Surgical Treatment of Aortic Dissection in a Patient with Metastatic Prostate Cancer

Acute aortic dissection bears all the stigmata of a true clinical emergency. The natural history of this acute aortic syndrome warrants prompt surgical intervention, with only a few absolute contraindications to this line of treatment. We present a 74-year-old man with documented metastatic prostate cancer who underwent emergent surgery for acute Stanford A aortic dissection. Having acknowledged the relatively favorable evolution of our patient’s malignant disease, we were not deterred by its presence from pursuing surgical treatment of his aortic dissection

Definition of Acetylsalicylic Acid Resistance Using Whole Blood Impedance Aggregometry in Patients Undergoing Coronary Artery Surgery

A beneficial effect of acetylsalicylic acid (ASA) on vein graft patency has been described, but some patients experience adverse cardiac events despite appropriate ASA treatment. Study aim was to define ASA resistance using Multiple elec- trode aggregometry (MEA) preoperatively in group of patients undergoing coronary artery bypass grafting (CABG). Pro- spective observational trial at University Hospital Center Zagreb enrolled 131 patients scheduled for CABG, and divided them into 4 groups with respect to preoperative antiplatelet therapy (APT). Group 1 received 100 mg ASA per day, Group 2 100 mg ASA + 75 mg clopidogrel per day, Group 3 75 mg clopidogrel per day, and Group 4 did not receive any APT. MEA with ASPI test (sensitive to ASA) and ADP test (sensitive to clopidogrel) was performed prior to surgery. In Group 1, patients were characterized as ASA resistant if their ASPI test value exceeded the 75 th percentile distribution. Study en- rolled 131 patients. Significant differences both in the ASPI (p<0.001) and the ADP test (p=0.038) were observed be- tween patients in different APT groups. In Group (1) ASPI test value of 30 AUC presented 75 th percentile of distribution, thus indicating ASA resistance. Group 2 patients had slightly lower ADP test values, but no significant difference oc- curred (mean 60.05 vs. 63.32 AUC, p=0.469). In Group 1 and 2, significant correlations between the ADP test and both, platelet count (r=0.347, p<0.001) and fibrinogen level (r=0.364, p<0.001) were observed. Association between low re- sponse to ASA and post-CABG major adverse ischemic events risk increase has been described thus indicating need for ASA resistant patients detection. In patients with preoperative ASPI test exceeding 30 AUC postoperative, ASA dose ad- justment or clopidogrel addition according to MEA results should be considered

Influence of Oak Wood on the Quality of Apple Brandy

Rakija od voća je jako alkoholno piće proizvedeno isključivo alkoholnom fermentacijom i destilacijom mesnatih plodova voća ili mošta od voća, bobica ili zelenih dijelova, destilirano na manje od 86 % vol. alkohola tako da ima miris i okus destilirane sirovine. Rakija od voća mora sadržavati količinu hlapivih tvari od najmanje 200 grama po hektolitru preračunato na 100 % vol. alkohola. Na temelju dobivenih fizikalnih i kemijskih parametara, koji u potpunosti zadovoljavju kriterije Pravilnika o jakim alkoholnim pićima, zaključuje se da je za proizvodnju destilata korištena kvalitetna sirovina u odgovarajućem stadiju zrelosti, te da je proces ukomljavanja, fermentacije i destilacije pravilno vođen. Odležavanjem rakije od jabuka kroz šest mjeseci došlo je do smanjenja udjela metanola i etil-acetata, dok je udio ostalih hlapive komponenata rastao, što je u konačnici utjecalo i na veći udio ukupnih hlapivih komponenti u finalnom proizvodu. Nadalje, praćenjem utjecaja šestomjesečnog dozrijevanja rakije u hrastovoj bačvi te na temelju analiza, zaključujemo da se odležavanjem dobiva kvalitetan finalni proizvod.Fruit brandy is a strong alcoholic drink produced exclusively by alcoholic fermentation and distillation of fleshy fruits or most of fruit, berry or green parts, distillled to less than 86 % alcohol by volume so that it has the smell and taste of the distilled raw material. Fruit brandy must contain a quantity of volatile substances of at least 200 grams per hectoliter converted to 100 % alcohol by volume.Based on the obtained physical and chemical parameters, wich fully meet the criteria of the Ordinance on strong alcoholic beverages, it is concluded that high-quality raw material at the appropriate stage of maturity were used for the production of distillate, and that the process of chopping and storing fruit, fermentation and distillation was properly managed. Ageing the apple brandy for six months resulted in a decrease in the proportion of methanol and ethyl acetate, while the proportion of other volatile components increased, which ultimately had an effect on the higher proportion of total volatile components in the final product. Furthermore, by monitoring the influence of the six-month maturation of brandy in an oak barrel and based on analyses, we conclude that ageing results in a high-quality final product

Influence of Oak Wood on the Quality of Apple Brandy

Rakija od voća je jako alkoholno piće proizvedeno isključivo alkoholnom fermentacijom i destilacijom mesnatih plodova voća ili mošta od voća, bobica ili zelenih dijelova, destilirano na manje od 86 % vol. alkohola tako da ima miris i okus destilirane sirovine. Rakija od voća mora sadržavati količinu hlapivih tvari od najmanje 200 grama po hektolitru preračunato na 100 % vol. alkohola. Na temelju dobivenih fizikalnih i kemijskih parametara, koji u potpunosti zadovoljavju kriterije Pravilnika o jakim alkoholnim pićima, zaključuje se da je za proizvodnju destilata korištena kvalitetna sirovina u odgovarajućem stadiju zrelosti, te da je proces ukomljavanja, fermentacije i destilacije pravilno vođen. Odležavanjem rakije od jabuka kroz šest mjeseci došlo je do smanjenja udjela metanola i etil-acetata, dok je udio ostalih hlapive komponenata rastao, što je u konačnici utjecalo i na veći udio ukupnih hlapivih komponenti u finalnom proizvodu. Nadalje, praćenjem utjecaja šestomjesečnog dozrijevanja rakije u hrastovoj bačvi te na temelju analiza, zaključujemo da se odležavanjem dobiva kvalitetan finalni proizvod.Fruit brandy is a strong alcoholic drink produced exclusively by alcoholic fermentation and distillation of fleshy fruits or most of fruit, berry or green parts, distillled to less than 86 % alcohol by volume so that it has the smell and taste of the distilled raw material. Fruit brandy must contain a quantity of volatile substances of at least 200 grams per hectoliter converted to 100 % alcohol by volume.Based on the obtained physical and chemical parameters, wich fully meet the criteria of the Ordinance on strong alcoholic beverages, it is concluded that high-quality raw material at the appropriate stage of maturity were used for the production of distillate, and that the process of chopping and storing fruit, fermentation and distillation was properly managed. Ageing the apple brandy for six months resulted in a decrease in the proportion of methanol and ethyl acetate, while the proportion of other volatile components increased, which ultimately had an effect on the higher proportion of total volatile components in the final product. Furthermore, by monitoring the influence of the six-month maturation of brandy in an oak barrel and based on analyses, we conclude that ageing results in a high-quality final product

Eighteen years of heart transplantation: a single center experience

The best option for the treatment of a failing heart is heart transplantation. The transplantation program at the University Hospital Center Rebro Zagreb started in 1988. To the best of our knowledge this is the first retrospective study on cardiac transplantation in Croatia looking into survival following heart transplantation. Between 1988 and 2006, we performed 81 heart transplantations at the University Hospital Center Rebro Zagreb. Our study focused on the last ten years after establishment of the Department of cardiac surgery as a separate institution. There were thirteen different hospitals throughout Croatia, which contributed to the donor network. Average age of the heart recipient was 48+/-11.8 years (range 14-72), and average age of the heart donor was 34+/-10.7 years (range 14-56). There were more women among the heart donors (34%) then among the heart recipients (18%). During the first ten years, from 1988-1998, the average number of cardiac transplantations was 3 per year In the period from 1998-2006, average number of cardiac transplantations increased to 6 per year. The average thirty-day mortality for the last nine years was 27%. It declined from 30% and 40% in 1998 and 1999, respectively down to 0% in the last two years. Average age of the patients who died was 50+/-6.5years (range 44-62) and did not significantly differ from those who survived. The donor network has grown up to fourteen different hospitals throughout Croatia. The limiting factor in cardiac transplant surgery is the number of available donors. Therefore in attempt to form a good transplant program it is crucial to form an efficient donor network. The number of performed cardiac transplantations is expected to rise until it reaches the number of available donors. With advances in operative technique and postoperative management--immunosuppressive therapy we have observed a remarkable drop in the early operative mortality in the studied period

Surgical treatment of aortic dissection in a patient with metastatic prostate cancer [Liječenje akutne disekcije aorte u bolesnika s metastatskim karcinomom prostate]

Acute aortic dissection bears all the stigmata of a true clinical emergency. The natural history of this acute aortic syndrome warrants prompt surgical intervention, with only a few absolute contraindications to this line of treatment. We present a 74-year-old man with documented metastatic prostate cancer who underwent emergent surgery for acute Stanford A aortic dissection. Having acknowledged the relatively favorable evolution of our patient's malignant disease, we were not deterred by its presence from pursuing surgical treatment of his aortic dissection

Tehnički priručnik

Tvrtka Welplast utemeljena je 1983. godine i trenutno je vodeća tvrtka u završnoj preradi polimernih materijala (polietilen PE i polipropilen PP) na prostoru BIH i Republike Hrvatske odnosno na prostorima jugoistočne Europe

Definition of acetylsalicylic acid resistance using whole blood impedance aggregometry in patients undergoing coronary artery surgery [Definicija rezistencije na acetilsalicilnu kiselinu upotrebom impedancijske agregometrije kod bolesnika koji se podvrgavaju operaciji koronarnog premoštenja]

A beneficial effect of acetylsalicylic acid (ASA) on vein graft patency has been described, but some patients experience adverse cardiac events despite appropriate ASA treatment. Study aim was to define ASA resistance using Multiple electrode aggregometry (MEA) preoperatively in group of patients undergoing coronary artery bypass grafting (CABG). Prospective observational trial at University Hospital Center Zagreb enrolled 131 patients scheduled for CABG, and divided them into 4 groups with respect to preoperative antiplatelet therapy (APT). Group 1 received 100 mg ASA per day, Group 2 100 mg ASA + 75 mg clopidogrel per day, Group 3 75 mg clopidogrel per day, and Group 4 did not receive any APT. MEA with ASPI test (sensitive to ASA) and ADP test (sensitive to clopidogrel) was performed prior to surgery. In Group 1, patients were characterized as ASA resistant if their ASPI test value exceeded the 75th percentile distribution. Study enrolled 131 patients. Significant differences both in the ASPI (p < 0.001) and the ADP test (p = 0.038) were observed between patients in different APT groups. In Group (1) ASPI test value of 30 AUC presented 75th percentile of distribution, thus indicating ASA resistance. Group 2 patients had slightly lower ADP test values, but no significant difference occurred (mean 60.05 vs. 63.32 AUC, p = 0.469). In Group 1 and 2, significant correlations between the ADP test and both, platelet count (r = 0.347, p < 0.001) and fibrinogen level (r = 0.364, p < 0.001) were observed. Association between low response to ASA and post-CABG major adverse ischemic events risk increase has been described thus indicating need for ASA resistant patients detection. In patients with preoperative ASPI test exceeding 30 AUC postoperative, ASA dose adjustment or clopidogrel addition according to MEA results should be considered

Eighteen Years Of Heart Transplantation – A Single Center Experience

The best option for the treatment of a failing heart is heart transplantation. The transplantation program at the University Hospital Center Rebro Zagreb started in 1988. To the best of our knowledge this is the first retrospective study on cardiac transplantation in Croatia looking into survival following heart transplantation. Between 1988 and 2006, we performed 81 heart transplantations at the University Hospital Center Rebro Zagreb. Our study focused on the last ten years after establishment of the Department of cardiac surgery as a separate institution. There were thirteen different hospitals throughout Croatia, which contributed to the donor network. Average age of the heart recipient was 48±11.8 years (range 14–72), and average age of the heart donor was 34±10.7 years (range 14–56). There were more women among the heart donors (34%) then among the heart recipients (18%). During the first ten years, from 1988–1998, the average number of cardiac transplantations was 3 per year. In the period from 1998–2006, average number of cardiac transplantations increased to 6 per year. The average thirty-day mortality for the last nine years was 27%. It declined from 30% and 40% in 1998 and 1999, respectively down to 0% in the last two years. Average age of the patients who died was 50±6.5 years (range 44–62) and did not significantly differ from those who survived. The donor network has grown up to fourteen different hospitals throughout Croatia. The limiting factor in cardiac transplant surgery is the number of available donors. Therefore in attempt to form a good transplant program it is crucial to form an efficient donor network. The number of performed cardiac transplantations is expected to rise until it reaches the number of available donors. With advances in operative technique and postoperative management – immunosuppressive therapy we have observed a remarkable drop in the early operative mortality in the studied period

Definicija rezistencije na acetilsalicilnu kiselinu upotrebom impedancijske agregometrije kod bolesnika koji se podvrgavaju operaciji koronarnog premoštenja

A beneficial effect of acetylsalicylic acid (ASA) on vein graft patency has been described, but some patients experience adverse cardiac events despite appropriate ASA treatment. Study aim was to define ASA resistance using Multiple electrode aggregometry (MEA) preoperatively in group of patients undergoing coronary artery bypass grafting (CABG). Prospective observational trial at University Hospital Center Zagreb enrolled 131 patients scheduled for CABG, and divided them into 4 groups with respect to preoperative antiplatelet therapy (APT). Group 1 received 100 mg ASA per day, Group 2 100 mg ASA + 75 mg clopidogrel per day, Group 3 75 mg clopidogrel per day, and Group 4 did not receive any APT. MEA with ASPI test (sensitive to ASA) and ADP test (sensitive to clopidogrel) was performed prior to surgery. In Group 1, patients were characterized as ASA resistant if their ASPI test value exceeded the 75th percentile distribution. Study enrolled 131 patients. Significant differences both in the ASPI (p < 0.001) and the ADP test (p = 0.038) were observed between patients in different APT groups. In Group (1) ASPI test value of 30 AUC presented 75th percentile of distribution, thus indicating ASA resistance. Group 2 patients had slightly lower ADP test values, but no significant difference occurred (mean 60.05 vs. 63.32 AUC, p = 0.469). In Group 1 and 2, significant correlations between the ADP test and both, platelet count (r = 0.347, p < 0.001) and fibrinogen level (r = 0.364, p < 0.001) were observed. Association between low response to ASA and post-CABG major adverse ischemic events risk increase has been described thus indicating need for ASA resistant patients detection. In patients with preoperative ASPI test exceeding 30 AUC postoperative, ASA dose adjustment or clopidogrel addition according to MEA results should be considered.Povoljan učinak acetilsalicilne kiseline na prohodnost venskih graftova već je opisana, ali određeni broj bolesnika poslijeoperacijski doživi nepovoljna ishemijska zbivanja unatoč adekvatnom liječenju acetilsalicilnom kiselinom. Cilj studije je prijeoperacijski definirati rezistenciju na acetilsalicilnu kiselinu upotrebom impedancijske agregometrije (MEA) u skupini bolesnika koji se podvrgavaju operaciji koronarnog premoštenja (CABG). Prospektivna opservacijska studija u Kliničkom bolničkom centru Zagreb uključila je 131 bolesnika kod kojih je planiran CABG. Bolesnici su podijeljeni u 4 skupine obzirom na prijeoperacijski ordiniranu antiagregacijsku terapiju. Skupina 1 je primala acetilsalicilnu kiselinu 100 mg/dnevno, skupina 2 100 mg acetilsalicilne kiseline te 75 mg klopidogrel dnevno, skupina 3 je primala klopidogrel 75 mg dnevno dok skupina 4 nije primala antiagregacijsku terapiju prije operacije. MEA s ASPI testom (koji je senzitivan na učinak acetilsalicilne kiseline) i ADP testom (senzitivan na učinak klopidogrela) je izvedena prije operacije. U skupini 1, bolesnici kojima je vrijednost ASPI testa iznosila vise od 75. percentile distribucije vrijednosti ASPI testa su okarakterizirani kao rezistentni na acetilsalicilnu kiselinu. Značajne razlike u vrijednostima ASPI (p<0.001) i ADP testa (p=0.038)uočene su između skupina bolesnika definiranih prema režimu prijeoperacijskog antiagregacijskog liječenja. U skupini 1, vrijednost ASPI testa od 30 AUC (engl. area under curve) je predstavljala vrijednost 75-te percentile, označavajući graničnu vrijednos za definiciju rezistencije na acetilsalicilnu kiselinu.U skupini 2 (izloženi klopidogrelu) izmjerene su niže vrijednosti ADP testa, međutim bez statistički značajne razlike (srednja vrijednost 60.05 vs. 63.32 AUC, p=0.469). U skupini 1 i 2,uočene su značajne korelacije između vrijednosti ADP testa i broja trombocita (r=0.347, p<0.001) te razine fibrinogena (r=0.364, p<0.001).Povezanost između izostanka odgovora na acetilsalicilnu kiselinu i povećanog rizika za neželjena poslijeoperacijska ishemijska zbivanja je već opisana što naglašava potrebu za brzim i lakoizvedivim definiranjem bolesnika s rezistencijom na acetilsalicilnu kiselinu. Kod bolesnika s prijeoperacijskim vrijednostima ASPI testa većim od 30 AUC, trebalo bi razmotriti prilagodbu doze acetilsalicilne kiseline ili dodavanje klopidogrela (tzv. dvojna antiagregacijska terapija) na osnovi MEA monitoriranja