Surgical Treatment of Aortic Dissection in a Patient with Metastatic Prostate Cancer

Acute aortic dissection bears all the stigmata of a true clinical emergency. The natural history of this acute aortic syndrome warrants prompt surgical intervention, with only a few absolute contraindications to this line of treatment. We present a 74-year-old man with documented metastatic prostate cancer who underwent emergent surgery for acute Stanford A aortic dissection. Having acknowledged the relatively favorable evolution of our patient’s malignant disease, we were not deterred by its presence from pursuing surgical treatment of his aortic dissection

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

Definition of Acetylsalicylic Acid Resistance Using Whole Blood Impedance Aggregometry in Patients Undergoing Coronary Artery Surgery

A beneficial effect of acetylsalicylic acid (ASA) on vein graft patency has been described, but some patients experience adverse cardiac events despite appropriate ASA treatment. Study aim was to define ASA resistance using Multiple elec- trode aggregometry (MEA) preoperatively in group of patients undergoing coronary artery bypass grafting (CABG). Pro- spective observational trial at University Hospital Center Zagreb enrolled 131 patients scheduled for CABG, and divided them into 4 groups with respect to preoperative antiplatelet therapy (APT). Group 1 received 100 mg ASA per day, Group 2 100 mg ASA + 75 mg clopidogrel per day, Group 3 75 mg clopidogrel per day, and Group 4 did not receive any APT. MEA with ASPI test (sensitive to ASA) and ADP test (sensitive to clopidogrel) was performed prior to surgery. In Group 1, patients were characterized as ASA resistant if their ASPI test value exceeded the 75 th percentile distribution. Study en- rolled 131 patients. Significant differences both in the ASPI (p<0.001) and the ADP test (p=0.038) were observed be- tween patients in different APT groups. In Group (1) ASPI test value of 30 AUC presented 75 th percentile of distribution, thus indicating ASA resistance. Group 2 patients had slightly lower ADP test values, but no significant difference oc- curred (mean 60.05 vs. 63.32 AUC, p=0.469). In Group 1 and 2, significant correlations between the ADP test and both, platelet count (r=0.347, p<0.001) and fibrinogen level (r=0.364, p<0.001) were observed. Association between low re- sponse to ASA and post-CABG major adverse ischemic events risk increase has been described thus indicating need for ASA resistant patients detection. In patients with preoperative ASPI test exceeding 30 AUC postoperative, ASA dose ad- justment or clopidogrel addition according to MEA results should be considered

GUIDELINES FOR PREVENTION, CONTROL AND TREATMENT OF INFECTIONS CAUSED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA): Changes and updates of chapter 7.0: Treatment of patients with MRSA infection

Meticilin-rezistentni Staphylococcus aureus (MRSA) važan je bolnički patogen u cijelome svijetu, pa i u Republici Hrvatskoj. Stoga se pristupilo izradi smjernica, kojih je svrha smanjiti broj bolesnika inficiranih/koloniziranih sojevima MRSE u zdravstvenim ustanovama i domovima za starije i nemočne osobe u Republici Hrvatskoj te na taj način smanjiti morbiditet i mortalitet koji uzrokuje ova bakterija. Interdisciplinarni tim stručnjaka načinio je Smjernice, koriste}i se internacionalnim publikacijama i smjernicama koje govore o prevenciji i kontroli MRSE, te liječenju i laboratorijskoj dijagnostici MRSE. Snaga preporuka određena je metodologijom CDC/HICPAC, a kategorizirane su na temelju postojećih znanstvenih podataka, teoretske logične podloge, primjenjivosti i ekonomskog utjecaja. Nakon Široke rasprave u stručnim društvima Smjernice su prihvaćene. Nakon toga došo je do određenih izmjena u mogućnostima liječenja infekcija koje uzrokuje MRSA u Republici Hrvatskoj te je poglavlje 7.0. Liječenje bolesnika s infekcijama koje uzrokuje MRSA izmijenjeno i nadopunjeno prema novim mogućnostima liječenja. Preostali dio Smjernica zasada nije izmijenjen.Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen throughout the world, and as well in Croatia. Therefore it was decided to develop guidelines with the aim to reduce the number of patients infected/colonized with MRSA in healthcare facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. An interdisciplinary team of experts developed these guidelines using existing international guidelines from different countries, and literature reviews about prevention, control, treatment and laboratory diagnosis of MRSA infections. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. In the meantime, several new possibilities appeared in the treatment of patients with MRSA infections in Croatia, so the Chapter 7.0 Treatment of patients with MRSA infections is changed and updated according to the new treatment possibilities. The rest of the Guidelines was not changed

GUIDELINES FOR PREVENTION, CONTROL AND TREATMENT OF INFECTIONS CAUSED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA): Changes and updates of chapter 7.0: Treatment of patients with MRSA infection

Meticilin-rezistentni Staphylococcus aureus (MRSA) važan je bolnički patogen u cijelome svijetu, pa i u Republici Hrvatskoj. Stoga se pristupilo izradi smjernica, kojih je svrha smanjiti broj bolesnika inficiranih/koloniziranih sojevima MRSE u zdravstvenim ustanovama i domovima za starije i nemočne osobe u Republici Hrvatskoj te na taj način smanjiti morbiditet i mortalitet koji uzrokuje ova bakterija. Interdisciplinarni tim stručnjaka načinio je Smjernice, koriste}i se internacionalnim publikacijama i smjernicama koje govore o prevenciji i kontroli MRSE, te liječenju i laboratorijskoj dijagnostici MRSE. Snaga preporuka određena je metodologijom CDC/HICPAC, a kategorizirane su na temelju postojećih znanstvenih podataka, teoretske logične podloge, primjenjivosti i ekonomskog utjecaja. Nakon Široke rasprave u stručnim društvima Smjernice su prihvaćene. Nakon toga došo je do određenih izmjena u mogućnostima liječenja infekcija koje uzrokuje MRSA u Republici Hrvatskoj te je poglavlje 7.0. Liječenje bolesnika s infekcijama koje uzrokuje MRSA izmijenjeno i nadopunjeno prema novim mogućnostima liječenja. Preostali dio Smjernica zasada nije izmijenjen.Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen throughout the world, and as well in Croatia. Therefore it was decided to develop guidelines with the aim to reduce the number of patients infected/colonized with MRSA in healthcare facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. An interdisciplinary team of experts developed these guidelines using existing international guidelines from different countries, and literature reviews about prevention, control, treatment and laboratory diagnosis of MRSA infections. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. In the meantime, several new possibilities appeared in the treatment of patients with MRSA infections in Croatia, so the Chapter 7.0 Treatment of patients with MRSA infections is changed and updated according to the new treatment possibilities. The rest of the Guidelines was not changed

Surgical treatment of aortic dissection in a patient with metastatic prostate cancer [Liječenje akutne disekcije aorte u bolesnika s metastatskim karcinomom prostate]

Acute aortic dissection bears all the stigmata of a true clinical emergency. The natural history of this acute aortic syndrome warrants prompt surgical intervention, with only a few absolute contraindications to this line of treatment. We present a 74-year-old man with documented metastatic prostate cancer who underwent emergent surgery for acute Stanford A aortic dissection. Having acknowledged the relatively favorable evolution of our patient's malignant disease, we were not deterred by its presence from pursuing surgical treatment of his aortic dissection

NT-pro-BNP, but not C-reactive Protein, is predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery

Objective: Atrial fibrillation (AF) remains the most commonly observed complication following myocardial revascularization surgery. We aimed to evaluate the clinical utility of NT-pro-BNP, troponin T, transcoronary lactate gradient (TCLG) and C-reactive protein as predictors of atrial fibrillation in patients undergoing isolated CABG. ----- Methods: Two hundred and fifteen consecutive patients in sinus rhythm (SR) undergoing elective CABG between May 2007 and May 2008 were included. Patients were grouped according to their respective postoperative rhythm into SR and AF groups. The data are presented as mean values ± standard deviation, or medians with quartiles. ----- Results: Fifty five patients developed AF (26%). The preoperative NT-pro-BNP values were 273 ± 347 and 469 ± 629 pg/ml in the SR and AF groups, respectively (p < 0.0001). The postoperative NT-pro-BNP values were 3110 ± 3600 in the SR and 4625 ± 5640 pg/ml in the AF group (p = 0.027). The transcoronary lactate gradient rose from the pre-cardiopulmonary bypass (CPB) values to those observed 5 minutes after revascularization in both groups (-0.05 ± 0.37 to 0.39 ± 0.46 mmol/l (p < 0.0001) in the SR group and -0.01 ± 0.27 to 0.43 ± 0.46 mmol/l (p < 0.0001) in the AF group). The CRP values increased from 6 ± 13 to 163 ± 88 mg/L (p < 0.0001) in the SR group, and from 6 ± 16 to 163 ± 104 mg/l (p < 0.0001) in the AF group. The dynamics of TCLG and CRP did not differ between the groups (p = 0.71, p = 0.44, respectively). The troponin T values on postoperative day one were significantly higher in the AF than the SR group (0.86 [0.49-2.1] ng/ml vs. 0.67 [0.37-1.16] ng/ml, p = 0.046). The duration of cardiopulmonary bypass (CPB) was 85 ± 24 in the SR and 93 ± 30 min in the AF group (p = 0.05). Patients who developed AF were older (66 ± 7 vs 60 ± 9 years, p < 0.0001) and had a higher EuroSCORE (3.9 ± 2.7 vs 2.9 ± 2.2, p = 0.009). Multivariate analysis identified age (p = 0.0043), preoperative NT-pro-BNP (p = 0.019) and duration of cardiopulmonary bypass (p = 0.035) as independent predictors of AF. ----- Conclusions: Preoperative and postoperative NT-pro-BNP, as well as, TnT values were significantly higher in patients that subsequently developed AF. TCLG and CRP were not useful in identifying patients at higher risk for AF. Multivariate analysis identified age, preoperative NT-pro-BNP and duration of CPB as independent correlates of AF

Endomedullary radiofrequency ablation of metastatic lesion of the right femur 5 years after primary breast carcinoma: a case report

Metastatic tumors of the long bones usually present with severe pain refractory to analgesic therapy. Pathologic fractures of the bone may lead to the significant decrease of patient's quality of life and necessitate further surgical therapy. We present 66 year old female with metastatic left breast carcinoma (T2N0M0) diagnosed 5 years before presentation of the metastatic lesion of the right femur causing severe pain in the middle of the right upper leg. Pain persisted after palliative irradiation therapy. We performed radiofrequency ablation of the metastatic lesion of the right femur using R.I.TA. Medical System Generator. This resulted in total necrosis of the tumor mass that caused osteolysis of the internal part of the femoral cortex. First three months after RFA procedure, the pain and tenderness were absent and normal daily activities were performed without restrictions