Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients

TECHNOLOGY OF OZONE APPLICATIONS IN VITAL MEDICAL FIELDS

Veliki broj bolesti nastaje prvenstveno zbog nedostatka kisika u tkivima zbog akumulacije toksina u tijelu. Bezbolan i prirodan tretman ozonom pomaže kod operativnog oporavka i liječenja brojnih ozljeda i bolesti, pa čak i tumora, a za sada se najčešće koristi u stomatologiji. Ozon ima pozitivan utjecaj na zacjeljivanje rana, stimulaciju imunološkog sustava, oksigenaciju i protok krvi u tkivu, te smanjuje oticanje i bol.A large number of disease is primarily due to the lack of oxygen in the tissue due to the accumulation of toxins in the body. Painless and natural treatment with ozone helps with after-operating recovery and cure numerous injuries and illnesses, even tumors, and for now the most commonly used in dentistry. Ozone has a positive effect on wound healing, stimulation of the immune system, oxygenation and blood flow to tissues and to reduce swelling and pain

APPLICATIONS OF OZONE COMMUNICATION TECHNOLOGY IN VITAL MEDICAL FIELDS

Veliki broj bolesti nastaje prvenstveno zbog nedostatka kisika u tkivu i zbog nakupljanja toksina u tijelu. Bezbolno i prirodno liječenje ozonom pomaže kod poslije-operacijskog oporavka, a može izliječiti mnogobrojne povrede i oboljenja, čak i novotvorine, a zasad se najčešće koristi u stomatologiji. Ozon ima pozitivan učinak na zacjeljivanje rana, stimulaciju imunosnog sustava, oksigenaciju i prokrvljenost tkiva, te na smanjenje oteklina i boli. Klinička istraživanja ozona dovela su do zaključka kako ozon u liječenju ginekoloških upalnih bolesti ima u osnovi antioksidacijski učinak, a istovremeno služi kao popravljač stanične i humoralne imunosti. Ozon u liječenju takvih stanja ima detoksicirajući, analgetični i sedativni učinak što dovodi do smanjenja standardnih lijekova koji bi se koristili u navedenim stanjima. Osim u ginekologiji, ozon ima primjenu i u drugim granama medicine s ciljem poboljšanja cirkulacije i opskrbe tkiva krvnim tjelešcima i kisikom, liječenju upala i sprječavanju osnova za razvoj brojnih bolesti i zločudnih novotvorina u njihovim temeljima.A large number of diseases occur primarily due to lack of oxygen in the tissue and because of accumulation of toxins in the body. Painless an natural treatment with ozone helps with postoperating recovery, and can cure many diseases and injuries, and even tumors, and is now commonly used in dentistry. Ozone has a positive effect on wound healing, stimulation of the immune system, circulation and tissue oxygenation and on reduction of swelling and pain. Clinical studies of ozone have led to the conclusion that ozone in the treatment of inflammatory gynecological diseases has basically the antioxidant effect, while also serving as a fixer of cellular and humoral immunity. Ozone in the treatment of such conditions has detoxicating, analgetic and sedative effects, what leads to a reduction of standard drugs used in these situations. Except in gynecology, ozone has applications in other fields of medicine: it improves blood circulation and supply of blood cells and tissue with oxygen, it helps with many diseases and malignant neoplasms in their foundations

The prevalence of cardiovascular disease risk factors in patients from Croatian Zagorje County treated at Department of Medicine, Zabok General Hospital from 2000 to 2006

The aim of the study was to assess the prevalence of risk factors for cardiovascular disease in patients treated for coronary heart disease (CHD) at Department of Medicine, Zabok General Hospital during the 2000-2006 period. Cardiovascular diseases are a group of diseases that occur due to arterial. The risk factors that lead to the development and occurrence of cardiovascular disease are hypertension, cigarette smoking, hyperholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history. Additional factors favoring the occurrence of cardiovascular disease include overweight, inadequate physical activity, and emotional stress. Data on all patients hospitalized and diagnosed with CHD at Department of Medicine, Zabok General Hospital during the 2000-2006 period were analyzed for the prevalence of risk factors for CHD, i.e. hypertension, cigarette smoking, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history of cardiovascular disease. Hypercholesterolemia was defined by a cholesterol level higher than 5.1 mmol/L, hypertension from history data and blood pressure measurement on admission greater than 140/90 mmHg, diabetes mellitus from history data, and hypertriglyceridemia by a triglyceride level greater than 1.7 mmol/L. Information on heredity and cigarette smoking was collected from history and a questionnaire filled out on admission. All laboratory values were determined on patient admission to the hospital. Analysis of the risk factors for CHD recorded in patients from Zagorje County during the 2000-2006 period revealed hypertension to be the most common risk factor in our patients. According to sex, CHD was found to show a male preponderance. According to age at admission, CHD predominated in the > 70 age group, which accounted for one third of all patients, followed by a comparable proportion of the 50-60 and 60-70 age groups, i.e. still active population groups. As CHD is one of the leading health threats worldwide, estimated to remain so at least by 2020, it is fully justified to invest all efforts in the study of cardiovascular disease. New research projects should be focused on the prevention and early detection of the disease, improvement of diagnosis procedures, introduction of novel therapeutic options, use of new concepts, and due survey of the measures taken. CHD poses great socioeconomic burden upon every community in industrialized societies because of the ever younger age at onset. Actions should be taken to improve awareness of the CHD risks and morbidity in the population at large, stimulating favorable lifestyle and dietary modifications, and one's own health awareness, in order to upgrade the control of risk factors for and morbidity of cardiovascular disease

Monosystem Multifocal Langerhans Cell Histiocytosis (Multifocal Eosinophilic Granulomas of the Bone) in a 36-Year Old Patient: Case Report, Therapeutic Doubts and Review of Literature

Our aim is to provide review of available studies on Langerhans cell histiocytosis (LCH) and discuss treatment for polyostotic monosystem form of disease based on our clinical experience. LCH is an enigmatic disease with insufficiently understood etiology, pathophysiology, and variety of clinical presentations ranging from solitary eosinophilic granuloma to severe multisystem disease. It is marked by formation of granuloma in practically any organ. We present rare case of multifocal bone disease in 36-year old patient without visceral involvement. Treatment protocols for adult LCH patients, especially for uncommon form in our case have not yet been defined. Our therapeutical trial with corticosteroids showed limited success with numerous side-effects. We conclude that LCH treatment can commence only after diagnosis and staging of the disease. Other factors like patient’s age, comorbidity, general condition, severity of symptoms and contraindications for therapy modalities should also be considered. In our experience expectative approach has better clinical outcome than immunosuppressive therapy in patients suffering from polyostotic multifocal form LCH with mild symptoms

Quality of the Blood Sampled From Surgical Drainage after Total Hip Arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12 % patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients

Mechanical ventilation in chronic obstructive pulmonary disease patients, noninvasive vs. invasive method (randomized prospective study) [Usporedba neinvazivne i invazivne umjetne ventilacije kod bolesnika s kroničnom opstruktivnom plućnom bolesti: prospektivna randomizirana studija]

Acute respiratory failure due to chronic obstructive pulmonary disease (COPD) presents an increasing problem throughout the world. The aim of this study was to compare invasive and non-invasive mechanical ventilation (MV) for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit for the period of 36 months and included 156 patients with COPD. MV procedure was performed using standard methods, and was applied as either invasive MV (IMV) or noninvasive MV (NIMV). Patients were randomized in two groups for application of MV using closed, nontransparent envelops. Comparison was made based on patient characteristics, objective parameters on admission and 1h, 4h, 24h, and 48h after admission and based on treatment outcome. We have confirmed that NIMV method is superior to IMV for patients with COPD. MV duration NIMV:IMV was 94:172 hours, p<0.001, time spent in Intensive Care Unit 120:223 hours, p<0.001. Ventilator associated pneumonia 5(6%):29(37%), p<0.001.The advantage of NIMV in COPD patients, especially in the early stages was confirmed

Unilateral Multicentric Breast Cancer

Clinical characteristics of unilateral multicentric breast cancer (UMBC) were explored depending on aggressiveness, survival rate, disease-free period and local recurrence. The study included 296 women with breast cancer, surgically treated between 1990 and 2001. UMBC was histologically proved in 29 (9.8%) patients. Multicentricity was defined by following criteria: a) tumor with minimum one satellite node in the same or other quadrant of the breast; b) minimum one cut through the breast without tumor cells; c) histopathologically, discontinued tumors with intra-ductal invasion. The average age of patients was 63.4 (range 36–85). There were 9 (31.0%) women with one satellite node, 7 (24.1%) women with two satellite nodes, and 13 (44.8%) women with three or more satellite nodes. At the operation, axilla was positive in 20 (68.9%) women. Steroid receptors were highly positive in 12 (41.4%) patients. Primary and secondary tumors were of the same histological type in 26 (89.6%) patients. Local recurrence was found in only 3 (10.3%) patients. A five-year period without disease was achieved in 24 (82.7%) women. Kaplan-Meier analysis showed a significantly higher survival rate at lower tumor stages (I or II) unlike in advanced stages with predominantly N2 grade. The results of this study showed a slightly lower five-year disease-free period than in the case of patients with monocentric breast cancer (MOBC). The survival rate was significantly lower at all advanced stages, especially determined by N2 axilla. Therefore, the conclusion is that multicentricity doesn’t increase the risk of poor prognosis, especially at lower tumor stages

Prevalence of Depressive Symptoms among College Students and the Influence of Sport Activity

The present study asses the prevalence of depressive symptoms among college students in Split, Croatia, and positive influence of sport activity on decreasing the depression symptoms. Authors screened all 664 college students of the first year of study. All of them were over the 18 years and the mean age was 19.4±1.2 years. There were 466 females (70.2%) and 178 (26.8%) males. They answered The Beck Depression Inventory (BDI) and questionnaire about their sport activity (no sport activity, recreational and active in sports). For the purpose of the analysis depressive symptoms were defined as a score of > 11. Chi-square and Mann-Whitney test were used for data analysis. 9.4% of the students had significant depression symptoms (score > 11). No one student had score > 26 (symptoms of major depression). Statistically significant lower score on BDI have students who are active in sports (score median=3) compared to group of recreational (score median=4) and in correlation to group who are not active in sports (score median=5) (Kruskal – Wallis: p<0.001). In the group of active in sports (n=254) there are only 5.5% with depressions symptoms, while in the group of non active in sports (n=60) are 18 depressive (χ² test: p=0,005). Females are statistically more depressed than males (χ² test: p=0.01). In the female group 49 (10.5%) are depressed, and in the male group are 9 (5%). Compared to gender in separate analysis we did not find correlation of decreasing depression symptoms and sport activity among males (χ² test: p=0.47), while in females we find that sport activity has significant effect (χ² test: p=0.026). Our results shoved moderate values of depression symptoms among college population in Split, Croatia. More females than males experienced depressive symptoms. While sport activity did not have significant influence on the depression in male population, it has significant influence in reducing the depression symptoms among females

Effects of Clonidine Preemptive Analgesia on Acute Postoperative Pain in Abdominal Surgery

Preemptive analgesia refers to blockade of afferent nerve fibers before a painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. The aim of the study was to compare the effect of clonidine used before and at the end of operation on pain control in abdominal surgery. A total of 77 patients admitted for colorectal surgery were randomly classified into three groups: epidural clonidine before operation, epidural clonidine at the end of operation, and control group. After the operation on patient demand, analgesia with boluses of epidural morphine was instituted. The parameters of postoperative pain level using VAS score (visual analog scale), sedation and analgesics consumption were determined as outcome measures at 1, 2, 6, and 24 h of the operation. Clonidine administered before operation provided lowest pain scores at 6 and 24 h (p<0.05). Clonidine administered at the end of operation had low pain scores at 1 and 2 h, with a significant pain breakthrough thereafter (6.93±1.66 at 6 h and 4.04±2.39 at 24 h) compared with the group administered clonidine before operation (3.60±2.94 and 3.71±1.82). Clonidine administered before operation provided less sedation (p<0.05) and a significantly lower use of analgesics (p<0.05). Blockade of nociceptive stimulus using the centrally acting a2-adrenergic agonist clonidine before the onset of pain stimulus resulted in reduced pain levels, sedation and analgesic requirement