Uporaba piezoelektričnog svojstva u poboljšanju kvalitete instrumenata i sigurnosti bolesnika u laparoskopskoj kirurgiji

The piezoelectric properties of some natural crystals and polymers can also be used in surgery. For this purpose, a prototype of an endoscopic instrument was constructed with piezoelectric material attached to its working end with the aim of recognizing pulsating blood vessels during laparoscopic surgery. To test the properties of the new instrument in laboratory conditions, simulated blood circulation was used with the possibility of changing pressure and frequency. The instrument was tested in the pressure range of 40-180 mm Hg at constant frequency of 72/min and frequency range of 36-130 beats per minute at constant pressure of 120 mm Hg. Test results showed that the instrument with certainty recognized a pulsating “blood vessel” in the expected pressure ranges and at different blood pump frequencies. Given the piezoelectric material’s very small dimensions and flexible form, it can be installed at the working end of most standard laparoscopic instruments and thus significantly increase certainty in the recognition of arteries during surgery, which would reduce the possibility of their injury or accidental ligation.Piezoelektrična svojstva nekih prirodnih kristala i nekih polimera moguće je koristiti i u kirurgiji. U tu svrhu konstruiran je prototip endoskopskog instrumenta na čijem je radnom dijelu ugrađen piezoelektrični materijal s ciljem prepoznavanja pulzirajućih krvnih žila tijekom laparoskopskih operacija. Za ispitivanje svojstava novoga instrumenta u laboratorijskim uvjetima korišten je simulirani krvotok s mogućnošću mijenjanja tlaka i frekvencije. Rad instrumenta je ispitivan u rasponu tlakova 40-180 mm Hg uz konstantnu frekvenciju 72/min, te u rasponu frekvencija 36-130 otkucaja u minuti uz konstantan tlak 120 mm Hg. Rezultati ispitivanja pokazuju da instrument sa sigurnošću prepoznaje pulzirajuću „krvnu žilu“ u očekivanom rasponu tlakova i pri različitim frekvencijama rada krvne pumpe. S obzirom na to da se radi o vrlo malim dimenzijama i prilagodljivim oblicima piezoelektričkog materijala, moguće ga je postaviti na radni dio većine standardnih laparoskopskih instrumenata i time značajno povećati sigurnost prepoznavanja arterija tijekom operacijskog zahvata, što bi smanjilo mogućnost njihove ozljede ili slučajnog podvezivanja

Common position of indels that cause deviations from canonical genome organization in different measles virus strains

BACKGROUND: The canonical genome organization of measles virus (MV) is characterized by total size of 15 894 nucleotides (nts) and defined length of every genomic region, both coding and non-coding. Only rarely have reports of strains possessing non-canonical genomic properties (possessing indels, with or without the change of total genome length) been published. The observed mutations are mutually compensatory in a sense that the total genome length remains polyhexameric. Although programmed and highly precise pseudo-templated nucleotide additions during transcription are inherent to polymerases of all viruses belonging to family Paramyxoviridae, a similar mechanism that would serve to non-randomly correct genome length, if an indel has occurred during replication, has so far not been described in the context of a complete virus genome. ----- METHODS: We compiled all complete MV genomic sequences (64 in total) available in open access sequence databases. Multiple sequence comparisons and phylogenetic analyses were performed with the aim of exploring whether non-recombinant and non-evolutionary linked measles strains that show deviations from canonical genome organization possess a common genetic characteristic. ----- RESULTS: In 11 MV sequences we detected deviations from canonical genome organization due to short indels located within homopolymeric stretches or next to them. In nine out of 11 identified non-canonical MV sequences, a common feature was observed: one mutation, either an insertion or a deletion, was located in a 28 nts long region in F gene 5' untranslated region (positions 5051-5078 in genomic cDNA of canonical strains). This segment is composed of five tandemly linked homopolymeric stretches, its consensus sequence is G6-7C7-8A6-7G1-3C5-6. Although none of the mononucleotide repeats within this segment has fixed length, the total number of nts in canonical strains is always 28. These nine non-canonical strains, as well as the tenth (not mutated in 5051-5078 segment), can be grouped in three clusters, based on their passage histories/epidemiological data/genetic similarities. There are no indications that the 3 clusters are evolutionary linked, other than the fact that they all belong to clade D. ----- CONCLUSIONS: A common narrow genomic region was found to be mutated in different, non-related, wild type strains suggesting that this region might have a function in non-random genome length corrections occurring during MV replication

Solitary neurocysticercosis: case report and short review

Solitarna neurocisticerkoza je vrlo rijedak oblik bolesti CNS-a u Hrvatskoj. Obično se javlja u multiploj formi, a rezultat je prodora larve Teniae solium u moždano tkivo i njezinoga razvoja unutar ciste. Ovisno o lokalizaciji unutar CNS-a manifestira se fokalnim ili generaliziranim epileptičkim napadajima, senzomotoričkim deficitom, intelektualnim ili psihološkim ispadima, razvojem hidrocefalusa, a može i doživotno ostati asimptomatska. Prikazali smo bolesnicu u dobi od 18 godina s pojavom prvog epileptičkog napadaja tipa grand mal. Učinjenom neuroradiološkom obradom nalazi se temporalno lijevo ovalna tumorska tvorba. Neurokirurškim zahvatom ekstirpirana je tumorska tvorba, a patohistološki nalaz upućuje na kalcificirani cisticerk. Po provedenom liječenju stanje bolesnice je dobro, bez neuroloških ispada i diseminacije parazitarne bolesti. Cilj ovoga rada je prikazati kako je u slučaju pojave prvog epileptičkog napadaja i radiološki verficirane nejasne tumorske tvorbe potrebno diferencijalno dijagnostički razmišljati i o solitarnom cisticerk granulomu.Solitary neurocysticercosis is a very rare form of CNS disease in Croatia, and it normally occurs as multiple neurocysticercosis. The disease is caused by an infection of the brain tissue with larval stage of Taenia solium and its development within a cyst. Depending on its position within the CNS, it manifests itself through focal or generalised epileptic seizures, sensomotoric deficits, intellectual or psychological dysfunction, sporadic development of hydrocephalus, but it may remain asymptomatic permanently. The paper discusses an 18-year-old patient who suffered her first grand mal epileptic seizure. A neuroradiological assessment detected an oval tumour mass in the left temporal lobe. The tumour mass was extirpated through a neurosurgical procedure, and a pathohistological diagnosis indicates a calcified cysticercus. Following the treatment, the patient\u27s condition is good, with no neurological episodes or parasitic disease dissemination. This paper aims to demonstrate that differential diagnostic thinking is needed to consider the solitary cysticercus granuloma in cases of unclear solitary tumorous masses

Gigantocellular arteritis of the vertebral arteries as a cause of ishemic stroke

Gigantocelularni arteritis, temporalni arteritis ili Horton\u27s arteritis je sistemski vaskulitis i kronična upalna bolest velikih i srednje velikih krvnih žila. Uglavnom zahvaća temporalne arterije, esktrakranijski dio karotidnih arterija, torakalnu i abdominalnu aortu. Obostrana okluzija vertebralnih arterija je rijetka i ozbiljna manifestacija gigantocelularnog arteritisa. U radu smo prikazali bolesnicu koja je tri tjedna prije bolničke obrade razvila neurološke ispade, glavobolju, vrtoglavicu, otežan hod i gubitak ravnoteže. Za vrijeme boravka na odjelu učinjena je laboratorijska obrada, patološki nalazi su bili ubrzana sedimentacija eritrocita, povišeni C reaktivni protein, leukocitoza i trombocitoza. Neuroradiološkom obradom dokazani su obostrano okcipitalno ishemijski infarkti. Klinička slika, laboratorijski nalazi i neuroradiološka obrada upućuju na cerebralni vaskulitis. Tijek bolesti je dodatno kompliciran razvojem pneumonije, što je rezultiralo smrtnim ishodom. Konačna dijagnoza gigantocelularnog arteritisa vertebralnih arterija potvrđena je obdukcijom i patohistološkom dijagnostikom.Gigantocellular arteritis, temporal arteritis or Horton’s arteritis is a systemic vasculitis and a chronic inflammatory disease of large and medium-sized blood vessels, especially the temporal arteries, the extracranial part of the carotid arteries, the thoracic and the abdominal arteries. Bilateral vertebral artery occlusion is a rare and serious manifestation of gigantocellular arteritis. The paper reviews the case of a patient hospitalized three weeks after the onset of neurological symptoms, headache, vertigo, gait instability and sight loss. Pathological laboratory tests indicated erythrocyte sedimentation rate, elevated C-Reactive Protein, fibrinogen, thrombocytosis and leukocytosis. Clinical presentations, the course of the disease and a bilateral infarction of the posterior circulation confirmed by a brain computerized tomography scan, indicated possible cerebral arteritis, therefore corticosteroid therapy was introduced. The disease was complicated by the development of pneumonia, resulting in the death of the patient. A diagnosis gigantocellular arteritis of the vertebral arteries was definitely confirmed through autopsy and pathohistological analysis

Gigantocellular arteritis of the vertebral arteries as a cause of ishemic stroke

Gigantocelularni arteritis, temporalni arteritis ili Horton\u27s arteritis je sistemski vaskulitis i kronična upalna bolest velikih i srednje velikih krvnih žila. Uglavnom zahvaća temporalne arterije, esktrakranijski dio karotidnih arterija, torakalnu i abdominalnu aortu. Obostrana okluzija vertebralnih arterija je rijetka i ozbiljna manifestacija gigantocelularnog arteritisa. U radu smo prikazali bolesnicu koja je tri tjedna prije bolničke obrade razvila neurološke ispade, glavobolju, vrtoglavicu, otežan hod i gubitak ravnoteže. Za vrijeme boravka na odjelu učinjena je laboratorijska obrada, patološki nalazi su bili ubrzana sedimentacija eritrocita, povišeni C reaktivni protein, leukocitoza i trombocitoza. Neuroradiološkom obradom dokazani su obostrano okcipitalno ishemijski infarkti. Klinička slika, laboratorijski nalazi i neuroradiološka obrada upućuju na cerebralni vaskulitis. Tijek bolesti je dodatno kompliciran razvojem pneumonije, što je rezultiralo smrtnim ishodom. Konačna dijagnoza gigantocelularnog arteritisa vertebralnih arterija potvrđena je obdukcijom i patohistološkom dijagnostikom.Gigantocellular arteritis, temporal arteritis or Horton’s arteritis is a systemic vasculitis and a chronic inflammatory disease of large and medium-sized blood vessels, especially the temporal arteries, the extracranial part of the carotid arteries, the thoracic and the abdominal arteries. Bilateral vertebral artery occlusion is a rare and serious manifestation of gigantocellular arteritis. The paper reviews the case of a patient hospitalized three weeks after the onset of neurological symptoms, headache, vertigo, gait instability and sight loss. Pathological laboratory tests indicated erythrocyte sedimentation rate, elevated C-Reactive Protein, fibrinogen, thrombocytosis and leukocytosis. Clinical presentations, the course of the disease and a bilateral infarction of the posterior circulation confirmed by a brain computerized tomography scan, indicated possible cerebral arteritis, therefore corticosteroid therapy was introduced. The disease was complicated by the development of pneumonia, resulting in the death of the patient. A diagnosis gigantocellular arteritis of the vertebral arteries was definitely confirmed through autopsy and pathohistological analysis

Synchronous caecal small-cell neuroendocrine carcinoma and adenocarcinoma of the rectum

Neuroendokrini karcinom malih stanica debeloga crijeva rijedak je entitet s najčešće lošom prognozom. Osamdesetogodišnja žena podvrgnuta je operaciji debeloga crijeva zbog sinkronog tumora rektuma i cekuma. Patohistološka analiza tumora cekuma pokazala je trabekularne i čvrste nakupine, relativno uniformne male do srednje velike epitelne stanice, oskudne citoplazme, a u vezivnom tkivu bilo je dosta mitoza s većim područjima nekroze. Imunohistokemija je bila pozitivna na kromogranin A. Tumor je dijagnosticiran kao neuroendokrini karcinom malih stanica cekuma. Osim toga, tumor rektuma pokazao je mikroskopske nalaze u skladu s IIA stadijem adenokarcinoma. Imunohistokemijski panel pokazao je da je tumor bio negativan na neuroendokrine markere. Nije bilo kliničkoga nalaza koji ukazuje na pojačanu sekreciju hormona. Metastaze karcinoma nisu nađene. Provedena je postoperativna kemoterapija. Pacijentica je i dalje živa, dobrog općega stanja, bez znakova progresije tumora.Small-cell neuroendocrine colon carcinoma is a rare entity with a usually poor prognosis. An 80-year-old female had colon cancer surgery due to synchronous tumour of the rectum and caecum. Pathohystological analysis of the caecal tumour showed trabecular and solid clusters, relatively uniformed small to middle sized epithelial cells, deficient cytoplasm and there were a great number of mitosis with larger areas of necrosis in the connective tissue. The immunohistochemistry was positive for chromogranin A. The caecal tumour was diagnosed as a small-cell neuroendocrine carcinoma. In addition, the rectal tumour showed microscopic findings consistent with stage IIA adenocarcinoma. The immunohistochemical panel showed that the tumour was negative for neuroendocrine markers. There were no clinical findings suggestive of hormone hypersecretion. Cancer metastases were not found. Postoperative chemotherapy was applied. The patient is still alive, in good general condition and with no signs of tumour progression

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Giant schwannoma in the knee area

Schwanom je benigni tumor ovojnice perifernih živaca. Može se pojaviti duž perifernih živaca na svim dijelovima tijela. Rijetko recidivira ili maligno alterira. Ovim radom prikazali smo 20-godišnjeg bolesnika s recidivom velikog Schwanoma u području koljena. Prvi operativni zahvat učinjen je u dobi od 13 godina. Bolesnik je primijetio recidiv tumora četiri godine nakon prve operacije. Budući da se radilo o bolesniku s posebnim potrebama koji nije imao neuroloških simptoma, javio se na pregled sedam godina nakon prve operacije, odnosno kada su se pojavili bolovi. Operativnim zahvatom tumor je odstranjen u cijelosti. Nakon operacije nije imao recidiv tumora, niti neuroloških simptoma.Schwannoma is a benign tumor of peripheral nerve sheaths, which may occur along peripheral nerves in all parts of the body. Recurrence or malignant alteration of schwannoma is rare. A case is described of a 20- year-old patient with recurrence of a large schwannoma in the knee area. At age 13, the patient underwent operative removal of a schwannoma in the medial segment of his right knee. Four years after the first operation, the patient observed tumor recurrence. The patient was characterized by some special needs, but was free from neurologic symptoms. He presented for examination seven years after the first operation, i.e. when pains developed. The tumor was operatively removed in total. Postoperatively, no tumor relapse or neurologic symptoms were recorded