15 research outputs found
Rinogeni meningitis uzrokovan kongenitalnim kolesteatomom apeksa piramide: simultano kirurÅ”ko lijeÄenje transotiÄkim i transsfenoidnim pristupom
A 66-year-old male patient was admitted due to high fever, severe headaches
and disturbance of consciousness. Meningitis was confirmed by lumbar puncture and intravenous
antimicrobial therapy was started. Since he had undergone radical tympanomastoidectomy 15 years
before, otogenic meningitis was suspected, so the patient was referred to our department. Clinically,
the patient manifested watery discharge from the right nostril. Microbiological analysis verified
Staphylococcus aureus in a cerebrospinal fluid (CSF) sample acquired by lumbar puncture. Radiological
work-up, including computed tomography and magnetic resonance imaging scans, showed an
expanding lesion of the petrous apex of the right temporal bone disrupting the posterior bony wall
of the right sphenoid sinus with radiological characteristics indicating cholesteatoma. Those findings
confirmed rhinogenic meningitis caused by expansion of the petrous apex congenital cholesteatoma
into the sphenoid sinus, allowing nasal bacteria to enter the cranial cavity. The cholesteatoma was
removed completely by the simultaneous transotic and transsphenoidal approach. Since the right labyrinth
was already non-functional, there was no surgical morbidity after labyrinthectomy. The facial
nerve remained preserved and intact. The transsphenoidal approach enabled removal of the sphenoid
portion of the cholesteatoma and two surgeons met together at the level of the retrocarotid segment
of the cholesteatoma, completely removing the lesion. This case represents an extremely rare condition
in which a petrous apex congenital cholesteatoma expanded through the petrous apex to the sphenoid
sinus, causing CSF rhinorrhea and rhinogenic meningitis. According to available literature, this is the
first case of petrous apex congenital cholesteatoma causing rhinogenic meningitis successfully treated
with the simultaneous transotic and transsphenoidal approach.Bolesnik u dobi od 66 godina primljen je zbog visoke temperature, jake glavobolje i poremeÄaja svijesti. Lumbalna
punkcija potvrdila je meningitis i zapoÄeta je intravenska antibiotska terapija. BuduÄi da je 15 godina ranije kod bolesnika
raÄena radikalna timpanomastoidektomija, postavljena je sumnja na otogeni meningitis te je upuÄen na naÅ”u Kliniku. Nakon
primitka je uoÄena desnostrana rinolikvoreja, a ponovljenom lumbalnom punkcijom u likvoru je izoliran Staphylococcus aureus.
RadioloÅ”ka obrada ukljuÄujuÄi kompjutoriziranu tomografiju i magnetsku rezonancu pokazala je ekspanzivnu leziju vrha piramide
desne temporalne kosti s destrukcijom stražnje stijenke sfenoidnog sinusa i radiomorfoloŔkim osobinama kolesteatoma.
Ovi nalazi potvrdili su da se radi o rinogenom meningitisu koji je uzrokovan Ŕirenjem kongenitalnog kolesteatoma vrha
piramide u sfenoidni sinus, Å”to je omoguÄilo prodor bakterija iz nosa u endokranij. Kolesteatom je u cijelosti odstranjen simultanim
kombiniranim transotiÄkim i transsfenoidnim pristupom. BuduÄi da je desni labirint od ranije bio nefunkcionalan,
nije bilo kirurÅ”kog morbiditeta nakon labirintektomije. OÄuvani su integritet i funkcija liÄnog živca. Transsfenoidni pristup
omoguÄio je odstranjenje sfenoidnog dijela kolesteatoma, a oba operatera susrela su se na razini retrokarotidnog segmenta
kolesteatoma koji je tako odstranjen u cijelosti. Ovaj bolesnik predstavlja iznimno rijedak sluÄaj kod kojega se kongenitalni
kolesteatom vrha piramide proÅ”irio u sfenoidni sinus uzrokujuÄi rinolikvoreju i rinogeni meningitis. Prema dostupnoj literaturi,
ovo je prvi takav sluÄaj koji je ujedno uspjeÅ”no lijeÄen simultanim transotiÄkim i transsfenoidnim pristupom
Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage [Usporedba viŔeslojne kompjuterizirane tomografije i duplex Doppler ultrazvuka u otkrivanju aterosklerotskih karotidnih plakova kompliciranih krvarenjem u plak ]
This study compared sensitivity and specificity of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Carotid plaques from 50 patients operated for carotid artery stenosis were analyzed. Carotid endarterectomy was performed within one week of diagnostic evaluation. Results of multidetector-row computed tomography and duplex Doppler ultrasonography diagnostic evaluation were compared with results of histological analysis of the same plaque areas. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 14.7 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 54.3 Hounsfield units (p = 0.00003). The highest tissue density observed for complicated plaques was 31.8 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 70.4%, with tissue density of 33.8 Hounsfield units as a threshold value. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed sensitivity of 21.7% and specificity of 89.6% in detecting plaques complicated with intraplaque hemorrhage. Multidetector-row computed tomography showed a very high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed a low level of sensitivity and a moderate-high level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage
Comparison of Multidetector-Row Computed Tomography and Duplex Doppler Ultrasonography in Detecting Atherosclerotic Carotid Plaques Complicated with Intraplaque Hemorrhage
This study compared sensitivity and specificity of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Carotid plaques from 50 patients operated for carotid artery stenosis were analyzed. Carotid endarterectomy was performed within one week of diagnostic evaluation. Results of multidetector-row computed tomography and duplex Doppler ultrasonography diagnostic evaluation were compared with results of histological analysis of the same plaque areas. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 14.7 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 54.3 Hounsfield units (p=0.00003). The highest tissue density observed for complicated plaques was 31.8 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 70.4%, with tissue density of 33.8 Hounsfield units as a threshold value. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed sensitivity
of 21.7% and specificity of 89.6% in detecting plaques complicated with intraplaque hemorrhage. Multidetector-row computed tomography showed a very high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed a low level of sensitivity and a moderate-high level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage
Increase in Specific Density of Levobupivacaine and Fentanyl Solution Ensures Lower Incidence of Inadequate Block
The clinical presentation of a subarachnoid block (SAB) is dependent upon the intrathecal spread of local anesthetic
(LA). Intrathecal distribution depends on the chemical and physical characteristics of LA, puncture site, technique used,
patient anatomical characteristics and hydrodynamic properties of cerebrospinal fluid. We tried to determine whether a
combined glucose/LA solution can render a clinically significant difference in sensory block distribution and motor block
intensity.This was a controlled, randomized and double blinded study. The surgical procedures were stripping of the
great or small saphenous vein and extirpation of remaining varicose veins. The study included 110 patients distributed
into two groups: Hyperbaric (7.5 mg levobupivacaine (1.5 ml 0.5% ChirocaineĀ®) + 50 mg Fentanyl (0.5 ml FentanilĀ®) and
1 ml 10% glucose (Pliva)) vs. Hypobaric (7.5 mg levobupivacaine (1.5 ml 0.5% ChirocaineĀ®) + 50 mg Fentanyl (0.5 ml
FentanilĀ®) and 1 ml 0.9% NaCl (Pliva, Zagreb)) adding to a total volume of 3.5 ml per solution. Spinal puncture was at
L3-L4 level. Spinal block distribution was assessed in five minute intervals and intensity of motor block was assessed according
to the modified Bromage scale. Pain was assessed with the Visual Analogue Scale. A statistically significant difference
in sensory block distribution, motor block intensity and recovery time was established between hyperbaric and
hypobaric solutions. By increasing the specific density of anesthetic solution, a higher sensory block, with lesser variability,
a diminished influence of Body Mass Index, decreased motor block intensity and faster recovery time may be achieved
Kortizon u slini kao potencijalni prediktor izloženosti buci i povezanom stresu na radnome mjestu
Salivary cortisone strongly correlates with serum cortisol, and since it is less invasive to measure salivary cortisone than serum cortisol and easier than to measure cortisol in saliva, as its concentrations are much lower, we wanted to compare salivary cortisone and cortisol levels as markers of noise-induced stress reaction. The study included 104 participants aged 19ā30 years, 50 of whom were exposed to occupational noise ā„85 dB(A) and 54 non-exposed, control students. All participants took samples of their saliva with SalivetteĀ® Cortisol synthetic swabs on three consecutive working days first thing in the morning. Salivary cortisone and cortisol levels were determined with high-performance liquid chromatography. In addition, they completed a 10-item Perceived Stress Scale (PSS-10) questionnaire, and occupationally noise-exposed participants also completed the Health and Safety Executive (HSE) questionnaire on occupational psychosocial risks. The exposed participants had significantly higher cortisone (P<0.001) and cortisol (P<0.001) levels than controls, and the correlation between cortisone and cortisol levels in the exposed participants was strong (Ļ=0.692, P<0.001), which suggests that salivary cortisone can replace cortisol measurements in saliva as a more reliable method than salivary cortisol and less invasive than serum cortisol. However, the level of perceived stress scored on PSS-10 in the exposed participants did not differ significantly from stress reported by controls, but correlated negatively with cortisone levels, which is contrary to our expectations and raises questions as to why.Kortizon u slini snažno je povezan sa serumskim kortizolom, a kako je manje invazivno mjeriti kortizon u slini nego serumski kortizol te ga je lakÅ”e mjeriti nego kortizol u slini jer su mu koncentracije niske, htjeli smo usporediti koncentracije kortizona i kortizola kao biljega stresne reakcije izazvane bukom. U istraživanju su sudjelovala 104 ispitanika u dobi od 19 do 30 godina, od kojih je 50 izloženo buci ā„85 dB(A) na radnome mjestu, a 54 su neizloženi kontrolni studenti. Svi su sudionici prouzroÄili svoju slinu sintetiÄkim nosaÄima SalivetteĀ® Cortisol tijekom triju uzastopnih radnih dana, odmah nakon jutarnjeg buÄenja. Koncentracije kortizona i kortizola u slini bile su odreÄene tekuÄinskom kromatografijom visoke djelotvornosti. TakoÄer, sudionici su ispunili Ljestvicu doživljenog stresa (PSS-10), a izloženi i upitnik Health and Safety Executive (HSE) o psihosocijalnim rizicima na radnome mjestu. Izloženi sudionici imali su znaÄajno viÅ”e koncentracije kortizona (P<0,001) i kortizola (P<0,001) nego kontrolni, te je korelacija izmeÄu koncentracija kortizona i kortizola u izloženih sudionika bila jaka (Ļ=0,692, P<0,001), Å”to upuÄuje na to da odreÄivanje kortizona u slini može zamijeniti odreÄivanje kortizola u slini, i to kao pouzdanija metoda od odreÄivanja kortizola u slini te kao manje invazivna od odreÄivanja serumskoga kortizola. Razina doživljenog stresa odreÄena ljestvicom u izloženih sudionika nije se znaÄajno razlikovala od razine stresa u kontrolnih sudionika, ali je bila negativno povezana s koncentracijama kortizona, Å”to je suprotno naÅ”im oÄekivanjima te otvara nova pitanja
Spontaneously Ruptured Gastrointestinal Stromal Tumor (GIST) of the Jejunum Mimicking Acute Appendicitis
Gastrointestinal stromal tumors (GISTs) are characterized with diverse clinical presentations, including acute and chronic gastrointestinal bleeding, abdominal pain, presence of an intra-abdominal mass, anorexia, and intestinal obstruction. A 60-year-old obese woman presented as an acute abdominal emergency with right lower quadrant (RLQ) pain and tenderness, nausea and leukocytosis, all mimicking acute appendicitis. Laparotomy revealed a spontaneously ruptured GIST of the jejunum, which was localized to the RLQ due to postoperative adhesions following previous two cesarean sections and cholecystectomy. Complete surgical resection was performed, followed by an uneventful early postoperative course
Smjernice za lijeÄenje stenoze karotidne arterije [Guidelines for treatment of carotid artery stenosis]
Carotid artery stenosis is a risk factor for developing a stroke. Large randomized studies have shown that carotid endarterectomy (CEA) plays a significant role in preventing a stroke. Carotid endarterectomy decreases the risk of stroke and increases the quality of life after surgery. During the past decades carotid artery stenting (CAS) has evolved as a less invasive way of treating extracranial artery stenosis. Carotid artery stenting is supposed to be less invasive but equally successful and durable (randomized studies are expected to support this statement). Carotid artery stenting is being performed by vascular surgeons, general surgeons, neurosurgeons, cardiologists, radiologists etc1. In addition to these guidelines we provide indications for CEA (especially within 2 weeks after the onset of symptoms) and indications for the treatment of restenosis after CEA or CAS. Indications were presented and accepted by the members of the Croatian Society for Vascular Surgery (CSVS) during the meeting in Vodice in May, 2016. Making of these guidelines is not financially supported. The guidelines are primarily intended for vascular surgeons and interventional radiologists to provide a unified stance in the treatment of patients with a significant narrowing of the internal carotid artery
GUIDELINES FOR TREATMENT OF CAROTID ARTERY STENOSIS
Stenoza unutarnje karotidne arterije poveÄava rizik od moždanog udara. Velike randomizirane studije pokazale su da karotidna endarterektomija (engl. carotid endarterectomy ā CEA) ima važnu ulogu u prevenciji moždanog udara te da se kod operiranih bolesnika smanjuje rizik i dugoroÄno poboljÅ”ava kvaliteta života. Tijekom posljednjeg desetljeÄa metoda postavljanja stenta u karotidnu arteriju (engl. carotid artery stenting ā CAS) razvila se kao naÄin lijeÄenja ekstrakranijalne stenoze karotide. Ideja je da se karotidna endarterektomija zamijeni manje invazivnim postupkom koji je poÅ”tedniji za bolesnika, a s jednakim rezultatima lijeÄenja (Å”to tek treba potvrditi randomiziranim studijama). Zahvat izvode lijeÄnici razliÄitih specijalnosti poput vaskularnih kirurga, opÄih kirurga, neurokirurga, kardiologa, radiologa i sl.1 Stoga su smjernice namijenjene potonjima radi zauzimanja jedinstvenog stajaliÅ”ta o lijeÄenju bolesnika sa znatnim suženjem unutarnje karotidne arterije. Dodatak smjernicama jest dio koji se odnosi na CEA-u do 2 tjedna nakon moždanog udara te indikacija za lijeÄenje restenoze nakon CEA-e ili CAS-a. Älanovi Hrvatskog druÅ”tva za vaskularnu kirurgiju (HDVK) prihvatili su izložene smjernice na struÄnom sastanku HDVK u Vodicama u svibnju 2016. god. Njihova izrada nije bila financijski potpomognuta. Smjernice su namijenjene ponajprije vaskularnim kirurzima i interventnim radiolozima koji provode invazivno lijeÄenje bolesnika sa znatnim suženjem unutarnje karotidne arterije radi zauzimanja jedinstvenog stajaliÅ”ta.Carotid artery stenosis is a risk factor for developing a stroke. Large randomized studies have shown that carotid endarterectomy (CEA) plays a significant role in preventing a stroke. Carotid endarterectomy decreases the risk of stroke and increases the quality of life after surgery. During the past decades carotid artery stenting (CAS) has evolved as a less invasive way of treating extracranial artery stenosis. Carotid artery stenting is supposed to be less invasive but equally successful and durable (randomized studies are expected to support this statement). Carotid artery stenting is being performed by vascular surgeons, general surgeons, neurosurgeons, cardiologists, radiologists etc1. In addition to these guidelines we provide indications for CEA (especially within 2 weeks after the onset of symptoms) and indications for the treatment of restenosis after CEA or CAS. Indications were presented and accepted by the members of the Croatian Society for Vascular Surgery (CSVS) during the meeting in Vodice in May, 2016. Making of these guidelines is not financially supported. The guidelines are primarily intended for vascular surgeons and interventional radiologists to provide a unified stance in the treatment of patients with a significant narrowing of the internal carotid artery