24 research outputs found

    Life-saving percutaneous coronary interventions on the unprotected left main coronary artery in patients with acute coronary syndrome in the catheterization laboratory without cardiosurgical back-up

    Get PDF
    Introduction. The optimal revascularization strategy for unprotected left main coronary disease (ULMCD) is the subject of ongoing debate and patients with ULMCD still represent a challenge for interventionalist, especially in the setting of an acute coronary syndome (ACS). Case report. We presented two cases of percutaneous treatment of ULMCD in the settings of ACS (ST Segment Myocardial Infarction and Non ST Segment Myocardial Infarction - STEMI and NSTEMI) in a catheterization laboratory without back-up of cardiosurgical department. Both patients were hemodynamically unstable with clinical signs of cardiogenic shock. Coronary angiography revealed left main thromobosis and using intra-aortic balloon pump as hemodynamic support primary angioplasty procedures were performed. Immediately after the procedures the patients hemodynamically improved and remained stable till discharge from hospital. Conclusion. Percutaneous coronary intervention (PCI) has become the most common strategy of revascularization in ACS patients with ULMCD and is generally preferred in patients with multiple comorbidities and/or in very unstable patients. In cases with no cardiosurgical departments PCI is an inevitable, bail-out, life saving procedure

    Contemporary approach to primary prophylaxis of venous thromboembolism regarding the impact of risk factors on anticoagulation therapy duration

    Get PDF
    Odgovarajuća tromboprofilaksa podrazumeva pravovremeno identifikovanje reverzibilnih i ireverzibilnih faktora rizika za venski tromboembolizam (VTE), kao i njihovu kategorizaciju. Podaci da najveći procenat plućnih embolija nastaje kod bolesnika sa nehirurÅ”kim oboljenjima i da se kod hirurÅ”ki lečenih bolesnika VTE uglavnom javlja posle otpusta iz bolnice nameću potrebu za odgovarajućom zaÅ”titom od VTE osoba obolelih od inflamatornih oboljenja, akutnih bolesti i drugih nehirurÅ”kih oboljenja, kao i produženjem i optimalizacijom antikoagulantnog režima posle hirurÅ”kih intervencija u primarnoj profilaksi VTE. Kao gotovo potpuno neprepoznate i u praksi zanemarene značajne faktore rizika za VTE posebno ističemo hroničnu opstruktivnu bolest pluća (HOBP) i insuficijenciju srca, naročito kod bolesnika koji pripadaju trećoj i četvrtoj funkcionalnoj klasi prema klasifikaciji NjujorÅ”kog udruženja za srce (NYHA III i IV) sa značajno smanjenom funkcijom leve komore. Postoji opasnost da se kod bolesnika sa HOBP znaci dispneje i kaÅ”alj jednostrano pogreÅ”no protumače kao tipični simptomi uzrokovani isključivo osnovnom respiratornom boleŔću, a da se znaci pogorÅ”anja oboljenja kod osoba s insuficijencijom srca pripiÅ”u samo pogorÅ”anju kardijalnog statusa, zanemarujući mogućnost da je u osnovi reč o plućnom tromboembolizmu koji nije na odgovarajući način prepoznat i lečen. Savremeni način života pogoduje nastanku novih faktora rizika za VTE, kao Å”to je 'putnička' tromboza, naročito kod osoba koje lete na dugačkim avionskim linijama, kao i ljudi koji veći deo dana sede ispred kompjutera (engl. e-thrombosis). Utvrđivanje i prepoznavanje faktora rizika za VTE, naročito zanemarenih nehirurÅ”kih, i istovremenog postojanja viÅ”estrukih faktora rizika u određenom vremenskom intervalu neophodno je radi određivanja odgovarajućeg antikoagulantnog terapijskog režima kod bolesnika s nehirurÅ”kim oboljenjima i onih koji su hirurÅ”ki lečeni u primarnoj prevenciji VTE.Adequate thromboprophylaxis primarily requires timely detection of reversible and irreversible risk factors of venous thromboembolism (VTE) and their categorization. It is important to note that the highest percentage of VTE episodes occur in non-surgical (medical) patients and that VTE develops in a large number of surgical patients upon hospital discharge; this emphasizes the need for adequate VTE prevention in inflammatory diseases, acute medical illness and other medical diseases as well as for prolonging and optimizing the anticoagulant regimen after surgical intervention in the primary VTE prophylaxis. As almost completely unrecognized and neglected major risk factors of VTE in clinical practice, we particularly point out the chronic obstructive pulmonary disease (COPD) and heart failure, especially in NYHA functional class III and IV patients with significantly reduced left heart ventricle. It is necessary to raise clinicians' awareness of a potential danger from wrongly and one-sidedly interpreted dyspnea and coughing signs in patients with COPD as typical symptoms of basic respiratory disease as well as from ascribing the signs of disease aggravation in heart failure patients exclusively to cardial status worsening, neglecting the possibility of having unrecognized and untreated pulmonary embolism at issue. Contemporary way of life enhances the development of new VTE risk factors such as traveler's thrombosis, in particular during long-haul flights as well as in individuals sitting at a computer for prolonged periods (e-thrombosis). Determining and recognizing VTE risk factors, especially those formerly neglected nonsurgical ones and simultaneous presence of multiple risk factors within a given period is required for defining an adequate anticoagulant regimen in primary VTE prophylaxis for surgical and non-surgical (medical) patients

    Zeolite pretreatment accomplishes partial brain radioprotective role by reducing iron and oxidative / nitrosative stress in rats

    Get PDF
    The aim of our study was to test the effect of subacutely applied micronized zeolite [micronized clinoptilolite (MZC)] on brain status of iron (Fe), reactive oxygen and nitrogen species (ROS, RNS), and radioprotective role against brain oxidative/nitrosative stress (OS/NS) initiated by single ionizing radiation of 2 or 10Gray (Gy). Wistar rats on normal (n=18) and 5% MZC supplemented diet (n=18), during 4 weeks, were internally subdivided into 3 subgroups (6 rats in each subgroup), with one of subgroup remaining as a control, and the other two subjected to single ionizing radiation of 2Gy or 10Gy. Thus, we had groups on normal diet: C ā€“ controls, 2Gy and 10Gy; and on 5% MZC supplemented diet: MZC, MZC+2Gy and MZC+10Gy. Concentrations of nitrates (a final RNS metabolite) and superoxide anion radical (O2 ā€¢-) (an initial ROS) were measured in homogenates of selective vulnerable brain regions (cerebellum, hippocampus and forebrain cortex), while Fe was determined in whole brain of rats. Results documented a significant drop of Fe in MZC and MZC+2Gy/10Gy groups; decrease of O2 ā€¢- and nitrate in MZC group; almost equal drop of O2 ā€¢- , in 2Gy and MZC+2Gy groups; and nitrate increase in 10Gy and MZC+10Gy groups. We confirmed that subacute MZC pretreatment contributes to partially accomplished brain radioprotective effect in rats exposed to single radiation dose of 2Gy and 10Gy, probably due to reduced OS/NS and Fe

    Review of thirty patients with bone chondroblastoma

    No full text
    Background/Aim. To analyse the results of the treatment of the patients with the diagnosis of chondroblastoma, to confirm the possible malignancy and to recommend the best and the safest method of the treatment. Methods. We reviewed the cases of 30 patients with chondroblastoma who were treated between 1975 and 2004. Data were obtained using complete medical documentation, physical examinations, radiographic findings, and the available additional diagnostic procedures. Results. We found that the proximal part of the tibia, proximal part of the humerus, and distal part of the femur were the most common sites of the tumor in 63% of the cases. The higher prevalence of chondroblastoma in male patients was found, especially in the second decade of life. The patients were treated with different surgical procedures after histologically confirmed chondroblastoma. In 1 of the patients, radiation therapy was performed because the lesion recurred, after which the malignant transformation of chondroblastoma occurred. We found two more malignant chondroblastomas, one of which had been diagnosed as a primary tumor. Seven patients had a local recurrence, one of them had a second recurrence and the malignant transformation of chondroblastoma. The only solution was a below knee amputation. Conclusion. Chondroblastoma of bone is a rare lesion with the high local recurrence rate. We emphasized the need for an adequate and rapid diagnosis, including histological verification. The treatment was strictly surgical. The basic goal of the treatment was to avoid tumor penetration into articular cavity and/or local soft tissues. Malignant chondroblastoma of bone should be treated with radical surgical resection, avoiding any adjuvant therapy

    Chiari pelvic osteotomy in treatment of hip dysplasia

    No full text
    Chiari pelvic osteotomy is a surgical procedure having been performed for almost sixty years in patients with the insuffcient coverage of the femoral head. It is most frequently used in young patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. Even though performance of the Chiari osteotomy is associated with positive therapeutical results, above all, its main goal is to delay inevitable degenerative changes. Original surgical technique has been modified and improved over time. Nevertheless, the basic idea has remained unchanged - increasing of the femoral head coverage by medial displacement of the distal part of the pelvis along with capsular interpositioning. Given the complexity of operation, the complication percentage is rather low. Chiari pelvic osteotomy has lost its actuality and importance during this past six decades. The role of Chiari pelvic osteotomy has been considerably taken over by other more efficient and more lasting surgical procedures. Nonetheless, Chiari pelvic osteotomy is still present in modern orthopedic practice, above all as ā€žsalvageā€œ osteotomy. [Projekat Ministarstva nauke Republike Srbije, br. 41004

    Contribution of novel anticoagulants fondaparinux and dabigatran to venous thromboembolism prevention

    No full text
    The data that episodes and sequels of venous thromboembolism (VTE) are recorded in a significant percentage of patients receiving standard anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight heparin and vitamin K inhibitors) as well as the fact that these drugs have significant limitations and that they may cause serious side-effects in some patients indicate the need for the introduction of new anticoagulant drugs. Fondaparinux, a selective inhibitor of Factor Xa, administered following major orthopedic surgeries having a high risk for the development of VTE, is more efficient than enoxaparin sodium used in European and North-American approved doses. The increased incidence of major bleeding (excluding fatal) due to fondaparinux could be perhaps lowered by dosage reduction in patients with a mildly decreased creatinine clearance. Dabigatran, a peroral direct thrombin inhibitor, administered for VTE prophylaxis in elective hip and knee surgery, showed in to date studies the efficacy comparable (if dabigatran is given in both dosage regimes of 150 mg and 220 mg daily) or superior (if dabigatran is given at a dose of 220 mg daily) to enoxaparin administered in European-approved doses, while North American-approved doses of enoxaparin were superior than dabigatran in VTE reduction. No significant differences in bleeding rates were determined in any of the study groups. We consider that the introduction of new anticoagulants, including fondaparinux and dabigatran, will contribute to the establishment of a better safety profile and efficacy, and will also enable adequate therapy individualization for each patient depending on his/hers clinical characteristics. The introduction of novel peroral anticoagulants will, inter alia, significantly contribute to improvement in the quality of life, release the patient from numerous limitations in nutrition, interreaction, frequent laboratory monitoring, and also significantly improve therapeutic predictability. [Projekat Ministarstva nauke Republike Srbije, br. 173008: Kompleksne bolesti kao model sistem za proučavanje modulacije fenotipa ā€“ strukturna i funkcionalna analiza molekularnih biomarkera

    THE FREQUENCY OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESE PATIENTS WITH ARTERIAL HYPERTENSION

    No full text
    The aim of this research was to investigate the potential relationship between the longterm exposure to air pollution, as a risk factor, and the development of allergic reactions in the population. The observed sample consisted of Nis citizens of different age groups who lived in areas with high concentrations of air pollutants (investigated group) such as the Square of the October Revolution and Sindjelicā€™s Square (investigated group), as well as the citizens of Niska Banja (control group) which is the zone with the lowest concentration of air pollution. The investigation was carried out in the Public Health Institute in the period between 1996 and 2000. A significance test was performed using a Mantel-Haenszel chi square test. This test was used to check for a statistically significant difference between the incidence of the obstructive lung disease between the investigated group and the control group across all age groups. The cross-risk and relative risk were determined. The highest value of the chi square test was determined in the age group 26-50 (RR=3.50), in the group up to 25, RR=2.25, and in the group above 51, RR=1.89. The obtained results prove that the incidence of the obstructive lung disease is significantly higher in the exposed population than in the non-exposed

    Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous coronary intervention

    No full text
    Introduction. Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication. Case Outline. We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular) was stranded and bended in the left main coronary artery (LMCA), probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo) that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc) 3.0x18 mm was implanted in the target lesion. Conclusion. Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications
    corecore