Frequency of endoleaks after endovascular treatment of abdominal aortic aneurysm

Nowadays, there are more and more advantages of endovascular treatments for aneurysms of the abdominal aorta compared to open surgical treatment. Endovascular procedure is less invasive and the mortality rate is significantly lower in contrast to open surgical treatment. One of the complications of endovascular treatment of abdominal aortic aneurysm is the occurrence of permeability or endoleak. In this paper, we investigated the frequency and characteristics of endoleaks in patients treated endovascularly for the abdominal aortic aneurysm. Work methods are based on statistical data processing of 60 patients who were treated at the Clinical Department for diagnostic and interventional radiology, University Hospital Split. The data is collected from the archives of the mentioned clinical institute from patients who were treated in the period from January 2016 to May 2019. The analysis revealed that endoleak appeared in 63% of patients. The most common type of endoleak that occurred was endoleak type II. Reintervention related to endoleak was required in 4 patients. In most patients, endoleak type II gradually receded and did not require re-intervention. The average follow-up time of the patients analyzed in this study was 26 months. The average number of controls was 4. Endovascular treatment is a newer method of treatment and constant monitoring of the implanted stent-graft is required

Otitis media with effusion - evaluation and therapy

Sekretorna upala srednjega uha odnosi se na negnojnu sekreciju iza intaktnog bubnjića koja nije povezana s akutnim simptomima upale uha ili sistemnim znakovima upale. Sekret je gotovo sterilan. Proces se može podijeliti na akutni (sekrecija traje do tri tjedna), subakutni (sekrecija traje do tri mjeseca) i kronični (sekrecija traje dulje od tri mjeseca). Sekretorni otitis media je najčešća bolest uha u djece vrtićke i školske dobi te jedna od najčešćih bolesti uopće. Bolest je najčešće samolimitirajuća, ali može utjecati na razvoj sluha i govora. U prosjeku 3 – 4 % djece ima kroničnu formu sekretorne upale uha (Probst et al, 2006). Glavni uzroci sekretornog otitisa slabija su funkcija Eustahijeve cijevi i povećana mukolitička aktivnost žlijezda. Dva su vrška pojavnosti – dvije i pet godina (Graham et al, 2007). Najčešće je razdoblje pojavljivanja ove bolesti zimski period. Simptomi su kod djece često odsutni, a glavni simptom, na koji se djeca rijetko žale, gubitak je sluha. Starija djeca se žale na bolnost i pucketanje uha. Dio djece ima problema sa spavanjem i koncentracijom. Dijagnoza se postavlja otoskopski, pri čemu bubnjić bude žućkast ili plavičast, slabo mobilan te se vide krvne žilice po bubnjiću, zatim timpanometrijom, gdje se uočava ravna krivulja na timpanogramu i audiometrijom. U odraslih, bolest je ista kao kod djece, s tim da treba pomisliti i na neke druge uzroke, koji se neće naći kod djece, primjerice „sleep apnea“ sindrom ili tumor nazofarinksa. Stoga je potrebna i dodatna dijagnostička obrada. Liječenje kod akutnih i subakutnih oblika većinom je konzervativno, dok liječenje kroničnog oblika u slučaju gubitka sluha treba biti kirurški, paracentezom i ugradnjom ventilacijskih cjevčica, ako se smatra da je tako najbolje za dijete nakon razdoblja „pažljivog nadgledanja“.Otitis media with effusion refers to nonpurulent secretion behind an intact tympanic membrane that is not associated with acute otologic symptoms or systemic signs. Secretion is almost sterile. The process may be classified as acute (effusion lasting up to 3 weeks), subacute (up to 3 months), or chronic (more than 3 months). Otitis media with effusion is the most common ear disease in preschool-age children and one of the most common diseases altogether. Approximately 3 – 4 % of children have a chronic form (Probst et al, 2006). The main causes od OME are malfunctioning of Eustachian tube and increased mucolytic activity of glands. There are two peaks of distribution, 2 years and 5 years (Graham et al, 2007). The most common period of appearance is during the winter. There is usually a lack of symptoms in children, and the main symptom, which children rarely complain of, is hearing loss. Older children usually complain of pain and crackling in the ear. Some children have problems with sleeping or concentration. Diagnosis is made otoscopically, where gold or bluish colouration of the tympanic membrane, low mobility and small blood vessels can be found, tympanometrically, with a flat curve on the tympanogram and audiometrically. In adults, the disease is the same as in children, but it is important to think about some other causes, which won't be found in children, such as sleep apnea syndrome or nasopharyngeal tumors, so additional diagnostic tests should be done. The treatment of acute and subacute types is conservative, while the treatment of chronic type in situations of hearing loss should be surgical - paracentesis and implantation of ventilation tubes, if it is considered to be the best way, after a period of „careful observation“

Gender differences in risk factors and cardiovascular outcomes in symptomatic peripheral artery disease patients

AIM: To compare the influence of gender on adverse cardiovascular events in patients with sympto- matic peripheral artery disease (PAD) based on their clinical presentation (intermittent claudication or critical limb ischemia, CLI). PATIENTS AND METHODS: A prospective, registry-based study involving patients with symp- tomatic peripheral artery disease was conducted. Patients were divided according to initial clinical presentation (intermittent claudication or CLI) and gender and were analyzed separately. Risk factors, prognosticators and longitudinal events (major adverse cardiovascular events, MACE: myocardial infarction, stroke, death) were collected. Data were obtained prospectively from hospital records and death certificates. RESULTS: 1084 patients (35% women) with symptomatic PAD were included in the study. Mean follow-up period was 45 months, and 371 patients (34%) experienced MACE. Compared to males, females were older (p <0.001) and were more likely to have CLI (p=0.006) and impaired renal func- tion (p <0.001). Diabetes (p=0.043) and smoking (p <0.001) were more prevalent in men, as well as polyvascular disease (p=0.024). No significant difference was found regarding the use of medications. No differences were observed in MACE-free survival between women and men, both in subgroups of patients with intermittent claudication (log-rank p=0.759) and CLI (log-rank p=0.558). CONCLUSIONS: Our study showed no gender differences in the occurrence of MACE based on initial clinical presentations of PAD

Subacute aortic dissection – case report

60-godišnjeg bolesnika s poznatom ljevostranom nefrolitijazom i arterijskom hipertenzijom. Hitna je služba u nekoliko navrata obrađivala zbog boli u lumbalnoj regiji. Tijekom obrade utvrđene su povišene vrijednosti arterijskog tlaka i povišene razine kreatinina u serumu, međutim, bez prikladnog ultrazvučnog prikaza desnog bubrega. Pri obradi u našoj ustanovi ultrazvučno i obojenim doplerom postavljena je sumnja na infarkt desnog bubrega, koja je potvrđena MSCT angiografijom uz popratnu disekciju descendentne aorte. Cilj je ovog članka upozoriti na potrebu proširenih dijagnostičkih pretraga pri pojavi naglo nastale boli u lumbalnoj regiji radi isključivanja potencijalno fatalnih komplikacija i prevencije smrtnog ishoda.A 60-year-old man with previously known left-sided nephrolithiasis and arterial hypertension has been examined several times in an emergency room because of the pain in the lumbar area. During an examination, high blood pressure and increased creatinine levels have been verified, without adequate ultrasound of the right kidney. During an examination in our hospital, kidney ultrasound and color Doppler showed suspected infarction of the right kidney. MSCT angiography showed the infarction of the right kidney and the dissection of the descending aorta. The purpose of this article is to warn about the importance of expanded diagnostic procedures when an acute lumbar pain occurs, in order to exclude potentially fatal complications and to prevent lethal outcome

Acute heart failure due to the left atrial myxoma causing mitral valve obstruction

A 64 year-old woman without history of cardiovascular diseases and without cardiovascular risk factors was referred to our hospital because of acute heart failure. A real-time three-dimensional echocardiography (3D) revealed left atrium tumor causing mitral valve obstruction. 3D characteristics of the tumor were highly suggestive of cardiac myxoma. Surgical excision was successfully performed and myxoma was confirmed histologically. Although cardiac myxoma typically presents a silent heart failure, our case suggests that it should be even considered a cause of acute heart failure, especially in patients with no previous history or signs of cardiovascular disease