Endoskopsko liječenje sindroma škljocavog kuka vanjskog tipa: kirurška tehnika i prikaz dvaju slučajeva

Snapping hip or coxa saltans is a condition characterized by an audible and/or palpable snapping during hip movement and can be associated with pain around the hip. There are various causes of this condition and can be divided into two types: extra-articular and intra-articular. The most common type is the external extra-articular, where the snapping is due to thickened posterior part of the iliotibial band or anterior part of the gluteus maximus muscle sliding over the greater trochanter during hip movement. Two patients with external snapping hip are presented, who were treated with our original endoscopic iliotibial band release and greater trochanteric bursectomy. There were no surgical complications and the patients did not experience snapping or pain in the hip during 24-month follow-up period. Results of various open techniques and one endoscopic technique in the treatment of external snapping hip are also reported.Škljocavi kuk ili coxa saltans je stanje u kojem dolazi do čujnog i/ili palpabilnog škljocanja prilikom pokreta u kuku, tijekom čega se mogu javljati i bolovi. Prema uzrocima škljocavi kuk se dijeli na ekstra-artikularni i intra-artikularni. Najčešći tip je vanjski ekstra-artikularni, gdje do škljocanja dolazi zbog preskakanja zadebljanog stražnjeg dijela traktusa iliotibijalisa ili prednjeg dijela mišića gluteusa maksimusa preko velikog trohantera tijekom pokreta u kuku. U ovom radu prikazujemo dvoje bolesnika s vanjskim tipom škljocavog kuka koji su podvrgnuti endoskopskom opuštanju traktusa iliotibijalisa i uklanjanju burze nad velikim trohanterom našom vlastitom metodom. Oba zahvata su prošla bez komplikacija te bolesnici nisu imali bolove ili škljocanje u kuku u vremenu praćenja od dvije godine. Ujedno prikazujemo rezultate mnogobrojnih otvorenih tehnika i jedne endoskopske tehnike u liječenju škljocavog kuka

Tumors after Liver Transplantation

Sve dulje preživljenje nakon transplantacije jetre povezano je s porastom kasnih komplikacija. Najčešći uzrok mortaliteta godinama nakon transplantacije jetre su de novo maligne bolesti i recidivi malignih bolesti. Najčešće de novo maligne bolesti nakon transplantacije jetre su maligni tumori kože, posttransplantacijska limfoproliferativna bolest, maligni tumori pluća i maligni tumori gastrointestinalnog sustava. Kako bismo prevenirali i u ranom stadiju dijagnosticirali malignu bolest kod pacijenta kojem je transplantirana jetra, potrebno je educirati pacijenta, provoditi redovite kontrolne preglede te odabrati imunosupresivnu terapiju prilagođenu pacijentu. U slučaju dijagnosticirane maligne bolesti kod pacijenta s transplantiranom jetrom potrebno je provoditi odgovarajuće liječenje čime značajno utječemo na produljenje preživljenja i poboljšanje kvalitete života pacijenata nakon transplantacije jetre.More prolonged survival after liver transplantation is associated with an increase in late complications after liver transplantation. The most common causes of death years after liver transplantation are de novo malignant diseases and recurrences of malignant diseases. The most common de novo malignant diseases after liver transplantation are malignant skin tumors, post-transplantation lymphoproliferative disease, lung tumors, and gastrointestinal tumors. In order to prevent and diagnose malignant disease in liver transplant patients at an early stage, it is necessary to educate patients, carry out regular check-ups, reduce immunosuppressive therapy, and adapt it to the patient. In the case of a diagnosed de novo malignant disease in liver transplant patients at an early stage, it is necessary to educate patients, carry out regular check-ups, reduce immunosuppressive therapy, and adapt it to a patient. In the case of a diagnosed de novo malignant disease in patients after liver transplant, it is necessary to carry out adequate treatment. In this way, we can prolong patients’ survival after liver transplantation and improve their quality of life

Liver transplantation in patients with neuroendocrine tumors: a case series and literature review

Neuroendocrine tumors (NET) are a rare and heterogeneous group of neoplasms with variable biological behavior. They frequently metastasize to the liver, requiring active, multimodality treatment. Surgical resection, possible in only a minority of cases, was until recently the only potentially curative option. For unresectable NET with liver metastases, liver transplantation (LT) emerged as a potential curative treatment due to relatively slow growth and indolent behavior of the metastases. In this case series with literature review, we retrospectively analyzed the characteristics of 12 highly selected patients with metastatic NET disease as an indication for LT treated in our center. We also summarized the proposed prognostic factors, and evaluated and compared the existing selection criteria. The main poor prognostic factors in our patients were high grade NET and primary tumor in the pancreas. Inconsistent liver transplantation outcome parameters make it difficult to standardize patient selection criteria. There is a need for further studies that would fully elucidate the curative potential of LT in patients diagnosed with NET

Quality of life change in patients with liver cirrhosis after transplantation

Cilj: Kvaliteta života primatelja jetre jedan je od najvažnijih parametara uspjeha transplantacijskog liječenja. Cilj ovog istraživanja bio je ispitati utjecaj prije i poslijetransplantacijskih kliničko-laboratorijskih obilježja i kvalitete presatka jetre na kvalitetu života primatelja jetre. ----- Metode i ispitanici: U istraživanje je uključeno 100 bolesnika s cirozom jetre dobi između 18 i 65 godina, transplantiranih u periodu 2015. do 2017. godine. Kvaliteta života procijenjena je generičkim -SF-36 i specifičnim upitnikom - CLDQ, koje su ispitanici ispunjavali prije transplantacije te 6 i 12 mjeseci nakon transplantacije. ----- Rezultati: U svim domenama SF-36 upitnika, osim u BP (p=0,582), te u svim domenama CLDQ upitnika, pokazano je da postoji statistički značajno poboljšanje kvalitete života uspoređujući stanje prije i nakon transplantacije jetre. Univarijatnom analizom se pokazalo da su faktori s pozitivnim utjecajem na kvalitetu života nakon transplantacije muški spol, etilična ciroza te viši CTP i MELD rezultat, dok su arterijska hipertenzija, HCC i viši DRI faktori s negativnim utjecajem. Spearmanova korelacija pokazala je statistički značajnu pozitivnu povezanost MELD rezultata s kvalitetom života 12 mjeseci nakon transplantacije u MCS domeni SF-36 upitnika (r=0,267, p=0,007), te u ukupnom rezultatu CLDQ upitnika (r=0,274, p=0,006). Multivarijatna raščlamba pokazala je da je značajno bolja kvaliteta života nakon transplantacije prisutna kod ispitanika s cirozom etilične geneze (p=0,037), te kod onih koji nemaju arterijsku hipertenziju (p=0,042). ----- Zaključak: Nakon transplantacije jetre dolazi do značajnog poboljšanja kvalitete života bolesnika. Faktori s pozitivnim utjecajem na kvalitetu života nakon transplantacije su muški spol, etilična ciroza te viši CTP i MELD rezultat, dok negativno utječu arterijska hipertenzija, HCC i viši DRI rezultat.Background: Quality of life is one of the most important success parameters after liver transplantation. The aim of this study was to evaluate the impact of pre- and post-transplantation clinical and laboratory parameters and liver graft quality on liver recipients quality of life. ----- Methods: The study comprised 100 patients with liver cirrhosis aged >18 and <65 years, transplantated in the period between year 2015 and 2017. Quality of life was assessed with a generic- SF-36 and specific questionnaire- CLDQ, at 3 times: before, and at 6 and 12 months after transplantation. ----- Results: We observed a significant improvement in quality of life after liver transplantation in all domains of SF-36, except in BP (p=0,582), and CLDQ questionnaire. Univariate analysis found that factors with positive effect on post-transplant quality of life are male gender, ethylic cirrhosis and higher CTP and MELD score, while arterial hypertension, HCC and higher DRI are factors with negative effect. Spearman analysis showed a significant positive correlation between MELD and results 12 months after transplantation, in the MCS SF-36 domain (r=0,267, p=0,007), and overall CLDQ domain (r=0,274, p=0,006). Multivariate analysis found significantly better post-transplant quality of life according to CLDQ overall domain, in patients with ethylic cirrhosis (p=0,037) and those without arterial hypertension (p=0,042). ----- Conclusion: Quality of life improved significantly after liver transplantation. Factors that positively affect post-transplant quality of life are male gender, ethylic cirrhosis and higher CTP and MELD score. Arterial hypertension, HCC and higher DRI are factors that adversely affect post-transplant quality of life

Quality of life change in patients with liver cirrhosis after transplantation

Cilj: Kvaliteta života primatelja jetre jedan je od najvažnijih parametara uspjeha transplantacijskog liječenja. Cilj ovog istraživanja bio je ispitati utjecaj prije i poslijetransplantacijskih kliničko-laboratorijskih obilježja i kvalitete presatka jetre na kvalitetu života primatelja jetre. ----- Metode i ispitanici: U istraživanje je uključeno 100 bolesnika s cirozom jetre dobi između 18 i 65 godina, transplantiranih u periodu 2015. do 2017. godine. Kvaliteta života procijenjena je generičkim -SF-36 i specifičnim upitnikom - CLDQ, koje su ispitanici ispunjavali prije transplantacije te 6 i 12 mjeseci nakon transplantacije. ----- Rezultati: U svim domenama SF-36 upitnika, osim u BP (p=0,582), te u svim domenama CLDQ upitnika, pokazano je da postoji statistički značajno poboljšanje kvalitete života uspoređujući stanje prije i nakon transplantacije jetre. Univarijatnom analizom se pokazalo da su faktori s pozitivnim utjecajem na kvalitetu života nakon transplantacije muški spol, etilična ciroza te viši CTP i MELD rezultat, dok su arterijska hipertenzija, HCC i viši DRI faktori s negativnim utjecajem. Spearmanova korelacija pokazala je statistički značajnu pozitivnu povezanost MELD rezultata s kvalitetom života 12 mjeseci nakon transplantacije u MCS domeni SF-36 upitnika (r=0,267, p=0,007), te u ukupnom rezultatu CLDQ upitnika (r=0,274, p=0,006). Multivarijatna raščlamba pokazala je da je značajno bolja kvaliteta života nakon transplantacije prisutna kod ispitanika s cirozom etilične geneze (p=0,037), te kod onih koji nemaju arterijsku hipertenziju (p=0,042). ----- Zaključak: Nakon transplantacije jetre dolazi do značajnog poboljšanja kvalitete života bolesnika. Faktori s pozitivnim utjecajem na kvalitetu života nakon transplantacije su muški spol, etilična ciroza te viši CTP i MELD rezultat, dok negativno utječu arterijska hipertenzija, HCC i viši DRI rezultat.Background: Quality of life is one of the most important success parameters after liver transplantation. The aim of this study was to evaluate the impact of pre- and post-transplantation clinical and laboratory parameters and liver graft quality on liver recipients quality of life. ----- Methods: The study comprised 100 patients with liver cirrhosis aged >18 and <65 years, transplantated in the period between year 2015 and 2017. Quality of life was assessed with a generic- SF-36 and specific questionnaire- CLDQ, at 3 times: before, and at 6 and 12 months after transplantation. ----- Results: We observed a significant improvement in quality of life after liver transplantation in all domains of SF-36, except in BP (p=0,582), and CLDQ questionnaire. Univariate analysis found that factors with positive effect on post-transplant quality of life are male gender, ethylic cirrhosis and higher CTP and MELD score, while arterial hypertension, HCC and higher DRI are factors with negative effect. Spearman analysis showed a significant positive correlation between MELD and results 12 months after transplantation, in the MCS SF-36 domain (r=0,267, p=0,007), and overall CLDQ domain (r=0,274, p=0,006). Multivariate analysis found significantly better post-transplant quality of life according to CLDQ overall domain, in patients with ethylic cirrhosis (p=0,037) and those without arterial hypertension (p=0,042). ----- Conclusion: Quality of life improved significantly after liver transplantation. Factors that positively affect post-transplant quality of life are male gender, ethylic cirrhosis and higher CTP and MELD score. Arterial hypertension, HCC and higher DRI are factors that adversely affect post-transplant quality of life

Quality of life change in patients with liver cirrhosis after transplantation

Cilj: Kvaliteta života primatelja jetre jedan je od najvažnijih parametara uspjeha transplantacijskog liječenja. Cilj ovog istraživanja bio je ispitati utjecaj prije i poslijetransplantacijskih kliničko-laboratorijskih obilježja i kvalitete presatka jetre na kvalitetu života primatelja jetre. ----- Metode i ispitanici: U istraživanje je uključeno 100 bolesnika s cirozom jetre dobi između 18 i 65 godina, transplantiranih u periodu 2015. do 2017. godine. Kvaliteta života procijenjena je generičkim -SF-36 i specifičnim upitnikom - CLDQ, koje su ispitanici ispunjavali prije transplantacije te 6 i 12 mjeseci nakon transplantacije. ----- Rezultati: U svim domenama SF-36 upitnika, osim u BP (p=0,582), te u svim domenama CLDQ upitnika, pokazano je da postoji statistički značajno poboljšanje kvalitete života uspoređujući stanje prije i nakon transplantacije jetre. Univarijatnom analizom se pokazalo da su faktori s pozitivnim utjecajem na kvalitetu života nakon transplantacije muški spol, etilična ciroza te viši CTP i MELD rezultat, dok su arterijska hipertenzija, HCC i viši DRI faktori s negativnim utjecajem. Spearmanova korelacija pokazala je statistički značajnu pozitivnu povezanost MELD rezultata s kvalitetom života 12 mjeseci nakon transplantacije u MCS domeni SF-36 upitnika (r=0,267, p=0,007), te u ukupnom rezultatu CLDQ upitnika (r=0,274, p=0,006). Multivarijatna raščlamba pokazala je da je značajno bolja kvaliteta života nakon transplantacije prisutna kod ispitanika s cirozom etilične geneze (p=0,037), te kod onih koji nemaju arterijsku hipertenziju (p=0,042). ----- Zaključak: Nakon transplantacije jetre dolazi do značajnog poboljšanja kvalitete života bolesnika. Faktori s pozitivnim utjecajem na kvalitetu života nakon transplantacije su muški spol, etilična ciroza te viši CTP i MELD rezultat, dok negativno utječu arterijska hipertenzija, HCC i viši DRI rezultat.Background: Quality of life is one of the most important success parameters after liver transplantation. The aim of this study was to evaluate the impact of pre- and post-transplantation clinical and laboratory parameters and liver graft quality on liver recipients quality of life. ----- Methods: The study comprised 100 patients with liver cirrhosis aged >18 and <65 years, transplantated in the period between year 2015 and 2017. Quality of life was assessed with a generic- SF-36 and specific questionnaire- CLDQ, at 3 times: before, and at 6 and 12 months after transplantation. ----- Results: We observed a significant improvement in quality of life after liver transplantation in all domains of SF-36, except in BP (p=0,582), and CLDQ questionnaire. Univariate analysis found that factors with positive effect on post-transplant quality of life are male gender, ethylic cirrhosis and higher CTP and MELD score, while arterial hypertension, HCC and higher DRI are factors with negative effect. Spearman analysis showed a significant positive correlation between MELD and results 12 months after transplantation, in the MCS SF-36 domain (r=0,267, p=0,007), and overall CLDQ domain (r=0,274, p=0,006). Multivariate analysis found significantly better post-transplant quality of life according to CLDQ overall domain, in patients with ethylic cirrhosis (p=0,037) and those without arterial hypertension (p=0,042). ----- Conclusion: Quality of life improved significantly after liver transplantation. Factors that positively affect post-transplant quality of life are male gender, ethylic cirrhosis and higher CTP and MELD score. Arterial hypertension, HCC and higher DRI are factors that adversely affect post-transplant quality of life

Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy

Residual platelet reactivity (RPR) following coronary artery bypass grafting (CABG) might be related to thrombotic complications and major ischemic cardiac events. The aim of this study was to evaluate the changes in platelet reactivity monitored pre- and postoperatively using multiple-electrode aggregometry (MEA) and to propose an alternative therapeutic approach in a subgroup of patients with postoperative RPR. Ninety-nine patients undergoing elective CABG were enrolled in the study, of whom 41 (41.4%) were diabetic. Preoperatively, all patients received 100 mg acetylsalicylic acid (ASA), with 47 of 99 (47.4%) patients receiving an additional 75 mg clopidogrel (CLO). The blood samples were drawn the day before surgery, and on the first and 4th postoperative day. Platelet count and fibrinogen level were documented, as well as type and daily dose of antiplatelet therapy (APT) received pre- and postoperatively. Multiple-electrode aggregometry using tests based on arachidonic acid (ASPI test) and adenosine diphosphate (ADP test) was performed on the day before and 4 days after surgery. Preoperatively, we detected 31 of 99 (31.3%) patients with RPR (ASPI > 30 AUC). Platelet count correlated with both the ASPI (P = 0.03) and ADP (0.002) tests. Fibrinogen correlated with ADP test values (P 30 AUC at the 4th postoperative day consequently received as a part of our clinical routine an additional 75 mg CLO per day, in terms of platelet inhibition optimization. Multiple-electrode aggregometry can recognize patients with RPR during both the pre- and post-CABG period. Postoperatively administered ASA (300 mg) did not sufficiently inhibit platelet aggregation in 46.5% of post-CABG patients. In this group of patients a switch to dual APT should be considered

Endoskopsko liječenje sindroma škljocavog kuka vanjskog tipa: kirurška tehnika i prikaz dvaju slučajeva

Snapping hip or coxa saltans is a condition characterized by an audible and/or palpable snapping during hip movement and can be associated with pain around the hip. There are various causes of this condition and can be divided into two types: extra-articular and intra-articular. The most common type is the external extra-articular, where the snapping is due to thickened posterior part of the iliotibial band or anterior part of the gluteus maximus muscle sliding over the greater trochanter during hip movement. Two patients with external snapping hip are presented, who were treated with our original endoscopic iliotibial band release and greater trochanteric bursectomy. There were no surgical complications and the patients did not experience snapping or pain in the hip during 24-month follow-up period. Results of various open techniques and one endoscopic technique in the treatment of external snapping hip are also reported.Škljocavi kuk ili coxa saltans je stanje u kojem dolazi do čujnog i/ili palpabilnog škljocanja prilikom pokreta u kuku, tijekom čega se mogu javljati i bolovi. Prema uzrocima škljocavi kuk se dijeli na ekstra-artikularni i intra-artikularni. Najčešći tip je vanjski ekstra-artikularni, gdje do škljocanja dolazi zbog preskakanja zadebljanog stražnjeg dijela traktusa iliotibijalisa ili prednjeg dijela mišića gluteusa maksimusa preko velikog trohantera tijekom pokreta u kuku. U ovom radu prikazujemo dvoje bolesnika s vanjskim tipom škljocavog kuka koji su podvrgnuti endoskopskom opuštanju traktusa iliotibijalisa i uklanjanju burze nad velikim trohanterom našom vlastitom metodom. Oba zahvata su prošla bez komplikacija te bolesnici nisu imali bolove ili škljocanje u kuku u vremenu praćenja od dvije godine. Ujedno prikazujemo rezultate mnogobrojnih otvorenih tehnika i jedne endoskopske tehnike u liječenju škljocavog kuka