Kraniocerebralne ozljede u osoba s alkoholnom bolešću

The issue of severe head injuries in alcohol abusers is presented. During the 1993 - 2002 period, 3700 patients with a history of alcohol abuse were treated for severe head injuries at the University Department of Neurosurgery, Sestre milosrdnice University Hospital in Zagreb. The leading injury was brain concussion, followed by acute subdural hematoma. Severe head injury in alcohol abusers results in high mortality and morbidity in both younger and older population. The mortality rate in patients who underwent surgery ranged between 23% and 55%, and in those not operated on between 38% and 85%.U radu su prikazane kraniocerebralne ozljede u populaciji osoba s alkoholnom bolešću. Provedena je retrospektivna analiza bolesnika koji su liječeni u Klinici za neurokirurgiju Kliničke bolnice "Sestre milosrdnice" u razdoblju od 1993. do 2002. godine. U prikazanom materijalu prevladavaju teške kraniocerebralne ozljede koje se najčešće očituju kao akutni subduralni hematomi, često u kombinaciji s teškim nagnječenjem mozga i politraumom. Ove ozljede rezultiraju izrazito visokim stupnjem smrtnosti i pobola kako u mlađim tako i u starijim dobnim skupinama. Kod neoperiranih bolesnika kreću se u rasponu od 23% do 55%, a kod operiranih bolesnika od 38% do 85%

Prva iskustva u endoluminalnoj rekonstrukciji aneurizme abdominalne aorte uz upotrebu bifurkacijske proteze

The procedure of non-ruptured abdominal aortic aneurysm endoluminal repair is described. The first two procedures in Croatia by use of an AneuRx stent graft were performed in two patients admitted to the Division of Vascular Surgery, Sestre milosrdnice University Hospital in Zagreb. To our knowledge, these were the first self-supporting procedures carried out in Croatia. The principal characteristics of endoluminal material and equipment as well as their use are presented. Preoperative diagnostic procedures and postoperative course in the two patients are also described. Special emphasis is given to the indications and contraindications for this type of procedure as well as to the major possible complications. Endoluminal repair for aortic aneurysm is a new and revolutionary approach to the treatment of this serious and severe illness. Endovascular surgery is expected to mark the first decade of the new millennium.Prikazan je postupak endoluminalne rekonstrukcije nerupturirane aneurizme abdominalne aorte. Operacije je izvedena u dvojice bolesnika na Odjelu za vaskularnu kirurgiju Kliničke bolnice “Sestre milosrdnice” u Zagrebu, upotrebom AneuRx stent grafta. Prema našim spoznajama, operacija je prvi put samostalno učinjena u Hrvatskoj. Prikazana su glavna obilježja materijala i uređaja te njihova primjena. Također se daje prikaz prijeoperacijske dijagnostike i poslijeoperacijskog tijeka u dvojice operiranih bolesnika. Navedene su indikacije i kontraindikacije za primjenu postupka, kao i glavne moguće komplikacije. Endoluminalni način u liječenju aneurizme abdominalne aorte predstavlja nov i revolucionaran pristup, primjena kojega će doći do izražaja u prvom desetljeću novoga tisućljeća

Prva iskustva u endoluminalnoj rekonstrukciji aneurizme abdominalne aorte uz upotrebu bifurkacijske proteze

The procedure of non-ruptured abdominal aortic aneurysm endoluminal repair is described. The first two procedures in Croatia by use of an AneuRx stent graft were performed in two patients admitted to the Division of Vascular Surgery, Sestre milosrdnice University Hospital in Zagreb. To our knowledge, these were the first self-supporting procedures carried out in Croatia. The principal characteristics of endoluminal material and equipment as well as their use are presented. Preoperative diagnostic procedures and postoperative course in the two patients are also described. Special emphasis is given to the indications and contraindications for this type of procedure as well as to the major possible complications. Endoluminal repair for aortic aneurysm is a new and revolutionary approach to the treatment of this serious and severe illness. Endovascular surgery is expected to mark the first decade of the new millennium.Prikazan je postupak endoluminalne rekonstrukcije nerupturirane aneurizme abdominalne aorte. Operacije je izvedena u dvojice bolesnika na Odjelu za vaskularnu kirurgiju Kliničke bolnice “Sestre milosrdnice” u Zagrebu, upotrebom AneuRx stent grafta. Prema našim spoznajama, operacija je prvi put samostalno učinjena u Hrvatskoj. Prikazana su glavna obilježja materijala i uređaja te njihova primjena. Također se daje prikaz prijeoperacijske dijagnostike i poslijeoperacijskog tijeka u dvojice operiranih bolesnika. Navedene su indikacije i kontraindikacije za primjenu postupka, kao i glavne moguće komplikacije. Endoluminalni način u liječenju aneurizme abdominalne aorte predstavlja nov i revolucionaran pristup, primjena kojega će doći do izražaja u prvom desetljeću novoga tisućljeća

Intrakranijski venski angiomi - prikaz slučaja

Two cases of intracranial venous angiomas, one in a 42-year-old woman and another one in a 27-year-old-man, are presented. Intracranial venous angiomas, also known as developmental venous anomalies, represent one of four cerebral vascular malformations. Usually they are incidentally discovered on cerebral imaging. These lesions have a characteristic appearance in the venous phase of angiography, a starburst pattern or umbrella sign, described as caput medusae. Most of the lesions are clinically silent, however, they can be symptomatic with clinical presentation including seizures, headache, dizziness and focal neurologic deficits. They are sometimes associated with cerebral hemorrhage. In general, no treatment is required. Surgery is only indicated if seizures attributed to the lesion or hemorrhage occur.Prikazana su dva slučaja intrakranijskih venskih angioma, jedan u 42-godišnje žene i drugi u 27-godišnjeg muškarca. Intrakranijski venski angiomi, također poznati kao razvojne venske anomalije, čine jednu od četiri cerebralne malformacije. Obično se slučajno otkrivaju neuroradiološkom obradom. Ove lezije se znakovito prikazuju u venskoj fazi angiograma kao zvjezdasti uzorak ili poput kišobrana, što se opisuje kao caput medusae. Većina venskih angioma su klinički asimptomatski, iako mogu biti i simptomatski te se tada klinički očituju epileptičnim napadajem, glavoboljom, vrtoglavicom i žarišnim neurološkim deficitom. Ponekad su povezani s intracerebralnim krvarenjem. U većini slučajeva ne zahtijevaju liječenje. Operacijsko liječenje je indicirano samo u slučajevima dokazane povezanosti angioma i epileptičnih napadaja odnosno u slučaju krvarenja

Pallister Killian Syndrome: Unusual Significant Postnatal Overgrowth in a Girl with otherwise Typical Presentation

Pallister Killian syndrome (PKS) is a rare genetic disorder caused by tetrasomy of the short arm of chromosome 12, revealed usually in mosaic distribution of an extra i(12)(p10) chromosome in fibroblasts. The syndrome presents with a recognizable pattern of findings including pigmentary skin changes, coarse face, high forehead, sparse anterior scalp hair, hypertelorism, seizures and progressive psychomotor developmental delay. It was first described independently by Pallister in 1977 and by Killian and Teschler-Nikola in 19811,2. We report a case of 21 month old girl with PKS and significant overgrowth. Cytogenetic analysis was performed using the GTG banding technique. The karyotype of cultured lymphocytes was normal. The karyotype from skin fibroblasts was established as mosaic tetrasomy of 12p 47,XX,+i(12) (p10)/46,XX. The origin of the extra marker chromosome was determinated by fluorescence in situ hybridization with chromosome 12 specific DNA probes confirming that supernumerary marker is chromosome i(12p) in 68% of cells. Despite the excessive postnatal growth we found low serum growth hormone levels and reduced response to pharmacological stimulation test. This is also the first report of a postnatal patient in our country

Pallister Killian Syndrome: Unusual Significant Postnatal Overgrowth in a Girl with otherwise Typical Presentation

Pallister Killian syndrome (PKS) is a rare genetic disorder caused by tetrasomy of the short arm of chromosome 12, revealed usually in mosaic distribution of an extra i(12)(p10) chromosome in fibroblasts. The syndrome presents with a recognizable pattern of findings including pigmentary skin changes, coarse face, high forehead, sparse anterior scalp hair, hypertelorism, seizures and progressive psychomotor developmental delay. It was first described independently by Pallister in 1977 and by Killian and Teschler-Nikola in 19811,2. We report a case of 21 month old girl with PKS and significant overgrowth. Cytogenetic analysis was performed using the GTG banding technique. The karyotype of cultured lymphocytes was normal. The karyotype from skin fibroblasts was established as mosaic tetrasomy of 12p 47,XX,+i(12) (p10)/46,XX. The origin of the extra marker chromosome was determinated by fluorescence in situ hybridization with chromosome 12 specific DNA probes confirming that supernumerary marker is chromosome i(12p) in 68% of cells. Despite the excessive postnatal growth we found low serum growth hormone levels and reduced response to pharmacological stimulation test. This is also the first report of a postnatal patient in our country

Udaljena endarterektomija s ugradnjom endoluminalnog stenta: alternativni postupak u revaskularizaciji obliterirane bedrene arterije

Remote endarterectomy is an endovascular, minimally invasive approach in the treatment of obliterated femoral artery. Successful revascularization of the superficial femoral artery achieved by the procedure of remote endarterectomy using the Mollring Cutter device, followed by endoluminal stent positioning at the distal intimal flap, is described. A 72-year-old man with obliteration of the right femoral artery and intermittent claudication was operated on with this endovascular procedure. The operation lasted 70 minutes. The postoperative period was uneventful. A 64-year old man with obliteration of the femoral artery and ischemic ulcers on the same leg underwent the same procedure, which took 68 minutes. Peripheral pulses were normal at discharge.Udaljena endarterektomija predstavlja endovaskularni pristup i minimalno invazivni postupak u liječenju obliteracije bedrene arterije. Prikazane su uspješno učinjene revaskularizacije površinske bedrene arterije primjenom postupka udaljene endarterektomije upotrebom Mollring Cuttera uz postavljanje endoluminalnog stenta na distalnoj stubi. Bolesnik u dobi od 72 godine s obliteracijom desne bedrene arterije te klaudikacijskim tegobama operiran je ovim endovaskularnim postupkom. Operacijski zahvat trajao je 70 minuta. Poslijeoperacijski tijek protekao je uredno. Bolesnik star 64 godine s obliteracijom bedrene arterije i ishemijskim ulkusom na istoj nozi operiran je istim postupkom. Kirurški zahvat trajao je 68 minuta. Pri otpustu imao je uredne periferne pulzacije

Kronična disekcija prsne aorte: liječenje ugradnjom endoluminalnog stenta

Chronic dissection of thoracic aorta is the subject of cardiac surgery and its treatment is burdened with high mortality and morbidity. The procedure of endoluminal stent graft placement in a 53-year-old male patient with an 8 cm wide false lumen is presented. Two stent grafts of 148 and 94 mm in length, both 44 mm in diameter, were applied. The surgical procedure lasted 6 hours. Thrombosis of the false lumen was registered perioperatively. The postoperative period proceeded without serious complications.Kronična disekcija prsne aorte predmetom je sretane kirurgije, a njezino liječenje opterećeno je visokom smrtnošću i pobolom. Prikazan je zahvat ugradnje endoluminalnog stenta u 53-godišnjeg bolesnika s 8 cm širokim lažnim lumenom. Primijenjena su dva stent usatka duljine 148 i 94 mm i promjera 44 mm oba. Kirurški zahvat trajao je 6 sati. Prijeoperacijski je zabilježena tromboza lažnog lumena. Poslijeoperacijski tijek protekao je bez ozbiljnijih komplikacija