19 research outputs found
Effect of pentadecapeptide BPC 157 on platelet aggregation and viscoelastic properties of blood clot in rats
Prethodna istraživanja pokazala su da BPC 157 sprjeÄava nastanak okluzivnog tromba i ubrzava razgradnju veÄ stvorenog ugruÅ”ka nakon formiranja anastomoze aorte, a da, s druge strane, smanjuje vrijeme krvarenja kod Å”takora tretiranih varfarinom, heparinom i aspirinom. Temeljem toga, nametnula se potreba odreÄivanja njegova utjecaja na agregaciju trombocita i viskoelastiÄna svojstva krvnog ugruÅ”ka. Za ispitivanje eventualne ukljuÄenosti NO sustava u djelovanje BPC 157 koriÅ”ten je selektivni inhibitor topljive gvanilil ciklaze, ODQ. Životinje (n=60) su najprije podijeljene u skupine ovisno o tome koji antiagregacijski lijek primaju (1.aspirin, 2.klopidogrel, 3.cilostazol), a te skupine su tada nasumiÄno podijeljene u Äetiri podskupine koje su primale a) fizioloÅ”ku otopinu, b) BPC 157, c) ODQ, d) BPC 157 + ODQ. Mjerenja su izvrÅ”ena impendancijskom agregometrijom s 4 razliÄita agonista (ADP, AA, AA/PGE1, kolagen), te rotacijskom tromboelastometrijom s 3 razliÄita agonista (preko vanjskog i unutarnjeg puta zgruÅ”avanja, te bez doprinosa trombocita). Iz rezultata dobivenih usporedbom podskupina a i b, te b i d unutar svake skupine možemo zakljuÄiti da BPC 157 oporavlja inhibiranu agregaciju trombocita, ali da nema utjecaja na viskoelastiÄna svojstva krvnog ugruÅ”ka u ispitivanih Å”takora.As a natural extension of previous research that confirmed the role of BPC 157 in the prevention of obstructive thrombus formation and rapid destruction of an already formed one after aortic anastomosis, but also shortening of the bleeding time in rats treated with anticoagulants and aspirin, there was a necessity to determine how BPC 157 influences platelet aggregation and viscoelastic properties of the blood clot. To assess its relation to NO system, sCG selective inhibitor (ODQ) was used. Rats (n=60) were divided into groups depending on the antiaggregatory drug they were treated with (1.aspirin, 2.clopidogrel, 3.cilostazol). Groups were further divided into four subgroups treated with a) normal saline, b) BPC 157, c) ODQ, d) BPC 157 + ODQ. Impendance aggregomery measurements with four agonists (ADP, AA, AA/PGE1 and collagen), and also rotational thromboelastometric measurements with 3 agonists (for initiating external and internal coagulation pathway and without platelet contribution) were performed. Based on the results obtained by comparing subgroups a versus b, and b versus d in each group, we can conclude that BPC 157 rescues inhibited platelet aggregation, but it has no effect on viscoelastic properties of the blood clot
Infective endocarditis following wisdom tooth extraction in a pro-fessional basketball player with bicuspid aortic valve
Bacterial endocarditis may be rare, but is a fatal complication following routine dental pro-cedures. Although patients with bicuspide aortic valve are considered to be at intermedia-te risk of bacterial endocarditis, administering antibiotic prophylaxis before dental proce-dures is not recommended by international guidelines
PREOPERATIVE ANAESTHESIOLOGIC EVALUATION OF PATIENT WITH KNOWN ALLERGY
Anaphylaxis is an unanticipated systemic hypersensitivity rea ction which can produce deleterious effects, even death, if not
treated promptly. Preventive approach implies taking a thorough anamnesis with the emphasis on previously diagnosed allergies. If
an allergic reaction occurred during previous surgery, a detailed documentation of administered anaesthetic agents and drugs would
be crucial for the following anaesthesiologic management. Preoperative planning and avoiding cross-reactivity with drugs
commonly used during anaesthesia are the key points to prevent an anaphylaxis. In case of emergency surgery when the exact
identification of allergens is not possible, premedication prophylaxis should be considered. General measures for prevention of
anaphylaxis could be undertaken as well, such as the choice of anaesthesiologic drugs and techniques in the operating theatre
adequately equipped for the management of predictable anaphylaxis
TRANSPLANTACIJA PLUÄA U KLINIÄKOM BOLNIÄKOM CENTRU ZAGREB U HRVATSKOJ
Objective: Lung transplantation has become a standard of care for patients with a variety of non-malignant end-stage lung diseases. The aim of the study was to report on the safety and feasibility of lung transplantation at the Zagreb University Hospital Center. Methods: In this single center retrospective observational study, all consecutive patients undergoing lung transplantation at the Zagreb University Hospital Center from April 2021 until December 2022 were included. The only inclusion criterion was surgery for lung transplantation. Patient demographic and operative characteristics were reported, as well as early outcomes, including 30-day mortality, hospital stay, intensive care unit stay, duration of mechanical ventilation, and incidence of primary graft dysfunction. The degree of primary graft dysfunction was graded based on the International Society for Heart and Lung Transplantation criteria at 72 hours after transplantation with grades 0 to 3. Results: During the 21-month study period, 19 patients were successfully transplanted. There was no 30-day mortality. There was one late death at 18 months after transplantation. Median in-hospital stay was 32 days, ranging from 21 to 62 days. Mean mechanical ventilation duration was 105Ā±58 h and median of intensive care unit stay was 6 days, ranging from 4 to 15 days. Only two (11%) patients had the highest grade 3 primary graft dysfunction. Of the remaining patients, 16 (84%) had none (grade 0) and one (5%) patient had mild primary graft dysfunction (grade 1). Conclusion: Our results suggest that lung transplantation is safely performed at the Zagreb University Hospital Center. Initial results with no operative mortality are encouraging. Further follow-up and experience are needed to make inferences on long-term outcomes of our lung transplantation patients.Cilj: Transplantacija pluÄa postala je standard skrbi za pacijente s nizom nemalignih pluÄnih bolesti u zavrÅ”nom stadiju. Cilj ovog istraživanja bio je izvijestiti o sigurnosti i izvedivosti transplantacije pluÄa u KliniÄkom bolniÄkom centru Zagreb u Hrvatskoj. Metode: U ovu retrospektivnu opservacijsku studiju ukljuÄeni su svi uzastopni pacijenti koji su bili podvrgnuti transplantaciji pluÄa u KliniÄkom bolniÄkom centru Zagreb od travnja 2021. do prosinca 2022. godine. Jedini kriterij za ukljuÄivanje bio je kirurÅ”ki zahvat transplantacije pluÄa. Zabilježene su demografske i operativne karakteristike pacijenata, kao i rani ishodi, ukljuÄujuÄi 30-dnevnu smrtnost, boravak u bolnici, boravak na jedinici intenzivne njege, trajanje mehaniÄke ventilacije i incidenciju primarne disfunkcije presatka. Stupanj primarne disfunkcije presatka ocijenjen je na temelju kriterija MeÄunarodnog druÅ”tva za transplantaciju srca i pluÄa 72 sata nakon transplantacije ocjenama od 0 do 3. Rezultati: Tijekom dvadesetjednomjeseÄnog razdoblja istraživanja transplantacija je uspjeÅ”no primijenjena u 19 pacijenata. Nije bilo 30-dnevne smrtnosti. Dogodila se jedna kasna smrt 18 mjeseci nakon transplantacije. Medijan boravka u bolnici bio je 32 dana, u rasponu od 21 do 62 dana. ProsjeÄno trajanje mehaniÄke ventilacije bilo je 105Ā±58 h, a medijanboravka u jedinici intenzivne njege bio je 6 dana, u rasponu od 4 do 15 dana. Samo dva (11 %) bolesnika imala su primarnu disfunkciju presatka najviÅ”eg stupnja 3. Od preostalih bolesnika 16 (84 %) ih nije imalo nikakav (stupanj 0), a jedan (5%) bolesnik imao je blagi, stupanj 1. Rasprava: U ovom Älanku prikazujemo naÅ”e poÄetno iskustvo s transplantacijom pluÄa. Transplantacija pluÄa bila je jedina od transplantacija solidnih organa koja se donedavno u Hrvatskoj nije rutinski izvodila, s napomenom da je prva transplantacija pluÄa u Hrvatskoj uÄinjena joÅ” 2003. godine u Klinici za torakalnu kirurgiju Jordanovac, ali se program transplantacije nije tada nastavio. Od travnja 2021. godine transplantacije pluÄa rutinski se izvode u naÅ”em centru i hrvatski pacijenti viÅ”e ne moraju putovati u inozemstvo radi transplantacije pluÄa. Sveukupni nedostatak donora pluÄa i dalje je glavni ograniÄavajuÄi Äimbenik za broj transplantacija koje se izvode na godinu. Svega 20%-30% doniranih pluÄa iskoristi se za transplantaciju. Potrebno je kontinuirano unaprjeÄenje i razvoj strategija koje Äe poveÄati broj donora i uporabljivih pluÄnih presadaka. ZakljuÄak: NaÅ”i rezultati pokazuju da se transplantacija pluÄa sigurno izvodi u KliniÄkom bolniÄkom centru Zagreb. PoÄetni rezultati bez operativnog mortaliteta su ohrabrujuÄi. Daljnje praÄenje i iskustvo potrebni su za donoÅ”enje zakljuÄaka o dugoroÄnim ishodima naÅ”ih pacijenata s transplantacijom pluÄa
TRANSPLANTACIJA PLUÄA U KLINIÄKOM BOLNIÄKOM CENTRU ZAGREB U HRVATSKOJ
Objective: Lung transplantation has become a standard of care for patients with a variety of non-malignant end-stage lung diseases. The aim of the study was to report on the safety and feasibility of lung transplantation at the Zagreb University Hospital Center. Methods: In this single center retrospective observational study, all consecutive patients undergoing lung transplantation at the Zagreb University Hospital Center from April 2021 until December 2022 were included. The only inclusion criterion was surgery for lung transplantation. Patient demographic and operative characteristics were reported, as well as early outcomes, including 30-day mortality, hospital stay, intensive care unit stay, duration of mechanical ventilation, and incidence of primary graft dysfunction. The degree of primary graft dysfunction was graded based on the International Society for Heart and Lung Transplantation criteria at 72 hours after transplantation with grades 0 to 3. Results: During the 21-month study period, 19 patients were successfully transplanted. There was no 30-day mortality. There was one late death at 18 months after transplantation. Median in-hospital stay was 32 days, ranging from 21 to 62 days. Mean mechanical ventilation duration was 105Ā±58 h and median of intensive care unit stay was 6 days, ranging from 4 to 15 days. Only two (11%) patients had the highest grade 3 primary graft dysfunction. Of the remaining patients, 16 (84%) had none (grade 0) and one (5%) patient had mild primary graft dysfunction (grade 1). Conclusion: Our results suggest that lung transplantation is safely performed at the Zagreb University Hospital Center. Initial results with no operative mortality are encouraging. Further follow-up and experience are needed to make inferences on long-term outcomes of our lung transplantation patients.Cilj: Transplantacija pluÄa postala je standard skrbi za pacijente s nizom nemalignih pluÄnih bolesti u zavrÅ”nom stadiju. Cilj ovog istraživanja bio je izvijestiti o sigurnosti i izvedivosti transplantacije pluÄa u KliniÄkom bolniÄkom centru Zagreb u Hrvatskoj. Metode: U ovu retrospektivnu opservacijsku studiju ukljuÄeni su svi uzastopni pacijenti koji su bili podvrgnuti transplantaciji pluÄa u KliniÄkom bolniÄkom centru Zagreb od travnja 2021. do prosinca 2022. godine. Jedini kriterij za ukljuÄivanje bio je kirurÅ”ki zahvat transplantacije pluÄa. Zabilježene su demografske i operativne karakteristike pacijenata, kao i rani ishodi, ukljuÄujuÄi 30-dnevnu smrtnost, boravak u bolnici, boravak na jedinici intenzivne njege, trajanje mehaniÄke ventilacije i incidenciju primarne disfunkcije presatka. Stupanj primarne disfunkcije presatka ocijenjen je na temelju kriterija MeÄunarodnog druÅ”tva za transplantaciju srca i pluÄa 72 sata nakon transplantacije ocjenama od 0 do 3. Rezultati: Tijekom dvadesetjednomjeseÄnog razdoblja istraživanja transplantacija je uspjeÅ”no primijenjena u 19 pacijenata. Nije bilo 30-dnevne smrtnosti. Dogodila se jedna kasna smrt 18 mjeseci nakon transplantacije. Medijan boravka u bolnici bio je 32 dana, u rasponu od 21 do 62 dana. ProsjeÄno trajanje mehaniÄke ventilacije bilo je 105Ā±58 h, a medijanboravka u jedinici intenzivne njege bio je 6 dana, u rasponu od 4 do 15 dana. Samo dva (11 %) bolesnika imala su primarnu disfunkciju presatka najviÅ”eg stupnja 3. Od preostalih bolesnika 16 (84 %) ih nije imalo nikakav (stupanj 0), a jedan (5%) bolesnik imao je blagi, stupanj 1. Rasprava: U ovom Älanku prikazujemo naÅ”e poÄetno iskustvo s transplantacijom pluÄa. Transplantacija pluÄa bila je jedina od transplantacija solidnih organa koja se donedavno u Hrvatskoj nije rutinski izvodila, s napomenom da je prva transplantacija pluÄa u Hrvatskoj uÄinjena joÅ” 2003. godine u Klinici za torakalnu kirurgiju Jordanovac, ali se program transplantacije nije tada nastavio. Od travnja 2021. godine transplantacije pluÄa rutinski se izvode u naÅ”em centru i hrvatski pacijenti viÅ”e ne moraju putovati u inozemstvo radi transplantacije pluÄa. Sveukupni nedostatak donora pluÄa i dalje je glavni ograniÄavajuÄi Äimbenik za broj transplantacija koje se izvode na godinu. Svega 20%-30% doniranih pluÄa iskoristi se za transplantaciju. Potrebno je kontinuirano unaprjeÄenje i razvoj strategija koje Äe poveÄati broj donora i uporabljivih pluÄnih presadaka. ZakljuÄak: NaÅ”i rezultati pokazuju da se transplantacija pluÄa sigurno izvodi u KliniÄkom bolniÄkom centru Zagreb. PoÄetni rezultati bez operativnog mortaliteta su ohrabrujuÄi. Daljnje praÄenje i iskustvo potrebni su za donoÅ”enje zakljuÄaka o dugoroÄnim ishodima naÅ”ih pacijenata s transplantacijom pluÄa
DISORDERS OF HEMOSTASIS IN CHRONIC RENAL FAILURE AND RENAL TRANSPLANTATION
KroniÄno bubrežno zatajenje (KBZ) povezano je sa znaÄajnim utjecajem na hemostazu koje se može kliniÄki manifestirati u rasponu od tromboze do krvarenja. Patogeneza uremiÄkog krvarenja povezana je s mnogobrojnim Äimbenicima. Njen vodeÄi uzrok je trombocitna disfunkcija unutar koje je naroÄito poremeÄeno meÄudjelovanje trombocita kao i trombocita i stijenke krvne žile. Bubrežna nadomjesna terapija smanjuje pojavnost i težinu krvarenja, ali unatoÄ tome joÅ” uvijek postoji rizik od njenog nastanka. PoremeÄaji koagulacijskog-fibrinolitiÄkog sustava kod uremiÄnih bolesnika koji vode protrombotskom stanju povezani su sa znaÄajnim rizikom od aterosklerotskih kardiovaskularnih bolesti kao i trombotskih komplikacija poput tromboze vaskularnih pristupa. U bolesnika s KBZ-om postoje razlike u hemostatskim parametrima ovisno o vrsti bubrežnog nadomjesnog postupka. PoremeÄaji hemostaze koji se uoÄavaju kod bolesnika s KBZ-om preklapaju se s promjenama u koagulacijsko-fibrinolitiÄkom sustavu koje nastaju nakon transplantacije bubrega. UnatoÄ etiologiji, bolesnici s transplantiranim bubregom poveÄanog su rizika za razvoj tromboembolijskih dogaÄaja kao rezultat protrombotskog stanja zbog abnormalnosti koagulacijsko/fibrinolitiÄkog sustava. To hiperkoagulabilno stanje u velikoj je mjeri povezano s imunosupresivnom terapijom. Ovaj pregledni Älanak daje sažeti pogled na hemostazu u bolesnika s KBZ-om i nakon transplantacije bubrega.The presence of end-stage renal disease (ESRD) has been associated with profound clinical effects on hemostasis ranging from thrombosis to bleeding complications. The pathogenesis of uremic bleeding is multifactorial. It has been attributed to platelet dysfunction, the most important feature, particularly platelet-platelet and platelet-vessel wall interactions. Renal replacement therapy has helped reduce bleeding episodes, but the risk of morbidity and mortality due to hemorrhage persists. Abnormalities of blood coagulation and fibrinolysis predispose uremic patients to hypercoagulable state carrying the risk of atherosclerotic cardiovascular disease and thrombotic complications such as thrombosis of the vascular access wall. There are differences in the measurement of various hemostatic parameters in patients with ESRD concerning treatment with either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Hemostatic disturbances are overlapped by changes in the coagulation/ fibrinolytic system after renal transplantation (RT). Despite the etiology, renal transplant patients are at an increased risk of thromboembolic events as a consequence of prothrombotic clotting and fibrinolytic abnormalities. This hypercoagulable state is to a large extent associated with immunosuppressive drugs. This review will give a summary of views on hemostasis in patients with ESRD and after RT
Definition of Acetylsalicylic Acid Resistance Using Whole Blood Impedance Aggregometry in Patients Undergoing Coronary Artery Surgery
A beneficial effect of acetylsalicylic acid (ASA) on vein graft patency has been described, but some patients experience adverse cardiac events despite appropriate ASA treatment. Study aim was to define ASA resistance using Multiple elec- trode aggregometry (MEA) preoperatively in group of patients undergoing coronary artery bypass grafting (CABG). Pro- spective observational trial at University Hospital Center Zagreb enrolled 131 patients scheduled for CABG, and divided them into 4 groups with respect to preoperative antiplatelet therapy (APT). Group 1 received 100 mg ASA per day, Group 2 100 mg ASA + 75 mg clopidogrel per day, Group 3 75 mg clopidogrel per day, and Group 4 did not receive any APT. MEA with ASPI test (sensitive to ASA) and ADP test (sensitive to clopidogrel) was performed prior to surgery. In Group 1, patients were characterized as ASA resistant if their ASPI test value exceeded the 75 th percentile distribution. Study en- rolled 131 patients. Significant differences both in the ASPI (p<0.001) and the ADP test (p=0.038) were observed be- tween patients in different APT groups. In Group (1) ASPI test value of 30 AUC presented 75 th percentile of distribution, thus indicating ASA resistance. Group 2 patients had slightly lower ADP test values, but no significant difference oc- curred (mean 60.05 vs. 63.32 AUC, p=0.469). In Group 1 and 2, significant correlations between the ADP test and both, platelet count (r=0.347, p<0.001) and fibrinogen level (r=0.364, p<0.001) were observed. Association between low re- sponse to ASA and post-CABG major adverse ischemic events risk increase has been described thus indicating need for ASA resistant patients detection. In patients with preoperative ASPI test exceeding 30 AUC postoperative, ASA dose ad- justment or clopidogrel addition according to MEA results should be considered
A diagnosis of a renal injury by early biomarkers in patients exposed to cardiopulmonary bypass during cardiac surgery
We prospectively studied renal function in 158 patients scheduled for elective cardiac surgery with the use of cardiopulmonary
bypass (CPB).
The patients involved in this study had normal renal function as well as normal function of the left ventricle. The results of
the study showed a statistically significant increase of early markers of renal injury Alpha-1-Microglobulin (A1M) and Neutrophil
Gelatinase-Associated Lipocalin (NGAL), which were being traced in the patientsā urine 5 hours and 24 hours after
CPB. In contrast with the aforementioned early markers, the so-called āclassicalā markers of renal injury ā serum urea and
creatinine ā did not show a statistical significance of value increase after CPB. Using early factors of renal injury A1M and
NGAL, the study managed to show slight, subclinical injuries of the proximal renal tubules after CPB and cardiac surgeries.
The value of these factors lies in their early and precise detection of renal injury, which is a significant clinical parameter for
monitoring renal function, especially after cardiac surgery with the use of CPB
Successful separation of xypho-omphalopagus conjoined twins with extrauterine twin-twin transfusion syndrome: a case report
Conjoined twining is a rare medical phenomenon, with an overall prevalence of 1.47 per 100ā000 births. This report describes a successful separation of xypho-omphalopagus conjoined twins complicated by unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma. Significant extrauterine twin-twin transfusion syndrome caused by unbalanced shunting is an extremely rare, and probably under-recognized, hemodynamic complication in conjoined twins necessitating urgent separation. Progressive deterioration with a poor outcome can be prevented if the condition is recognized in a timely manner