Acute mesenteric ischemia caused by isolated dissection of the superior mesenteric artery and thrombotic occlusion of its major branches: treatment by systemic thrombolysis with recombinant tissue plasminogen activator (rtPA)

Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dissection, is relatively uncommon. Therefore, there are insufficient data to support a particular therapeutic option in the specific setting of isolated SMA dissection associated with thrombotic complications. Case report. In this article we describe the diagnosis and treatment of a patient who presented to the Emergency Department with the clinical picture of an acute abdomen and signs suggestive of acute occlusion of the SMA. Diagnostic studies showed an isolated SMA dissection with acute thrombotic occlusion of its main branches. The patient was successfully treated with systemic recombinant tissue plasminogen activator (rtPA) thrombolysis. To the best of our knowledge, this is the first description of a case of isolated SMA dissection associated with thrombotic occlusion of its main branches. Conclusion. In patients presenting with persistent abdominal pain and unspecific clinical findings, rare causes should be considered because of their life threatening complications. Systemic thrombolysis is a feasible technique for the treatment of isolated SMA dissection associated with thrombotic complications in the absence of bowel necrosis

Acute mesenteric ischemia caused by isolated dissection of the superior mesenteric artery and thrombotic occlusion of its major branches: treatment by systemic thrombolysis with recombinant tissue plasminogen activator (rtPA)

Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dissection, is relatively uncommon. Therefore, there are insufficient data to support a particular therapeutic option in the specific setting of isolated SMA dissection associated with thrombotic complications. Case report. In this article we describe the diagnosis and treatment of a patient who presented to the Emergency Department with the clinical picture of an acute abdomen and signs suggestive of acute occlusion of the SMA. Diagnostic studies showed an isolated SMA dissection with acute thrombotic occlusion of its main branches. The patient was successfully treated with systemic recombinant tissue plasminogen activator (rtPA) thrombolysis. To the best of our knowledge, this is the first description of a case of isolated SMA dissection associated with thrombotic occlusion of its main branches. Conclusion. In patients presenting with persistent abdominal pain and unspecific clinical findings, rare causes should be considered because of their life threatening complications. Systemic thrombolysis is a feasible technique for the treatment of isolated SMA dissection associated with thrombotic complications in the absence of bowel necrosis

Towards a Low-Cost Mobile Subcutaneous Vein Detection Solution Using Near-Infrared Spectroscopy

Excessive venipunctures are both time- and resource-consuming events, which cause anxiety, pain, and distress in patients, or can lead to severe harmful injuries. We propose a low-cost mobile health solution for subcutaneous vein detection using near-infrared spectroscopy, along with an assessment of the current state of the art in this field. The first objective of this study was to get a deeper overview of the research topic, through the initial team discussions and a detailed literature review (using both academic and grey literature). The second objective, that is, identifying the commercial systems employing near-infrared spectroscopy, was conducted using the PubMed database. The goal of the third objective was to identify and evaluate (using the IEEE Xplore database) the research efforts in the field of low-cost near-infrared imaging in general, as a basis for the conceptual model of the upcoming prototype. Although the reviewed commercial devices have demonstrated usefulness and value for peripheral veins visualization, other evaluated clinical outcomes are less conclusive. Previous studies regarding low-cost near-infrared systems demonstrated the general feasibility of developing cost-effective vein detection systems; however, their limitations are restricting their applicability to clinical practice. Finally, based on the current findings, we outline the future research direction

Lemierre’s syndrome: case of a patient with pulmonary embolism and cavernous sinus thrombosis complicating a septic internal jugular vein thrombus

Lemierre’s syndrome is a complex and unusual clinical entity, characterized by septic thrombophlebitis of the internal jugular vein. We present the case of a patient with Lemierre’s syndrome, pulmonary embolism and propagation of an internal jugular vein thrombus retrograde to the cavernous sinus. The patient was treated with antibiotics and heparin. The importance of rapid diagnosis of the extent of the disease, in directing the otherwise somewhat controversial treatment with heparin in patients with Lemierre’s syndrome, is stressed

Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom tijekom karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnog premošćivanja

Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarterectomy, surgical management of intracranial aneurysms and coronary artery bypass grafting is important because it enables recording of the flow in the middle cerebral artery in real time. An adequate blood flow through the middle cerebral artery during carotid endarterectomy allows for selective choice of intraluminal shunt as well as an operation without it, timely identification of cerebral hyperperfusion, vasospasm and hypoperfusion, and detection of cerebral microembolisms, thus minimizing postoperative neurologic complications such as cerebrovascular events or cognitive dysfunction.Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom za vrijeme karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnih premoštenja veoma je značajno, jer omogućava promatranje protoka u srednjoj moždanoj arteriji u stvarnom vremenu. Dostatan protok krvi u srednjoj moždanoj arteriji za vrijeme karotidne endarterektomije omogućava selektivan izbor intraluminalog spoja (shunt) i operaciju bez njega, pravodobno otkrivanje moždane hiperperfuzije, vazospazma, hipoperfuzije i cerebralnih mikroembolija, što može bitno smanjiti poslijeoperacijske neurološke komplikacije kao cerebrovaskularni incident ili kognitivnu disfunkciju

Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom tijekom karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnog premošćivanja

Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarterectomy, surgical management of intracranial aneurysms and coronary artery bypass grafting is important because it enables recording of the flow in the middle cerebral artery in real time. An adequate blood flow through the middle cerebral artery during carotid endarterectomy allows for selective choice of intraluminal shunt as well as an operation without it, timely identification of cerebral hyperperfusion, vasospasm and hypoperfusion, and detection of cerebral microembolisms, thus minimizing postoperative neurologic complications such as cerebrovascular events or cognitive dysfunction.Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom za vrijeme karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnih premoštenja veoma je značajno, jer omogućava promatranje protoka u srednjoj moždanoj arteriji u stvarnom vremenu. Dostatan protok krvi u srednjoj moždanoj arteriji za vrijeme karotidne endarterektomije omogućava selektivan izbor intraluminalog spoja (shunt) i operaciju bez njega, pravodobno otkrivanje moždane hiperperfuzije, vazospazma, hipoperfuzije i cerebralnih mikroembolija, što može bitno smanjiti poslijeoperacijske neurološke komplikacije kao cerebrovaskularni incident ili kognitivnu disfunkciju

Modelling the mechanical response of two-layered artery using thermomechanical analogy approach

Ovaj rad obrađuje problem predviđanja mehaničkog odziva dijela zajedničke arterije glave (ZAG). Zaostala naprezanja u arteriji uzeta su u obzir uporabom termo-mehaničke analogije (TMA), koja se primjenjuje u ovom radu za potrebe modeliranja mehaničkog odziva dvoslojne strukture stijenke arterije. Obično se modeliranju zaostalih naprezanja u arteriji pristupi s uzdužno otvorenim modelom arterije, tzv. cut-open section, koji u slučaju bolesnikove arterije nije poznat. S TMA pristupom, umjesto uporabe uzdužno prerezane stijenke arterije, koja doduše osigurava početno stanje bez zaostalih naprezanja, u termo-mehaničkom modelu zajedničke arterije glave također je postignuto početno stanje bez zaostalih naprezanja ali na modelu stvarne, in vivo arterije. Tim pristupom, zaostalo naprezanje u ZAG aproksimirano je podvrgavanjem ZAG modela obujamskom deformacijom, t.j. primjenom odgovarajućih termičkih dilatacija. Takav pristup potvrđen je na modelu arterije kružnog presjeka i postizanjem stanja bez naprezanja u slučaju uzdužnog rezanja stijenke.This work deals with the prediction of the mechanical response of a section of a human common carotid artery (CCA). The arterial residual stress state is accounted for using the thermomechanical analogy (TMA) approach, which is applied in this work to model the mechanical response of a two-layered arterial structure. The starting point to model the arterial residual stress state is normally the cut-open section, which is in the case of patient-specific artery not known. With TMA approach, however, instead of using the arterial zero-stress cut-open configuration to predict the arterial residual stress state, a thermomechanical model of the CCA is considered with its zero-stress geometry defined based on the actual CCA in vivo configuration. The approximation to the CCA residual stress state is then obtained by exposing the auxiliary CCA model to a volumetric deformation, enforced via adequate thermal dilatations. The approach is validated on a circular arterial model and by predicting the CCA cut-open zero-stress state

Diabetično stopalo kot zaplet sladkorne bolezni

Uvod: Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pripeljejo do destrukcije tkiva, končna posledica je zbolevnost, lahko pa tudi amputacija. Namen raziskave je bil ugotoviti pogostost pojava diabetičnega stopala pri pacientih s sladkorno boleznijo. Metode: V raziskavi je bila uporabljena raziskava mešanih metod. Tehnika zbiranja podatkov je bilo anketiranje 60 pacientov s sladkorno boleznijo in delno strukturiran intervju z dvema medicinskima sestrama, ki delata v diabetološki ambulanti. Kvantitativni podatki so bili analizirani z opisno in bivariatno statistiko. Kvalitativni podatki so bili analizirani s pomočjo metode analize vsebine. Rezultati: Ugotovili smo, da amputacija noge ni pogost zaplet diabetičnega stopala (U = 4,4, p = 0,217) in da ne moremo trditi, da je diabetično stopalo pogostejše pri moških kot pri ženskah (U = 0,6, p = 0,417), ter da so pacienti zelo dobro poučeni glede nege stopal in pravilne obutve. Diskusija in zaključek: Najpomembnejša informacija o zdravstveni vzgoji pri diabetičnem stopalu za paciente je, da so o tem zapletu ozaveščeni pisno in ustno. Diabetično stopalo za paciente najpogosteje prinese spremembo v kakovosti življenja. Možnost za nadaljevanje raziskave bi bila izvedba enake raziskave na večjem številu pacientov

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

No fault compensation for medical injuries

For decades in both Europe and the United states , the issue of compensation for victims f medical injuries has led to lively debates. Many scholars have analyzed the adverse effects of the "tort system" (based on negligence standards and court proceedings) on the increasing costs of insurance premiums, on the patient-doctor relationship and the quality of care. These debates have led to changes in compensation in some countries. Compensation would be based not on negligence, but rather on a broader avoidable medical injury standard. Some nations have long operated administrative schemes based on no fault principle. No fault compensation model for victims of medical injuries might be characterized by the choices it makes regarding some key issues: (a) the definition of compensation criteria in particular the status given to fault(b) the organization of the decision -making process. What type of body adjudicates medical claims? (c) Who finances the mechanism. What injuries are likely to be compensated for, to what extent and by whom? This article reviews the origins and operations of the no fault systems, the evolution of their compensation criteria, and how these criteria are actually applied