Dissecting lesions of common carotid artery after carotid surgery: a case report

This case report represents rare complication of carotid surgery, iatrogenic dissection of the common carotid artery and its successful endovascular treatment. We herein report a case of 55 year-old female patient in whom carotid surgery was performed due to constant tinnitus caused by kinking of right internal carotid artery. On day 7th carotid control ultrasound was performed, according to hospital’s protocol. The carotid ultrasound showed dissecting lesion of right common carotid artery in a length of three centimeters that was confirmed with computed tomography angiography of neck vessels, and dual antithrombotic therapy was initiated. One month later percutaneous angioplasty was performed with stent implantation

Analysis of Internal Deletions of a Rat Col1a1 Promoter Fragment in Transfected ROS17/2.8 Cells

The aim of this paper is identification of regulatory sequences downstream of –1683 base pairs (bp) in the rat Col1a1 promoter important for expression in osteoblasts. Previous findings suggest that a rat Col1a1 gene fragment extending from –1719 to +115 bp linked to the chloramphenicol acetyl transferase (CAT) reporter gene (ColCAT1719) is highly and selectively expressed in osteoblasts. Three internal deletions within the ColCAT1719 construct were generated and stably transfected into ROS 17/2.8 cells. CAT activity was measured in cell extracts. An internal deletion of ColCAT1719 from –1637 to –504 bp caused an almost complete loss of CAT activity, whereas deletions of –1284 to –905 bp and –1284 to –451 bp had little effect on CAT activity. We hypothesized that removal of a Runx2/Cbfa1 consensus site at –1376 bp may have caused the loss of activity produced by the –1637 to –504 bp deletion. To test this hypothesis, we produced a more restricted internal deletion of ColCAT1719 from –1418 to –1284 bp, which removes this site. This deletion did not affect promoter activity. Our results suggest that the Runx2 site at –1376 bp by itself does not influence Col1719 promoter activity. Future studies will focus on the region between –1637 to 1418 bp, which contains several potentially interesting transcription factor binding sites

Analysis of Internal Deletions of a Rat Col1a1 Promoter Fragment in Transfected ROS17/2.8 Cells

The aim of this paper is identification of regulatory sequences downstream of –1683 base pairs (bp) in the rat Col1a1 promoter important for expression in osteoblasts. Previous findings suggest that a rat Col1a1 gene fragment extending from –1719 to +115 bp linked to the chloramphenicol acetyl transferase (CAT) reporter gene (ColCAT1719) is highly and selectively expressed in osteoblasts. Three internal deletions within the ColCAT1719 construct were generated and stably transfected into ROS 17/2.8 cells. CAT activity was measured in cell extracts. An internal deletion of ColCAT1719 from –1637 to –504 bp caused an almost complete loss of CAT activity, whereas deletions of –1284 to –905 bp and –1284 to –451 bp had little effect on CAT activity. We hypothesized that removal of a Runx2/Cbfa1 consensus site at –1376 bp may have caused the loss of activity produced by the –1637 to –504 bp deletion. To test this hypothesis, we produced a more restricted internal deletion of ColCAT1719 from –1418 to –1284 bp, which removes this site. This deletion did not affect promoter activity. Our results suggest that the Runx2 site at –1376 bp by itself does not influence Col1719 promoter activity. Future studies will focus on the region between –1637 to 1418 bp, which contains several potentially interesting transcription factor binding sites

A Rare Case of Multiple Aneurysms in a Young Patient

Multiple aneurysms are clinically common in population aged over sixty and are caused mainly by atherosclerosis. When occurring in young population other etiologies such as trauma, infections, Bechet’s disease, Marfan syndrome, neurofibromatosis or inflammatory disease are responsible for the development of arterial aneurysms. A rare case of multiple aneurysms in a 40-year-old man, affecting the infrarenal part of abdominal aorta, both iliac arteries, common femoral arteries, left femoral superficial and popliteal arteries on both legs, is reported. The underlying pathology was progressive atherosclerosis, favored by familial hyperlipidemia and excessive cigarette smoking

Spontana heterotopična, ektopična cervikalna i ektopična tubarna trudnoća - uvijek prisutna dijagnostička poteškoća: prikaz triju slučajeva

The incidence of heterotopic/ectopic pregnancy in recent times has increased partly due to the increase in assisted reproductive technologies, whereas such medical cases and cervical pregnancy in particular are extremely rare with spontaneous conception. We report on three patients referred to our department in one week: one patient each with spontaneous heterotopic pregnancy, cervical pregnancy and tubal pregnancy. All of them had conceived spontaneously and were properly diagnosed and treated, however, additional care is needed in diagnosing and managing the potentially fatal consequences of ectopic pregnancy if not recognized early and managed properly, despite its low incidence.Incidencija heterotopičnih/ektopičnih trudnoća se u posljednje vrijeme povećava između ostalog i zbog sve veće upotrebe metoda pomognute oplodnje, ali ovi slučajevi, a naročito cervikalna trudnoća, iznimno su rijetki u spontanim zanošenjima. Prikazujemo tri bolesnice koje su se javile u našu Kliniku u tjedan dana: bolesnica sa spontanom heterotopičnom trudnoćom, druga s cervikalnom i treća s tubarnom trudnoćom. Sve su spontano zanijele, pravodobno dijagnosticirane i izliječene, ali naglašavamo da je osobita pozornost potrebna u dijagnozi i liječenju potencijalno fatalnih posljedica izvanmaterničnih trudnoća ako nisu prepoznate i liječene dovoljno rano, unatoč tako iznimno rijetkoj pojavnosti

Spontaneous Isolated Dissection of the Abdominal Aorta

Isolated spontaneous dissection of the abdominal aorta is such a rare entity and there are only a few cases reported in literature up to date. A 42-year old male was admitted to the hospital with mild pain in the lower abdomen and back that had began seven days prior to admission together with the sudden onset of the ischemic symptoms of the left leg (ischemic ulcers of the calf, gangrenous toe and pallor foot). Patient denied any trauma, hypertension history was negative, while he was active cigarette smoker. MSCT and digital subtracted angiography have shown a dissection of the abdominal aorta approximately two centimeters below the origin of the inferior mesenteric artery extending in the left common iliac artery, with no sign of the aneurysmatic dilatation of the abdominal aorta. Emergent surgery was performed with aorto- biiliacal bypass graft interposition, amputation of the left toe and necrectomy of the left calf. Postoperative follow up and local vascular condition were satisfied. Even though is rare entity, isolated abdominal aorta dissection accounts for ap proximately 2–4% of all aortic dissection. Nowadays therapeutic regimen includes endovascular, open surgery or conser vative treatment

Two-Incision Laparoscopic Cholecystectomy – Our Experience

Cilj: Članak opisuje tehniku i rezultate izvođenja laparoskopske kolecistektomije kroz dvije incizije, primijenjene na 42 bolesnika, te ju uspoređuje sa standardnom laparoskopskom kolecistektomijom. Metode: Učinjena je laparoskopska kolecistektomija kroz dvije incizije (skupina A) u 42 bolesnika. Rezultati su uspoređeni s rezultatima standardne laparoskopske kolecistektomije (skupina B – 50 bolesnika). Rezultati: Srednje operacijsko vrijeme bilo je 45 ± 3,5 min (skupina A) i 43 ± 4 min (skupina B). Nisu zabilježene unutaroperacijske ili poslijeoperacijske komplikacije. Srednje vrijeme hospitalizacije bilo je jednako u objema skupinama. Zaključak: Laparoskopska kolecistektomija kroz dvije incizije jednako je siguran postupak kao standardna laparoskopska kolecistektomija kroz tri incizije, ali s boljim estetskim rezultatom te bez dodatnih troškova.Objective: This article describes the technique and the results of two-incision laparoscopic cholecystectomy performed on 42 patients, and compares it with standard cholecystectomy. Methods: Two-incision laparoscopic cholecystectomy (group A) was performed on 42 patients. Results were compared with standard laparoscopic cholecystectomy (group B) – 50 patients. Results: Mean operative time was 45 ± 3.5 min (group A), and 43 ± 4 min (group B). No intraoperative or postoperative complications were observed. Average hospital stay was equal in both groups. Conclusion: Two-incision laparoscopic cholecystectomy is equally safe as standard laparoscopic cholecystectomy with three incisions but with better cosmetic results and without the extra cost

RARE DISORDERS OF EXTRACRANIAL CAROTID ARTERIES

Prikazana su dva rjeđa slučaja bolesti ekstrakranijskih karotidnih arterija s osvrtom na način kirurškog liječenja. Radi se o zavojitosti (engl. coiling) unutarnje karotidne arterije (ACI). Oba su bolesnika podvrgnuta uspješnom kirurškom liječenju. U prvom slučaju opisana je simptomatska kombinacija presavinuća (engl. kinking) i zavojitosti ipsilateralne ACI, bez prateće stenoze ACI, a učinjena je resekcija ACI, uz reanastomozu. Druga je bolesnica imala dvostruku zavojitost ACI, odnosno ACI je formirala dvostruku petlju, uz subtotalnu simptomatsku stenozu početnog segmenta ACI. Pri operaciji je učinjena resekcija produženog segmenta, koja je uključivala i područje stenoze ACI, uz naknadnu reanastomozu. S obzirom na rijetkost navedenih bolesti karotidnih arterija i činjenice da dosada u literaturi nisu objavljene veće studije osim opisa pojedinačnih slučajeva, svako dodatno iskustvo i prikaz liječenja doprinijet će daljnjem razumijevanju i smjernicama u liječenju ovih rijetkih bolesti.Abnormalities of the internal carotid arteries (ACI) are rare findings, usually not linked with neurologic symptoms and frequently are diagnosed during routine duplex scanning or angiographic examination. These abnormalities are predominantly elongation of the vessel that leads to kinking, coiling or tortuosity of the artery, and the origin is congenital or acquired related to atherosclerosis. We report on two symptomatic cases related to elongation of ACI. The first case was a 56-year-old female that had bilateral coiling. The second patient was a 64-year-old female that suffered from symptomatic double coiling of the left ACI connected with high grade stenosis. In both cases, successful operation was done with resection of the elongated and stenosed ACI segment and reanastomosis of the ACI and common carotid artery. Postoperatively, symptoms were resolved. In symptomatic cases of isolated carotid elongations, surgical treatment is a better option than conservative medical treatment alone, whilst in asymptomatic ACI elongation, conservative medical treatment is advised

EARLY CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS – OUR EXPERIENCE

U ovoj je studiji analiziran učinak endarterektomije unutarnje karotidne arterije (ACI) u bolesnika unutar tri tjedna od razvoja neurološke simptomatologije s obzirom na učestalost i vrstu neželjenih događaja u poslijeoperacijskom tijeku. U studiju su uključeni bolesnici sa simptomatskom stenozom visokog stupnja ACI, koji su preboljeli ishemijski moždani udar (IMU) ili tranzitornu ishemijsku ataku (TIA). Kod svih je bolesnika učinjena uzdužna karotidna endarterektomija u općoj anesteziji s uporabom intraluminalnog shunt-a. Praćenje bolesnika se odnosi na razdoblje između siječnja 2008. i listopada 2012. godine kada je operirano ukupno 69 simptomatskih bolesnika s visokim stupnjem stenoze ACI (70-99 %). Kontrolni ultrazvuk karotidnih arterija (CD) rađen je sedmi poslijeoperacijski dan te nakon jednog, tri, šest i dvanaest mjeseci, a nakon toga jednom godišnje. Od ukupnog broja operiranih (n = 69), 27 (39 %) bolesnika bilo je sa svježe preboljelim IMU-om koji su operirani unutar tri tjedna od razvoja neurološke simptomatologije, a najranije četrnaest dana nakon razvoja inzulta i 42 (61 %) bolesnika sa simptomima TIA-e, a koji su operirani neposredno nakon završetka prijeoperacijske obrade. Od poslijeoperacijskih neželjenih događaja došlo je do razvoja IMU-a u 2 (2,63 %) bolesnika i 2 odgođene restenoze (2,63 %) endarterektomirane unutarnje karotidne arterije koje su zahtijevale endovaskularno liječenje. Zaključujemo da provođenje rane endarterektomije u klinički odabranih bolesnika s visokim stupnjem stenoze ACI, shodno našim rezultatima i rezultatima drugih studija, ne nosi veći rizik od kasne endarterektomije, a zasigurno snižava postotak recidiva IMU i TIA-a, koji su najčešći u ranom razdoblju razvoja neurološke simptomatologije.Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlin’s sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61%) patients had TIA symptoms with verified significant ACI stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid end- arterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely

RARE DISORDERS OF EXTRACRANIAL CAROTID ARTERIES

Prikazana su dva rjeđa slučaja bolesti ekstrakranijskih karotidnih arterija s osvrtom na način kirurškog liječenja. Radi se o zavojitosti (engl. coiling) unutarnje karotidne arterije (ACI). Oba su bolesnika podvrgnuta uspješnom kirurškom liječenju. U prvom slučaju opisana je simptomatska kombinacija presavinuća (engl. kinking) i zavojitosti ipsilateralne ACI, bez prateće stenoze ACI, a učinjena je resekcija ACI, uz reanastomozu. Druga je bolesnica imala dvostruku zavojitost ACI, odnosno ACI je formirala dvostruku petlju, uz subtotalnu simptomatsku stenozu početnog segmenta ACI. Pri operaciji je učinjena resekcija produženog segmenta, koja je uključivala i područje stenoze ACI, uz naknadnu reanastomozu. S obzirom na rijetkost navedenih bolesti karotidnih arterija i činjenice da dosada u literaturi nisu objavljene veće studije osim opisa pojedinačnih slučajeva, svako dodatno iskustvo i prikaz liječenja doprinijet će daljnjem razumijevanju i smjernicama u liječenju ovih rijetkih bolesti.Abnormalities of the internal carotid arteries (ACI) are rare findings, usually not linked with neurologic symptoms and frequently are diagnosed during routine duplex scanning or angiographic examination. These abnormalities are predominantly elongation of the vessel that leads to kinking, coiling or tortuosity of the artery, and the origin is congenital or acquired related to atherosclerosis. We report on two symptomatic cases related to elongation of ACI. The first case was a 56-year-old female that had bilateral coiling. The second patient was a 64-year-old female that suffered from symptomatic double coiling of the left ACI connected with high grade stenosis. In both cases, successful operation was done with resection of the elongated and stenosed ACI segment and reanastomosis of the ACI and common carotid artery. Postoperatively, symptoms were resolved. In symptomatic cases of isolated carotid elongations, surgical treatment is a better option than conservative medical treatment alone, whilst in asymptomatic ACI elongation, conservative medical treatment is advised