20 research outputs found
Gastric tube ulcer perforating the pericardium after subtotal esophagectomy [Perforacija ulkusa želuÄanog supstituta u perikard nakon subtotalne ezofagektomije]
Subtotal esophagectomy with retrosternal transposition of the gastric tube to the neck was performed in a 62-year-old patient with squamous cell carcinoma of the proximal third of the esophagus. He developed a salivatory fistula in the early postoperative period that healed spontaneously. Five months later, the patient developed partial stenosis of the esophagogastric anastomosis which required recervicotomy and excision, after numerous failed dilatation attempts. Eighteen months later, the patient presented to the hospital for severe pain in the upper abdomen. Clinical work-up revealed pericardial perforation by the gastric tube ulcer necessitating emergent surgery and gastric tube removal. We present a patient who developed both early and late complications of subtotal esophagectomy with gastric tube transposition as well as a review of the literature
Opseg struka ne korelira s funkcionalnom pluÄnom sposobnosti kod umjerene i teÅ”ke kroniÄne opstruktivne pluÄne bolesti
Waist circumference is a good predictor of the risk of heart diseases, but dana on the relationship between waist circumference and pulmonary diseases are sparse. The aim of this study was to investigate its influence on pulmonary function regarding exercise capacity in moderate and severe chronic obstructive pulmonary disease (COPD), according to Global Initiative for Lung Diseases (GOLD) stages. During 2009, a total of 70 COPD patients aged 33 to 80 years were stratified into GOLD 2 and GOLD 3 stages. Diagnostic separation between COPD severity groups was made upon percentage of predicted forced expiratory volume in 1 second. Anthropometric measures, lung function testing and prognostic scoring systems were assessed. Logistic regression analysis was used to make comparisons while taking into account the possible confounding factors. Waist circumference did not show substantial variations between GOLD 2 and GOLD 3 stages (p>0.5). There was a weak positive correlation between waist circumference and percent of predicted 6-minute walking distance (r=0.237; p=0.001). Another parameter, suprailiac skinfold, was significantly different between GOLD 2 and GOLD 3 stages (19.41 vs. 15.32 mm; p=0.047). Although waist circumference is a meaningful marker of abdominal obesity, which influences pulmonary function, we failed to prove its importance in correlation with functional lung capacity in a selected COPD population. However, suprailiac skinfold deserves greater attention and further evaluation.PoveÄani je opseg struka dobar predskazatelj rizika za razvoj srÄanih bolesti, no gotovo da nema podataka o odnosu opsega struka i pluÄnih bolesti. Cilj ove studije bio je ispitati utjecaj veliÄine opsega struka na funkcionalnu pluÄnu sposobnost prema klasifikaciji GOLD (Global Initiative for Lung Diseases). Tijekom 2009. godine 70 bolesnika u dobi od 33 do 80 godina podijeljeno je u skupine GOLD2 i GOLD3 ovisno o težini bolesti. DijagnostiÄka razdioba ovih skupina temelji se na razlici dobivenih vrijednosti predviÄenog forsiranog ekspiracijskog volumena u prvoj sekundi. Analizirane su brojne antropometrijske mjere, testovi pluÄne funkcije i prognostiÄki bodovni sustavi. U statistiÄkoj je obradi koriÅ”tena logistiÄka regresijska analiza. Razlika u veliÄini opsega struka izmeÄu stupnjeva GOLD2 i GOLD3 nije dosegla statistiÄku znaÄajnost (p>0,5). NaÄena je slaba pozitivna korelacija izmeÄu opsega struka i postotka predviÄene udaljenosti u 6-minutnom hodu (r=0,237; p=0,001). No, statistiÄki znaÄajna razlika izmeÄu dviju ispitivanih skupina naÄena je u debljini suprailijaÄnog nabora (19,41 prema 15,32 mm; p=0,047). Opseg struka je jedan od parametara koji definiraju abdominalnu pretilost. Iako pretilost utjeÄe na pluÄnu funkciju, ova studija nije dokazala da postoji korelacija izmeÄu veliÄine opsega struka i funkcionalne pluÄne sposobnosti u odabranoj populaciji bolesnika s kroniÄnom pluÄnom boleÅ”Äu. No, daljnju evaluaciju i vrednovanje u kliniÄkoj praksi zaslužuje mjerenje suprailijaÄnog nabora
Videotorakoskopska biopsija pluÄa i pleure u dijagnostici kroniÄnih izljeva prsiÅ”ta
Chronic pleural effusion requires pleural and lung biopsy in more than 60% of patients. Open lung biopsy was formerly considered as the most reliable diagnostic method, whereas now the procedure is mostly performed via video-assisted thoracoscopy. During the last ten-year period (1995Ā-2005), 96 patients aged 31-72 (mean age 53) years were operated on at University Department of Thoracic Surgery, Jordanovac University Hospital for Lung Diseases by video-assisted thoracoscopy in general anesthesia. All biopsies were done by clamp sampling from parietal or visceral pleura, and in 31 patients lung tissue was sampled by endostapler wedge resection. Conversion to mini-thoracotomy was needed in only 12 patients, due to massive adhesions. Tissue samples were referred for histopathologic analysis. After the procedure, the patients had a thoracic drain connected to negative pressure. Histopathologic diagnosis was made in almost all patients, yielding a 97% success rate. In 16 patients, drain airflow had to be prolonged to more than 5 days, while the mean drainage duration was 4 days and mean hospital stay 8 days. Talc pleurodesis was performed in most patients with malignant effusion to stop effusion accumulation. Video-assisted thoracoscopic biopsy allows for adequate pleural and lung sampling with a high rate of accuracy. Postoperative mortality and morbidity are lower in comparison with open lung biopsy. It is concluded that video-assisted thoracoscopic biopsy is an efficient and safe method in the diagnosis of chronic pleural effusion.Dugotrajni izljevi pleuralne Å”upljine zahtijevaju biopsiju pleure i pluÄa kod viÅ”e od 60% bolesnika. Ranije se otvorena biopsija pluÄa smatrala najpouzdanijom dijagnostiÄkom metodom, dok se danas taj zahvat najÄeÅ”Äe izvodi videotorakoskopskim putem. U zadnjih deset godina, od 1995. do 2005. godine, u Klinici za torakalnu kirurgiju "Jordanovac" operirano je videotorakoskopskim naÄinom 96 bolesnika u opÄoj anesteziji. ProsjeÄna životna dob bila je 53 godine, s rasponom od 31-72 godina. Sve biopsije su raÄene uzimanjem uzoraka hvataljkom s parijetalne ili visceralne pleure, a kod 31 bolesnika uzet je i komadiÄ pluÄevine klinastom resekcijom uz pomoÄ endostaplera. Samo kod 12 bolesnika uÄinjena je konverzija u minitorakotomiju zbog opsežnih priraslica. Svi uzorci su upuÄeni na patohistoloÅ”ku analizu. Nakon zahvata svaki bolesnik je imao torakalni dren koji je spojen na negativni tlak. HistopatoloÅ”ka dijagnoza postavljena je kod gotovo svih bolesnika, tako da je uspjeÅ”nost zahvata bila 97%. Kod 16 bolesnika postojao je produženi protok zraka na dren kroz viÅ”e od pet dana, dok je prosjeÄno vrijeme drenaže iznosilo 4 dana, a prosjeÄni boravak u bolnici 8 dana. Kod veÄine bolesnika s malignim izljevom raÄena je pleurodeza talkom kako bi prestalo nakupljanje izljeva. Videotorakoskopska biopsija omoguÄava uzimanje kvalitetnog uzorka pleure i pluÄevine (bioptata) uz visok postotak toÄnosti. Poslijeoperacijska smrtnost i pobol bili su niži nego kod otvorene biopsije pluÄa. ZakljuÄak je da je videotorakoskopska biopsija pluÄa uÄinkovita i sigurna metoda u dijagnostici kroniÄnog pleuralnog izljeva
Profilaksa poslijeoperacijske atrijske fibrilacije i resekcija pluÄa ā naÅ”a iskustva sa 608 uzastopnih bolesnika
Postoperative atrial fibrillation is a common complication after lung resection. It is burdened by increased mortality and morbidity, prolonged hospitalization, and higher resource utilization in thoracic surgery patients. Therefore, some kind of pharmacological prophylaxis is recommended. In our patients, diltiazem, a calcium antagonist, is administered. We collected data on all 608 patients having undergone lung resection (no less than lobectomy) between November 2012 and May 2015. This period included patients having received diltiazem during their postoperative stay in our Intensive Care Unit and surgical ward, and those that did not receive it. Patients having had atrial fibrillation before the surgery and patients with cardiac pacemaker were excluded from the trial. Other patients were divided into three groups: patients with some kind of antiarrhythmic therapy before and continued after the surgery; patients with diltiazem prophylaxis; and patients without any antiarrhythmic prophylaxis. Th e data collected were statistically analyzed. We found no statistically significant difference in the incidence of postoperative atrial fibrillation among the groups (p<0.05).Poslijeoperacijska atrijska fibrilacija je Äesta komplikacija resekcije pluÄa. Ona dovodi do poviÅ”enog pobola i smrtnosti, produljenog bolniÄkog lijeÄenja i poveÄane potroÅ”nje sredstava u torakokirurÅ”kih bolesnika. U skladu s tim, savjetuje se neki oblik farmakoloÅ”ke profilakse. U naÅ”ih bolesnika odabrani lijek je kalcijev antagonist diltiazem. Skupili smo podatke o svih 608 bolesnika podvrgnutih resekciji pluÄa (ne manjoj od lobektomije) u razdoblju izmeÄu studenog 2012. i svibnja 2015. Ovo razdoblje ukljuÄuje bolesnike koji su primali diltiazem tijekom njihova poslijeoperacijskog boravka u Jedinici intenzivnog lijeÄenja i na kirurÅ”kom odjelu te bolesnike koji ga nisu primali. Bolesnici s atrijskom fibrilacijom prije operacije i bolesnici s elektrostimulatorom srca iskljuÄeni su iz obrade. Ostali bolesnici podijeljeni su u tri skupine: skupinu lijeÄenu nekim antiaritmikom prije operacije koji su nastavili svoju terapiju i nakon operativnog zahvata, skupinu na profilaksi diltiazemom i skupinu bez profilakse. Skupljeni podaci su statistiÄki analizirani. Nismo naÅ”li statistiÄki znaÄajnu razliku izmeÄu skupina u incidenciji poslijeoperacijske atrijske fibrilacije (p<0,05)
TRANSPLANTACIJA PLUÄA U KLINIÄKOM BOLNIÄKOM CENTRU ZAGREB U HRVATSKOJ
Objective: Lung transplantation has become a standard of care for patients with a variety of non-malignant end-stage lung diseases. The aim of the study was to report on the safety and feasibility of lung transplantation at the Zagreb University Hospital Center. Methods: In this single center retrospective observational study, all consecutive patients undergoing lung transplantation at the Zagreb University Hospital Center from April 2021 until December 2022 were included. The only inclusion criterion was surgery for lung transplantation. Patient demographic and operative characteristics were reported, as well as early outcomes, including 30-day mortality, hospital stay, intensive care unit stay, duration of mechanical ventilation, and incidence of primary graft dysfunction. The degree of primary graft dysfunction was graded based on the International Society for Heart and Lung Transplantation criteria at 72 hours after transplantation with grades 0 to 3. Results: During the 21-month study period, 19 patients were successfully transplanted. There was no 30-day mortality. There was one late death at 18 months after transplantation. Median in-hospital stay was 32 days, ranging from 21 to 62 days. Mean mechanical ventilation duration was 105Ā±58 h and median of intensive care unit stay was 6 days, ranging from 4 to 15 days. Only two (11%) patients had the highest grade 3 primary graft dysfunction. Of the remaining patients, 16 (84%) had none (grade 0) and one (5%) patient had mild primary graft dysfunction (grade 1). Conclusion: Our results suggest that lung transplantation is safely performed at the Zagreb University Hospital Center. Initial results with no operative mortality are encouraging. Further follow-up and experience are needed to make inferences on long-term outcomes of our lung transplantation patients.Cilj: Transplantacija pluÄa postala je standard skrbi za pacijente s nizom nemalignih pluÄnih bolesti u zavrÅ”nom stadiju. Cilj ovog istraživanja bio je izvijestiti o sigurnosti i izvedivosti transplantacije pluÄa u KliniÄkom bolniÄkom centru Zagreb u Hrvatskoj. Metode: U ovu retrospektivnu opservacijsku studiju ukljuÄeni su svi uzastopni pacijenti koji su bili podvrgnuti transplantaciji pluÄa u KliniÄkom bolniÄkom centru Zagreb od travnja 2021. do prosinca 2022. godine. Jedini kriterij za ukljuÄivanje bio je kirurÅ”ki zahvat transplantacije pluÄa. Zabilježene su demografske i operativne karakteristike pacijenata, kao i rani ishodi, ukljuÄujuÄi 30-dnevnu smrtnost, boravak u bolnici, boravak na jedinici intenzivne njege, trajanje mehaniÄke ventilacije i incidenciju primarne disfunkcije presatka. Stupanj primarne disfunkcije presatka ocijenjen je na temelju kriterija MeÄunarodnog druÅ”tva za transplantaciju srca i pluÄa 72 sata nakon transplantacije ocjenama od 0 do 3. Rezultati: Tijekom dvadesetjednomjeseÄnog razdoblja istraživanja transplantacija je uspjeÅ”no primijenjena u 19 pacijenata. Nije bilo 30-dnevne smrtnosti. Dogodila se jedna kasna smrt 18 mjeseci nakon transplantacije. Medijan boravka u bolnici bio je 32 dana, u rasponu od 21 do 62 dana. ProsjeÄno trajanje mehaniÄke ventilacije bilo je 105Ā±58 h, a medijanboravka u jedinici intenzivne njege bio je 6 dana, u rasponu od 4 do 15 dana. Samo dva (11 %) bolesnika imala su primarnu disfunkciju presatka najviÅ”eg stupnja 3. Od preostalih bolesnika 16 (84 %) ih nije imalo nikakav (stupanj 0), a jedan (5%) bolesnik imao je blagi, stupanj 1. Rasprava: U ovom Älanku prikazujemo naÅ”e poÄetno iskustvo s transplantacijom pluÄa. Transplantacija pluÄa bila je jedina od transplantacija solidnih organa koja se donedavno u Hrvatskoj nije rutinski izvodila, s napomenom da je prva transplantacija pluÄa u Hrvatskoj uÄinjena joÅ” 2003. godine u Klinici za torakalnu kirurgiju Jordanovac, ali se program transplantacije nije tada nastavio. Od travnja 2021. godine transplantacije pluÄa rutinski se izvode u naÅ”em centru i hrvatski pacijenti viÅ”e ne moraju putovati u inozemstvo radi transplantacije pluÄa. Sveukupni nedostatak donora pluÄa i dalje je glavni ograniÄavajuÄi Äimbenik za broj transplantacija koje se izvode na godinu. Svega 20%-30% doniranih pluÄa iskoristi se za transplantaciju. Potrebno je kontinuirano unaprjeÄenje i razvoj strategija koje Äe poveÄati broj donora i uporabljivih pluÄnih presadaka. ZakljuÄak: NaÅ”i rezultati pokazuju da se transplantacija pluÄa sigurno izvodi u KliniÄkom bolniÄkom centru Zagreb. PoÄetni rezultati bez operativnog mortaliteta su ohrabrujuÄi. Daljnje praÄenje i iskustvo potrebni su za donoÅ”enje zakljuÄaka o dugoroÄnim ishodima naÅ”ih pacijenata s transplantacijom pluÄa
Immeasurable Levels of Serum Phosphate ā An Unidentified Cause of Respiratory Failure in a Diabetic Patient
We report a case of immeasurable levels of serum phosphate in a patient with juvenile type Diabetes mellitus and diabetic ketoacidosis who developed respiratory failure. A 27-year-old female with juvenile type insulin-dependent Diabetes mellitus was admitted because of suspected acute mediastinitis and respiratory failure, probably, among other responsible factors, caused and complicated by undetectable levels of serum phosphate. The serum phosphate concentration three days after aggressive treatment was only 0.2 mmol/L. Furthermore, a significant improvement in weakness and lethargy was observed. To the best of our knowledge, this is the first described case of immeasurable levels of serum phosphate. In patients with Diabetes mellitus, serum phosphate concentrations should be routinely checked in order to avoid additional complications
Euglycemic diabetic ketoacidosis induced by empagliflozin, sodium-glucose cotransporter-2 inhibitor, in patient with diabetes mellitus type 2 after thoracic surgery
Inhibitori kotransportera natrija i glukoze 2 (engl. Sodium-glucose cotransporter-2 inhibitors ā SGLT2i) noviji su oralni antidijabetici koji mogu uzrokovati euglikemijsku dijabetiÄku ketoacidozu (eDKA), i to ÄeÅ”Äe kod bolesnika sa Å”eÄernom bolesti tipa 1, a rijetko u onih s tipom 2 Å”eÄerne bolesti. Glavna karakteristika eDKA-a jest gotovo normalna razina glukoze u krvi (GUK) uz metaboliÄku ketoacidozu. U naÅ”em prikazu rijeÄ je o 42-godiÅ”njoj bolesnici u koje su se u ranome postoperativnom periodu, uz gotovo normalne vrijednosti GUK-a, razvili metaboliÄka acidoza, povraÄanje i pospanost. Sumnju da se radi o dijabetiÄkoj ketoacidozi potvrdio je, uz ostalo, pozitivan nalaz ketona u urinu. Na temelju kliniÄke slike, nalaza plinskih analiza arterijske krvi i laboratorijskih nalaza krvi i urina postavila se dijagnoza eDKA-a, nastalog kao posljedica SGLT2i-ja. Bolesnica je lijeÄena inzulinom, kristaloidnim otopinama i elektrolitima. TreÄega postoperativnog dana lijeÄenja otpuÅ”tena je s Odjela anestezije i intenzivnog lijeÄenja na KirurÅ”ki odjel, uz prethodni pregled endokrinologa. Rutinska perioperativna provjera plinskih analiza arterijske krvi pomogla nam je pri detekciji bolesti i lijeÄenju bolesnice. Ovaj prikaz upuÄuje na važnost
ranoga preoperativnog probira pacijenata na SGLT2i, moguÄi nastanak eDKA-a, važnost preoperativne pripreme i potrebe za lijeÄenjem.Sodium-glucose cotransporter-2 inhibitors(SGLT2i) medications are a class of newer antihyperglycemic agents that can induce euglycemic diabetic ketoacidosis (eDKA), usually in patients with diabetes mellitus
type 1,but very rarely in patients with diabetes mellitus type 2. The main characteristic of eDKA is that blood glucose level(BGL) is nearly normal. We present a case report of a 42-year-old patient who was scheduled for
elective thoracic surgery in which in the early postoperative period she developed metabolic acidosis with nausea and vomiting. Ketones in urine were positive and it was recognized as eDKA induced by SGLT2i. She was treated with intravenous insulin, fluids and electrolytes. She was dismissed from ICU on the third day to surgery department after endocrinologistĀ“s review. Arterial blood gas samples are a part of our routine preoperative and postoperative procedures that helped us in the detection and treatment of this patient. This case report points out the
importance of early recognition of patients on SGLT2i, appropriate preoperative assessment, and eventually the need for treatment
Our Experience in the Management of Congenital Chest Wall Deformities
Deformiteti stijenke prsnog koÅ”a su relativno rijetke bolesti nepoznate etiologije koje se javljaju u djetinjstvu i adolescenciji. Primjetna je obiteljska pojavnost deformiteta uz vrlo rijetko spontano izljeÄenje. KirurÅ”ko lijeÄenje predstavlja jedinu moguÄnost ispravljanja deformiteta bilo klasiÄnim operacijskim naÄinom ili minimalno invazivnom metodom lijeÄenja (endoskopskim putem). MeÄu kirurzima nema ujednaÄenog stava o tome u kojem je životom razdoblju najbolje uÄiniti ispravljanje deformiteta, jer su rezultati vrlo dobri bez obzira na primijenjenu metodu lijeÄenja. U ovom radu prikazani su rezultati lijeÄenja kod 105 bolesnika operiranih klasiÄnim naÄinom izmeÄu 1985. i 2005. godine u Klinici za torakalnu kirurgiju KliniÄke bolnice za pluÄne bolesti āJordanovacā.Chest wall deformities are relatively rare diseases of unknown etiology, which occur in childhood and adolescence. Pectus deformities show familial occurrence with very rare spontaneous resolution. Operative treatment is one of the possible therapeutic options for deformity correction by classic operative procedure or by minimally invasive method of treatment (endoscopic). There is no consensus among surgeons about the age at which correction of the chest wall deformity should best be performed because therapeutic results are very good irrespective of the method of treatment employed. Therapeutic results in 105 patients operated on by the classic method during the 1985-2005 period at University Department of Thoracic Surgery, Jordanovac University Hospital for Lung Diseases in Zagreb, Croatia, are reported