abstract
We present a case of acute traumatic optic neuropathy in 54 year old male patient. The patient presented with acute loss of vision in the right eye due to a blunt trauma to the eye. Lid haematoma and subconjunctival hemorrhage were present. Fluorescein staining was negative, anterior chamber and lens was clear. Intraocular pressure was normal. Retina and optic nerve head appeared normal on fundoscopy. The vision was “counting fingers at 1 meter” in the right eye. Color test indicated color perception dysfunction of the right eye. Relative afferent pupillary defect (RAPD) was positive. Ocular ultrasound, orbital X ray and CT scan was normal, but visual evoked potentials test was pathologic. The consideration was made whether to treat a patient or not since there are no consensus on the treatment of traumatic optic neuropathy. We decided to treat the patient immediately with the megadoses of steroids following the protocol suggested by Cerovski. The patient responded well to the treatment and recovered vision to normal.
Collapse
|
15
|
Poster session Thursday 6 December - AM: Other myocardial diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Abstract
We present an adolescent boy with unilateral supernumerary breast. It was a V type by Leung Clasification. Despite the average occurence between 0.22% and 6% in a normal population we have not had other cases in the last 20 years. The patient was an asthenic boy of sixteen in the IV stage of puberty. Sometimes he felt swelling and tenderness in this breast tissue two years ago. These symptoms became worse two months ago. At the admission he was symptom free. In the right hypochondrium inferomedially he had a nipple and areola with a small part of the glandular tissue. The axilla was empty. After an excision we got a 15 x 10 x 8 mm specimen. Pathohistological report described incompletely formed mammary lobule with smooth muscles and lactiferous ducts of nipple in dermis. This was consistent with the diagnosis of ectopic breast tissue. He wanted it removed for esthetic reasons. His hormonal state was normal. All blood checks were normal. Kidney ultrasound was normal. His grandmother had pyelon duplex and frequent uroinfections. As it is known, there is an association between supernumerary breast tissue and renal malformations. Since he did not have it, we think that a routine screening of the uropoetic system should be performed in any patient with supernumerary breast.
Collapse
|
17
|
Abstract
Article presents a laparoscopic cystogastrostomy of pancreatic pseudocysts. Pancreatic pseudocyst is a common complication of acute or chronic pancreatitis. It is treated by drainage. Until the development of laparoscopic method, the only surgical type of treatment was a drainage of pseudocyst into the stomach or intestine by the open surgery. In a recent years, a new procedures of laparoscopic treating of pseudocysts pancreatic were published. Despite of the small number of cases it is legible that this certain method of operative treatment has clear benefits for the patient. Herewith, we present a laparoscopic transgastric cystogastrostomy of the 44-year old woman who was admitted because of acute biliary pancreatitis. She was operated six months after the acute attack.
Collapse
|
18
|
[Hospitalization of children with traumatic brain wounds in Brodposavina county]. ACTA MEDICA CROATICA : CASOPIS HRAVATSKE AKADEMIJE MEDICINSKIH ZNANOSTI 2011; 65:445-451. [PMID: 22994015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Traumatic brain injury (TBI) is the most common cause of acquired disability and death in children. Retrospective analysis showed 350 children, 128 (36.6%) girls and 222 (63.4%) boys who were hospitalized for injury of neurocranium in a 5 year-period in Dr. Josip Bencević General Hospital in Slavonski Brod. Most of them had both contusion and commotion (46.8%), followed by just contusion of the head (12.5%) and fractures of the skull (10.5%). The haemorrhages and hemathomas were less common (epidural, subdural, SAH) (3.2%). The procedures performed showed that in almost all children X-rays had been performed (99.7%). The most commonly X-rays performed were those of the head (craniogram) and/or cervical spine, followed by CT, EEG, ultrasound and NMR. The occurence of complications was recorded in only 2% of injured children (seizure, syncopa, febrile convulsions). Analysis of treatment methods showed that in most children (89.6%) therapy was conservative. The injured children were hospitalizated mostly for 2 days (34.5%) or 3 days (32.5%), while longer hospitalization was less common. Regarding extra consultation of other specialists (besides neurosurgeons), the most commonly consulted were pediatrician, surgeon/traumatologist, specialist of ENT/maxilofacial surgery, neuropediatrician, pediatric surgeon, ophthalmologist and others. It can be said that the prognosis of TBI in children depends on the age, neurological status and kind of injury, and on the quality of care, which involves availability of neurosurgeons and other specialists.
Collapse
|
19
|
Poster Session 1: Thursday 8 December 2011, 08:30-12:30 * Location: Poster Area. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011. [DOI: 10.1093/ejechocard/jer206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
20
|
Massive necrosis of the upper gastrointestinal tract with acute gastric perforation and metabolic acidosis after hydrochloric acid (HCl) ingestion. Zentralbl Chir 2011; 136:289-90. [PMID: 21348002 DOI: 10.1055/s-0030-1262623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
21
|
Non-invasive ultrasound guided compression repair of post puncture femoral pseudoaneurysm. MEDICINSKI ARHIV 2011; 65:113-114. [PMID: 21585188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Pseudo aneurysm (PSA) of femoral artery is the second common post puncture complication. If PSA is less than 18 mm, it can be closed spontaneously and it can be asymptomatic. If not, it needs treatment. The most common non invasive method used in the treatment is ultrasound guided compression (UGC) with duplex color Doppler. In the treatment of PSA, other options are available, such as thrombin and collagen injection in the PSA sack, application of stent, but they are more invasive, with more complications than UGC. MATERIAL AND METHOD Retrospective study was performed in the period from 2005-2010. During this period, 4575 punctions of femoral artery were performed. Because of suspected PSA of femoral artery, we examined and diagnosed 28 PSA in the ward of ultrasound diagnostic. Data regarding the location and morphologic characteristics of PSA, morbid disease were documented. RESULTS UGC was performed in 22 PSA patients, 12 men and 9 women, with average age of 48 years. 20 PSA were obliterated, while 2 remained persistent even after second attempt, and they were surgically treated. Efficacy of this method was 90%. Control examination was performed after 12 and 24 hours, and after 1 and 3 months. Intra- and after procedural complications were not observed. CONCLUSION Non invasive treatment of PSA with UGC is cheap, efficient and easy to perform, with minor complications in well selected patients.
Collapse
|
22
|
Laparoscopic appendectomy is safe procedure in the pregnant patients in second trimester. MEDICINSKI ARHIV 2011; 65:125-126. [PMID: 21585192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Optimal approach to appendicitis in pregnancy remains controversial issue. There is also some concern that laparoscopy during pregnancy may cause fetal injury and alter fetal perfusion. Supporters of laparoscopy claim that minimally invasive approach even in pregnant state possesses several advantages, including fewer wound complications and less postoperative pain, producing faster return to normal activities and early hospital discharge, with no increased fetal risk. We present our series of pregnant patients who underwent laparoscopic appendectomy that shows that in the hands of an experienced surgeon, this method is a safe option in pregnant patients in the second trimester.
Collapse
|
23
|
Poster session I * Thursday 9 December 2010, 08:30-12:30. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010. [DOI: 10.1093/ejechocard/jeq136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
24
|
Succcessful laparoscopic treatment of cholecystoduodenal fistula. MEDICINSKI ARHIV 2010; 64:379-380. [PMID: 21218763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Cholecystoduodenal fistula (CD) is a rare complication of gallstone disease. Laparoscopic stapling techniques have been reported as feasible methods for treating this fistula, however these procedures are not always performed successfully. We have reported five cases of CD diagnosed intraoperatively, managed successfully by laparoscopic approach. MATERIALS AND METHODS During the 3-year period, from 2007 to 2009, 1500 patients underwent LC for gallstone desease, five of them (3.3%), who presented with classic symptoms of symptomatic cholelithiasis, intraoperatively CD were found. Data were collected on patients' age, sex, pre-operative diagnoses, operative methods, morbidity and management. Laparoscopic surgery was performed using the standard three trocars technique. RESULTS All patients were females, 67 years old on average. They had gallstones detected by abdominal ultrasound, but CD's were found during operative treatment of gallstones. In three cases CD was completely mobilized with a combination of blunt and sharp dissection and divided using the endoscopic linear stapling device. In the other two cases after division of the cystic duct and artery the gallbladder was dissected from the liver bed, leaving just the fistulous connection to the duodenum. Then division of the fistula was completed using the same stapling device. All five patients had uneventful postoperative course. The hospital stay of five patients ranged from 5 do 10 days (median 6 days). CONCLUSION CD does not preclude a laparoscopic approach. With more experience and improved techniques, most of these cases could be performed laparoscopically, with all of the advan-tages of minimally invasive surgery.
Collapse
|
25
|
Treatment of common bile duct stones--is the role of ERCP changed in era of minimally invasive surgery? MEDICINSKI ARHIV 2010; 64:187-188. [PMID: 20645517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED In 10-15% of the patients that underwent cholecystectomy, common bile duct stones were found either during the preoperative, intraoperative or postoperative evaluation. Their treatment traditionally was based on open approach and extraction of calculi, with development of endoscopic procedures we have ERCP with endoscopic sphincterotomy, but due to rapid development of laparoscopic procedures now-days we have other therapeutic options such as laparoscopic transcystic extraction and laparoscopic choledohotomy. METHODS During the period between 2007-2009 we treated 168 patients with common bile duct stones. Age range was 21-78 years, 105 female and 63 male patients. We have performed 47 open explorations, 9 laparoscopic transcystic exploration, as well as 112 ERCP and ES. We monitored the rate of success (%), intra- and postoperative complications. RESULTS The success rate of the cases of open exploration was 95%, in 2 cases postoperative cholangiogram showed concrement residues that were successfully treated later on with ERCP+ES. Out of 9 transcystic LCBDE we have performed, in 4 cases extraction was successful, 3 patients underwent conversion into open exploration, and 2 patients were successfully treated with postoperative ERCP. A total of 69 patients were treated with ERCP and ES with the 82% success rate of stone extraction. CONCLUSION Even though laparoscopic and endoscopic procedures have revolutionized treatment of common bile duct stones, the role of ERCP is not changed. Treatment in general hospital settings largely depends on availability of endoscopic and laparoscopic equipment and expertise, and must be individualized according to methods that are available. In our settings we have found that best summary of these demands are achieved by ERCP and laparoscopic approach.
Collapse
|
26
|
Laparoscopic repair of traumatic diaphragmatic hernia. MEDICINSKI ARHIV 2010; 64:121-122. [PMID: 20514783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case.
Collapse
|
27
|
Personality Disorder and Something Else…. Eur Psychiatry 1997. [DOI: 10.1016/s0924-9338(97)80757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|