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

Hematuria Secondary to an Internal Iliac Artery Aneurysm

We report a case of macroscopic hematuria secondary to an aneurysm of the internal iliac artery. An 84-year-old male presented to our department with a 12-hour history of painless gross hematuria. Cystoscopy showed decreased expansion suggesting compression from outside the bladder. At the point of compression, increased vascularization was noted in the bladder mucosa without evidence of active bleeding. No trace of blood was identified coming from the ureteric orifices, the bladder neck, or the prostate. There was no evidence of intra-vesicular masses or other inflammatory changes. The abdominal computed tomography scan revealed left-sided hydronephrosis and an abdominal aortic aneurysm involving the aortic bifurcation and both internal iliac arteries. There was no evidence of rupture. An aneurysm of the internal iliac artery is a rare cause of macroscopic hematuria that can be fatal. Awareness of this as a possible cause of hematuria may assist in immediate diagnosis and appropriate treatment

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

Human cerebrovascular contractile receptors are upregulated via a B-Raf/MEK/ERK-sensitive signaling pathway

<p>Abstract</p> <p>Background</p> <p>Cerebral ischemia results in a rapid increase in contractile cerebrovascular receptors, such as the 5-hydroxytryptamine type 1B (5-HT_1B), angiotensin II type 1 (AT₁), and endothelin type B (ET_B) receptors, in the vessel walls within the ischemic region, which further impairs local blood flow and aggravates tissue damage. This receptor upregulation occurs via activation of the mitogen-activated protein kinase pathway. We therefore hypothesized an important role for B-Raf, the first signaling molecule in the pathway. To test our hypothesis, human cerebral arteries were incubated at 37°C for 48 h in the absence or presence of a B-Raf inhibitor: SB-386023 or SB-590885. Contractile properties were evaluated in a myograph and protein expression of the individual receptors and activated phosphorylated B-Raf (p-B-Raf) was evaluated immunohistochemically.</p> <p>Results</p> <p>5-HT_1B, AT₁, and ET_Breceptor-mediated contractions were significantly reduced by application of SB-590885, and to a smaller extent by SB-386023. A marked reduction in AT₁receptor immunoreactivity was observed after treatment with SB-590885. Treatment with SB-590885 and SB-386023 diminished the culture-induced increase of p-B-Raf immunoreactivity.</p> <p>Conclusions</p> <p>B-Raf signaling has a key function in the altered expression of vascular contractile receptors observed after organ culture. Therefore, specific targeting of B-Raf might be a novel approach to reduce tissue damage after cerebral ischemia by preventing the previously observed upregulation of contractile receptors in smooth muscle cells.</p

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