Laparoskopska apendektomija ne povećava stopu negativne apendektomije uz nižu stopu perforiranog apendicitisa - rezultati na 1899 bolesnika u KBC Zagreb

Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.Laparoskopska apendektomija metoda je izbora većine stručnih društava zbog dokazanih mnogobrojnih prednosti. Pitanje je da li se u slučajevima nejasne dijagnoze kirurzi ranije odlučuju na laparoskopsku eksploraciju u odnosu na opservaciju zbog manje invazivnosti i bržeg oporavka i eksploracije cijelog abdomena. Na KBC Zagreb retrospektivno je analizirano 1899 bolesnika u razdoblju od 2009. do 2016. godine kod kojih su operacije započete izmjeničnim rezom ili laparoskopskim pristupom (lap) kod sumnje na akutni appendicitis kod djece i odraslih (stariji od 16 godina). Analizirane su: 1) ukupno negativne apendektomije, 2) negativno-negativne apendektomije (uredan apendiks i nije nađena druga patologija) i 3) negativno-pozitivne apendektomije (uredan apendiks, ali je nađena druga patologija). Nije bilo statistički značajne razlike u stopama negativne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,24); negativne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,15); negativno-negativne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,36); negativno-negativne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,21); negativno-pozitivne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,53); negativno-pozitivne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,56); negativne laparoskopske apendektomije – djeca prema odraslima (p=0,56). Utvrđena je statistički značajno viša stopa perforacija izmjeničnim rezom ukupno (p<0,0001), kod djece do 16 godina (p<0,0001) i kod odraslih (p=0,02). Nije bilo statistički značajne razlike u stopi perforacije kod laparoskopskog pristupa između odrasle i dječje populacije (p=0,24) te stopi perforacije kod pristupa izmjeničnim rezom između odraslih i djece (p=0,29). Rezultati upućuju na zaključak da niti u jednoj podskupini laparoskopska apendektomija ne rezultira višom stopom negativne apendektomije, no uz niže stope perforiranog apendicitisa pa se laparoskopska apendektomija preporuča kao metoda izbora kod sumnje na akutni apendicitis kod djece i odraslih

ALPPS – new approach in the treatment of advanced liver tumors

ALPPS (engl. Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy) je inovativni operacijski zahvat koji je prvi puta predstavljen 2012. godine, a u posljednje dvije godine postao je općeprihvaćen među hepatobilijarnim kirurzima diljem svijeta te su i u našoj ustanovi dosad izvedena tri ALPPS postupka. Budući da je ALPPS relativno nova metoda koja je indicirana samo kod pažljivo odabranih bolesnika, tek se očekuju studije na većem broju bolesnika, ali prema dosadašnjim rezultatima ALPPS se pokazao kao vrlo uspješna kirurška metoda koja omogućuje resektabilnost tumora koji su dosad smatrani neresektabilnima tako da omogućuje iznenađujuće brzu i intenzivnu hipertrofiju ostatnog dijela jetre.ALPPS (Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy) is an innovative surgical procedure which was presented for the first time in 2012, and in last two years it has become widely accepted by hepatobiliary surgeons and cosequently three ALPPS procedures have been performed at our institution so far. Considering that ALPPS is a relatively new method, indicated only in carefully selected patients, we still expect studies on larger number of patients, but according to last results ALPPS has proved to be a very successful surgical method which allows resectability of tumors that were considered irresectable, by promoting surprisingly fast and intensive hypertrophy of future liver remnant

Prevalence of increased body weight and hypertension in the population of Croatian mainland and Adriatic Islands - are islanders really healthier? [Usporedba prevalencije povećane tjelesne težine i povišenog krvnog tlaka između stanovnika kopnene Hrvatske i Jadranskih otoka - jesu li otočani uistinu zdraviji?]

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N = 9,070) served as an estimate for the mainland Croatian population, while the data from "1001 Dalmatian study" (N = 1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P < 0.001), and were more frequently overweight (P < 0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P < 0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P < 0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions

Laparoscopic Appendectomy does not Increase the Rate of Negative Appendectomy along with a Lower Rate of Perforated Appendicitis – Results in 1899 Patients at Zagreb UHC

Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis

ALPPS – new approach in the treatment of advanced liver tumors

ALPPS (engl. Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy) je inovativni operacijski zahvat koji je prvi puta predstavljen 2012. godine, a u posljednje dvije godine postao je općeprihvaćen među hepatobilijarnim kirurzima diljem svijeta te su i u našoj ustanovi dosad izvedena tri ALPPS postupka. Budući da je ALPPS relativno nova metoda koja je indicirana samo kod pažljivo odabranih bolesnika, tek se očekuju studije na većem broju bolesnika, ali prema dosadašnjim rezultatima ALPPS se pokazao kao vrlo uspješna kirurška metoda koja omogućuje resektabilnost tumora koji su dosad smatrani neresektabilnima tako da omogućuje iznenađujuće brzu i intenzivnu hipertrofiju ostatnog dijela jetre.ALPPS (Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy) is an innovative surgical procedure which was presented for the first time in 2012, and in last two years it has become widely accepted by hepatobiliary surgeons and cosequently three ALPPS procedures have been performed at our institution so far. Considering that ALPPS is a relatively new method, indicated only in carefully selected patients, we still expect studies on larger number of patients, but according to last results ALPPS has proved to be a very successful surgical method which allows resectability of tumors that were considered irresectable, by promoting surprisingly fast and intensive hypertrophy of future liver remnant

Prevalence of Increased Body Weight and Hypertension in the Population of Croatian Mainland and Adriatic Islands – Are Islanders Really Healthier?

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N=9,070) served as an estimate for the mainland Croatian population, while the data from »1001 Dalmatian study« (N=1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P<0.001), and were more frequently overweight (P<0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P<0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P<0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions

Usporedba prevalencije povećane tjelesne težine i povišenog krvnog tlaka između stanovnika kopnene Hrvatske i Jadranskih otoka - jesu li otočani uistinu zdraviji?

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N = 9,070) served as an estimate for the mainland Croatian population, while the data from "1001 Dalmatian study" (N = 1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P < 0.001), and were more frequently overweight (P < 0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P < 0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P < 0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions.Cilj istraživanja bio je usporediti prevalenciju povećane tjelesne težine (ITM) i povišenog krvnog tlaka između stanovnika kopnene Hrvatske i jadranskih otoka. Podaci za studiju dobiveni su iz Hrvatske zdravstvene ankete (N=9.070) kao izvora podataka za kopnenu Hrvatsku, i iz istraživačke studije »1001 Dalmatinac« (N=1.001) kao izvora podataka sa četiri jadranska otoka; Raba, Visa, Lastova i Mljeta. Prevalencije povećane tjelesne težine i povišenog krvnog tlaka izračunate su za četiri dobne skupine i analizirane korištenjem hi-kvadrat testa. Rezultati upućuju na to da muškarci na otocima rjeđe imaju normalnu tjelesnu težinu (P<0,001) i veću prevalenciju povećane tjelesne težine (P<0,001). Među ženama nije zabilježena statistički značajna razlika u prevalenciji povećane tjelesne težine između otočana i stanovnika kopna. Postotak ispitanika s normalnim krvnim tlakom bio je manji na otocima (P<0,001), dok je postotak novodijagnosticiranih ispitanika s povišenim krvnim tlakom kod oba spola bio veći na otocima (P<0,001). Rezultati upućuju da zdravstvena slika otočana nije tako povoljna, unatoč prikladnijem životnom stilu i mediteranskom načinu prehrane, barem u smislu prevalencije čimbenika rizika za nastanak kardiovaskularnih bolesti. Ovakav nalaz bi, osobito među muškarcima, mogao biti posljedica otežanog pristupa zdravstvenoj službi, odnosno manje brige za preventivne preglede i kontrolu zdravlja, što je mogući uzrok većoj pojavnosti novodijagnosticiranih ispitanika s povišenim krvnim tlakom i manjoj prevalenciji ispitanika s prikladno liječenom hipertenzijom. Dobiveni rezultati upućuju na to da su otočne populacije prikladne za javnozdravstvene intervencije i akcije kojima je cilj promicanje zdravlja i prevencija bolesti

Genome-wide Association Study of Anthropometric Traits in Korčula Island, Croatia

AIM: To identify genetic variants underlying six anthropometric traits: body height, body weight, body mass index, brachial circumference, waist circumference, and hip circumference, using a genome-wide association study. ----- METHODS: The study was carried out in the isolated population of the island of Korcula, Croatia, with 898 adult examinees who participated in the larger DNA-based genetic epidemiological study in 2007. Anthropometric measurements followed standard internationally accepted procedures. Examinees were genotyped using HumanHap 370CNV chip by Illumina, with a genome-wide scan containing 316730 single nucleotide polymorphisms (SNP). ----- RESULTS: A total of 11 SNPs were associated with the investigated traits at the level of P<10(-5), with one SNP (rs7792939 in gene zinc finger protein 498, ZNF498) associated with body weight, hip circumference, and brachial circumference (P=3.59-5.73 x 10(-6)), and another one (rs157350 in gene delta-sarcoglycan, SGCD) with both brachial and hip circumference (P=3.70-6.08 x 10(-6). Variants in CRIM1, a gene regulating delivery of bone morphogenetic proteins to the cell surface, and ITGA1, involved in the regulation of mesenchymal stem cell proliferation and cartilage production, were also associated with brachial circumference (P=7.82 and 9.68 x 10(-6), respectively) and represent interesting functional candidates. Other associations involved those between genes SEZ6L2 and MAX and waist circumference, XTP6 and brachial circumference, and AMPA1/GRIA1 and height. ----- CONCLUSION: Although the study was underpowered for the reported associations to reach formal threshold of genome-wide significance under the assumption of independent multiple testing, the consistency of association between the 2 variants and a set of anthropometric traits makes CRIM1 and ITGA1 highly interesting for further replication and functional follow-up. Increased linkage disequilibrium between the used markers in an isolated population makes the formal significance threshold overly stringent, and changed allele frequencies in isolate population may contribute to identifying variants that would not be easily identified in large outbred populations