Perioperative predictors of renal damage in patients with heart transplant

Bubrežno oštećenje u postoperativnom periodu nakon transplantacije srca čini značajnu komplikaciju u oporavku pacijenta i sa sobom nosi značajan morbiditet i mortalitet. Ovo istraživanje je pokušalo utvrditi korelaciju između određenih perioperativnih podataka i bubrežne funkcije koja se temeljila na postoperativnoj vrijednosti korigiranog klirensa kreatinina. Za potrebe istraživanja koristila se baza podataka pacijenata koji su podvrgnuti transplantaciji srca u KBC-u Zagreb u šestogodišnjem periodu od 2008. do 2014. godine. U tom razdoblju ukupno je bilo operirano 125 pacijenata. Ovisno o dostupnosti podakata, nisu svi mogli biti uključeni u studiju. Praćeno je 10 perioperativnih varijabli koje su akumulirane tijekom prvih 30 postoperacijskih dana. Pozitivnu korelaciju sa postoperativnim korigiranim klirensom kreatinina su pokazali parametri srčanog indeksa 2 sata nakon uspostave ekstrakorporalne cirkulacije (p<0.001), srčani indeks prvog postoperativnog dana (p<0.001), srčani indeks sedmog postoperativnog dana (p<0.001) i preoperativna vrijednost korigiranog klirensa kreatinina (p<0.001). Negativnu korelaciju sa postoperativnim korigiranim klirensom kreatinina su pokazali parametri dobi (p<0.014) i vršne postoperativne koncentracije C-reaktivnog proteina (p<0.014). Parametri vremena ishemije donorskog srca, trajanja ekstrakorporalne cirkulacije, preoperativnog srčanog indeksa i indeksa tjelesne mase nisu pokazali statistički značajnu korelaciju. Ovo istraživanje je uspjelo identificirati određene parametre koji bi mogli poslužiti kao prediktori oštećenja bubrežne funkcije u postoperativnom periodu nakon transplantacije srca.Renal failure is a significant complication of surgery in the postoperative period and can lead to severe illness or death. The goal of this research was to identify correlation between certain perioperative parameters and postoperative creatinine clearance, which was used as an indicator of renal function. For this research, a database of patients who underwent heart transplant surgery from 2008 to 2014 at the University Hospital Centre Zagreb was used. A total of 125 patients were operated on, but because of missing data, not all were included in this study. Perioperative data were acumulated up to and including the 30th postoperative day. Ten perioperative parameters were monitored. Of the 10, 6 showed significant statistical correlation with postoperative creatinine clearance. Positive correlation with postoperative creatinine clearance showed cardiac index 2 hours after extracorporeal circulation was established (p<0.001), cardiac index on the first postoperative day (p<0.001), cardiac index on the 7th postoperative day (p<0.001) and preoperative creatinine clearance (p<0.001). Patient age and peak C-reactive protein levels showed similar negative correlation (p<0.014). Parameters of donor heart ischemia duration, duration of extracorporeal circulation, preoperative cardiac index and body mass index showed no statistically significant correlation with postoperative creatinine clearance. This research has successfully identified certain perioperative parameters that can be used as predictors of renal failure in the postoperative period following heart transplantation

Perioperative predictors of renal damage in patients with heart transplant

Bubrežno oštećenje u postoperativnom periodu nakon transplantacije srca čini značajnu komplikaciju u oporavku pacijenta i sa sobom nosi značajan morbiditet i mortalitet. Ovo istraživanje je pokušalo utvrditi korelaciju između određenih perioperativnih podataka i bubrežne funkcije koja se temeljila na postoperativnoj vrijednosti korigiranog klirensa kreatinina. Za potrebe istraživanja koristila se baza podataka pacijenata koji su podvrgnuti transplantaciji srca u KBC-u Zagreb u šestogodišnjem periodu od 2008. do 2014. godine. U tom razdoblju ukupno je bilo operirano 125 pacijenata. Ovisno o dostupnosti podakata, nisu svi mogli biti uključeni u studiju. Praćeno je 10 perioperativnih varijabli koje su akumulirane tijekom prvih 30 postoperacijskih dana. Pozitivnu korelaciju sa postoperativnim korigiranim klirensom kreatinina su pokazali parametri srčanog indeksa 2 sata nakon uspostave ekstrakorporalne cirkulacije (p<0.001), srčani indeks prvog postoperativnog dana (p<0.001), srčani indeks sedmog postoperativnog dana (p<0.001) i preoperativna vrijednost korigiranog klirensa kreatinina (p<0.001). Negativnu korelaciju sa postoperativnim korigiranim klirensom kreatinina su pokazali parametri dobi (p<0.014) i vršne postoperativne koncentracije C-reaktivnog proteina (p<0.014). Parametri vremena ishemije donorskog srca, trajanja ekstrakorporalne cirkulacije, preoperativnog srčanog indeksa i indeksa tjelesne mase nisu pokazali statistički značajnu korelaciju. Ovo istraživanje je uspjelo identificirati određene parametre koji bi mogli poslužiti kao prediktori oštećenja bubrežne funkcije u postoperativnom periodu nakon transplantacije srca.Renal failure is a significant complication of surgery in the postoperative period and can lead to severe illness or death. The goal of this research was to identify correlation between certain perioperative parameters and postoperative creatinine clearance, which was used as an indicator of renal function. For this research, a database of patients who underwent heart transplant surgery from 2008 to 2014 at the University Hospital Centre Zagreb was used. A total of 125 patients were operated on, but because of missing data, not all were included in this study. Perioperative data were acumulated up to and including the 30th postoperative day. Ten perioperative parameters were monitored. Of the 10, 6 showed significant statistical correlation with postoperative creatinine clearance. Positive correlation with postoperative creatinine clearance showed cardiac index 2 hours after extracorporeal circulation was established (p<0.001), cardiac index on the first postoperative day (p<0.001), cardiac index on the 7th postoperative day (p<0.001) and preoperative creatinine clearance (p<0.001). Patient age and peak C-reactive protein levels showed similar negative correlation (p<0.014). Parameters of donor heart ischemia duration, duration of extracorporeal circulation, preoperative cardiac index and body mass index showed no statistically significant correlation with postoperative creatinine clearance. This research has successfully identified certain perioperative parameters that can be used as predictors of renal failure in the postoperative period following heart transplantation

Fascijalni alt slobodni režanj u kirurgiji glave i vrata

ALT režanj opće je poznat u plastično-rekonstruktivnoj kirurgiji, ne samo glave i vrata, već i ostalih regija u tijelu. Kratica dolazi od engleskog naziva „AnteroLateral Thigh flap“, što prevedeno na hrvatski, označava anterolateralni bedreni režanj, a koncept odizanja i vaskularnu anatomiju opisao je Song još 1984. godine. Od tada se ovaj slobodni režanj koristi u rekonstrukciji mnogih defekata u tijelu, a svoje mjesto našao je i u kirurgiji glave i vrata, te je uz podlaktični radijalni slobodni režanj, drugi najčešće korišteni slobodni režanj za rekonstrukciju mekotkivnih defekata. Snažna i relativno konstantna vaskularna opskrba, veliki volumen tkiva, te niska stopa morbiditeta donorskog mjesta, guraju ga u sam vrh rekonstruktivne ljestvice. ALT režanj baziran je na perforatorima descendentne grane lateralne cirkumfleksne femoralne arterije koja je prvi ogranak duboke femoralne arterije. Descendentna grana na svom putu perforatorima opskrbljuje fasciju i kožu iznad mišića vastusa lateralisa, kao i sami mišić, te se stoga na istoj peteljci mogu odići razne varijante ovoga režnja – kutani (suprafascijalni), fasciokutani, fascijalni, adipofascijalni, miokutani, te muskularni – sami vastus lateralis. Fascijalni i adipofascijalni ALT slobodni režanj, iako korišten i ranije, u rekonstrukciju defekata glave i vrata, u većem opsegu uveden je 2003. godine od strane V. Agostinija i suradnika koji opisuju iznimno uspješne rekonstrukcije defekata usne šupljine ovim režnjem. Od tada je zbog svoje velike podatljivosti, ne prevelikog volumena, sigurne vaskularne opskrbe, te nedostatka dlaka, ovaj režanj postao često korištena varijanta ALT režnja. Svoje mjesto u kirurgiji glave i vrata fascijalni slobodni ALT režanj našao je u rekonstrukciji sluzničkih defekata u području usne šupljine, posebice kod defekata nakon resekcije jezika i dna usne šupljine, u rekonstrukciji traheoezofagealnih fistula, u rekonstrukciji nosa nakon totalne ili hemirinektomije, te kao adipofascijalni režanj u augmentaciji lica kod defekata nastalih nakon totalne parotidektomije. U ovom predavanju prikazati ćemo rezultate i primjere rekonstrukcije fascijalnim ALT slobodnim režnjem, tima za kirurgiju glave i vrata s Klinike za otorinolaringologiju KBC-a Sestre milosrdnice u Zagrebu

Omjer limfnih čvorova kod karcinoma usne šupljine – naša iskustva

Kao jedan od značajnijih prognostičkih čimbenikaa u kirurškom liječenju karcinoma glave i vrata, pogotovo karcinoma usne šupljine, u posljednje se vrijeme pojavljuje omjer između patoloških limfnih čvorova na vratu i ukupnog broja limfnih čvorova na vratu (lymph node ratio) odstranjenih tijekom disekcije vrata. Istraživanja govore da, što je omjer manji (tj. što je veći ukupni broj čvorova u odnosu na patološke limfne čvorove), to je preživljenje bolje. U Hrvatskoj, prema našim saznanjima, istraživanja o omjeru čvorova kod bolesnika s karcinomima usne šupljine još nisu provedena. U našem istraživanju analizirali smo bolesnike operirane između 2017. i 2021. godine s karcinomom usne šupljine kod kojih je provedena ili elektivna ili selektivna/funkcionalna disekcija vrata s ili bez rekonstrukcije slobodnim režnjevima s minimalnim dvogodišnjim praćenjem, uz naglasak na poveznicu između preživljenja, omjera čvorova, ukupnog broja čvorova, te postojanja negativnih prognostičkih čimbenika (dubina invazije, limfovaskularna invazija, ekstranodalna ekstenzija)

Estradiol impact on hypertension profile in obese patients

Introduction: Obesity is a well-known risk factor for developing hypertension. Prehypertensive patients (with an average 24h monitored blood pressure between 120/85 and 139/89mmHg) rarely get physician’s attention despite their differences from non-hypertensive patients.1,2 Patients and Methods: We enrolled 42 obese female patients (age range from 26 to 69 years) from a multidisciplinary weight management program (BMI range 30 to 49.9 kg/m2). Firstly, because of estradiol levels, patients were divided into two groups, younger than 50 years (A) and older (B). Due to the average values of patient’s ambulatory monitored blood pressure, patients were additionally put into three groups (1 = below 120/85mmHg, 2 = between 120/85 to 139/89mmHg 3 = above 140/90mmHg). Systolic dipping profile, estradiol levels, and average nocturnal heart rate were also checked. Results: Prehypertensive obese patients older than 50 years (B) had higher nocturnal heart rate (58.50 vs. 70.25/min; p<0.05). Even though differences were found in younger patients, they were not statistically significant. Systolic dipping profile was different and age-dependent (Non-dippers A: 44.00%; B 82.35%; p=0.02). The number of non-dippers in the younger group was highest in group 2 (66% vs. 20% in group 1; p=0.03) while there were no differences in the older group. The prehypertensive group had very similar results to hypertensive patients. Estradiol levels (Figure 1) were age independently lower in non-dippers (A: 185.5 vs. 201.07, NS; B: 71.9 vs. 87.0, NS) and also in hypertensive patients (A: 111.0 vs 192.6 pmol/L, p=0.21; B: 59.0 vs. 98.0 pmol/L). Conclusion: Our results showed that estradiol levels seem to be protective in terms of blood pressure stability, systolic dipping profile and nocturnal heart rate probably due to its impact on autonomic nerve system functionality. Because of a small number of patients further investigation is needed to prove the statistical significance of this statement

LOWER URINARY TRACT SYMPTOMS IN CROATIAN OBESE PATIENTS

Background: Patients with obesity may experience lower urinary tract symptoms (LUTS). Little is known about these symptoms in obese patients in Croatia. The aim of this study was to asses LUTS in this group of patients. Subjects and methods: This cross-sectional study was carried out in a tertiary healthcare centre. 111 participants were included (81 women and 30 men, age 23-78 years), with BMI>30 kg/m2. LUTS were evaluated using International consultation on incontinence questionnaires (ICIQ) investigating symptoms of overactive bladder (OAB) and urinary incontinence (UI): ICIQ-OAB and ICIQ-UI Short Form (SF). We evaluated also some of the questions on the EQ-5D-5L questionnaire. Results: On ICIQ-OAB patients most often reported:UI (46.85% (N=52)), nocturia (42.34% (N=47)) and increased frequency of urination (34.23% (N=38)), and on ICIQ-UI SF: UI when coughing and sneezing (44.44% (N=32)), urgency UI (43.06% (N=31)) and UI during exercise/physical activity (22.22% (N=16)). Women were found to be more significantly affected by OAB symptoms (p<0.05). Significant correlations were found between the overall results on ICIQ-OAB and hypertension (r=0.32). Conclusions: The results of this study confirm that obese patients in Croatia experience LUTS as well. A higher incidence of LUTS was found among women and gender-independent among hypertensive obese patients

Excessive daytime sleepiness as cardiovascular risk in Croatian obese patients

Introduction: Excessive daytime sleepiness (EDS) is a very common complaint, especially in obese patients and is a potentially alarming symptom related to many risk factors and comorbidities1. In obese patients obstructive sleep apnea (OSA) is quite common. Our goal was to assess the connection between EDS and hypertension in Croatian obese patients. Patients and Methods: This cross-sectional study was carried out in a tertiary healthcare centre in an outpatient clinic for treatment of obesity. 49 participants were included. Inclusion criterion was BMI>30 kg/m2. Epworth Sleepiness Scale (ESS), consisting of 8 questions, every question ranged from 0-3 (overall range 0-24) was used to assess EDS. Spearman correlation coefficient, Welch t-test, chi-squared test and regression analysis were used. They were divided into 4 and 3 categories. 4 categories: 0-7, 8-9, 10-15 and 16-24. Many researches take ESS score 10 or greater as excessive daytime sleepiness, so our results were also interpreted as 3 categories: 0-7, 8-9 and 10 or greater. Results: Mean age of our participants was 50.29 ± 11.91 years. Overall mean BMI was 44.64±8.12 kg/m2. Results on ESS divided into 4 categories (Figure 1) were statistically significant correlated to hypertension: χ2= 9.61; p = .02. Also, results on ESS in 3 categories (Figure 2) were statistically significant correlated to hypertension: χ2(2) = 9.43; p = .009. Results on ESS were not significantly connected to AHI index (ESS in 4 categories: χ2(9)=8.43, p=.49; ESS in 3 categories : χ2(6)=6.45, p=.37). Furthermore, results on ESS were not correlated to sex (ESS in 4 categories χ2(3)=0.85, p=.84 and ESS in 3 categories: χ2(2)=0.56, p=.76). Conclusion: Our results show that the presence of hypertension alters the result on the ESS and is most visible in the so-called “borderline” area for the ESS score 8-9 in both divisions (into 3 and 4 categories), which shows a possible underestimation of the risk of the population achieving the result on the ESS <10, which is consistent with the studies of Borsini et al.