Uspješno liječenje oklozije gornje mezenteričke arterije u 86-godišnje bolesnice: prikaz slučaja

Chronic superior mesentery ischemia often presents a clinically asymptomatic diffuse atherosclerotic process. There are no compelling recommendations on the benefits of early revascularization strategy besides antithrombotic prophylaxis and statin treatment. Conversely, longterm prevalence of symptomatic cases in surgical patient cohorts is rarely reported in the literature. Acutization of chronic ischemia has a severe clinical course, so timely recognition may be considered lifesaving. We present a case of an 86-year-old woman hospitalized for acutized atherosclerotic narrowing of superior mesenteric artery. The patient was urgently operated on by aorto-mesenteric ring prosthesis revascularization. Postoperative course was uneventful and the patient regained 10 kilograms in the next few months.Kronična ishemija gornje mezenteričke arterije obično predstavlja klinički asimptomatsku pojavu difuznog aterosklerotskog procesa. Trenutno u pogledu medicine zasnovane na dokazima ne postoje jasne preporuke o korisnosti pristupa rane revaskularizacije prema terapiji antitrombocitnim lijekovima ili statinima. Na drugoj strani, studije učestalosti uz dugotrajno praćenje operiranih bolesnika su kroz literaturu oskudno zastupljene. Akutizacija kronične ishemije obično ima vrlo ozbiljne posljedice s visokom stopom smrtnosti, pa veća klinička pozornost uza što raniju dijagnostiku i pravodobnu terapijsku intervenciju predstavlja potencijalno spasonosni oblik liječenja. Prikazan je slučaj 86-godišnjakinje koja se javila u hitnu službu zbog akutizirane aterosklerotske okluzije gornje mezenteričke arterije. Bolesnica je hitno operirana uz primjenu aorto-mezenteričke prstenaste proteze. Poslijeoperacijski tijek bio je uredan, bez komplikacija, te je bolesnica povratila oko 10 kg u slijedećih nekoliko mjeseci

Vaskularna hibridna dvorana – operacijaska dvorana budućnosti

The last two decades have seen a paradigm shift in the treatment of vascular related diseases from once traditional open surgical repairs to the entire vascular tree being amenable to percutaneous interventions. Neither the classic operating room nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues for the vascular hybrid operating room include quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. The most important feature of working in a dedicated hybrid vascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. Establishment of an endovascular operating room suite has the benefit of a sterile environment, and the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. Consequently, better quality and service can be provided to the individual patient. These changes in the treatment of vascular disease require that a new type of vascular specialist, named ‘vascular hybrid surgeon’, trained to perform both endovascular and open surgical procedures in this highly complex patient group.U posljednja dva desetljeća primjećuje se pomak u liječenju vaskularnih bolesti od tradicionalno otvorenih kirurških zahvata prema perkutanoj intervenciji cijelog vaskularnog stabla. Niti klasične operativne dvorane, a niti konvencionalne angio dvorane nisu optimalne za izvođenje otvorene operacije ili za endovaskularne zahvate. Glavne značajke vaskularne hibridne operativne dvorane obuhvaćaju kvalitetnu opremu za snimanje, radijacijski štit, opremu za jednostavnu upotrebu, potrebu za dobro izučenim kadrom, ergonomičnost, mogućnost odvijanja otvorenih i perkutanih zahvata, sterilnu okolinu, kao i kvalitetu i učinkovitost bolesničke skrbi. Najznačajnija značajka rada u hibridnoj vaskularnoj operacijskoj dvorani trebala bi biti mogućnost pružanja najbolje operacije bolesniku s krvožilnom bolešću. Manje je važno tko će opremu upotrebljavati, intervencijski radiolog ili vaskularni kirurg. Uspostava jedne endovaskularne operativne dvorane ima prednost sterilne okoline, mogućnost izvođenja hibridnih zahvata, te ako je potrebno i konverzije. Također, angiografija učinjena neposredno prije operativnog zahvata pruža točnije anatomske informacije, a nakon zahvata pruža bolju kontrolu kvalitete. Posljedično, bolja kvaliteta i usluga može se ponuditi svakom pojedinačnom bolesniku. Takve promjene u liječenju bolesnika s bolešću krvnih žila zahtijevaju i novi profil vaskularnog kirurga nazvan “vaskularni hibridni kirurg” koji mora biti osposobljen u izvođenju endovaskularnih, ali i otvorenih operativnih zahvata kod iznimno složene skupine bolesnika

Povećana stopa doniranja organa u kliničkoj bolnici sestara milosrdnica

The rate of organ donation reflects the level of the respective society and country development. In Croatia, attempts have been made to increase this rate. As a consequence, the number of potential donors with confirmed brain death was observed to have steadily increased during the 2004-2008 period. Data on all potential donors where the confirmation procedure for brain death was completed were retrieved and analyzed. The percentage of donors out of all persons diagnosed with brain death and all deaths recorded at the Central Intensive Care Unit and at all Hospital departments was calculated. The mean number or organs per donor was also calculated. During the 2004-2008 period, the number of donors per brain death persons was 5/unknown, 6/10, 8/13, 11/13 and 18120; mean age 51, 50, 39, 48 and 44; donor rate per Central Intensive Care Unit deaths 5.9010, 5.6%,5.8%, 10.4% and 12.1%; donor rate per all hospital deaths 0.4%, 0.5%, 0.5%, 1.5% and 1.9%; and number of organs per donor 1.6, 2.4, 2.6, 3.0 and2.7, respectively. Study results showed a steady increase in the number of donors and organs per donor at Sestre milosrdnice University Hospital during the 2004-2008 period. More intensive education should be organized at medical schools and for medical professionals to identify brain death persons and potential donors. In addition, mass media campaigns should improve public awareness and perception of the issue.Stopa donacije organa je mjerilo razvijenosti zemlje. Kako bi se ta razina povećala, u Hrvatskoj su poduzete određene mjere. Posljedično je zamijećen stalan porast potencijalnih donora u kojih je potvrđena moždana smrt. Prikazujemo stalan porast razine donora od 2004. do 2008. godine. Analizirani su podaci svih potencijalnih donora u kojih je proveden postupak potvrđivanja moždane smrti. Izračunat je postotak broja donora u odnosu na osobe u kojih je dijagnosticirana moždana smrt te u odnosu na sve umrle u Središnjoj jedinici intenzivnog liječenja i u cijeloj bolnici. Također je izračunat srednji broj doniranih organa po donoru. Od 2004. do 2008. godine broj donora na broj moždano mrtvih osoba je bio 5/ nepoznato, 6/10, 8/13, 11/13 i 18/20, dok je srednja dob bila 51, 50, 39, 48 i 44 godine. Od 2004. do 2008. godine broj donora na broj umrlih u Središnjoj jedinici za intenzivno liječenje je bio 5,9%, 5,6%, 5,8%, 10,4% i 12,1%, a na sve umrle u bolnici 0,4%,0,5%,0,5%,1,5% i 1,9%. Srednji broj organa po donoru od 2004. do 2008. je bio 1,6; 2,4; 2,6; 3,0; 2,7. Od 2004. do 2008. godine vidljiv je stalan porast broja donora i broja doniranih organa u Kliničkoj bolnici "Sestre milosrdnice" Potrebno je provesti izobrazbu na Medicinskom fakultetu i medu profesionalnim osobljem kako bi se prepoznale osobe s moždanom smrti i potencijalni donori. Također treba provesti kampanje u medijima kako bi se poboljšao stav javnosti u tom području

Routes and Sources of Exposure to Electromagnetic Radiation in Croatia

Princip predostrožnosti jedan je od osnovnih principa na kojima počiva politika zaštite okoliša i ljudskog zdravlja Europske Unije. Pojačanu brigu za ljudsko zdravlje izazvao je i progresivni razvoj tehnologija za bežični prijenos telekomunikacijskog signala bez obzira na njihovu očiglednu sociološku i ekonomsku korist društvu. Svjedoci smo i naglog razvoja novih digitalnih tehnologija koje se koriste elektromagnetskim rendgenskim zračenjem u medicinskoj dijagnostici. Iako prirodno elektromagnetsko zračenje iz svemira ne doseže u potpunosti, osim u nekoliko intervala frekvencija, do Zemljine površine, neionizirajuće prirodno zračenje pokriva Zemlju značajno kompliciranije nego što to čini ionizirajuće elektromagnetsko zračenje. U radu su razmatrane vrlo niske i niske doze elektromagnetskoga rendgenskog zračenja koje primaju bolesnici za vrijeme medicinske dijagnostike. Trenutačno nema dovoljno znanstvenih podataka za prihvatljivu evaluaciju rizika od izlaganja ljudi visokofrekventnom elektromagnetskom neionizirajućem zračenju niskih i vrlo niskih doza. Zajedno s naglim razvojem i uporabom elektromagnetskoga rendgenskog zračenja razvijaju se i proizvode izvori neionizirajućeg zračenja utječući na okoliš i biotu na način koji nikako nije zanemariv. Zbog toga se predlaže holistički, specifi čniji dubinsko ekološki pristup zaštiti stanovništva Republike Hrvatske od izlaganja ionizirajućem i neionizirajućem umjetnom zračenju.The precautionary principle is explicitly laid down in the EU Treaty and is one of the starting points of the EU environmental policy. The concern over human health has been raised by extended use of mobile and wireless telecommunication technologies, regardless of their obvious economic and societal benefits for the modern society. We are also experiencing a growth in new electromagnetic X-ray technologies for medical diagnostics. Natural electromagnetic radiation from space does not reach the Earth’s surface, except at a very few wavelengths, but non-ionising background radiation covers the globe in a much more complex space matrix than background electromagnetic ionising radiation. This article looks into patient exposure to low-dose, high-frequency, non-ionising electromagnetic X-ray radiation from digital diagnostics machines. At present, there are not enough data to assess public health risk. As man-made ionising and non-ionising radiation sources are expanding enormously, we need to take a holistic as well as a more specifi c, deep ecology approach to protect Croatian population

Preporuke za liječenje bolesnika s karotidnom stenozom

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.U ovom članku objavljujemo preporuke za zbrinjavanje bolesnika sa stenozom karotidnih arterija, prihvaćene od Hrvatskoga društva za neurovaskularne poremećaje, Hrvatskoga neurološkog društva, Hrvatskoga društva za ultrazvuk u medicini i biologiji, Hrvatskoga radiološkog društva, Hrvatskoga društva za vaskularnu kirurgiju i Hrvatskoga društva za neurokirurgiju. Sastoje se od preporuka za neinvazivni probir bolesnika s karotidnom stenozom, preporuke za najbolje medikamentno liječenje te preporuka za intervenciju kao što je karotidna endarterektomija i postavljanje stenta, a zasnovane su na rezultatima internacionalnih randomiziranih kliničkih pokusa

Preporuke za liječenje bolesnika s karotidnom stenozom

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.U ovom članku objavljujemo preporuke za zbrinjavanje bolesnika sa stenozom karotidnih arterija, prihvaćene od Hrvatskoga društva za neurovaskularne poremećaje, Hrvatskoga neurološkog društva, Hrvatskoga društva za ultrazvuk u medicini i biologiji, Hrvatskoga radiološkog društva, Hrvatskoga društva za vaskularnu kirurgiju i Hrvatskoga društva za neurokirurgiju. Sastoje se od preporuka za neinvazivni probir bolesnika s karotidnom stenozom, preporuke za najbolje medikamentno liječenje te preporuka za intervenciju kao što je karotidna endarterektomija i postavljanje stenta, a zasnovane su na rezultatima internacionalnih randomiziranih kliničkih pokusa

Segmented flow generator for serial crystallography at the European X-ray free electron laser

Serial femtosecond crystallography (SFX) with X-ray free electron lasers (XFELs) allows structure determination of membrane proteins and time-resolved crystallography. Common liquid sample delivery continuously jets the protein crystal suspension into the path of the XFEL, wasting a vast amount of sample due to the pulsed nature of all current XFEL sources. The European XFEL (EuXFEL) delivers femtosecond (fs) X-ray pulses in trains spaced 100 ms apart whereas pulses within trains are currently separated by 889 ns. Therefore, continuous sample delivery via fast jets wastes >99% of sample. Here, we introduce a microfluidic device delivering crystal laden droplets segmented with an immiscible oil reducing sample waste and demonstrate droplet injection at the EuXFEL compatible with high pressure liquid delivery of an SFX experiment. While achieving ~60% reduction in sample waste, we determine the structure of the enzyme 3-deoxy-D-manno-octulosonate-8-phosphate synthase from microcrystals delivered in droplets revealing distinct structural features not previously reported

The psychological science accelerator’s COVID-19 rapid-response dataset

In response to the COVID-19 pandemic, the Psychological Science Accelerator coordinated three large-scale psychological studies to examine the effects of loss-gain framing, cognitive reappraisals, and autonomy framing manipulations on behavioral intentions and affective measures. The data collected (April to October 2020) included specific measures for each experimental study, a general questionnaire examining health prevention behaviors and COVID-19 experience, geographical and cultural context characterization, and demographic information for each participant. Each participant started the study with the same general questions and then was randomized to complete either one longer experiment or two shorter experiments. Data were provided by 73,223 participants with varying completion rates. Participants completed the survey from 111 geopolitical regions in 44 unique languages/dialects. The anonymized dataset described here is provided in both raw and processed formats to facilitate re-use and further analyses. The dataset offers secondary analytic opportunities to explore coping, framing, and self-determination across a diverse, global sample obtained at the onset of the COVID-19 pandemic, which can be merged with other time-sampled or geographic data