The Advantages of End-to-Side Arteriovenous Anastomosis over the Other Two Types of Arteriovenous Anastomosis in Dialysis Patients

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications – The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant ( 2-test = 29.25; P=0.0001). Thrombosis – it has been found that thrombosis was the most frequent complication developing in 30.00 % patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant ( 2-test = 33.920; P=0.0001). The »primary patency« (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant ( 2-test = 49.009; P=0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant ( 2-test = 26.579; P=0.0001). According to our research, the end- -to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage

The Etiological Relation between Serum Iron Level and Infection Incidence in Hemodialysis Uremic Patients

Through the treatment of anaemia in dialysis patients part of the iron ions remain free in the serum which is at the bacterias disposal for growth and the strengthening of their virulence. The linear relation of the increased serum iron level and tissue iron stores in the body and the infection incidence in dialysed patients has become more emphasised. The need of a clearly defined upper threshold of the serum iron concentration limit has been mentioned in scientific journals intensely, and consequently the demand for more precise professional instructions for anaemia treatment. For the purpose of participating in these professional and scientific discussions, we have observed the relation between the iron overload of the organism and complication incidence in 120 of our haemodialysis uremic patients, with special emphasis on infections. It has been established that the sepses incidence is much higher in patients with a serum ferritin concentration above 500 mg/L, than in those patients with a ferritin level lower than the mentioned value (c 2=7.857, p=0.005). The incidence of vascular access infection is significantly higher in those patients with a serum ferritin level above 500 mg/L than in those patients with a ferritin level lower than the mentioned value (c 2=23.186, p=0.001). Furthermore, it has been determined that the incidence of total infection in patients is 3.8 episodes per 100 patients months, which is in accordance to the referral values of other authors. Conclusion – In the analysis of the achieved results, it has been determined that the infection incidence is significantly higher in dialysed patients with a serum iron level higher than 500 g/L, than in those patients with lower values

OUR EXPERIENCE IN THE TREATMENT OF LONG BONE SHAFT FRACTURES IN CHILDREN AND ADOLESCENTS USING ELASTIC STABILE INTRAMEDULLARY NAILING (ECMES

U mnogim medicinskim centrima još uvijek prevladava konzervativan stav u liječenju koštanih prijeloma djece i adolescenata. Aktivne kirurške metode u tim se sredinama primjenjuju primarno samo u bolesnika s posebnim oblicima prijeloma i k tomu samo nekih kostiju ili nakon neuspjela primarnoga konzervativnog liječenja. Sve više se danas, ipak, nameÊu agresivnije kirurške metode u liječenju ovih ozljeda djece i mladih, koje umnogome skraćuju liječenje, pojeftinjuju ga, a život tijekom liječenja čine sno šljivijim. Metoda intramedularne stabilne elastične osteosinteze (ECMES) primjenjuje se uvelike u liječenju prijeloma dugih kostiju djece i mladih. Autori iznose rezultate liječenja 45 bolesnika dječje i adolescentne dobi liječenih ovom novom kirur¹kom metodom, obrazlaæu samu tehniku, njezinu primjenu i upućuju na njezine prednosti. U liječenju bolesnika ovom metodom nisu imali niti jedan primjer pseudoartroze, osteomielitisa ni osificirajuÊeg miozitisa. Srednja vrijednost bolničkog liječenja u promatranih bolesnika iznosila je 6,4 dana. Od osteosinteze do poËetka optereÊenja ili uporabe ekstremiteta proteklo je 4 do 10 dana (srednja vrijednost 6,6 dana), a do potpunog optereÊenja ili uporabe 4 do 14 (srednja vrijednost 10 dana). Sudjelovanje fizijatra u sveukupnom lijeËenju bolesnika svodilo se samo na prikaz privremene uporabe potpazušnih ili podlaktičnih štaka

OUR EXPERIENCE IN THE TREATMENT OF LONG BONE SHAFT FRACTURES IN CHILDREN AND ADOLESCENTS USING ELASTIC STABILE INTRAMEDULLARY NAILING (ECMES

U mnogim medicinskim centrima još uvijek prevladava konzervativan stav u liječenju koštanih prijeloma djece i adolescenata. Aktivne kirurške metode u tim se sredinama primjenjuju primarno samo u bolesnika s posebnim oblicima prijeloma i k tomu samo nekih kostiju ili nakon neuspjela primarnoga konzervativnog liječenja. Sve više se danas, ipak, nameÊu agresivnije kirurške metode u liječenju ovih ozljeda djece i mladih, koje umnogome skraćuju liječenje, pojeftinjuju ga, a život tijekom liječenja čine sno šljivijim. Metoda intramedularne stabilne elastične osteosinteze (ECMES) primjenjuje se uvelike u liječenju prijeloma dugih kostiju djece i mladih. Autori iznose rezultate liječenja 45 bolesnika dječje i adolescentne dobi liječenih ovom novom kirur¹kom metodom, obrazlaæu samu tehniku, njezinu primjenu i upućuju na njezine prednosti. U liječenju bolesnika ovom metodom nisu imali niti jedan primjer pseudoartroze, osteomielitisa ni osificirajuÊeg miozitisa. Srednja vrijednost bolničkog liječenja u promatranih bolesnika iznosila je 6,4 dana. Od osteosinteze do poËetka optereÊenja ili uporabe ekstremiteta proteklo je 4 do 10 dana (srednja vrijednost 6,6 dana), a do potpunog optereÊenja ili uporabe 4 do 14 (srednja vrijednost 10 dana). Sudjelovanje fizijatra u sveukupnom lijeËenju bolesnika svodilo se samo na prikaz privremene uporabe potpazušnih ili podlaktičnih štaka

War Surgical Care – Experience from Franciscan Hospital »dr. fra Mato Nikoli}« in Nova Bila during Conflict in Central Bosnia (1993–1994)

This report presents experience in treatment of war injuries in Franciscan hospital »dr. fra Mato Nikoli}« in Nova Bila, during the war in Central Bosnia from 1993 to 1994, in conditions of encirclement and typhoid fever outbreak. Descriptive- retrospective analysis of organization, implementation and outcomes of surgical care for patients treated from January 1, 1993 till August 20, 1994. In this period, the hospital took care of 2500 wounded persons, 2286 (91.4%) of them male and 214 (8.6%) female, their the average age being 31.5 ± 12.8. There were 1412 gunshot injuries (56.5%), 1022 explosive injuries (40.9%), and 66 blunt injuries (2.6%). There were 1250 injuries to extremities (50.0%), 349 injuries to head and neck (14%), 233 chest injuries (9.3%) and 193 injuries to abdomen (7.7%). There were also 475 multiple injuries (19%). Surgical operations were performed in 1498 patients (60%), with surgical mortality rate of 4.5%. Total hospital mortality rate was 11.4 percent (n=286). Despite extremely difficult conditions of work and lack of doctors, we achieved a low hospital mortality rate. The hospital continued to work after the war. Today, it is a modern health institution in La{va Valley, Central Bosnia

Has Ombrëdanne’s Method of Hypospadic Urethra Reconstruction Been Ignored with Reason?

A B S T R A C T From January 1970 to December 1979 inclusive, 193 boys (aged 2 to 16) underwent surgery for distal hypospadia using Ombredanne’s method at the Department of Pediatric Surgery University Hospital Center Rijeka and at the Department of Pediatric Surgery Zagreb. Follow-up period was 7 to 20 years (mean 13.4). 20 (10.36%) subjects had post-operative organic complications and 15 (7.77%) of them required surgical correction. According to these findings, the success rate using Ombredanne’s method of reconstruction of the hypospadic urethra in no way lags behind the success rate using MAGPI and Mathieu’s methods as well as »Preputial island flap urethroplasty« for analogous cases. Out of 193 subjects who underwent surgery, 80 (41.45%) of those who were sexually mature and had normal psychosexual development were questioned. In this sample, 75 (93.75%) were satisfied with the post-operative appearance of the penis while only 5 (6.25%) were dissatisfied, 3 of which had hypoplastic penis. In 78 (97.50%) subjects questioned, the post-operative urinary squirt was normal and two of them had weak urinary squirt (2.50%), due to meatal stenosis. In conclusion, Ombredanne’s method of reconstruction of the urethra in boys with distal hypospadia is equally successful as other methods used for this purpose

The Etiological Relation between Serum Iron Level and Infection Incidence in Hemodialysis Uremic Patients

Through the treatment of anaemia in dialysis patients part of the iron ions remain free in the serum which is at the bacterias disposal for growth and the strengthening of their virulence. The linear relation of the increased serum iron level and tissue iron stores in the body and the infection incidence in dialysed patients has become more emphasised. The need of a clearly defined upper threshold of the serum iron concentration limit has been mentioned in scientific journals intensely, and consequently the demand for more precise professional instructions for anaemia treatment. For the purpose of participating in these professional and scientific discussions, we have observed the relation between the iron overload of the organism and complication incidence in 120 of our haemodialysis uremic patients, with special emphasis on infections. It has been established that the sepses incidence is much higher in patients with a serum ferritin concentration above 500 mg/L, than in those patients with a ferritin level lower than the mentioned value (c 2=7.857, p=0.005). The incidence of vascular access infection is significantly higher in those patients with a serum ferritin level above 500 mg/L than in those patients with a ferritin level lower than the mentioned value (c 2=23.186, p=0.001). Furthermore, it has been determined that the incidence of total infection in patients is 3.8 episodes per 100 patients months, which is in accordance to the referral values of other authors. Conclusion – In the analysis of the achieved results, it has been determined that the infection incidence is significantly higher in dialysed patients with a serum iron level higher than 500 g/L, than in those patients with lower values