Klinički ishod u bolesnika nakon operacije hernije intervertebralnog diska pomoću proteze za rekonstrukciju defekta anulusa: rezultati dvogodišnjeg praćenja

Annular Reinforcement Device represents a modification of operative treatment of intervertebral disk herniation. It is a prosthesis that is anchored into the body of the vertebra. The intradiscal part of the implant is placed in the inner part of the annulus fibrosus defect. The aim of this technique is to reduce the incidence of reherniation and the degree of intervertebral space collapse, which is the most frequent adverse effect of diskectomy. Clinical outcomes of the treatment group indicated a statistically significant improvement with respect to the control group. Furthermore, over the period of two years, no cases of symptomatic reherniation were recorded. Considering that no serious complications occurred during the procedures, it would appear that this is an implant that, given its encouraging results, should be further verified in carefully designed future studies.Ugradnja proteze za rekonstrukciju defekta anulusa čini modifikaciju operacijskog liječenja hernije intervertebralnog diska. Radi se o protezi koja se ugrađuje (usidri) u korpus kralješka. Intradiskalni dio implantata postavlja se s unutarnje strane defekta anulusa fibrozusa. Cilj navedene tehnike je smanjivanje incidencije rehernijacija te smanjivanje stupnja kolapsa intervertebralnog prostora kao najčešćih neželjenih posljedica diskektomije. Klinički ishod ispitivane skupine pokazao je statistički značajan napredak u odnosu na kontrolnu skupinu. Također tijekom dvije godine nije zabilježen nijedan slučaj simptomatske rehernijacije. S obzirom na to da nije bilo ozbiljnih komplikacija tijekom samog zahvata, smatramo da se radi o implantatu čiji početni rezultati ohrabruju te se moraju potvrditi u slijedećim dobro dizajniranim prospektivnim studijama

Nonfatal Systemic Air Embolism: A Grave Complication of Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

Transthoracic computed tomography-guided core needle biopsy (TTNB) is a well-established method for diagnosing focal pulmonary lesions. However, the dangers associated with this method as well as the significant number of complications caused by it cannot be ignored. Systemic air embolism is a rare but potentially fatal complication that can accompany transthoracic needle biopsies of pulmonary lesions. In this study, we report nonfatal systemic air embolism as a complication of a transthoracic needle core biopsy of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis. Although extremely rare, the complication may result in a transient myocardial ischemia, which is presented with a transient depression of the ST segment

Subarachnoid haemorrhage

Spontano subarahnoidealno krvarenje (SAH) u najveæem broju sluèajeva nastaje kao posljedica rupure aneurizme, najèešæe unutarnje karotidne arterije, prednje komunikantne ili srednje cerebralne arterije. Velièina i lokalizacija aneurizme su znaèajni neovisni prognostièki èimbenici. Prema smještaju na krvnim žilama mozga aneurizme se dijele na aneurizme prednje i stražnje moždane cirkulacije (odnosno karotidnog i vertebrobazilarnog sliva). Ishodi lijeèenja su bitno nepovoljniji u bolesnika s aneurizmama stražnje cirkulacije zbog relativne kirurške nedostupnosti i blizine moždanog debla. Klinièki se SAH manifestira naglim nastupom jake glavobolje, poremeæajima svijesti uz znakove povišenog intrakranijskog tlaka, te koèenjem šije. Dijagnostièke metode izbora su raèunalna tomografija i cerebralna angiografija koja je zlatni standard u dokazivanju aneurizmatskog proširenja. Lijeèenje može biti kirurško ili endovaskularno, a ovisi o stanju bolesnika, anatomskom smještaju aneurizme i sposobnostima kirurga. Kirurški pristup ovisi o lokalizaciji aneurizme.Spontaneous subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm, most frequently the aneurysm of internal carotid artery, anterior communicating artery or middle cerebral artery. Significant prognostic factors include the localization and size of the aneurysm. Intracranial aneurysms can be divided according to their anatomical location to aneuryms of anterior and posterior brain circulation (i.e. aneurysm of the carotid and vertebrobasilar circulation). Due to the localization and closeness to the brain stem, patients with aneurysms of the posterior circulation have a poor outcome. The most common clinical symptom of SAH is sudden and severe headache, reduced level of consciousness, signs of increased intracranial pressure and nuchal rigidity. Diagnostic methods of choice are computerized tomography scans and cerebral angiography which represent the gold standard. The treatment of SAH can be surgical or endovascular and the choice depends on patient status, anatomical localization of the aneurysm and surgeon competencies. The surgical approach depends on the anatomical localization of the aneurysm

Subarachnoid haemorrhage

Spontano subarahnoidealno krvarenje (SAH) u najveæem broju sluèajeva nastaje kao posljedica rupure aneurizme, najèešæe unutarnje karotidne arterije, prednje komunikantne ili srednje cerebralne arterije. Velièina i lokalizacija aneurizme su znaèajni neovisni prognostièki èimbenici. Prema smještaju na krvnim žilama mozga aneurizme se dijele na aneurizme prednje i stražnje moždane cirkulacije (odnosno karotidnog i vertebrobazilarnog sliva). Ishodi lijeèenja su bitno nepovoljniji u bolesnika s aneurizmama stražnje cirkulacije zbog relativne kirurške nedostupnosti i blizine moždanog debla. Klinièki se SAH manifestira naglim nastupom jake glavobolje, poremeæajima svijesti uz znakove povišenog intrakranijskog tlaka, te koèenjem šije. Dijagnostièke metode izbora su raèunalna tomografija i cerebralna angiografija koja je zlatni standard u dokazivanju aneurizmatskog proširenja. Lijeèenje može biti kirurško ili endovaskularno, a ovisi o stanju bolesnika, anatomskom smještaju aneurizme i sposobnostima kirurga. Kirurški pristup ovisi o lokalizaciji aneurizme.Spontaneous subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm, most frequently the aneurysm of internal carotid artery, anterior communicating artery or middle cerebral artery. Significant prognostic factors include the localization and size of the aneurysm. Intracranial aneurysms can be divided according to their anatomical location to aneuryms of anterior and posterior brain circulation (i.e. aneurysm of the carotid and vertebrobasilar circulation). Due to the localization and closeness to the brain stem, patients with aneurysms of the posterior circulation have a poor outcome. The most common clinical symptom of SAH is sudden and severe headache, reduced level of consciousness, signs of increased intracranial pressure and nuchal rigidity. Diagnostic methods of choice are computerized tomography scans and cerebral angiography which represent the gold standard. The treatment of SAH can be surgical or endovascular and the choice depends on patient status, anatomical localization of the aneurysm and surgeon competencies. The surgical approach depends on the anatomical localization of the aneurysm