Examination the role of C reactive protein as an early predictor of the wound line dehiscence in various types of reconstruction in elective abdominal surgery

abdominalnoj hirurgiji, najvažniji i najčešći operativni zahvat predstavlja resekcija obolelog segmenta sa istovremenom anastomozom presečenih krajeva u svrhu uspostavljanja intestinalnog kontinuiteta. Najvažnije za uspeh operativnog lečenja je uspešno zarastanje intestinalne anastomoze. U pokušaju ranog otkrivanja njenog neuspešnog zarastanja ispitivani su različiti biomarkeri među kojima i C reaktivni protein (CRP). CILJ: Ispitivanje uloge CRP-a u predikciji problematičnog zarastanja šavne linije na digestivnim anastomozama u prvoj nedelji posle operacije. METOD: Istraživanje je obuhvatilo 100 pacijenata obolelih od benigne i maligne bolesti digestivnog trakta, koji su hirurški lečeni na Klinici za hirurgiju Kliničko Bolničkog Centra Zvezdara, u Beogradu, u periodu od 2014. do 2015.godine. U postoperativnom toku merene su vrednosti CRP-a, leukocita i telesne temperature i njihove vrednosti praćenje u odnosu na razvoj svih postoperativnih komplikacija. REZULTATI: Pacijenti sa komplikacijama u postoperativnom toku imali su više vrednosti leukocita svakoga dana počevši od trećeg postoperativnog dana u odnosu na pacijente koji nisu imali komplikacije, iako njihova vrednost nije značajno prelazila referentne vrednosti. Beležeći postoperativnu visinu telesne temperature, značajno više prosečne vrednosti imali su pacijenti sa dehiscencijom anastomoze III, V i VI postoperativnog dana u odnosu na pacijente koji nisu imali komplikacije iako srednja vrednost nije nije značajno prelazila 37C. Vrednosti CRP-a II PO dana skoro 9 puta su veće od preoperativnih kod pacijenata koji nemaju postoperativne komplikacije, a 14 puta veće kod pacijenata koji su ih imali. ZAKLJUČAK: Određivanje postoperativnih vrednosti CRP-a može da ukaže na problematično zarastanje anastomoze na digestivnom traktu pre pojave kliničkih znakova.In abdominal surgery, the most important and most common surgical procedure is the resection of the diseased segment with simultaneous anastomosis of the cut ends for the purpose of establishing intestinal continuity. The most important for the success of operative treatment is successful healing of intestinal anastomosis. In the attempt of early detection of its unsuccessful healing, various biomarkers were studied, among them C reactive protein (CRP). OBJECTIVE: Testing the role of CRP in the prediction of problematic healing of the wound line on digestive anastomosis in the first week after surgery. METHOD: The study included 100 patients with benign and malignant digestive tract diseases, who were surgically treated at the Clinic for Surgery at the Clinical Hospital Center Zvezdara in Belgrade in the period from 2014. to 2015. In the postoperative course, the values of CRP, leukocyte and body temperature and their values were measured in relation to the development of all postoperative complications. RESULTS: Patients with complications in the postoperative course had more leukocyte values every day starting from the third postoperative day compared to patients who did not have complications, although their value did not significantly exceed the reference values. By recording the postoperative height of body temperature, significantly more average values had patients with dehiscence of anastomosis III, V, and VI postoperative days compared to patients who did not have complications, although the mean did not significantly exceed 37C. The values of CRP on the second postoperative day are almost 9 times greater than preoperative in patients who have no postoperative complications and 14 times greater in patients who had them. CONCLUSION: Determination of postoperative values of CRP can indicate a problematic healing of digestive tract anastomosis before the appearance of clinical signs

Giant esophageal fibrovascular polyp with clinical behaviour of inflammatory pseudotumor: A case report and the literature review

Introduction. Esophageal fibrovascular polyps are rare, benign, intraluminal, submucosal tumor-like lesions, characterized by pedunculated masses which can demonstrate enormous growth. The most frequent symptoms are dysphagia, vomiting and weight loss. Fibrovascular polyps with long stalks can regurgitate into the airways and cause asphyxia. Esophageal inflammatory pseudotumor is extremely rare lesion accompanied with various systemic manifestations as fever, anemia and thrombocytosis. Case report. We presented a 29-year-old man complaining of a long-lasting fever and dysphagia. He was found to have huge pedunculated submucosal tumor of esophagus, surgically completely resected. Histopathological examination showed that this giant tumor, 24 x 9 x 6 cm, was a fibrovascular polyp. The postoperative course was uneventful. The preoperative fever, anemia and thrombocytosis disappeared and did not recur in the postoperative course. Conclusion. We reported a patient with giant esophageal pedunculated tumor with clinical manifestations of inflammatory pseudotumor and histopathological picture of fibrovascular polyp, that we have not found described in the literature before

Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia

BACKGROUND: Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. METHODS: Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. RESULTS: Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. CONCLUSIONS: By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings

Myocardial Na+ K+-ATPase and SERCA: Clinical and Pathological Significance From a Cytological Perspective

Structure and functions of Na+/K+-ATPase and SERCA are described with details on their subunits, isoforms, and intracellular localization. Main regulatory mechanisms are summarized. Molecular mechanisms of cell death and heart failure are explained with the analysis of the role of Na+/K+-ATPase and SERCA in these processes. Facts are considered from a cytological, pathological, and clinical perspective with an accent to new therapeutic strategies. The aim of this contribution is an overview of functional results in a structural context.Part of the Advances in Biochemistry in Health and Disease book series (ABHD,volume 15)