Multidisciplinary approach in the management of pregnancy with placenta accreta spectrum disorder - Case report

From the histopathologic perspective Placenta accreta spectrum (PAS) shows the absence of the normal intervening decidua and invasion of the placenta into the myometrium. There is placenta accreta with the chorionic villi attach directly to the surface of the myometrium in the absence of the decidual layer and placenta increta when the chorionic villi penetrate deeply into the myometrium reaching the external layer. There is also placenta percreta where the invasive chorionic villi reach and penetrate through the myometrium to uterine serosa and it is nowadays the most common reason for peripartum hysterectomy (1). Drawing the line between these subtypes is not always easy, especially in the clinical situations when the invasiveness of the placenta is not known before the delivery (2). The maternal and fetal outcomes are improved upon appropriate antepartum diagnosis and care by multidisciplinary experts with experience in PAS treatment (3). Here we present a pregnancy and multidisciplinary delivery management of a 40-year-old female, gravida V, para IV, with history of the three cesarean sections, in 36+2 weeks of gestation in a tertiary academic teaching hospital. We confirmed suspected PAS antenatally based on ultrasound and magnetic resonance imaging (MRI). Preoperative preparation included the ensuring of blood products availability, the use of arterial occlusion balloons to reduce hemorrhage, and the use of double JJ stent to prevent ureteral injuries. We performed a cesarean section with immediate uterine amputation due to severe bleeding, after which the patient fully recovered. If PAS timely suspected and confirmed intraoperatively, the best maternal and neonatal outcome is achieved by the multidisciplinary approach that enables adequate elective procedure

Posttraumatic hepatic artery pseudoaneurysm presenting as gastrointestinal bleeding

Posttraumatic hepatic artery pseudoaneurysm is a rare, but life threatening condition which should be considered in patients with a history of blunt abdominal trauma who present with abdominal pain or gastrointestinal bleeding. We report a case of a patient with such a pseudoaneurysm discovered five months after a bicycle accident resulting in hepatic rupture that was treated conservatively. The patient presented with fatigue, dizziness, inability to tolerate major exertion and gastrointestinal bleeding. After extensive diagnostic procedures, a right hepatic artery pseudoaneurysm was found. The condition was treated successfully with transcatheter coil embolization

CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH COLORECTAL CANCER

Rak kolorektuma treći je najčešći maligni tumor muškaraca i četvrti najčešći maligni tumor žena u Republici Hrvatskoj. Klinički se najčešće očituje poremećajem formiranja stolice, osjećajem nedovoljnog pražnjenja crijeva, prisutnošću krvi u stolici te gubitkom tjelesne težine i umorom. Pravodobna dijagnoza, potvrđena patohistološkim nalazom, temelj je uspješnog liječenja. Odluka o liječenju donosi se temeljem kliničke procjene stadija bolesti te drugih čimbenika rizika, a nakon provedene dijagnostičke obrade. Ovisno o tome, mogućnosti liječenja uključuju kirurški zahvat i primjenu sistemske terapije (kemoterapija, imunoterapija) te radioterapiju. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, upravljanja i liječenja te praćenja bolesnika s kolorektalnim rakom u Republici HrvatskojColorectal cancer is the third most common malignant tumour in males and the fourth most common malignancy in women in the Republic of Croatia. It is usually manifested as stool forming disorders, feeling that bowel does not empty completely, finding blood in the stool, weight loss and fatigue. In-time diagnosis, confirmed by pathohistological findings, is cornerstone of successful treatment. The decision about treatment is made based on clinical assessment of disease stage and other risk factors, after completion of the diagnostic process. Depending on that, treatment options include surgery, the application of systemic therapy (chemotherapy, immunotherapy) and radiotherapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, treatment and monitoring of patients with colorectal cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH COLORECTAL CANCER

Rak kolorektuma treći je najčešći maligni tumor muškaraca i četvrti najčešći maligni tumor žena u Republici Hrvatskoj. Klinički se najčešće očituje poremećajem formiranja stolice, osjećajem nedovoljnog pražnjenja crijeva, prisutnošću krvi u stolici te gubitkom tjelesne težine i umorom. Pravodobna dijagnoza, potvrđena patohistološkim nalazom, temelj je uspješnog liječenja. Odluka o liječenju donosi se temeljem kliničke procjene stadija bolesti te drugih čimbenika rizika, a nakon provedene dijagnostičke obrade. Ovisno o tome, mogućnosti liječenja uključuju kirurški zahvat i primjenu sistemske terapije (kemoterapija, imunoterapija) te radioterapiju. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, upravljanja i liječenja te praćenja bolesnika s kolorektalnim rakom u Republici HrvatskojColorectal cancer is the third most common malignant tumour in males and the fourth most common malignancy in women in the Republic of Croatia. It is usually manifested as stool forming disorders, feeling that bowel does not empty completely, finding blood in the stool, weight loss and fatigue. In-time diagnosis, confirmed by pathohistological findings, is cornerstone of successful treatment. The decision about treatment is made based on clinical assessment of disease stage and other risk factors, after completion of the diagnostic process. Depending on that, treatment options include surgery, the application of systemic therapy (chemotherapy, immunotherapy) and radiotherapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, treatment and monitoring of patients with colorectal cancer in the Republic of Croatia

Multidisciplinary approach in the management of pregnancy with placenta accreta spectrum disorder - Case report

From the histopathologic perspective Placenta accreta spectrum (PAS) shows the absence of the normal intervening decidua and invasion of the placenta into the myometrium. There is placenta accreta with the chorionic villi attach directly to the surface of the myometrium in the absence of the decidual layer and placenta increta when the chorionic villi penetrate deeply into the myometrium reaching the external layer. There is also placenta percreta where the invasive chorionic villi reach and penetrate through the myometrium to uterine serosa and it is nowadays the most common reason for peripartum hysterectomy (1). Drawing the line between these subtypes is not always easy, especially in the clinical situations when the invasiveness of the placenta is not known before the delivery (2). The maternal and fetal outcomes are improved upon appropriate antepartum diagnosis and care by multidisciplinary experts with experience in PAS treatment (3). Here we present a pregnancy and multidisciplinary delivery management of a 40-year-old female, gravida V, para IV, with history of the three cesarean sections, in 36+2 weeks of gestation in a tertiary academic teaching hospital. We confirmed suspected PAS antenatally based on ultrasound and magnetic resonance imaging (MRI). Preoperative preparation included the ensuring of blood products availability, the use of arterial occlusion balloons to reduce hemorrhage, and the use of double JJ stent to prevent ureteral injuries. We performed a cesarean section with immediate uterine amputation due to severe bleeding, after which the patient fully recovered. If PAS timely suspected and confirmed intraoperatively, the best maternal and neonatal outcome is achieved by the multidisciplinary approach that enables adequate elective procedure

Smjernice za dijagnosticiranje, liječenje i praćenje bolesnika oboljelih od raka debelog crijeva [Clinical guidelines for diagnosis, treatment and monitoring patients with colorectal cancer]

Colorectal cancer (CRC) is one of the most common malignant tumors in Western countries. The treatment outcomes of this disease have improved significantly in recent years due to the improvement of diagnostic methods (pathohistology, radiology, nuclear medicine), screening and treatment improvements: surgical and oncological (chemotherapy, immunotherapy, radiotherapy). Additional progress has been made in the definition of prognostic and predictive factors of CRC. It is very important to emphasize the multidisciplinary approach to patients with CRC and to make a decision on optimal treatment based on evidence