Третман на ателектази

Ателектази се најчести пулмонални компликации и се јавуваат кај 25% од оперираните во торакална и абдоминална хирургија. Најчесто се јавуваат кај постарите и адипозни болни, кај пушачите или кај пациенти кои веке имаат некое респираторно заболување. Ателектазите се евидентни 48 часа по операција и се одговорни за фебрилните епизоди во овој период во преко 90% случајеви

Asessment of coronary arteries with ECG GATED 64-multidetector computed tomography (MDCT) in patients with suspected aortic dissection Stanford type A

The purpose of our study is to show the value of ECG gated 64-MDCT as an non - invasive and reliable method for simultaneous assessment of coronary arteries as part of the aortic root evaluation. Methods and Materials. From February 2009 until March 2010 we performed 46 ECG - gated, 64 MDCT examinations to confirm a diagnosis of suspected aorta ascendens dissection . A transthoracic (TTE) and/or transesophageal (TEE) echocardiography was initially performed in all patients ( mostly TEE) Patients (pts) with arrhythmia and non-stable haemodynamic conditions were excluded. All MDCT scans were performed with retrospectively ECG gated technique (0,625mm slice thickness). Premedicaton with i.v. betaBlocker (propranolol) was administrated in all with heart rate> 70 bpm

Amplatzer оклузија на паравалвуларен leak на механичка протеза по реоперација на дехисценција на митрална механичка протеза- Приказ на случај

Во трудот се опишува случајот на 46-годишна жена со парававуларното протекување или leak по второ заменување на митрална механичка протеза, кој е успешно третиран со Amplatzer оклузија на паравалвуларниот leak

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

BACKGROUND: Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine.AIM: Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO.MATERIAL AND METHODS: Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure.RESULTS: During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001).CONCLUSIONS: Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms

International Nosocomial Infection Control Consortium report, datasummary of 50 countries for 2010-2015 : Device-associated module

Q3Artículo original1495-1504Background: We report the results of International Nosocomial Infection Control Consortium (INICC) sur-veillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America,Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.Methods:During the 6-year study period, using Centers for Disease Control and Prevention National Health-care Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregateof 3,506,562 days.Results:Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAIrates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associatedpneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples,frequencies of resistance ofPseudomonasisolates to amikacin (29.87% vs 10%) and to imipenem (44.3%vs 26.1%), and ofKlebsiella pneumoniaeisolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27%vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.Conclusions:Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported inCDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the re-duction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC’s main goal tocontinue facilitating education, training, and basic and cost-effective tools and resources, such as stan-dardized forms and an online platform, to tackle this problem effectively and systematically

Autotransplantation for treatment of a giant left atrium

We performed autotransplantation on 2 cases. Case1' 54-year-old male in end-stage heart failure due to end-stage of the mitral valve insufficiency and severe tricuspid insufficiency. Patient had enormous enlargement 01 left atrium (LA) (14x16cm) with interatrial septum aneurysmatically delormated (EF=3D% , EDV=225ml, ESV=138ml)

Surgical treatment of multylocular hydracyst of the left ventricle - A case report

Echinococcus cyst in the heart, a life threatening condition, has incidence in localization of only 0.5-2%. We have described a Gal a 23-year old patient with echinococcus cyst localized in the myoGall of the left ventricle

Перкутана трахеостома

Наши искуства - Методата е воведена 05/2004; Едукација добиена во Deutsche Herz Centrum – Berlin; Пласирано кај 55 пациенти; Се работи без бронхоскопија. Kомпликации: крварење од a.inominata. Кај сите пациенти: влезната врата успешно заздравена; не е забележан пореметен рефлекс на голтање; гласот вратен веднаш после вадење на трахеостомската канила

Transesophageal Evaluation of Reconstructive Surgery for Aortic Valve Stenosis

BACKGROUND: With transesophageal echocardiography (TEE), were evaluated morphological characteristics and early hemodynamic parameters of stentless three leaflets pericardial patch in patients with aortic stenosis (AS) undergoing aortic valve (AV) surgery. AIM: The aim of the study was to point the importance of two-dimensional and three-dimensional TEE imaging intra and early postoperatively. METHODS: At Zan Mitrev Clinic, 2002–2020, were included 377 patients following the actual guidelines of European Society of Cardiology for valvular disease, whereas patients with dilatation of aortic annulus, rheumatoid arthritis, and chronic program on hemodialysis were excluded from the study. Instead of using a standard prosthesis, we made a reconstructive surgery implanting three new created leaflets using bovine/equine pericardium by replacing destroyed valve cusps. Leaflets were implanted separately, using continuous sutures with two supported stitches and that is how real stentless AV without any stent or sowing ring was created. Intraoperative and post-operative TEE was performed. RESULTS: 377 pts with aortic valvular disease (211–56% male, and 166–44% female; 82–21, 75% with AS, 32–8, 49% with aortic insufficiency, and 263–69, 76% with combined stenosis and insufficiency) were included in the study. Post-operative TEE showed aortic morphology close to normal AV, average pressure gradient was 8 mmHg. 121 pts got a combination with aortocoronary bypass (2.3 grafts per pts). 4 patients were re-operated. Mortality rate was 12.46% (44 pts). Follow-up period was 18 years. CONCLUSIONS: Real stentless aortic bioprosthesis is with a close morphology and hemodynamic parameters as a normal valve. TEE such as tool for assessment of AV morphology, anatomy of aortic root, pre-, and intra-operative plays a pivotal role in guiding case selection, surgical planning, and in evaluating procedural success

Шок - хемодинамика при кардиоген шок

Шок • “Транзиција помеѓу живот и смрт” • Неможност за оксигенација и адекватно хранење на телото • Смртност > 20%. Патофизиологија и биохемија; Клинички карактеристики и менаџмент; Специфични причини и третман..