10 research outputs found
The Effect of Analgesics and Physical Therapy on Respiratory Function after Open and Laparoscopic Cholecystectomy
In this study we present prospective clinical trial included 100 patients. One half of the patients underwent open
cholecystectomy, whereas laparoscopic cholecystectomy was performed in the other half. Spirometric parameters, arterial
blood gases, acid-base balance, were determined preoperatively, and then at 6 h, 24 h, 72 h and 144 h postoperatively. The
impact of physical therapy on the respiratory parameter patterns, VAS-pain score and use of tramadol were studied after
cholecystectomy. Significantly lower VAS-pain score and less tramadol use, higher values and faster recovery of ventilation
parameters and PaO2 were recorded after laparoscopic cholecystectomy than after open cholecystectomy (p=0.001 for
both). Physical therapy resulted in a significant improvement in the values of respiratory parameters in the open cholecystectomy
group within a short time (30 min) after therapy was performed. Physical therapy failed to produce any improvement
of respiratory parameters in laparoscopic cholecystectomy, whereas in open cholecystectomy group who had a favorable
although transient effect, strictly limited to the short time from its application. (p=0.005). The patients operated on by
open cholecystectomy had statistically significantly more pronounced disturbances including hypoxia, hypocapnia and hyperventilation
when compared to the group submitted to laparoscopic cholecystectomy. It is recommended that physical
therapy be more frequently performed during the postoperative period in patients submitted to open cholecystectom
Complications after Hip Rearthroplastics with Revision Endoprosthesis
The stability of the revision endoprosthesis components is more difficult to achieve than in primary endoprosthesis
due to large bone defects and/or decreased bone mass quality. That is the reason for more frequent complications for revision
than in primary arthroplasty. The aim of this study was to investigate the frequency of complications in 122 patients
who were operated with the revision endoprosthesis in the Department of Orthopedics in University Hospital Split in the
period of 1998 to 2007 and accepted to participate in this study. There were 3 patients treated on bought hips. The average
follow up time was four years (0.6ā10.6). There were 32 (26.2%) males and 90 (73.8%) females. The average age was
70.66Ā±7.63 years. The average time from operation to physical therapy was 3.53Ā±2.56 days. There were 27 (21.6%) complications.
The most common complication was infection in 9 (7.2%) cases. From those cases, 4 (3.2%) had superficial,
and 5 (4%) had deep infection. From other complications, there were 5 (4%) endoprosthesis reluxations, 2 (1.6%) periprosthetic
femur fractures, 5 (4%) urinary infections, and 6 (4.8%) other complications (lung mycroembolia, heart infarction,
lumbal plexus lesion from L2, spinal cord infarction with paraplegia, pneumonia and severe sacral bed-sore). There
were 10 (8%) re-interventions following the revision arthroplasty. The result was good or excellent in 80% of operated patients,
satisfied in 17%, and bad in 3%. The revision hip procedures are characterized with a high complications incidence
rate. Our results are comparable with the results from literature
Acute Appendicitis and Ileal Perforation with a Toothpick Treated by Laparoscopy
A 69-year-old man underwent an emergency laparoscopic procedure after the acute appendicitis diagnosis has been
established. Laparoscopic exploration showed inflamed appendix and perforation of terminal ileum with a swallowed
part of the wooden toothpick. The treatment consisted of typical laparoscopic appendectomy and laparoscopic removal of
the foreign body, followed by laparoscopic closure of the perforation site and lavage of the abdominal cavity. The postoperative
course was uneventful and the patient was discharged from the hospital on day 3 after the operation
Laparoscopic Abdominal Cysts Fenestration Using Harmonic Scalpel
The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery,
which can be related to different complications. Its working principle is to transform the electric power into
the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in
the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using
the harmonic scalpel. The average age was 40.8 (ranging from 15ā60) years. Laparoscopic abdominal cyst fenestration
was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one
patient during the same operation. The average duration of the operation was 40 (ranging from 25ā70) minutes and hospital
stay was 2.8 (ranging from 1ā5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a
safe and successful operation, with good results including all the advantages of the minimally invasive surgery
Partial Cecal Necrosis Treated by Laparoscopic Partial Cecal Resection
Acute colonic ischemia is the common cause of colitis in elderly population. However, isolated ischemic necrosis of cecum
is rare entity, often associated with variety of conditions. Here we present a case of a 73-year old woman with a past history
of hypertension presented with clinical symptoms of right lower quadrant abdominal pain and tenderness localized
to the right lower quadrant, guarding and rebound tenderness. With diagnosis of acute appendicitis, the patient underwent
laparoscopy where the cecal partial necrosis was discovered. Necrotic area of cecum was excised using two endoscopic
cutters and laparoscopic appendectomy was performed. Pathologist report showed thrombosis of vessels and necrosis
of entire cecal wall. The patient completely recovered without any surgical complications. This is the first case of
partial cecum necrosis laparoscopicaly managed and with a partial cecal resection only
Laparoscopic Colon Surgery: Our Results
Formerly, the laparoscopic surgery was accepted as a method of choice for benign diseases, and for palliative operations
in progressive stages of malignant diseases of the colon. Today, the laparoscopic surgery of the colon has been also
adopted in treating malignant diseases. The first laparoscopic colon resection was performed in our Clinic on December
12, 2002, and 114 patients have been successfully operated until June 1, 2007. Among those 114 patients 56 were men
and 57 were women with the average age 65 (ranging from 28ā86) years. A series of various laparoscopic operations have
been performed for malignant disease mainly (almost 80%). The pre-surgical treatment, preparation of patients and the
types of the operations were identical to those applied in patients treated by open surgery. Patients with colon carcinoma
have been operated on with the principles of oncologic radicality. In post-operative period we encountered eight complications
(four minor and four major) with only one fatal outcome. According to our experience and the facts found in literature,
the results of laparoscopic colon surgery are comparable with open surgery
CROATIAN POPULATION AND CLINICAL EPIDEMIOLOGICAL STUDIES OF CONGENITAL HEART DISEASE (1995ā2011): THE USE OF ABC SCORE AND RACHS-1 CARDIOSURGICAL MODEL FOR THE ASSESSMENT OF QUALITY OF TREATMENT OF CONGENITAL HEART DISEASE
Cilj: 1. Prikazati epidemioloÅ”ku (populacijsku i kliniÄku) studiju priroÄenih srÄanih grjeÅ”aka (PSG) u Hrvatskoj u razdoblju od 16 godina (1995. ā 2011.). 2. Analizirati ishod operacijskog pristupa za sve bolesnike u petogodiÅ”njem razdoblju (2002. ā 2007.) i usporediti rezultate izmeÄu Hrvatske i inozemnih centara. 3. Prikazati napredak u operacijskom zbrinjavanju PSG-a u Hrvatskoj uzimajuÄi u obzir potrebu za postizanjem rane postoperacijske smrtnosti ispod 5%. 4. Ocijeniti projekciju pozitivnog razvoja zbrinjavanja PSG-a u Hrvatskoj u suradnji s razvijenijim kardiokirurÅ”kim centrima u susjednim zemljama. Metode: Populacijska studija obuhvaÄa svu djecu roÄenu izmeÄu 1995. ā 2000. godine te izmeÄu 2002. ā 2007. godine na osnovi baze podataka sastavljene prema uzoru na EUROCAT i BWIS. Za analizu ishoda koristili smo se dvama modelima (ABC i RACHS-1) s ocjenom rane smrtnosti i vremena provedenog u jedinici intenzivnog lijeÄenja. Rezultati: Srednja vrijednost prevalencije PSG-a na osnovi dviju odvojenih studija u Hrvatskoj jest 7,6 promila. Na temelju analize ishoda prema spomenutim evaluacijskim modelima za razdoblje od 2002. do 2007. godine u Hrvatskoj se operiraju djeca s nižim stupnjem kompleksnosti u odnosu prema kompleksnosti upuÄenih u inozemne centre, ali je zato rana smrtnost ispod zadane granice od 5%, a nema ni razlika u vremenu provedenom u jedinici intenzivnog lijeÄenja. U tom je razdoblju u inozemstvu uÄinjeno Äak 63% operacija, a u Hrvatskoj preostalih 37% (351 : 202). U sljedeÄem ÄetveroĀgodiÅ”njem razdoblju (2008. ā 2011.) znatno se poveÄava broj operacija uÄinjenih u Hrvatskoj u odnosu prema inozemstvu (59 : 4% ili 380 : 264). Nezavisna analiza EACTS-a upuÄuje na pozitivan trend postupnog porasta broja operacija uz prihvaÄanje viÅ”e razine kompleksnosti u Hrvatskoj, ali uz oÄuvani cilj (rana smrtnost ispod 5%). Doprinos studije: Ispravni odabir bolesnika prema kompleksnosti kardiokirurÅ”kog zahvata preduvjet je za nisku smrtnost i rijetke postoperacijske komplikacije. Napredak u struci u uskoj suradnji s razvijenijim inozemnim centrima uspjeÅ”niji je i prihvatljiviji nego s Ā»krivuljama uÄenjaĀ«. ZakljuÄak: Pedijatrijska kardijalna kirurgija mora se u zemljama u razvoju oslanjati na iskustva razvijenih kardiokirurÅ”kih centara u susjednim zemljama zbog kompleksnosti priroÄenih srÄanih grjeÅ”aka. Sama po sebi pedijatrijska je kardiologija javnozdravstveni problem, a on se poveÄava s pojavom velikog broja odraslih pacijenata s priroÄenim srÄanim grjeÅ”kama.Aim: 1. To present an epidemiological (population and clinical) study of congenital heart defects (CHD) in Croatia in a 16-year period (1995ā2011). 2. To analyze outcomes of surgical procedures for all patients in a five-year period (2002ā2007) and to compare the results between Croatian and foreign centers. 3. To present the progress in surgical care of CHD in Croatia while acknowledging the requirement of achieving postsurgical mortality rate of below 5%. 4. To evaluate the projection of positive development of CHD management in Croatia in cooperation with major cardiac surgical centers in the neighboring countries. Methods: Population study includes all children born from 1995 to 2000 and from 2002 to 2007 included in a database modeled by EUROCAT and BWIS. Outcome analysis was made using two models (ABC and RACHS-1) with early mortality rating and prolonged length of stay. Results: Based on two separate studies, mean value of CHD prevalence in Croatia is 7.6 ā°. Outcome analysis according to the two mentioned evaluation models for the 2002ā2007 period shows that children operated on in Croatia had a lower level of complexity compared to the complexity of those sent to foreign centers, but early mortality was below the assigned margin of 5% and there were also no differences in prolonged length of stay. As much as 63% of surgeries in the period were performed abroad, while the remaining 37% were performed in Croatia (351:202). In the following four-year period (2008ā2011) there was a significant increase in the number of surgeries performed in Croatia when compared to those performed abroad (59:4% or 380:264). Independent EACTS analysis points to a positive trend of gradual increase in the number of surgeries and acceptance of higher complexity level of surgeries performed in Croatia, while maintaining the assigned margin (early mortality below 5%). Contribution: Proper selection of patients according to the complexity of cardiac surgical procedure is a prerequisite for both low mortality and fewer postsurgical complications. Professional advance relying on close cooperation with foreign centers is much faster and more acceptable than by Ā»learning curvesĀ«. Conclusion: Pediatric cardiac surgery in the developing countries must rely on the experiences of developed cardiac surgical centers in the neighboring countries due to complexity of congenital heart defects. Pediatric cardiology is inherently a public health problem, but the problem exacerbates with the appearance of a large number of adults with congenital heart defects (GUCH patients)