Ozljede glavnog žučovoda tijekom otvorene i laparoskopske kolecistektomije u Kliničkoj bolnici "Sestre milosrdnice" od 1995. do 2001. godine

Bile duct injury is one of the most severe complications of cholecystectomy. Several multi-center studies have demonstrated these injuries to be more commonly associated with laparoscopic cholecystectomy than with open cholecystectomy. During a 7-year period, from January 1995 till December 2001, 4528 patients underwent cholecystectomy at the University Department of Surgery, Sestre milosrdnice University Hospital in Zagreb, Croatia. Laparoscopic cholecystectomy was performed in 2657 (58%) of these patients. Bile duct injury was recorded in 15 (0.33%) patients, three (0.16%) of them submitted to open cholecystectomy. Of the latter, partial transsection of the common bile duct occurred in two patients and complete transsection in one patient. In the series of patients with laparoscopic cholecystectomy, bile duct injury occurred in 12 (0.45%) patients, with complete transsection of the common bile duct observed in five, partial transsection in three, and bile duct injury with a metal clip in three patients. Common bile duct stricture without apparent intraoperative injury developed in one patient during the late postoperative period. All these 15 patients with iatrogenic bile duct injury that occurred during either open or laparoscopic cholecystectomy were surgically managed. Roux-en-Y choledochojejunostomy was performed in nine patients, whereas the remaining six patients underwent common bile duct reconstruction by creating a terminoterminal anastomosis and T-tube insertion. Stricture of the anastomosis in the late postoperative period developed in five of these patients, who underwent secondary reconstruction of biliary continuity by Roux-en-Y choledochojejunostomy.Ozljeda glavnog žučovoda jedna je od najtežih komplikacija kolecistektomije. Nekoliko je multicentričnih studija pokazalo kako su ove ozljede češće kod laparoskopske negoli kod otvorene kolecistektomije. Tijekom sedmogodišnjeg razdoblja, od siječnja 1995. do prosinca 2001. godine, na Klinici za kirurgiju Kliničke bolnice "Sestre milosrdnice" u Zagrebu izvedena je kolecistektomija u 4528 bolesnika. Laparoskopska kolecistektomija učinjena je u 2657 (58%) bolesnika. Ozljeda glavnog žučovoda zabilježena je u 15 (0,33%) bolesnika. Ozljeda glavnog žučovoda nastala je u troje (0,16%) operiranih bolesnika metodom otvorene kolecistektomije. Djelomično presijecanje glavnog žučovoda nastupilo je kod dvoje bolesnika, a potpuno presijecanje kod jednog bolesnika. U skupini bolesnika kod kojih je učinjena laparoskopska kolecistektomija do ozljeda glavnog žučovoda došlo je u 12 (0,45%) operiranih: potpuno presijecanje glavnog žučovoda u petero, djelomično presijecanje u troje, ozljeda metalnom kopčom također u troje te suženje glavnog žučovoda bez intraoperacijski vidljive ozljede u jednog bolesnika i to u kasnom poslijeoperacijskom razdoblju. Svi bolesnici s jatrogenom ozljedom glavnog žučovoda koja je nastala nakon otvorene ili laparoskopske kolecistektomije liječeni su kirurški. Koledokojejuno-anastomoza po Rouxu izvedena je u devetoro bolesnika a kod šestoro bolesnika napravljena je rekonstrukcija glavnog žučovoda pomoću terminoterminalne anastomoze i uvođenjem T cjevčice. Suženje anastomoze nastupilo je u kasnom poslijeoperacijskom razdoblju u petoro bolesnika. Zato je kod njih izvedena sekundarna rekonstrukcija žučnog kontinuiteta pomoću koledokojejuno-anastomoze po Roux-u

Klatskin Tumor – Results of Surgical Therapy

Between January 1st 1990 and December 31st 1999, 24 patients affected by Klatskin tumor underwent operation in our department of surgery. According to Bismuth’s classification, there were 0 (0%) type I, 5 (21%) type II, 6 (25%) type IIIa, 4 (17%) type IIIb and 9 (37%) type IV tumors. Five patients (21%) were treated by curative resection (group I) while in 14 patients (58%) palliative surgical procedure was performed (group II). In 5 cases (21%) the extension of malignancy did not allowed any procedure (group III). Curative resection for malignant tumors of the hepatic duct bifurcation included wide tumor excision and bile duct resection at the liver hilum (with »wedge« hepatic resection in one patient) and creation of biliary-enteric anastomosis. Palliative surgical procedure included stent insertion. Jaundice was completely relieved in all patients undergoing resection, since 3 patients (21%) after stenting hadn’t satisfactory biliary drainage. There was 1 (20%) perioperative death in the group 1, while in group 2, 5 patients (36%) died postoperatively. In this series, the mean postoperative survival of all patients was 16 months. The mean postoperative survival of patients undergoing localized tumor resection with curative intent was 38 months, in contrast to 10 months for those undergoing operative stent insertion. In addition, only 1 patient from group III, in whom only exploratory surgery were performed survived 7 months, while other 4 patients died in the hospital. This retrospective review suggests that aggressive surgical treatment could improve survival and quality of life in patients suffering from Klatskin tumor

Uloga fotodinamske terapije u liječenju karcinoma probavnog sustava

The discovery that particular substances can cause photosensitivity is attributed to Oscar Raab, however, the modern era of photodynamic therapy was established by Dr. T.J. Dougherty from Buffalo Memorial Institute. He was the first to report that a systemically injected porphyrin (hematoporphyrin), when activated by red light, caused complete eradication of transplanted experimental tumors. He also was the first to demonstrate the preferential accumulation of the photosensitizer in malignant cells. The first clinical application of photodynamic therapy was in 1980 at the Tokyo Medical College in a patient with a small upper bronchial squamous cell tumor, treated at bronchoscopy with photodynamic therapy using a laser as the light source. The tumor was completely eradicated. Simultaneously, a case of large obstructing esophageal cancer similarly treated with photodynamic therapy with good relief of dysphagia and prolonged survival was reported. The current state-of-the-art and results recorded in the clinical use of photodynamic therapy in the management of gastrointestinal malignancies are presented.Otkriće da određene tvari mogu uzrokovati fotosenzitivnost pripisuje se Oscaru Raabu, međutim, ocem moderne ere fotodinamske terapije smatra se T. J. Dougherty s Instituta Buffalo Memorial. On je naime prvi objavio da sistemski dan porfirin (hematoporfirin), kada se aktivira crvenom svjetlošću, uzrokuje potpuno uništenje transplantiranog eksperimentalnog tumora. Također je prvi otkrio i objavio da fotosenzibilizirajuće tvari imaju sklonost nakupljanju u malignim stanicama. Prvi slučaj kliničke primjene fotodinamske terapije učinjen je na Tokyo Medical Collegeu 1980. godine. Bolesnik s malim skvamoznim tumorom gornjeg bronha bio je bronhoskopski podvrgnut fotodinamskoj terapiji, pri čemu se kao izvor svjetlosti rabio laser, a rezultat je bio potpuna eradikacija tumora. Istodobno je objavljen slučaj kliničke primjene fotodinamske terapije kao palijacijske metode u bolesnika s velikim karcinomom jednjaka, što je dovelo do uklanjanja disfagije te produžilo bolesnikov život. Ovaj rad prikazuje dosadašnje spoznaje i rezultate kliničke primjene fotodinamske terapije u liječenju malignih bolesti probavnog sustava

Albert Camus Existential Philosophy

Iako se egzistencijalizam ne može smatrati ujedinjenim pravcem te se filozofi egzistencijalizma u mnogočemu razilaze, jedno je pitanje u srži ovog filozofskog pravca: kakav čovjek jest, tj. kako treba živjeti. Okrenutost prema čovjekovoj biti je razmatrana kroz glavne ideje egzistencijalizma, poput slobode, jastva, autentičnosti te subjektivne istine. Iako se često smatraju depresivnima, ambicija egzistencijalista je omugućiti prihvaćanje naše egzistencije i suočavanje s ljudskom situacijom. Kao glavni autor i filozof u ovome radu istaknut je Albert Camus te se sagleda njegov glavni filozofski doprinos, a to je filozofija apsurda. Camus svoju filozofiju apsurda objašnjava uz pomoć samoubojstva koje je oprečno egzistenciji. Glavno pitanje kojime se bavi je ima li smisla živjeti, koje razrađuje u Mitu o Sizifu te predstavlja javnosti u svom književnom djelu Stranac

Zur Versöhnung der positiven Religionen und ihrer Bekenner : Vortr., geh. im Mendelssohn-Verein zu Frankfurt a. M.

von Benjamin Hochstädte

Religionsphilosophische Erläuterungen zur biblisch reinen Glaubens- und Pflichtenlehre

[s.c.