Placenta praevia percreta with initial bladder and parametrial invasion: a cause of life threatening hemorrhage after repeated cesarean section

Placenta percreta is a rare, but potentially life-threatening condition associated with high maternal mortality and morbidity rates, and caused by severe obstetric hemorrhage. Due to rising cesarean section rates, an increased incidence of different forms of adherent placentas (accreta, increta and percreta) has been observed. Although unsuspected during the antenatal period, diagnosis at the time of labor is usually secondary to the inability to define a cleavage plane. The associated hemorrhage can be substantial, and hysterectomy is frequently required. Definitive surgical management is the traditional treatment strategy; however, several authors have recently reported their experiences with conservative management, and some of them had success with this approach. We describe a case of massive, post-cesarean vaginal hemorrhage that occurred in the third postpartum period as the result of a misunderstood placenta percreta invading the parametria and bladder. Post-cesarean hysterectomy, bladder wall repair, and unilateral internal iliac artery ligation were performed to control massive intraoperative hemorrhage. There should be high rate of suspicion for placenta percreta with bladder and parametrium invasion in the evaluation of pregnant women with a history of Cesarean delivery and placenta previa at Cesarean section

Smjernice za dijagnostiku i liječenje bolesnika oboljelih od raka debelog crijeva u Općoj bolnici Pula

Cancers of the colon and rectum altogether are the third most common tumour type worldwide. The prognosis for the survival after disease progression is usually poor and directly depends on early detection. National program for colorectal cancer screening was started by ministry of health and supported by health program of istrian county. Standardization of health protection recommend making of guidelines in screening, diagnosis, therapy, and surveillance of 10 most frequently clinical diseases so this guidelines has goals to improve clinical work to health professionals and to provide additional safety to patients

TRANSPENDICULAR FIXATOR INFORCED WITH SHORT HOOKS IN THE TREATMENT OF INSTABILE SPINAL VERTEBRAL FRACTURES

Objectives. Clinical trial to compare HR-P with anterior fixation technique in neurological outcome and preoperative parameters in the emergency treatment of unstable burst thoracolumbar fracture. Patients and methods. Twenty nine patients with burst fracture underwent either anterior neurodecompression and fixation (n=13) or posterior reposition and fixation with HR-P (n=16) depending on the type of implants available at the time of operation. Neurologically injured patients were operated within the first 8 hours and neurologically intact patients within the first 2 days after fracture. Neurological improvement was assessed according to the Frankel scale and the Prolo economic/ function outcome scale. We recorded operation time, blood loss, hospital stay and cost, complication and donor site pain. Results. There were no significant differences between the groups in either neurological improvement (p=0.789), economic and functional outcome (p=0.294, p=0.163), operative time was shorter in the HR-P posterior approach group than in the anterior group (median 172 min, range 145-220, vs. Median 255 min, range 200-295, p<0.001). Blood loss, hospital cost and complication rate was significantly lower in the posterior fixation group (p<0.001). Conclusion. Both surgical techniques were equally effective in neurological improvement. HR-P can be recommended in emergency neurodecompression and fixation of unstable lumbar and thoracolumbar fractures because of the shorter operation time and smaller blood loss

Fuoroscopic iliosacral screw placement made safe

Aim: Unstable posterior pelvic ring injuries should be stabilised successfully by percutaneous iliosacral screwing. The intervention takes place under intraoperative fluoroscopic guidance. The inlet and outlet views are crucial and are performed by tilting the image intensifier. Safely interpreting fluoroscopic views can be challenging in certain clinical scenarios.We demonstrated on a series of patients howpreoperative CT scans can be used to anticipate the appropriate intraoperative inlet and outlet fluoroscopic views and positioning of the patient on the operating table, thereby avoiding possible operating table obstacles. Materials and methods: We analysed at random 30 pelvic CT scans from patients of different ages and both sexes, utilising the sagittal reconstructions. Inlet and outlet angle measurements were calculated on the scans to determine the appropriate intraoperative inlet and outlet views. Results: The analysed CT scans showed an average inlet view of 22.3° (range 10.4°–39.8°) and an average outlet viewof 42.3° (range 31.5°–53.1°). Sex and age had no influence on results. The calculated required free space under the operating table for unobstructed tilting of the C-arm was a minimum of 145 cm. Conclusion: The significant anatomic variations of the posterior pelvic ring have been well documented in the literature. The angles required to obtain appropriate intraoperative inlet and outlet views are not perpendicular and differ greatly from traditional settings, which directed the beam 45° caudally and 45° cranially. The fluoroscopic beam would need to be angled differently in each patient to obtain ideal cardinal views that ultimately assist in safe iliosacral screw placement. To avoid collision of the C-arm with the operating table, it is essential to provide secure free space under the operating table of at least 145 cm

Fuoroscopic iliosacral screw placement made safe

Aim: Unstable posterior pelvic ring injuries should be stabilised successfully by percutaneous iliosacral screwing. The intervention takes place under intraoperative fluoroscopic guidance. The inlet and outlet views are crucial and are performed by tilting the image intensifier. Safely interpreting fluoroscopic views can be challenging in certain clinical scenarios.We demonstrated on a series of patients howpreoperative CT scans can be used to anticipate the appropriate intraoperative inlet and outlet fluoroscopic views and positioning of the patient on the operating table, thereby avoiding possible operating table obstacles. Materials and methods: We analysed at random 30 pelvic CT scans from patients of different ages and both sexes, utilising the sagittal reconstructions. Inlet and outlet angle measurements were calculated on the scans to determine the appropriate intraoperative inlet and outlet views. Results: The analysed CT scans showed an average inlet view of 22.3° (range 10.4°–39.8°) and an average outlet viewof 42.3° (range 31.5°–53.1°). Sex and age had no influence on results. The calculated required free space under the operating table for unobstructed tilting of the C-arm was a minimum of 145 cm. Conclusion: The significant anatomic variations of the posterior pelvic ring have been well documented in the literature. The angles required to obtain appropriate intraoperative inlet and outlet views are not perpendicular and differ greatly from traditional settings, which directed the beam 45° caudally and 45° cranially. The fluoroscopic beam would need to be angled differently in each patient to obtain ideal cardinal views that ultimately assist in safe iliosacral screw placement. To avoid collision of the C-arm with the operating table, it is essential to provide secure free space under the operating table of at least 145 cm