Analiza promjena arterijskog tlaka kod ugradnje zglobnih endoproteza u spinalnoj i općoj anesteziji

The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who underwent total hip or knee replacement surgery in the period between July 2010 and February 2011 at Sveti Duh University Hospital were retrospectively evaluated. Seventeen patients underwent the operation in general anesthesia and 63 patients in regional anesthesia. They were allocated into groups of normotensive (n=24) or hypertensive patients (n=56). The anthropologic and hematologic parameters of normotensive and hypertensive patients were compared, as well as their blood pressures immediately before and during the operation. Blood pressure immediately before anesthesia induction, the highest and the lowest intraoperative blood pressures were recorded. Blood pressure immediately before anesthesia induction was significantly higher in hypertensive patients who underwent the operation in regional anesthesia compared to normotensive patients (158.48 mm Hg vs. 144.71 mm Hg, P<0.01). The highest intraoperative systolic blood pressure was also significantly higher in hypertensive patients operated on in regional anesthesia compared to normotensive patients (161.20 mm Hg vs. 146.76 mm Hg, P<0.01). The difference between the highest and the lowest intraoperative systolic blood pressure was significantly greater in hypertensive patients undergoing the operation in regional anesthesia compared to normotensive patients (46.41 mm Hg vs. 35.88 mm Hg, P<0.05). The results presented in this paper indicate that the fluctuations of intraoperative blood pressure were greater and the highest intraoperative systolic blood pressure was higher in hypertensive compared to normotensive patients undergoing the operation in regional anesthesia. In our study, there were no significant differences in intraoperative blood pressure between hypertensive and normotensive patients who underwent the operation in general anesthesia.U ovom radu su analizirane hemodinamske promjene u hipertenzivnih i normotenzivnih bolesnika tijekom operacija ugradnje totalnih endoproteza kuka i koljena u općoj i regionalnoj anesteziji. Retrospektivno su analizirani podatci 80 bolesnika kojima je od srpnja 2010. do veljače 2011. u Kliničkoj bolnici Sveti Duh ugrađena totalna endoproteza kuka ili koljena. Sedamnaest bolesnika operirano je u općoj anesteziji, a 63 u regionalnoj. Njih 24 je svrstano u skupinu normotenzivnih, a 56 u skupinu hipertenzivnih bolesnika. Uspoređivani su njihovi antropološki i hematološki pokazatelji, kao i intraoperacijsko kretanje tlaka. Zabilježen je njihov arterijski tlak neposredno prije uvoda u anesteziju, te najviši i najniži tlak tijekom zahvata. Arterijski tlak neposredno prije uvoda u anesteziju bio je statistički značajno viši u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (158,48 mm Hg prema 144,71 mm Hg, P<0,01). Također najviši intraoperacijski sistolički tlak bio je statistički značajno viši u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (161,20 mm Hg prema 146,76 mm Hg, P<0,01). Razlika između najvišeg i najnižeg intraoperacijskog sistoličkog tlaka bila je statistički značajno viša u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (46,41 mm Hg prema 35,88 mm Hg, P<0,05). Rezultati izneseni u ovom radu govore u prilog tome da su kolebanja intraoperacijskog tlaka veća, te da je najviši intraoperacijski sistolički tlak viši u hipertenzivnih u odnosu na normotenzivne bolesnike operirane u regionalnoj anesteziji. Nisu pronađene statistički značajne razlike intraoperacijskog tlaka između hipertenzivnih i normotenzivnih bolesnika operiranih u općoj anesteziji

Combined atrial septal defect and pulmonic stenosis in an adult patient

Atrijski septalni defekt (ASD) u kombinaciji sa stenozom plućne arterije (PS) rijedak je u odraslih bolesnika. U zadnje vrijeme povećava se broj izvještaja o perkutanome liječenju ovih dvaju poremećaja jer je dokazano da su učinkoviti i izvedivi. Ovdje se prikazuje slučaj odrasloga bolesnika s teškim PS-om povezanim s ASD-om, koji je liječen kirurški zbog nepovoljne anatomije koja je onemogućila perkutano liječenje.Atrial septal defect (ASD) combined with pulmonic stenosis (PS) is a relatively uncommon condition in adult patients. Recently, reports on percutaneous therapy of PS and ASD have increased, since percutaneous therapy has been demonstrated to be effective as well as feasible. This report is about an adult patient with severe PS and associated ASD, who was treated surgically because of unfavourable anatomy which precluded the use of a percutaneous device

Combined atrial septal defect and pulmonic stenosis in an adult patient

Atrijski septalni defekt (ASD) u kombinaciji sa stenozom plućne arterije (PS) rijedak je u odraslih bolesnika. U zadnje vrijeme povećava se broj izvještaja o perkutanome liječenju ovih dvaju poremećaja jer je dokazano da su učinkoviti i izvedivi. Ovdje se prikazuje slučaj odrasloga bolesnika s teškim PS-om povezanim s ASD-om, koji je liječen kirurški zbog nepovoljne anatomije koja je onemogućila perkutano liječenje.Atrial septal defect (ASD) combined with pulmonic stenosis (PS) is a relatively uncommon condition in adult patients. Recently, reports on percutaneous therapy of PS and ASD have increased, since percutaneous therapy has been demonstrated to be effective as well as feasible. This report is about an adult patient with severe PS and associated ASD, who was treated surgically because of unfavourable anatomy which precluded the use of a percutaneous device

Analiza promjena arterijskog tlaka kod ugradnje zglobnih endoproteza u spinalnoj i općoj anesteziji

The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who underwent total hip or knee replacement surgery in the period between July 2010 and February 2011 at Sveti Duh University Hospital were retrospectively evaluated. Seventeen patients underwent the operation in general anesthesia and 63 patients in regional anesthesia. They were allocated into groups of normotensive (n=24) or hypertensive patients (n=56). The anthropologic and hematologic parameters of normotensive and hypertensive patients were compared, as well as their blood pressures immediately before and during the operation. Blood pressure immediately before anesthesia induction, the highest and the lowest intraoperative blood pressures were recorded. Blood pressure immediately before anesthesia induction was significantly higher in hypertensive patients who underwent the operation in regional anesthesia compared to normotensive patients (158.48 mm Hg vs. 144.71 mm Hg, P<0.01). The highest intraoperative systolic blood pressure was also significantly higher in hypertensive patients operated on in regional anesthesia compared to normotensive patients (161.20 mm Hg vs. 146.76 mm Hg, P<0.01). The difference between the highest and the lowest intraoperative systolic blood pressure was significantly greater in hypertensive patients undergoing the operation in regional anesthesia compared to normotensive patients (46.41 mm Hg vs. 35.88 mm Hg, P<0.05). The results presented in this paper indicate that the fluctuations of intraoperative blood pressure were greater and the highest intraoperative systolic blood pressure was higher in hypertensive compared to normotensive patients undergoing the operation in regional anesthesia. In our study, there were no significant differences in intraoperative blood pressure between hypertensive and normotensive patients who underwent the operation in general anesthesia.U ovom radu su analizirane hemodinamske promjene u hipertenzivnih i normotenzivnih bolesnika tijekom operacija ugradnje totalnih endoproteza kuka i koljena u općoj i regionalnoj anesteziji. Retrospektivno su analizirani podatci 80 bolesnika kojima je od srpnja 2010. do veljače 2011. u Kliničkoj bolnici Sveti Duh ugrađena totalna endoproteza kuka ili koljena. Sedamnaest bolesnika operirano je u općoj anesteziji, a 63 u regionalnoj. Njih 24 je svrstano u skupinu normotenzivnih, a 56 u skupinu hipertenzivnih bolesnika. Uspoređivani su njihovi antropološki i hematološki pokazatelji, kao i intraoperacijsko kretanje tlaka. Zabilježen je njihov arterijski tlak neposredno prije uvoda u anesteziju, te najviši i najniži tlak tijekom zahvata. Arterijski tlak neposredno prije uvoda u anesteziju bio je statistički značajno viši u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (158,48 mm Hg prema 144,71 mm Hg, P<0,01). Također najviši intraoperacijski sistolički tlak bio je statistički značajno viši u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (161,20 mm Hg prema 146,76 mm Hg, P<0,01). Razlika između najvišeg i najnižeg intraoperacijskog sistoličkog tlaka bila je statistički značajno viša u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (46,41 mm Hg prema 35,88 mm Hg, P<0,05). Rezultati izneseni u ovom radu govore u prilog tome da su kolebanja intraoperacijskog tlaka veća, te da je najviši intraoperacijski sistolički tlak viši u hipertenzivnih u odnosu na normotenzivne bolesnike operirane u regionalnoj anesteziji. Nisu pronađene statistički značajne razlike intraoperacijskog tlaka između hipertenzivnih i normotenzivnih bolesnika operiranih u općoj anesteziji

Nomogram s jednostavnim i rutinskim kliničkim i biokemijskim parametrima može biti prediktor patološkog remodeliranja ventrikula u bolesnika sa STEMI-jem

Heart failure is the leading cause of morbidity and mortality worldwide, with ischemic heart disease being one of the most important etiologic factors. Heart failure develops due to ventricular remodeling, which leads to increases in left ventricular end-systolic and end-diastolic volumes. In this prospective observational study, we included 101 patients with first episode of ST-segment elevation myocardial infarction in whom percutaneous coronary intervention was conducted within 12 h and Thrombolysis in Myocardial Infarction III flow was achieved. The aim was to determine which clinical and biochemical parameters can help predict pathologic ventricular remodeling 1 year after myocardial infarction. We created a nomogram based on routinely used blood tests and vital parameters which showed highest correlation with pathologic ventricular remodeling. The nomogram included NTproBNP value 12 h after reperfusion, aspartate transaminase value 12 h after reperfusion, systolic blood pressure value on admission, and culprit coronary artery. We performed ROC analysis which yielded great predictive value of the nomogram. The area under curve was 0.907 (95% CI 0.842-0.973). The nomogram value of -3.54 had 91.4% sensitivity and 74.0% specificity. We believe that this nomogram, once validated, could offer a widely available, low-cost option that would help identify patients at risk of developing pathologic left ventricular remodeling and achieve this at a very early stage of myocardial infarction (12 h after reperfusion has been achieved).Zatajivanje srca je vodeći uzrok pobola i smrtnosti u svijetu, a ishemijska bolest srca je njegov najvažniji etiološki čimbenik. Zatajivanje srca nastaje posljedično remodeliranju lijevog ventrikula, koje uzrokuje povećanje njegova volumena na kraju sistole i dijastole. U ovom prospektivnom opservacijskom istraživanju uključili smo 101 bolesnika koji su imali prvu epizodu STEMI i kojima je učinjena perkutana koronarna intervencija 12 sati od početka bolova uz postignuti protok TIMI III. Cilj istraživanja bio je utvrditi koji klinički i biokemijski parametri mogu pomoći u predviđanju nastupanja patološkog ventrikulskog remodeliranja godinu dana nakon preboljelog infarkta. Na temelju rezultata istraživanja stvoren je nomogram koji je uključivao vitalne parametre i rutinske biokemijske nalaze koji su pokazali najbolju korelaciju s pojavom patološkog ventrikulskog remodeliranja. Nomogram uključuje vrijednost NTproBNP-a 12 sati nakon postignute reperfuzije, vrijednost AST-a 12 sati nakon reperfuzije, vrijednost sistoličkog tlaka kod prijma te koronarnu arteriju okluzija koje je odgovorna za nastanak infarkta miokarda. Učinjena je ROC analiza koja je pokazala izvrsnu prediktivnu vrijednost nomograma. Površina ispod krivulje (AUC) je bila 0,907 (95% CI 0,842-0,973). Vrijednost nomograma od -3,54 imala je osjetljivost od 91,4% i specifičnost od 74,0%. Mišljenja smo da bi ovaj nomogram, jednom validiran, mogao ponuditi jeftinu i široko primjenjivu metodu za rano prepoznavanje bolesnika koji će razviti patološko ventrikulsko remodeliranje nakon preboljelog infarkta miokarda i to omogućiti već u vrlo ranoj fazi bolesti odnosno 12 sati nakon postignute reperfuzije

Periurethral bulking agents in the treatment of female stress urinary incontinence

Stress urinary incontinence (SUI) is a common type of urinary incontinence in women, affecting large proportion of women. Surgical methods, especially suburethral sling operations are the most important modes of the treatment of SUI. Bulking agents were created as an alternative to conventional surgical methods and may be the first line of therapy in certain patients. Periurethral bulking implies implantation of various biocompatible agents around the urethra in order to improve coaptation of the urethral walls during intra-abdominal pressure elevation. The rates of cure are lower with bulking methods as compared with surgical techniques but are associated with a lower prevalence of postoperative complications. Bovine collagen remains the most frequently injected agent worldwide, with cure rates of 53% at 12 months after procedure. Polyacrylamide hydrogel and silicone micro implants have showed promising results, with about 64% improvement rate at 18 to 24 months after procedure. Application of urethral bulking agents is minimally invasive procedure and is mostly applied outpatiently in local anesthesia. Urethral bulking agents are safe for clinical usage. Bulking agents should not be recommended as a method of final cure because they only lead to short-term improvement

The Differences in Estimation of Pain Intensity Among Hospitalized Patients Between Patients, Doctors and Nurses

Cilj je ovoga rada bio istražiti razliku u tome kako bolesnikovu bol procjenjuju bolesnici, liječnici i medicinske sestre. Također, obratila se pozornost na učestalost i uzroke boli među hospitaliziranim bolesnicima te zadovoljstvo postignutom analgezijom i hospitalizacijom. U istraživanju je sudjelovalo 52 bolesnika, pet liječnika i jedna glavna medicinska sestra. Svakodnevne procjene boli provodile su se pomoću numeričke ocjenske ljestvice. Rezultati su pokazali da većina bolnički liječenih bolesnika pati od boli (71 %). Medicinska sestra i liječnici bolesnikovu su bol procijenili znatno slabijom od samoga bolesnika (u prosjeku za 2,295, odnosno 1,297 boda), a razlike u procjeni bile su statistički značajne (p < 0,01). Zaključno, istraživanjem je utvrđeno da medicinsko osoblje ipak podcjenjuje intenzitet bolesnikove boli te su nužna daljnja istraživanja o navedenoj temi. Trebalo bi poticati razvoj svijesti o boli među medicinskim osobljem, kvalitetnu komunikaciju s bolesnikom te trajnu edukaciju o liječenju boli.The aim of this study was to investigate the difference between patient’s, nurse’s and doctor’s estimation of patient’s pain intensity. Pain prevalence among hospitalized patients, etiology of the pain, satisfaction with analgesia and satisfaction with hospitalization were also investigated. The research included 52 patients, five doctors, and one head nurse. Pain assessment was obtained every day using a Numerical Rating Scale. Most of the patients (71%) reported that they had experienced pain during their hospital stay. Patients estimated their pain intensity higher than nurses and doctors (by 2.295 and 1.297 points on average, respectively). The difference was statistically significant (p < 0.01). The differences in pain estimation suggest that doctors and nurses still underestimate pain intensity, and that there is a need for further investigation of this topic. Awareness of pain, effective communication with patients, and ongoing pain treatment education should be encouraged among medical personnel