10 research outputs found
A Rare Case of Multiple Aneurysms in a Young Patient
Multiple aneurysms are clinically common in population aged over sixty and are caused mainly by atherosclerosis.
When occurring in young population other etiologies such as trauma, infections, Bechetās disease, Marfan syndrome,
neurofibromatosis or inflammatory disease are responsible for the development of arterial aneurysms. A rare case of
multiple aneurysms in a 40-year-old man, affecting the infrarenal part of abdominal aorta, both iliac arteries, common
femoral arteries, left femoral superficial and popliteal arteries on both legs, is reported. The underlying pathology was
progressive atherosclerosis, favored by familial hyperlipidemia and excessive cigarette smoking
EARLY CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS ā OUR EXPERIENCE
U ovoj je studiji analiziran uÄinak endarterektomije unutarnje karotidne arterije (ACI) u bolesnika unutar tri tjedna od razvoja neuroloÅ”ke simptomatologije s obzirom na uÄestalost i vrstu neželjenih dogaÄaja u poslijeoperacijskom tijeku. U studiju su ukljuÄeni bolesnici sa simptomatskom stenozom visokog stupnja ACI, koji su preboljeli ishemijski moždani udar (IMU) ili tranzitornu ishemijsku ataku (TIA). Kod svih je bolesnika uÄinjena uzdužna karotidna endarterektomija u opÄoj anesteziji s uporabom intraluminalnog shunt-a. PraÄenje bolesnika se odnosi na razdoblje izmeÄu sijeÄnja 2008. i listopada 2012. godine kada je operirano ukupno 69 simptomatskih bolesnika s visokim stupnjem stenoze ACI (70-99 %). Kontrolni ultrazvuk karotidnih arterija (CD) raÄen je sedmi poslijeoperacijski dan te nakon jednog, tri, Å”est i dvanaest mjeseci, a nakon toga jednom godiÅ”nje. Od ukupnog broja operiranih (n = 69), 27 (39 %) bolesnika bilo je sa svježe preboljelim IMU-om koji su operirani unutar tri tjedna od razvoja neuroloÅ”ke simptomatologije, a najranije Äetrnaest dana nakon razvoja inzulta i 42 (61 %) bolesnika sa simptomima TIA-e, a koji su operirani neposredno nakon zavrÅ”etka prijeoperacijske obrade. Od poslijeoperacijskih neželjenih dogaÄaja doÅ”lo je do razvoja IMU-a u 2 (2,63 %) bolesnika i 2 odgoÄene restenoze (2,63 %) endarterektomirane unutarnje karotidne arterije koje su zahtijevale endovaskularno lijeÄenje. ZakljuÄujemo da provoÄenje rane endarterektomije u kliniÄki odabranih bolesnika s visokim stupnjem stenoze ACI, shodno naÅ”im rezultatima i rezultatima drugih studija, ne nosi veÄi rizik od kasne endarterektomije, a zasigurno snižava postotak recidiva IMU i TIA-a, koji su najÄeÅ”Äi u ranom razdoblju razvoja neuroloÅ”ke simptomatologije.Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlinās sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61%) patients had TIA symptoms with verified significant ACI stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid end-
arterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely
ACUTE ABDOMEN TWO DAYS AFTER VAGINAL BIRTH AFTER CESAREAN SECTION
Prikazan je sluÄaj akutnoga abdomena u babinju sa znacima difuznoga peritonitisa i paralitiÄnoga ileusa nastalih dva dana nakon nezamijeÄenog kompletnog razdora maternice u vaginalnom poroÄaju poslije prethodnoga carskoga reza i manualne eksploracije
materiÅ”ta. UÄinjena je eksploracijska laparotomija, intestinalna adhezioliza, revizija i Å”avi maternice, lavaža trbuÅ”ne Å”upljine i drenaža. Nakon operacije bolesnica se potpuno oporavila uz saÄuvanu fertilnost. Raspravlja se o medicinskim i forenziÄkim aspektima.A case is presented of puerperal acute abdomen with diffuse peritonitis and paralytic ileus two days after unnoticed complete uterine rupture after VBAC (vaginal birth after cesarean section) and uterine cavity obstetric examination. Explorative laparotomy,
intestinal adhesiolysis, uterine revision and sutures, abdominal lavage and drainage were performed. The operation was followed by successful recovery and intact fertility. Medical and forensic aspects are discussed
RARE DISORDERS OF EXTRACRANIAL CAROTID ARTERIES
Prikazana su dva rjeÄa sluÄaja bolesti ekstrakranijskih karotidnih arterija s osvrtom na naÄin kirurÅ”kog lijeÄenja. Radi se o zavojitosti (engl. coiling) unutarnje karotidne arterije (ACI). Oba su bolesnika podvrgnuta uspjeÅ”nom kirurÅ”kom lijeÄenju. U prvom sluÄaju opisana je simptomatska kombinacija presavinuÄa (engl. kinking) i zavojitosti ipsilateralne ACI, bez prateÄe stenoze ACI, a uÄinjena je resekcija ACI, uz reanastomozu. Druga je bolesnica imala dvostruku zavojitost ACI, odnosno ACI je formirala dvostruku petlju, uz subtotalnu simptomatsku stenozu poÄetnog segmenta ACI. Pri operaciji je uÄinjena resekcija produženog segmenta, koja je ukljuÄivala i podruÄje stenoze ACI, uz naknadnu reanastomozu. S obzirom na rijetkost navedenih bolesti karotidnih arterija i Äinjenice da dosada u literaturi nisu objavljene veÄe studije osim opisa pojedinaÄnih sluÄajeva, svako dodatno iskustvo i prikaz lijeÄenja doprinijet Äe daljnjem razumijevanju i smjernicama u lijeÄenju ovih rijetkih bolesti.Abnormalities of the internal carotid arteries (ACI) are rare findings, usually not linked with neurologic symptoms and frequently are diagnosed during routine duplex scanning or angiographic examination. These abnormalities are predominantly elongation of the vessel that leads to kinking, coiling or tortuosity of the artery, and the origin is congenital or acquired related to atherosclerosis. We report on two symptomatic cases related to elongation of ACI. The first case was a 56-year-old female that had bilateral coiling. The second patient was a 64-year-old female that suffered from symptomatic double coiling of the left ACI connected with high grade stenosis. In both cases, successful operation was done with resection of the elongated and stenosed ACI segment and reanastomosis of the ACI and common carotid artery. Postoperatively, symptoms were resolved. In symptomatic cases of isolated carotid elongations, surgical treatment is a better option than conservative medical treatment alone, whilst in asymptomatic ACI elongation, conservative medical treatment is advised
BILE STONE ILEUS WITH CHOLECYSTODUODENAL FISTULA ā BOUVERETāS SYNDROME
U prikazu kliniÄkog sluÄaja rijeÄ je o visokoriziÄnom kardijalnom sedamdesetjednogodiÅ”njem bolesniku, koji je primljen u hitnoj službi sa simptomima visoke temperature, kontinuiranim povraÄanjem i bolovima u epigastriju i pod desnim rebrenim lukom. Kompjuteriziranom tomografijom pronaÄena je patoloÅ”ka komunikacija žuÄnog mjehura s dvanaesnikom te veÄi žuÄni kamen koji opstruira silazni dio dvanaesnika ispred donjeg koljena. Bolesnik je podvrgnut uspjeÅ”nom kirurÅ”kom lijeÄenju.This is a case report of a 71-year-old man, who presented to emergency department with elevated temperature, vomiting and
epigastric pain. Computed tomography of the abdomen revealed a large fistulous tract extending from the gallbladder to the duodenal bulb, as well as a large calculus obstructing the second part of the duodenum. The patient subsequently underwent successful surgical therapy