A young soldier with syncope, shortness of breath and palpitations

Introduction. Coronary artery disease in people under 30 years is relatively uncommon, but once a disease occurs it brings a significant morbidity and psychological effects. Case report. We reported a 28-year-old patient presenting atypical symptoms after sincopa and non-specific changes on electrocardiogram at admission. After noninvasive and invasive cardiology diagnostic procedures were made, we concluded that he had a subtotal tubular stenosis in proximal segment of the left anterior descending coronary artery. Myocardial revascularization was successfully performed 24-hour after coronarography with the left internal mammary thoracic artery graft on the left anterior descending coronary artery and the patient had a prompt and satisfactory postoperative recovery. Conclusion. This case indicates the importance of a careful evaluation of young adults even if they do not experience typical anginal symptoms or do not have multiple risk factors for cardiovascular diseases

The impact of groove edge temperature and heat input on the structure and hardness of the heat affected zone of steel 460 NL1 welded joint

Polazne strukture i vreme hlađenja u temperaturnom intervalu 800 - 500°C (t8/5) imaju presudan uticaj na strukture i osobine zone uticaja toplote zavarenih spojeva čelika. Na vreme hlađenja t8/5 između ostalog, utiče i temperatura ivice žleba. Zbog zagrevanja toplotom luka temperatura ivice žleba duž spoja raste, zbog čega se vreme hlađenja zone uticaja toplote produžava. Samim tim, duž spoja se produžava i vreme hlađenja t8/5. U radu su prikazani rezultati merenja temperatura ivica žleba pri zavarivanju višeprolaznog sučeonog spoja mikrolegiranog čelika P 460 NL1. Određen je uticaj ovih temperatura na vremena hlađenja t8/5 i na makro i mikrostrukture i tvrdoće u zoni uticaja toplote ovog zavarenog spoja.The starting structures and cooling times in the temperature range 800 - 500°C (t8/5) have a decisive influence on the structures and properties of the heat affected zone of steel welded joints. At the cooling time t8/5, inter alia, the groove edge temperature has an effect. Due to heating by the electrical arc, the groove edge temperature along the joint, increases, resulting in extending of the cooling time of the heat affected zone. Therefore, the cooling time t 8/5 is extended along the joint. The paper presents the measurement results of the groove edges temperature during the welding of the multilayer joint of the microalloyed steel P 460 NL1. The influence of these temperatures on the cooling time t8/5 and on the macro and microstructure and hardness in the heat affected zone of this welded joint was determined

Diagnosis and results of treatment of heart myxoma

Background/Aim. Myxoma is the most common benign primary cardiac neoplasm, and usually originates from the left atrial septum. Early diagnosis of cardiac myxomas depends on a high index of a clinical suspicion. Surgical management must be done as soon as possible after diagnosis. The aim of this retrospective study was to present diagnostics and treatment outcome data of 61 patients with cardiac myxoma treated in the Military Medical Academy, Belgrade during a 49-years period. Methods. Intrahospital diagnosis was established in all the patients by the cardiologist. Diagnostic methods were various, in dependence on the examination period and suspected diagnosis. Results. Within a 49-years period (1961-2009) heart myxoma was diagnozed and treated in 61 patients in the Military Medical Academy, Belgrade. Most of the operated patients were females (38 or 62.3%). The operated patients were 19-68 years old. Average age of all the patients was 47.9%. The great majority of them (98.4%) had atrial, and only one operated patient had ventricular myxoma. In 13 (21.3%) of the patients heart myxoma was found out accidentally due to no previous cardiologic symptomatology. In most patients (27.44%) symptomatology was presented as thromboembolic disease. Because of the suspected ventricular myxoma in one patient, the patient was operated on, but Hodgkin's lymphoma was found out which, according to the subsequent course of the disease, could be justifiably recognized as primary heart lymphoma. This study presented brief descriptions of the course of the disease in 4 patients with myxomas in each of the cardiac cavities. Conclusion. The only diagnostic difficulty in cardiac myxoma is due to its asymptomatic and oligosymptomatic presence within the longer period of time, namely, its growth period. Echocardiography should be the standard method of cardiologic examination of these patients, which could considerably contribute to early diagnosis and treatment of heart myxoma. Surgical extirpation of myxoma is the only and very successful therapeutic method

Role of recombinant factor VIIa in the treatment of intractable bleeding in vascular surgery

BackgroundMost recent publications have shown that the recombinant form of activated factor VII (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsværd, Denmark) induces excellent hemostasis in patients with severe intractable bleeding caused by trauma and major surgery. The purpose of this study was to determine the influence of rFVIIa on the treatment of intractable perioperative bleeding in vascular surgery when conventional hemostatic measures are inadequate.Materials and MethodsThere were two groups of patients: the NovoSeven group (group N), 10 patients with ruptured abdominal aortic aneurysms (RAAAs) and 14 patients operated on due to thoracoabdominal aortic aneurysms (TAAAs); the control group (group C), 14 patients with RAAAs and 17 patients with TAAAs. All patients suffered intractable hemorrhage refractory to conventional hemostatic measures, while patients from group N were additionally treated with rFVIIa.ResultsPostoperative blood loss was significantly lower in group N treated with rFVII (P < .0001). Postoperative administration of packed red blood cells, fresh frozen plasma, and platelets was lower in patients from group N, (P < .0001). Successful hemorrhage arrest was reported in 21 patients (87.5%) treated with rFVIIa, and in 9 patients (29.03%) in group C (P < .001). Thirty-day mortality in these two groups significantly differed. The mortality rate was 12.5% (3 patients) in group N and 80.65% (25 patients) in group C (P < .0001).ConclusionOur findings suggest that rFVIIa may play a role in controlling the intractable perioperative and postoperative bleeding in surgical patients undergoing a repair of RAAAs and TAAAs. Certainly, prospective randomized trials are necessary to further confirm the efficacy and cost-effectiveness of rFVIIa in these patients