Upotreba mikrobioloških i laboratorijskih nalaza u izboru empirijske antibiotske terapije u bolesnika podvrgnutih laparoskopskoj kolecistektomiji - uloga lokalnih antibiograma

Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating local antibiograms is important because they ensure effective therapy in the given clinical environment. The study included 110 consecutive patients who underwent laparoscopic cholecystectomy, divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis (n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound examination. Bile samples for bacteriological testing were obtained under aseptic conditions during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis, Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the administration of antibiotics in elective patients is not justified. The results of this study indicate that third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.Antibiotska terapija je indicirana u liječenju akutnog kolecistitisa. Međutim, u liječenju nekomplicirane kolelitijaze profilaktična upotreba antibiotika je proturječna. Mikrobiološki i laboratorijski podaci su osnova za izbor antibiotske terapije. Stoga su nadzor i lokalni antibiogrami vrlo važni, jer daju djelotvornu terapiju u datom kliničkom okruženju. U istraživanje je bilo uključeno 110 bolesnika koji su podvrgnuti laparoskopskoj kolecistektomiji. Bolesnici su podijeljeni u dvije skupine: skupina s nekompliciranom kolelitijazom (n=60) i skupina s akutnim kolecistitisom (n=50). Prijeoperacijski podaci su uključivali dob, spol, indeks tjelesne mase, leukocite, C-reaktivni protein te ultrasonografski pregled. Uzorci žuči za bakteriološka testiranja uzeti su pod aseptičkim uvjetima tijekom kirurškog zahvata te evaluirani na aerobnu i anaerobnu floru i fungalne organizme primjenom rutinskih testova. Nakon kirurškog zahvata uzorci žučnog mjehura poslani su na patohistološku analizu. U skupini s nekompliciranom kolelitijazom pronađeno je 6/60 pozitivnih nalaza, a u skupini s akutnim kolecistitisom 25/50 pozitivnih mikrobioloških nalaza. U skupini s nekompliciranom kolelitijazom prevladavali su Citrobacter sp. i Enterococcus faecalis, a u skupini s akutnim kolecistitisom Escherichia coli, Enterococus faecalis, Proteus mirabilis, Citrobacter sp. U skupini s nekompliciranom kolelitijazom antibiotici su davani u 32/60 slučajeva, a u skupini s akutnim kolecitistisom u 49/50 slučajeva. Najčešće primijenjeni antibiotik bio je cefazolin, koji je bio također i najrezistentniji antibiotik. Može se zaključiti da davanje antibiotika elektivnim bolesnicima nije opravdano. Rezultati ove studije upućuju na to da u ovom kliničkom okruženju cefalosporin treće generacije ili ciprofloksacin + metronidazol treba davati kod blagog i umjerenog akutnog kolecistitisa, a u teškim slučajevima cefalosporin četvrte generacije + metronidazol. Primjerena upotreba antibiotika je presudna i treba biti integralni dio dobre kliničke prakse i standardne skrbi

Tissue Reaction to Absorbable Endoloop, Nonabsorbable Titanium Staples, and Polymer Hem-o-lok Clip After Laparoscopic Appendectomy

The mildest inflammatory changes postoperatively were found in the staple group followed by those in the Hem-O-Lok group

The effect of the shape of a clip on the magnetic field during magnetic resonance imaging examinations

Aim Plastic clips are a diamagnetic material and produce fewer artefacts in the MR field than titanium clips, which are standard in neurosurgery. However, alongside their physical properties, the shape of the clips, and their very geometry subtlety affects their behaviour in the magnetic field. Therefore, we performed a simulation in order to establish which clips cause less disturbance in the magnetic field from the point of view of the geometry of the body. Methods The simulation tool used for the research was the software package COMSOL Mph version 4.3. Since it was a question of magnetics, the models were prepared in the AC/DC module within the option Magnetic Fields, No Currents (mfnc). Within this module we were able to analyse electro-magnetic fields for a specific geometrical structure, using the Finite Element Method in order to resolve the two-dimensional electromagnetic problems. Results The value of the magnetic field with titanium clips with their specific geometric reference lines reached the value of c. (A/m). The simpler geometry of the plastic clips resulted in a less intensive magnetic field, amounting to c. (A/m), which is an entire order of magnitude less than the field with the titanium clips. Conclusion The simpler geometry of the plastic clips and the type of material from which they are made causes less disturbance to the magnetic field, which was precisely confirmed with the simulation model. The use of plastic clips in neurosurgery and neuroradiology will facilitate the interpretation of MR images

ANALYSIS THEORICO-PRACTICA DE VIRIBUS VIRUS FEBRIFERI, PESTIFERI, ATQUE SERPENTIN – PRVI MEDICINSKI ČLANAK AUTORA IZ BOSNE I HERCEGOVINE

This review describes the first medical article written by an author from Bosnia and Herzegovina. The article was published by Fr. Franjo Gracić (1740-1799), in Latin, under the title: “Analysis theorico-practica de viribus virus febriferi, pestiferi, atque serpentin”, and printed in Padua in 1795, translated as: “A Theoretical and Practical Presentation of the Effects of Fevers, Infectious Diseases, and Snake Poison”. From today’s standpoint, it may be said that it was a review article about some of the most frequent diseases of that time. The paper is of exceptional importance for the history of medicine in Bosnia and Herzegovina because it is the first documented medical article whose author was from Bosnia and Herzegovina. The paper contains observations of the course of diseases and treatment, in line with the medical insights of the time. The author refers to the authorities of that time, such as Samuel Auguste André Tissot, the Swiss physicist and doctor, Georg Bauer, the German doctor, and Lodovico Antonio Muratori, the Italian scholar, which makes this article a link between Bosnia and Herzegovina and the knowledge of the Europe of that time. This paper represents the beginning of medical writing in Bosnia and Herzegovina and has a very important place in the history of medicine in this country.Ovaj rad opisuje prvi medicinski članak koji je napisao autor iz Bosne i Hercegovine. Članak Analysis theorico-Practica de viribus virus febriferi, pestiferi, atque serpentinna latinskom je jeziku objavio fra Franjo Gracić (1740. – 1799.). Tiskan je u Padovi 1795. i preveden kao Teoretski i praktični prikaz učinaka groznica, zaraznih bolesti i zmijskog otrova. S današnjeg stajališta može se reći da je to bio pregledni članak o nekim od najčešćih bolesti toga doba. Rad je od iznimne važnosti za povijest medicine u Bosni i Hercegovini jer je to prvi dokumentirani medicinski članak čiji je autor bio iz Bosne i Hercegovine. Rad sadrži zapažanja o tijeku bolesti i liječenju, u skladu s tadašnjim medicinskim spoznajama. Autor se poziva na autoritete toga vremena, poput Samuela Augustea Andréa Tissota, švicarskog fizičara i liječnika, Georga Bauera, njemačkog liječnika, i Lodovica Antonia Muratorija, talijanskog učenjaka, što ovaj članak čini vezom između Bosne i Hercegovine i znanja tadaš-nje Europe. Ovaj rad znači početak medicinskog pisanja u Bosni i Hercegovini te ima važno mjesto u povijesti medicine u ovoj zemlji

CT advantages of potential use of polymer plastic clips in neurocranium

Aim Clips in neurosurgery are made of titanium alloys, which reduce artifacts on computed tomography (CT). The radiological advantage of plastic clips on the CT image was demonstrated when they were placed in an inter-hemispherical position at an angle of 90º. The aim of this study was to investigate the behaviour of the clip placed at different angles. Methods Sixty heads of domestic pigs were divided into two groups, in group 1 a titanium clip was placed to the interhemispheric position at an angle of 90º, 45º, 0º, ten heads for each angle. In group 2 a plastic clip was placed in the same way. CT scan of the brain was performed for each angle. The size of the density and possible artifact were measured on CT. Results The size of the titanium clip ranged from 17.05 mm at an angle of 0º in the axial plane to 91.47 mm at an angle of 0º in the sagittal plane. The average size of the plastic clip ranged from 6.4 mm at an angle of 0º in the axial plane to 23.22 mm in an angle of 90º in the sagittal plane. Artifacts were observed only in the titanium clip. Conclusion Plastic clips have shown radiological advantages over titanium clips in the CT image. The average density size of the plastic clip in all planes and all angles was smaller than the titanium clip

EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic

Background: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. Methods: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. Results: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. Conclusion: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems