The effect of injection speed on haemodynamic changes immediate after lidocaine/adrenaline infiltration of nasal submucosa under general anaesthesia

Background and Purpose: Substantial systemic absorption after adrenaline-containing local anaesthetic infiltration can cause transitional changes in heart rate and arterial blood pressure in humans even during general anaesthesia. The aim of this study was to determine the effect of injection speed of local infiltration of adrenaline- containing lidocaine solution on transitional haemodynamic changes during local infiltration of nasal submucosa under general anaesthesia. Patients and Methods: A retrospective, comparative, non-randomised, open study on 1–2 ASA physical status 83 patients, aged 18 to 81 years, scheduled for septoplasty, septorhinoplasty, classical or functional endoscopic sinus surgery was performed. All patients received the submucosal infiltration of 2%lidocaine containing adrenaline solution (2ml) plus adrenaline (0.025 mg) plus plain 2% lidocaine solution (5ml) before surgical incision. Two different infiltration techniques were identified: fast infiltration (Group F, n=40) and slower, incremental infiltation (Group S, n=43). Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were recorded before, five minutes after and ten minutes after infiltration. Results: There was no significant difference in HR, SAP,DAP nor MAP between the F group and the S group. There was significant decrease of HR (p=0.006), SAP (p=0.018), DAP (p=0.029), and MAP (p=0.010) at 10 minutes point within the S group compared to baseline. There was significant decrease of HR (p=0.04) at the 10 minutes point within the F group compared to baseline. Conclusions: This study did not confimed that the speed of injection of lidocaine with adrenaline made any effect on haemodynamic changes during local infiltration of nasal submucosa.However it confirmed that lidocaine with adrenaline induced a decrease of blood pressure

The effect of injection speed on haemodynamic changes immediate after lidocaine/adrenaline infiltration of nasal submucosa under general anaesthesia

Background and Purpose: Substantial systemic absorption after adrenaline-containing local anaesthetic infiltration can cause transitional changes in heart rate and arterial blood pressure in humans even during general anaesthesia. The aim of this study was to determine the effect of injection speed of local infiltration of adrenaline- containing lidocaine solution on transitional haemodynamic changes during local infiltration of nasal submucosa under general anaesthesia. Patients and Methods: A retrospective, comparative, non-randomised, open study on 1–2 ASA physical status 83 patients, aged 18 to 81 years, scheduled for septoplasty, septorhinoplasty, classical or functional endoscopic sinus surgery was performed. All patients received the submucosal infiltration of 2%lidocaine containing adrenaline solution (2ml) plus adrenaline (0.025 mg) plus plain 2% lidocaine solution (5ml) before surgical incision. Two different infiltration techniques were identified: fast infiltration (Group F, n=40) and slower, incremental infiltation (Group S, n=43). Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were recorded before, five minutes after and ten minutes after infiltration. Results: There was no significant difference in HR, SAP,DAP nor MAP between the F group and the S group. There was significant decrease of HR (p=0.006), SAP (p=0.018), DAP (p=0.029), and MAP (p=0.010) at 10 minutes point within the S group compared to baseline. There was significant decrease of HR (p=0.04) at the 10 minutes point within the F group compared to baseline. Conclusions: This study did not confimed that the speed of injection of lidocaine with adrenaline made any effect on haemodynamic changes during local infiltration of nasal submucosa.However it confirmed that lidocaine with adrenaline induced a decrease of blood pressure

The factors of tendon healing

Tetive zahtijevaju prolongirano vrijeme cijeljenja, a često je nemoguće postići potpun oporavak. Cijeljenje može početi iz okolnog tkiva odnosno ili iz same tetive. Manipulacija različitim staničnim elementima, čimbenicima rasta, medijatorima upale te utjecajem biomehaničkih čimbenika može doprinijeti ubrzanom cijeljenju tetiva. Korištenje autolognog kondicioniranog seruma (AKS), transformirajućeg čimbenik rasta beta (TGF-β), čimbenika rasta endotela krvnih žila (VEGF) te morfogenetskog proteina-2 ima pozitivan učinak na cijeljenje. Za uspješno i brzo cijeljenje tetive potrebno je liječenje započeti u što ranijoj fazi. Nužna je minimalno traumatska manipulacija tkivom te pravilan odabir šava i šivaćeg materijala. Ranom i umjerenom mobilizacijom tetive tijekom cijeljenja pojačava se njezina čvrstoća, a smanjuje pojava adhezija.Tendons require a prolonged time to heal and very often, full recovery is impossible. Healing may begin from the surrounding tissues or the tendon itself. Manipulation with different tissue elements, growth factors, inflammation mediators and influence of biomechanical factors can contribute to faster tendon tissue healing. For successful and rapid tendon healing, treatment must begin in the earliest phases. Minimally invasive tissue manipulation and correct suture type and material is necessary. Early and moderate tendon mobilization during healing boosts tendon strength and decreases adhesions

Orbitalni kavernozni hemangiom

The aim of this case report was to present a patient with a benign orbital tumor, cavernous hemangioma, who presented with symptoms of compressive orbital mass: unilateral axial proptosis, with motility restriction and sudden vision loss in the left eye. Ophthalmologic examination (visual acuity, applanation tonometry, Goldmann tonometer, visual field) and radiologic examination diagnosed a benign, well circumscribed, vascular, intraconal tumor that compresses the optic nerve. Treatment was operative: lateral orbitectomy Krönlein procedure and the tumor was removed. Pathologic and pathohistologic examination confirmed the previous diagnosis. Follow up examination, visual field and MRI of the orbit showed considerable improvement. Surgical treatment was also the final treatment and no adjuvant therapy was necessary. Prognosis for visual acuity and life is excellent.Cilj ovog rada bio je prikazati slučaj pacijentice s benignim tumorom orbite, kavernoznim hemangiomom, koji se javlja sa simptomima kompresivne tvorbe u orbiti: unilateralnom proptozom, smetnjama motiliteta te naglim gubitkom vida lijevog oka. Oftalmološkom obradom (ispitivanje vidne oštrine, aplanacijska tonometrija, ispitivanje vidnog polja po Goldmannu) te radiološkom obradom (MR, MSCT, MSCT angiografija) postavlja se dijagnoza benigne, dobro ograničene, vaskularne tvorbe u konusu koja pritišće očni živac. Pristupilo se operativnom zahvatu, napravila se lateralna orbitektomija po Krönleinu i odstranio tumor u cijelosti. Patološka i patohistološka pretraga potvrđuju raniju dijagnozu. Postoperativni tijek protiče uredno te se na nalazu kontrolnog vidnog polja i kontrolnim snimkama MR-a utvrđuje značajno poboljšanje. Kod pacijentice je kirurško liječenje bilo i konačno te nije bila potrebna dodatna terapija. Prognoza za vidnu oštrinu i život je odlična

Role of military medicine in massive immediate threat situations

Pandemija COVID-19 je ukazala na inkluzivnu ulogu nezdravstvenih aktera u procesu prilagodbe i odgovora na ugrozu. U Republici Hrvatskoj, navedeno je posebno vidljivo u višestrukim krizama koje su nas pogađale istovremeno – potresi i pandemija. U bliskoj budućnosti broj infektivnih agenasa sposobnih izazvati novu pandemiju postat će veći, kao i mogućnost suočavanja s drugim vrstama katastrofe. Danas, više nego ikad prije potrebna je unaprijed pripremljena i multidisciplinarno organizirana zdravstvena skrb. Buduća pripremljenost na katastrofu ne bi trebala podrazumijevati višestruke protokole za upravljanje rizikom, već jedan jedinstveni višeslojni protokol koji uključuje sve aktere državnih i javnih službi. Vojska je zbog svoje povijesne uloge, misije i sustava organizacije u potpunosti spremna postati dio multidisciplinarnog tima koji upravlja ugrozama masovnog stradavanja. Ključni elementi koji su potrebni za učinkovitu nacionalnu civilno-vojnu suradnju u području zdravstva s ciljem sprječavanja, otkrivanja, odgovaranja i oporavljanja od zdravstvenih kriza ili katastrofa uključuju (a) uspostavljanje strateškog plana suradnje za hitne zdravstvene intervencije; (b) uvažavanje razlika između civilnog i vojnog sustava; (c) utvrđivanje potencijalnih područja za suradnju na nacionalnoj razini; (d) standardizacija i institucionaliziranje civilno–vojne suradnje u području zdravstva; i (e) zajednička obuka i uvježbavanje civilnovojnih zdravstvenih kapaciteta pripravnosti za hitne slučajeve.The COVID-19 pandemic has highlighted the inclusive role of non-health actors in the process of adaptation and response to the threat. In the Republic of Croatia, this is particularly visible in the multiple crises that hit country at the same time – several earthquakes and the pandemic. In the near future, the number of infectious agents capable of causing a new pandemic will increase, as will the possibility of facing other types of disasters. Today, more than ever before, we need pre-prepared and multidisciplinary organized health care. Future disaster preparedness should not imply multiple protocols for risk management, but one single multi-layered protocol involving all actors of government and public services. Due to its historical role and organizational system, the army is fully prepared to become part of a multidisciplinary team that manages mass casualty threats. Key elements required for effective national civil-military health cooperation in planning, detecting, responding to, and recovering from health crises or disasters include (a) establishing a strategic cooperation plan for emergency health interventions; (b) appreciation of the differences between the civilian and military systems; (c) identification of potential areas for cooperation at the national level; (d) standardization and institutionalization of Civil Military Cooperation; and (e) joint training and exercise of civil-military emergency medical preparedness capacities

Clinical Presentation of a Patient with Localized Acquired Cutis Laxa of Abdomen: A Case Report

Background. Cutis laxa (CL) is a rare disorder of elastic tissue characterized by loose, sagging skin with reduced elasticity, and resilience without resulting scarring. CL may be inherited as a dominant, recessive, or X-linked recessive disease, or acquired. The heritable forms of CL predominantly begin at birth, but it may be delayed until puberty or age of 30 years with extracutaneous manifestations including pulmonary emphysema, umbilical and inguinal hernias, and gastrointestinal and vesicourinary tract diverticuli. An acquired form of the disease occurs in adults with no evidence of internal organ involvement. Objective. The aim of this case report was to present our patient suffering from CL, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Case Report. A 30-year-old female patient was admitted to our Hospital due to localized loose and sagging skin of abdomen, induced by prior cesarean section 6 years ago. CL has been diagnosed based on the clinical picture and pathohistological appearance. Conclusion. Reconstructive surgery provides a dramatic cosmetic improvement with significant psychosocial benefit. Repeated surgical procedures may be required to correct the lax skin, which worsens with age

VIDEO-ASSISTED EXTIRPATION OF BREAST FIBROADENOMA WITH IMMEDIATE BILATERAL BREAST AUGMENTATION – A CASE REPORT

Pozadina: Od sredine 1990-ih godina razvila se videoasistirana kirurgija dojke (VABS) za liječenje dobroćudnih i zloćudnih bolesti dojke. Prema studijama koje su provedene uglavnom u Japanu, ova je tehnika sigurna i lako se uči, a njezina je glavna prednost izvrstan kozmetski rezultat poslijeoperacijskog izgleda dojki koji se ne može postići standardnim kirurškim tehnikama. Cilj: Prikazati prvi slučaj videoasistirane kirurgije dojke u Hrvatskoj primijenjene u liječenju fibroadenoma dojke uz neposredno obostrano povećanje dojki. Prikaz bolesnice: Bolesnica u dobi od 39 godina primljena je u našu bolnicu radi elektivnog zahvata povećanja obiju dojki. Tom je prilikom upotrijebljena metoda videoasistirane ekstirpacije fibroadenoma kroz inframamarnu inciziju neposredno nakon koje je učinjeno obostrano povećanje dojki. Zaključak: VABS je izvediva uz očit kozmetski učinak i zbog tog postaje metoda izbora u kirurgiji dojke. Međutim, potrebno je steći daljnja iskustva u ovom području kako bismo adekvatnije mogli procijeniti ovu tehniku.Background: Since mid 1990s video-assisted breast surgery (VABS) has been developed in the treatment of benign and malignant breast diseases. According to studies that are conducted mainly in Japan, this tehnique is safe, easy to learn and his main advantage is excellent cosmetic results on postoperative appearance of breasts that cannot be achived with standard surgical procedures. Objective: To present a first case of video assisted breast surgery in Croatia applied to treatment of breast fibroadenoma and immediate bilateral breast augmentation. Case report: A 39 year old female patient was admitted to our hospital for elective procedure of breast augmentation. On this occasion video assisted extirpation of fibroadenoma was performed through inframammary incision and followed by immediate bilateral breast augmentation. Conclusion: VABS is feasible, cosmetic effects are evident and the VABS deserves attention as a possible surgical option in breast surgery. However further experience on this field must be gained and it remains to evaluate this tehnique on the additional studies

VIDEO-ASSISTED EXTIRPATION OF BREAST FIBROADENOMA WITH IMMEDIATE BILATERAL BREAST AUGMENTATION – A CASE REPORT

Pozadina: Od sredine 1990-ih godina razvila se videoasistirana kirurgija dojke (VABS) za liječenje dobroćudnih i zloćudnih bolesti dojke. Prema studijama koje su provedene uglavnom u Japanu, ova je tehnika sigurna i lako se uči, a njezina je glavna prednost izvrstan kozmetski rezultat poslijeoperacijskog izgleda dojki koji se ne može postići standardnim kirurškim tehnikama. Cilj: Prikazati prvi slučaj videoasistirane kirurgije dojke u Hrvatskoj primijenjene u liječenju fibroadenoma dojke uz neposredno obostrano povećanje dojki. Prikaz bolesnice: Bolesnica u dobi od 39 godina primljena je u našu bolnicu radi elektivnog zahvata povećanja obiju dojki. Tom je prilikom upotrijebljena metoda videoasistirane ekstirpacije fibroadenoma kroz inframamarnu inciziju neposredno nakon koje je učinjeno obostrano povećanje dojki. Zaključak: VABS je izvediva uz očit kozmetski učinak i zbog tog postaje metoda izbora u kirurgiji dojke. Međutim, potrebno je steći daljnja iskustva u ovom području kako bismo adekvatnije mogli procijeniti ovu tehniku.Background: Since mid 1990s video-assisted breast surgery (VABS) has been developed in the treatment of benign and malignant breast diseases. According to studies that are conducted mainly in Japan, this tehnique is safe, easy to learn and his main advantage is excellent cosmetic results on postoperative appearance of breasts that cannot be achived with standard surgical procedures. Objective: To present a first case of video assisted breast surgery in Croatia applied to treatment of breast fibroadenoma and immediate bilateral breast augmentation. Case report: A 39 year old female patient was admitted to our hospital for elective procedure of breast augmentation. On this occasion video assisted extirpation of fibroadenoma was performed through inframammary incision and followed by immediate bilateral breast augmentation. Conclusion: VABS is feasible, cosmetic effects are evident and the VABS deserves attention as a possible surgical option in breast surgery. However further experience on this field must be gained and it remains to evaluate this tehnique on the additional studies

Impact of aspirin resistance on outcomes among patients following coronary artery bypass grafting: exploratory analysis from randomized controlled trial (NCT01159639)

Individual variability in the response to aspirin, has been established by various platelet function assays, however, the clinical relevance of aspirin resistance (AR) in patients undergoing coronary artery bypass grafting (CABG) has to be evaluated. Our working group conducted a randomized controlled trial (NCT01159639) with the aim to assess impact of dual antiplatelet therapy (APT) on outcomes among patients with AR following CABG. Patients that were aspirin resistant on fourth postoperative day (POD 4) were randomly assigned to receive either dual APT with clopidogrel (75 mg) plus aspirin (300 mg)-intervention arm or monotherapy with aspirin (300 mg)-control arm. This exploratory analysis compares clinical outcomes between aspirin resistant patients allocated to control arm and patients that have had adequate platelet inhibitory response to aspirin at POD 4. Both groups were treated with 300 mg of aspirin per day following surgery. We sought to evaluate the impact of early postoperative AR on outcomes among patients following CABG. Exploratory analysis included a total number of 325 patients. Of those, 215 patients with adequate response to aspirin and 110 patients with AR allocated to aspirin monotherapy following randomization protocol. The primary efficacy end point (MACCEs-major adverse cardiac and cardiovascular events) occurred in 10 and 6 % of patients with AR and with adequate aspirin response, respectively (p = 0.27). Non-significant differences were observed in bleeding events occurrence. Subgroup analysis of the primary end point revealed that aspirin resistant patients with BMI > 30 kg/m(2) tend to have a higher occurrence of MACCEs 18 versus 5 % (relative risk 0.44 [95 % CI 0.16-1.16]; p = 0.05). This exploratory analysis did not reveal significant impact of aspirin resistance on outcomes among patients undergoing CABG. Further, sufficiently powered studies are needed in order to evaluate clinical relevance of AR in patients undergoing CABG

Bleeding risk assessment using whole blood impedance aggregometry and rotational thromboelastometry in patients following cardiac surgery

Excessive bleeding after cardiopulmonary bypass (CPB) is risk factor for adverse outcomes after elective cardiac surgery (ECS). Differentiating between patients who bleed due to surgical issues and those whose excessive chest tube output (CTO) is due to coagulopathy, remains challenging. Bedside suitable tests to identify hemostatic disturbances and predict excessive bleeding are desirable. The study sought to evaluate prediction of excessive bleeding after ECS using two bedside suitable devices for platelet function and viscoelastic blood clot properties assessment. We enrolled 148 patients (105 male and 43 female) undergoing ECS in a prospective observational study. Patients were characterized as bleeders if their 24 h CTO exceeded the 75th percentile of distribution. Multiple electrode aggregometry (MEA, with ASPI, ADP and the TRAP test) and rotational thromboelastometry (TEM, with ExTEM, HepTEM and FibTEM test), were performed at three time points: preoperatively (T1), during CPB (T2), and after protamine administration (T3). The primary endpoint was CTO and the secondary endpoint was administration of blood products, 30-day and 1 year mortality. The best predictors of increased bleeding tendency were the tests performed after protamine administration (T3). At T3, patients characterized as bleeders had significantly lower MEA ASPI (median, 14 vs. 27 AUC, p = 0.004) and ADP test values (median, 22 vs. 41 AUC, p = 0.002) as well as TEM values expressed in maximum clot firmness after 30 min (MCF 30) for ExTEM (53 vs. 56 mm, p = 0.005), HepTEM (48 vs. 52 mm, p = 0.003) and FibTEM (8 vs. 11 mm, p < 0.001) test. 24 h CTO inversely correlated with both the MEA (ASPI test: r = -0.236, p = 0.004; ADP test: r = -0.299, p < 0.001), and TEM MCF 30 (ExTEM: r = -0.295, p < 0.001; HepTEM: -0.329, p < 0.001; FibTEM: -0.377, p < 0.001) test values. Our study showed that MEA and TEM are useful methods for prediction of excessive bleeding after ECS. In order to prevent excessive postoperative CTO, hemostatic interventions with timely and targeted blood component therapy according to MEA and TEM results should be considered