17 research outputs found
ZaÄetak transplantacije bubrega u jugoistoÄnoj Europi
Organ transplantation is one of the most important medical achievements of the 20th century. Kidney transplantation is the most efficient method of renal replacement therapy. The first successful kidney transplantation in human was performed in 1954 in Boston, USA. In former Yugoslavia, the first kidney transplantation was performed on April 16, 1970 in Ljubljana, Slovenia, and second one on January 30, 1971 in Rijeka, Croatia. In both cases, the mother donated kidney to the son. In the article, we describe the prerequisite conditions for this operation, the characteristics of first patients, and the impact of transplantation program on the development of the hospitals and medical schools.Transplantacija organa zasigurno predstavlja jedno od najveÄih dostignuÄa 20. stoljeÄa. Transplantacija bubrega je najuÄinkovitija metoda od svih oblika nadomjeÅ”tanja bubrežne funkcije. Prva uspjeÅ”na transplantacija bubrega u ljudi je uÄinjena u Bostonu, SAD, 1954. godine. U bivÅ”oj Jugoslaviji prva transplantacija bubrega je uÄinjena 16. travnja 1970. u Ljubljani, Slovenija, a potom 30. sijeÄnja 1971. u Rijeci, Hrvatska. Darivatelj je kod oba bolesnika bila majka, a primatelj sin. U Älanku Äemo prikazati Å”to je prethodilo ovim operacijama, znaÄajke prvih bolesnika te utjecaj transplantacijskog programa na razvoj matiÄnih bolnica i fakulteta
Treatment of Advanced Peripheral Arterial Insuffifi ciency in the Elderly
Peripheral arterial insuffi ciency appears at all stages regardless of the patient age; however its appearance is most
common in the elderly in which cases it mostly appears as stage described by Fontaine as stage III or IV. The most common
cause of peripheral arterial insuffi ciency is atherosclerotic degeneration, and is remarkably often accompanied by
the diabetes. In the years 2012 and 2013 department of vascular surgery, University Hospital Rijeka admitted 169 patients
older than 70 with peripheral arterial insuffi ciency of type Fontaine III and IV. That number represents 68.8% of total
number of patients admitted for peripheral arterial insuffi ciency. The goal of this research is to identify to what extent
and in what percentage can patients older than 70 with advanced peripheral arterial insuffi ciency be subjected to vascular
treatment and if there exist and absolute indication for angiographic treatment of such patients. In majority of patients,
148 of them, three or more comorbidities were present. Diabetes was present at almost half of patients, to be exact 46.7%.
Assessment of possibility for vascular treatment and the need for angiographic treatment was followed in patients in three
age groups: 70ā75 years of age, 76ā80 years of age and over 80 years of age. Angiography was performed on 69 patients
and the insight into angiographic fi nding resulted in only 33 patients being subjected to some type of vascular treatment.
From the total number of patientās subjected to vascular treatment 20 had symptoms of Fontaine III while the remaining
13 had symptoms of Fontaine IV. Amputation procedure was performed 119 times. The research shows that angiographic
treatment is not a routine treatment in mentioned patients and that the number of vascular procedures is signifi cantly
higher in the 70ā75 years age group
Successful Treatment of Acute Aortic Dissection uccessful Treatment of Acute Aortic Dissection Type Stanford A Presenting as Limb Ischemia, ype Stanford A Presenting as Limb Ischemia, Successfully Treated with Operative and uccessfully Treated with Operat
We report a successful treatment of unusual case of a 48 year old male patient with acute aortic dissection type Stanford A that expanded into left common and external iliac artery diagnosed by MSCT angiography, presenting as a single leg paresis, without symptoms of a chest or back pain. Patient was operated with conventional ascending aortic replacement. Patient had no known prior medical condition. He has been treated for acute thrombosis of the left popliteal artery developing one day after ascending aortic replacement surgery, embolectomy was performed. Critical limb ischemia developed due to preocclusive stenosis of the left common and left external iliac artery and was treated by endovascular procedure of iliac artery stenting performed on the fifth postoperative day. After 17 days patient was discharged form hospital, showing no neurological or vascular deficit. For successful treatment of acute aortic dissection type Stanford A complicated with limb ischemia, rapidandaccuratediagnosis is essential, together with close cooperation of cardio surgeons, vascularsurgeonsandinvasiveradiologists and individual approach to these demanding patients
Frequency of early postoperative restenosis after carotid artery thrombendarterectomy
Cilj: Ustvrditi postotak pojavnosti poslijeoperacijske restenoze nakon operacijskog lijeÄenja visokopostotne stenoze arterije karotis na godiÅ”njoj razini te podatke usporediti s novijom svjetskom literaturom. Ispitanici i postupci: Podatci su dobiveni analizom ranih poslijeoperacij- skih kontrolnih nalaza dobivenih obojenim dupleks doplerom, izvrÅ”enih dva tjedna nakon zahvata trombendaterektomije karotidnog žilja, u laboratoriju za cerebrovaskularne bolesti, Klinike za neurologiju, KBC-a Rijeka, na 104 pacijenta operirana na Zavodu za torakovaskularnu kirurgiju, KirurÅ”ke klinike KBC-a Rijeka 2012. godine. Rezultati: U skupini od 104 operirana pacijenta poradi visokopostotne stenoze unutarnje karotidne arterije u ranom poslijeoperacijskom tijeku evidentirano je 11 pacijenata (10,5 %) s pojavom restenoze, no bez neuroloÅ”kih simptoma. Dodatnim praÄenjem naÅ”ih pacijenata nakon tri i Å”est mjeseci primijetili smo da se stupanj restenotskog procesa nije poveÄavao u 8 pacijenata, no u trojice pacijenata (2,9 %) evidentirano je znatno poveÄanje stupnja restenoze, te su oni podvrgnuti endovaskularnoj tzv. stenting pro- ceduri. ZakljuÄci: Trombendarterektomija karotidnog žilja je operacijski zahvat koji se u KBC-u Rijeka izvodi rutinski. Incidencija pojavnosti poslijeoperacijske restenoze je mala, no nije neuobiÄajena pojava, ali uz adekvatnu medikamentnu potporu gotovo nikad nije fatalna za pacijenta, te je reparabilna ako je to potrebno. Mnogi svjetski autori takoÄer izvjeÅ”tavaju u izvjesnom postotku o pojavnosti poslijeoperacijske restenoze unutarnje arterije karotis. Redovitim ultrazvuÄnim kontrolama pravovremeno se otkrivaju poslijeoperacijski restenotski procesi koji mogu biti od hemodinamskog znaÄaja u neuroloÅ”kih pacijenata. U postizanju dobrih kliniÄkih rezultata kod prevencije i lijeÄenja neuroloÅ”kih incidenata izuzetno je važna dobra i uska suradnja svih supspecijalistiÄkih timova koji se bave problematikom cerebrovaskularnog inzulta.Aim: To determine the percentage of postoperative restenosis frequency on an annual level after the operative treatement of the high-percent carotid artery stenosis, and to compare the data with recent literature. Subject and methods: Data was obtained by analysing ear- ly postoperative Colour Duplex Doppler control tests, which were performed two weeks after thrombendarterectomy of carotid vesells in the Laboratory of cerebrovascular diseases, Neurology clinic, Clinical hospital centre Rijeka on 104 patients treated at the Thoracovascular insti- tute, Surgery clinic, Clinical hospital centre Rijeka in the year 2012. Results: In a group of 104 treated patients, because of high-percent stenosis of internal carotid artery there was an evi- dent restenotic process without neurological symptoms in the early postoperative stages in 11 patients (10,5 %). With additional follow-up care of our patients after 3 and 6 monts, the level of restenotic proces did not increase in 8 patients, but in 3 (29 %) of our patients there was an evident increase of restenosis and they were treated with stenting procedure. Conclusions: Carotid thrombendarterectomy is a routine operative procedure in our Thoracovascular institute, and has been performed for many years. Fortunately, the frequency of postoperative resteno- sis is small but not unusual, and with adequate drugs support is almost never fatal and treatable if needed. Numerous authors have also reported a certain percentage of postoperative restenosis of internal carotid artery. With frequent ultrasound controls, postoperative restenotic process can be discovered in time, which can be of hemodinamic importance in neurological patients. A good cooperation between all subspecialistic teams involved in the assessment of cerebrovascular stroke is of great importance for accomplishing good clinical results in prevention and treatement of neurological incidents
Frequency of early postoperative restenosis after carotid artery thrombendarterectomy
Cilj: Ustvrditi postotak pojavnosti poslijeoperacijske restenoze nakon operacijskog lijeÄenja visokopostotne stenoze arterije karotis na godiÅ”njoj razini te podatke usporediti s novijom svjetskom literaturom. Ispitanici i postupci: Podatci su dobiveni analizom ranih poslijeoperacij- skih kontrolnih nalaza dobivenih obojenim dupleks doplerom, izvrÅ”enih dva tjedna nakon zahvata trombendaterektomije karotidnog žilja, u laboratoriju za cerebrovaskularne bolesti, Klinike za neurologiju, KBC-a Rijeka, na 104 pacijenta operirana na Zavodu za torakovaskularnu kirurgiju, KirurÅ”ke klinike KBC-a Rijeka 2012. godine. Rezultati: U skupini od 104 operirana pacijenta poradi visokopostotne stenoze unutarnje karotidne arterije u ranom poslijeoperacijskom tijeku evidentirano je 11 pacijenata (10,5 %) s pojavom restenoze, no bez neuroloÅ”kih simptoma. Dodatnim praÄenjem naÅ”ih pacijenata nakon tri i Å”est mjeseci primijetili smo da se stupanj restenotskog procesa nije poveÄavao u 8 pacijenata, no u trojice pacijenata (2,9 %) evidentirano je znatno poveÄanje stupnja restenoze, te su oni podvrgnuti endovaskularnoj tzv. stenting pro- ceduri. ZakljuÄci: Trombendarterektomija karotidnog žilja je operacijski zahvat koji se u KBC-u Rijeka izvodi rutinski. Incidencija pojavnosti poslijeoperacijske restenoze je mala, no nije neuobiÄajena pojava, ali uz adekvatnu medikamentnu potporu gotovo nikad nije fatalna za pacijenta, te je reparabilna ako je to potrebno. Mnogi svjetski autori takoÄer izvjeÅ”tavaju u izvjesnom postotku o pojavnosti poslijeoperacijske restenoze unutarnje arterije karotis. Redovitim ultrazvuÄnim kontrolama pravovremeno se otkrivaju poslijeoperacijski restenotski procesi koji mogu biti od hemodinamskog znaÄaja u neuroloÅ”kih pacijenata. U postizanju dobrih kliniÄkih rezultata kod prevencije i lijeÄenja neuroloÅ”kih incidenata izuzetno je važna dobra i uska suradnja svih supspecijalistiÄkih timova koji se bave problematikom cerebrovaskularnog inzulta.Aim: To determine the percentage of postoperative restenosis frequency on an annual level after the operative treatement of the high-percent carotid artery stenosis, and to compare the data with recent literature. Subject and methods: Data was obtained by analysing ear- ly postoperative Colour Duplex Doppler control tests, which were performed two weeks after thrombendarterectomy of carotid vesells in the Laboratory of cerebrovascular diseases, Neurology clinic, Clinical hospital centre Rijeka on 104 patients treated at the Thoracovascular insti- tute, Surgery clinic, Clinical hospital centre Rijeka in the year 2012. Results: In a group of 104 treated patients, because of high-percent stenosis of internal carotid artery there was an evi- dent restenotic process without neurological symptoms in the early postoperative stages in 11 patients (10,5 %). With additional follow-up care of our patients after 3 and 6 monts, the level of restenotic proces did not increase in 8 patients, but in 3 (29 %) of our patients there was an evident increase of restenosis and they were treated with stenting procedure. Conclusions: Carotid thrombendarterectomy is a routine operative procedure in our Thoracovascular institute, and has been performed for many years. Fortunately, the frequency of postoperative resteno- sis is small but not unusual, and with adequate drugs support is almost never fatal and treatable if needed. Numerous authors have also reported a certain percentage of postoperative restenosis of internal carotid artery. With frequent ultrasound controls, postoperative restenotic process can be discovered in time, which can be of hemodinamic importance in neurological patients. A good cooperation between all subspecialistic teams involved in the assessment of cerebrovascular stroke is of great importance for accomplishing good clinical results in prevention and treatement of neurological incidents
Complications of recent luxations in glenohumeral joint ā case report
Cilj: Komplikacije svježih luksacija su prijelomi, rupture rotatorne manžete, ozljede živaca
i vaskularne ozljede. Ozljede žila (a. axillaris, v. axillaris, grana aksilarne arterije ā a. circumflexa
anterior i posterior, a. subscapularis) mogu nastati za vrijeme iÅ”ÄaÅ”enja ili pokuÅ”aja
repozicije. Prikaz sluÄaja: 68-godiÅ”nji muÅ”karac pao je i ozlijedio lijevo rame. Verificira se luksacijski
prijelom humerusa, uz avulziju a. circumflexe posterior, intimalna lezija i tromboza aksilarne
arterije. UÄini se rekonstrukcija resekcijom mjesta ozljede uz graft-interpozitum v. saphene
magne te suture mjesta rupture a. circumflexe posterior, a zatim i osteosinteza phylos
ploÄom i vijcima. Rasprava i zakljuÄak: Nakon kliniÄke sumnje na iÅ”ÄaÅ”enje nadlaktice u ramenom
zglobu ili na prijelome preporuÄujemo utvrÄivanje vaskularnog i neuroloÅ”kog statusa
ruke, a kod sumnje na leziju žila i MSCT angiografiju.Aim: Complications of recent luxations are fractures, ruptures of rotator cuff,
nerve and vascular lesions. Vascular lesions (a. axillaris, v. axillaris, branch of axillary artery
ā a. circumflexa anterior and posterior, a. subscapularis) can occur during luxation or attempt
of reposition. Case report: A 68-year-old man fell and injured the shoulder. We have
verified shoulder fracture with luxation, avulsion of posterior circumflex artery and thrombosis
of axillary artery. Reconstruction included partial resection of artery, graft-interpositum
using v. saphena magna and sutures of ruptured part of a. circumflexa posterior. Afterwards,
osteosynthesis with phylos plate and screws was performed. Discussion and
conclusion: After clinical predicament of shoulder luxation or fractures, we suggest defining
of vascular and neurological status of the arm. When there is suspicion of vascular injury,
MSCT angiography is recommended
An overview of replantation and transplantation of the upper extremity
Glavni cilj replantacije ponovna je uspostava perfuzije ekstremiteta te minimiziranje vremena ishemije. Operacijski mikroskop i mikrovaskularna kirurÅ”ka tehnika osnove su na kojima se temelji replantacija i revaskularizacija. Kod replantacije koristimo sljedeÄe operacijske zahvate: osteosintezu, anastomozu i rekonstrukciju vaskularnih elemenata, rekonstrukciju živaca, tetive ili miÅ”iÄa te pokrova. Kontraindikacije za replantaciju dijele se na apsolutne i relativne. U apsolutne kontraindikacije ubrajaju se: amputacija s politraumom, opsežna ozljeda i kroniÄne bolesti. Relativne kontraindikacije su: amputacija jednog prsta, bolesnik iznad 50 godina, avulzijske ozljede, duga topla ishemija (viÅ”e od 12 sati za prste te 6 ā 8 sati za nadlakticu i podlakticu), jaka kontaminacija te ranija ozljeda s loÅ”im funkcijskim ishodom. Replantacije se favoriziraju kada su u pitanju djeca, palac Å”ake te viÅ”e prstiju Å”ake. Transplantacija vaskulariziranog ekstremiteta ili njegovih dijelova definira se kao alotransplantacija kompozitnog tkiva te nudi novu terapijsku moguÄnost za bolesnike s gubitkom ruke. Rutinska skrb tijekom poslijeoperacijske njege ukljuÄuje elevaciju replantiranog ekstremiteta, antikoagulacijsku zaÅ”titu, praÄenje boje, turgora, kapilarnog punjenja i temperature, primjenu antibiotske terapije te zabranu puÅ”enja i konzumacije kave i Äokolade, kako bi se prevenirao periferni vazospazam i time rizik od razvoja vaskularne tromboze. Prva uspjeÅ”na replantacija palca Å”ake u KBC-u Rijeka uÄinjena je 1980. godine, dok je replantacija podlaktice uÄinjena 1983. godine. Iako replantacija može biti izuzetno skupa te zahtijevati produženu hospitalizaciju i poslijeoperacijsku terapiju, ukupni troÅ”kovi mogu biti znaÄajno niži od mioelektriÄne proteze koja se mora periodiÄno mijenjati. UnatoÄ svemu, iskusan tim lijeÄnika i izuzetno motiviran bolesnik pridonose uspjeÅ”nosti operacije te zadovoljstvu, kako kozmetiÄkim, tako i funkcijskim rezultatom.The main goal of replantation is the re-establishment of extremity perfusion and minimization of ischemia time. Operational microscope and microvascular surgical technique are the basis of replantation and revascularization. The following operations are used in replantation: osteosynthesis, anastomosis and reconstruction of vascular elements, reconstruction of nerves, tendons or muscles and cover. Contraindications for replantation are classified as absolute and relative ones. Absolute contraindications include amputation with polytrauma, extensive injury and chronic diseases. Relative contraindications are one finger amputation, patient older than 50 years, avulsions, long warm ischemia (more than 12 hours for fingers and 6-8 hours for upper arm and forearm), severe contamination and earlier injury with poor functional result. Favored replantations include children, thumb and more hand fingers. Transplantation of vascularized extremity or its parts is defined as allotransplantation of composite tissue, offering new therapeutic opportunities for patients with an amputated arm. The common postoperative care consists of elevation of replanted extremity, anticoagulation therapy, monitoring of color, skin turgor, capillary filling and temperature, administration of antibiotics, prohibition of smoking, coffee and chocolate, in order to prevent peripheral vasospasm and eventual risk of vascular thrombosis. The first successful thumb replantation in Clinical Hospital Center Rijeka was performed in 1980, and forearm replantation in 1983. Although replantation can be extremely expensive, requiring extended hospitalization and postoperative therapy, total expenses could be considerably lower than myoelectrical prosthesis which must be changed periodically. Nevertheless, an experienced team of doctors and highly motivated patients contribute to operation success, as well as satisfaction with both cosmetic and functional result
DEBRIDEMENT POSSIBILITIES IN FAMILY MEDICINE
KroniÄne rane su znaÄajni zdravstveno-socioloÅ”ki i eikonomski problem za druÅ”tvo. Zahtijevaju dodatni angažman medicinskog i nemedicinskog osoblja u prehospitalnim i hospitalnim ustanovama, troÅ”e znaÄajne materijalne i nematerijalne resurse te dovode do smanjene kvalitete života bolesnika i njegove obitelji, odnosno skrbnika. napretkom medicine i tehnologije na podruÄju lijeÄenja rana otvaraju se moguÄnosti za provoÄenje jedne ili viÅ”e kvalitetnih metoda debridmana od medicinskog osoblja, bez potrebe za struÄnim angažmanom bolniÄkog osoblja. U danaÅ”nje se vrijeme boljom i sveobuhvatnijom edukacijom medicinskog osoblja, pa tako i timova obiteljske medicine, stvara moguÄnost ranog poÄetka kvalitetnog lijeÄenja akutnih i kroniÄnih rana. Pravodobna indikacija i adekvatna provedba debridmana kao poÄetnog i krucijalnog postupka nameÄe se kao temeljni postupak prema izlijeÄenju. obavljanjem spomenutog postiže se znaÄajna vremenska korist u procesu lijeÄenja, a izbjegava gubitak dragocjenog vremena utroÅ”enog na naruÄivanje pacijenta i njegov dolazak do specijalistiÄkih hospitalnih ambulanti.Life expectancy of the population is increasing every day. Accurate and timely diagnosis and appropriate therapeutic approach prevent exacerbation and complications of chronic noninfectious diseases. The result is the increasing trend in life expectancy and the growing proportion of elderly population. The increasing life expectancy is associated with a rising incidence of injuries and failing ill from chronic noninfectious diseases. The increase in comorbidity additionally decreases the biological potential of tissue regeneration, which results in an increasing number of chronic, slow-healing wounds in the elderly population. Chronic wounds represent a signiicant health, social and economic problem for the society. They require additional involvement of medical and non-medical staff in prehospital and hospital institutions, as well as substantial inancial resources. These wounds reduce quality of life of the patient, his/her family or custodian. nowadays, better and comprehensive education of medical staff, including teams of family medicine, make it possible to start early with quality healing of acute and chronic wounds. Timely indication and appropriate use of debridement as the initial and crucial procedure are the basic procedures to support wound healing. Implementing these procedures properly will save precious time in the process of healing, while avoiding wasting time for patient referral and admission to specialist hospital clinics
Treatment of polytrauma
Posljednja dva desetljeÄa relevantni svjetski podaci usporeÄuju problem politraume
s epidemijom, koristeÄi se sintagmom ātraumatizirani bolesnikā, svrstavajuÄi ga na treÄe
mjesto svih uzroka smrtnosti, a na prvo mjesto u dobnoj skupini od 1. do 44. godine života.
Zbog složenosti samih ozljeda, kao i zbog nedovoljno objaŔnjenih odgovora organizma na
samu traumu i na terapijske postupke, lijeÄenje politraumatiziranih bolesnika jedno je od
najsloženijih u suvremenoj medicini. U suvremenom pristupu lijeÄenju od velike su pomoÄi
algoritmi, Äijom se toÄnom primjenom postižu bolji rezultati uz smanjenje propusta i pogreÅ”aka
na najmanju moguÄu mjeru. Osnovni princip lijeÄenja politraumatiziranih bolesnika jest
da ono poÄinje na mjestu nezgode, traje tijekom transporta i nastavlja se u bolnici uz poÅ”tovanje
principa istovremenosti dijagnostike i lijeÄenja. Uspostava registra traume i neprestano
vrednovanje rezultata lijeÄenja predstavljaju jedan od osnovnih preduvjeta za osnivanje
centra trauma prve kategorije, a samim time i za poboljŔanje kvalitete zbrinjavanja politraumatiziranih
bolesnika.In the last two decades polytrauma is compared with the epidemic and the phrase
Ā»trauma diseaseĀ« is used, classifying it in the third place of general population mortality
and in the first place in the age group from 1-44 years. Due to the complexity of the injuries
and insufficiently explained patient response to the trauma itself and to the therapeutic
procedures, treatment of polytraumatized patients is one of the most demanding in the
modern medicine. The algorithms are of great help in the modern polytrauma treatment
and by using it we achieve better results and reduce omissions and errors to a minimum.
The basic principle of polytraumatized patients treatment is that it starts at the site of the
accident and continues during the transport and after arrival to the hospital with the fundamental
rule that the diagnostic and treatment procedures are performed simultaneously.
Establishing a trauma registry and constantly evaluating the results of patients treatment
are one of the main preconditions for the establishment of the first level trauma centre and
improving care quality of polytraumatized patients
ATHEROSCLEROTIC DISEASE OF THE CAROTID ARTERY - A REVIEW ARTICLE
Moždani udar je u Republici Hrvatskoj i u
svijetu vodeÄi uzrok invaliditeta te drugi
uzroÄnik mortaliteta. Jedan od uzroka
moždanog udara je i stenoza karotidne arterije uzrokovana aterosklerotskim plakom. Brojni su riziÄni faktori koji dovode
do ateroskleroze, a time i do stenoze karotidne arterije, a mogu biti promijenjivi i
nepromjenjivi. Pravovremenim djelovanjem na promjenjive riziÄne faktore kao
Ŕto su puŔenje, hiperlipoproteinemija i
poveÄana tjelesna težina na vrijeme bi se
mogla sprijeÄiti ova teÅ”ka bolest. Moždani
udar je bolest koja zbog fiziÄkih, socijalnih
i kognitivnih ograniÄenja dovodi do smanjene kvalitete života samog bolesnika, ali i
njegove obitelji. Pravovremenim otkrivanjem riziÄnih faktora te time prevencijom
moždanog udara sprijeÄio bi se ovaj veliki
zdravstveni problem koji zahvaÄa veliki broj
bolesnika svake godineStroke is a leading cause of disability in the
Republic of Croatia and in the world. It is
also the second cause of mortality. One of
the causes of stroke is the carotid artery
stenosis caused by atherosclerotic plaque.
There are numerous risk factors that lead to
atherosclerosis, and thus to carotid artery
stenosis, and may be variable and invariable. Timely action on variable risk factors
such as smoking, hyperlipoproteinemia and
increased body weight could prevent this
serious illness. Stroke is a disease that, due
to physical, social and cognitive limitations,
leads to a reduced quality of life of the patient but also his family. By timely detection
of risk factors and thus preventing stroke,
this major health problem that affects a large
number of patients every year could be prevented