Reuse of single-use surgical equipment - Survey on current practice and attitudes in Croatia

Aims: To gain an insight into current practice and attitudes regarding the reuse of single-use surgical equipment among surgeons and surgical residents in Croatia. Methods: During May 2020, an online survey was shared among Croatian surgeons and surgical residents via email link. The survey included 10 questions seeking information on respondents’ current positions at their departments, real-life practice about reusing single-use instruments, personal attitudes and knowledge about the current law frame. Results: The majority of 53 participants reused single-use surgical equipment in their practice (92.5%). More than half of them reused many single-use devices such as harmonic scalpels, bipolar dissectors, staplers, single-use trocars, graspers, and scissors. The participants had divided opinions on safety issues, personal support of such practice and the necessity of disclosing to patients. However, the majority was inclined towards the use of new instruments if they found themselves with patients on the operating table (75.5%). Very few participants were aware of the current legal regulations and the law changes that would take effect in the near future (5.6%). Conclusion: Current practice shows widespread reuse of single-use surgical equipment in Croatia despite the concerns of the involved surgeons. It seems that they recognize the potential safety and ethical issues, but at the same time, they are not well informed about the legal regulations of the practice which is alarming and calls for further education and preparation for the upcoming legal changes

Common Bile Duct Obstruction Caused by the Hydatid Daughter Cysts

Echinococcosis is a human parasitary disease. In 2002, 29 new cases of liver echinococcosis were recorded in Croatia. Liver is the most common site of hydatid cysts. Nine patients with echinoccocal liver disease were operated in our department in 2002. Here we present a case where a patient with verified hydatid cyst in the left liver lobe developed high fever, jaundice, nausea, vomiting and pain in the upper abdomen. The symptoms were initially ascribed to the acute cholangitis. After unsuccessful antibiotic treatment, computerized tomography and endoscopic retrograde cholangiopancreatography (ERCP) were performed, demonstrating daughter cysts in the common bile duct. During ERCP, papilotomy was made and daughter cysts were extracted. Hydatid cyst was surgically removed, and a communication between the cyst and left hepatic duct was noted during surgery. Pericystectomy, choledochotomy, removal of remaining daughter cysts from the common bile duct, and sutures of left hepatic duct were performed. The patient recovered fully after the surgery. One of the possible complications of the liver hydatid cysts is the communication between cyst and the biliary tree. Such communications are usually asymptomatic, but symptoms can also mimic acute cholangitis and jaundice, which may lead to the misdiagnosis of the patient’s condition

Potential use of Doppler perfusion index in detection of occult liver metastases from colorectal cancer

Many clinical and preclinical studies demonstrated that measurements of liver hemodynamic [Doppler perfusion index (DPI)] may be used to accurately diagnose and predict liver metastases from primary colorectal cancer in a research setting. However, Doppler measurements have some serious limitations when applied to general population. Ultrasound is very operator-dependent, and requires skilled examiners. Also, many conditions may limit the use of Doppler ultrasound and ultrasound in general, such as the presence of air in digestive tract, cardiac arrhythmias, vascular anomalies, obesity and other conditions. Therefore, in spite of the results from clinical studies, its value may be limited in everyday practice. On the contrary, scientific research of the DPI in detection of liver metastases is of great importance, since current research speaks strongly for the presence of systemic vasoactive substance responsible for observed hemodynamic changes. Identification of such a systemic vasoactive substance may lead to the development of a simple and reproducible laboratory test that may reliably identify the presence of occult liver metastases and therefore increase the success of adjuvant chemotherapy through better selection of patients. Further research in this subject is therefore of great importance

Reuse of single-use surgical equipment - Survey on current practice and attitudes in Croatia

Aims: To gain an insight into current practice and attitudes regarding the reuse of single-use surgical equipment among surgeons and surgical residents in Croatia. Methods: During May 2020, an online survey was shared among Croatian surgeons and surgical residents via email link. The survey included 10 questions seeking information on respondents’ current positions at their departments, real-life practice about reusing single-use instruments, personal attitudes and knowledge about the current law frame. Results: The majority of 53 participants reused single-use surgical equipment in their practice (92.5%). More than half of them reused many single-use devices such as harmonic scalpels, bipolar dissectors, staplers, single-use trocars, graspers, and scissors. The participants had divided opinions on safety issues, personal support of such practice and the necessity of disclosing to patients. However, the majority was inclined towards the use of new instruments if they found themselves with patients on the operating table (75.5%). Very few participants were aware of the current legal regulations and the law changes that would take effect in the near future (5.6%). Conclusion: Current practice shows widespread reuse of single-use surgical equipment in Croatia despite the concerns of the involved surgeons. It seems that they recognize the potential safety and ethical issues, but at the same time, they are not well informed about the legal regulations of the practice which is alarming and calls for further education and preparation for the upcoming legal changes

100 godina nakon prve splenektomije u imunosnoj trombocitopeniji - je li laparoskopska splenektomija još i danas dobra terapijska metoda? Prikaz vlastitih iskustava [A hundred years after first splenectomy for immune thrombocytopenia, is laparoscopic splenectomy still valid as a treatment option? A single center experience]

AIM: A single center experience with laparoscopic splenectomy (LS) in the treatmen t of immune thrombocytopenia (ITP) is presented in this paper. In addition, we discuss the role of splenectomy in the era of thrombopoietin receptor agonists (TPO-RAs). ----- PATIENTS AND METHODS: In this retrospective study, we present our 35 patients who underwent LS in the period of 12 years. There were 26 women and nine men with a median age of 50 years (ranging from 19 to 85 years). Prior to LS, all patients were treated with glucocorticoids +/- intravenous immunoglobulins (IVIG), whereas seven patients received also rituximab. The median time to splenectomy was seven months (ranging from one to 103 months). ----- RESULTS: Four (11%) patients failed to reach response after LS, and additional six patients relapsed during the follow up. After a median follow up of 33 months, the remaining 25 (71%) patients required no further treatment. The estimated sustained response rate at fi ve years was 59%. Patients who underwent splenectomy in the fi rst year after the diagnosis had better outcome when compared to patients with delayed splenectomy (P= 0.048). Sex and age did not infl uence the treatment outcome. Four patients had early serious postoperative complications of LS: portal vein thrombosis, deep vein thrombosis of the leg, sepsis, and intraperitoneal bleeding that required surgical revision. There were no deaths, nor late serious infections. Ten (29%) patients reported fatigue after LS. ----- CONCLUSION: Long-term cure rate of about 60% is comparable to other studies. However, we observed better response in patients who underwent splenectomy earlier. In our opinion, LS may still be considered as a safe, successful, and cost-effective second-line treatment of ITP, especially in patients who are in favor of fast and highly curative treatment. Nevertheless, the introduction of TPO-RAs will inevitably decrease the role of LS in Croatia, as in the western world

IL12RB2 Gene is Associated with the age of Type 1 Diabetes Onset in Croatian Family Trios

BACKGROUND: Common complex diseases are influenced by both genetic and environmental factors. Many genetic factors overlap between various autoimmune diseases. The aim of the present study is to determine whether four genetic variants known to be risk variants for several autoimmune diseases could be associated with an increased susceptibility to type 1 diabetes mellitus. METHODS AND FINDINGS: We genotyped four genetic variants (rs2358817, rs1049550, rs6679356, rs9865818) within VTCN1, ANXA11, IL12RB2 and LPP genes respectively, in 265 T1DM family trios in Croatian population. We did not detect association of these polymorphisms with T1DM. However, quantitative transmission disequilibrium test (QTDT, orthogonal model) revealed a significant association between the age of onset of T1DM and IL12RB2 rs6679356 variant. An earlier onset of T1DM was associated with the rs6679356 minor dominant allele C (p = 0.005). The association remained significant even after the Bonferroni correction for multiple testing and permutation. CONCLUSIONS: Variants originally associated with juvenile idiopathic arthritis (VTCN1 gene), sarcoidosis (ANXA11 gene), primary biliary cirrhosis (IL12RB2 gene) and celiac disease (LPP gene) were not associated with type 1 diabetes in our dataset. Nevertheless, association of IL12RB2 rs6679356 polymorphism with the age of T1DM onset suggests that this gene plays a role in defining the time of disease onset

Comparison of the Values of Basic Fibroblast Growth Factor Determined by an Immunoassay in the Sera of Patients with Traumatic Brain Injury and Enhanced Osteogenesis and the Effects of the Same Sera on the Fibroblast Growth In Vitro

Peer Reviewe

Incidence of Type 1 Diabetes Mellitus in 0 to 14-yr-old Children in Croatia – 2004 to 2012 Study

BACKGROUND: The incidence of type 1 diabetes mellitus (T1DM) among children and adolescents increased during the last 50 yr. The T1DM incidence in Croatia was 8.87/100.000/yr over 1995-2003, with an annual increase of 9%, which placed Croatia among countries with moderate risk for T1DM. AIM: To investigate incidence rates and trends of T1DM from 2004 to 2012 in 0 to 14-yr-old Croatian children, and to compare the results with previous studies in Croatia and other European countries. METHODS: T1DM crude incidence rates are estimated for the entire group and three subgroups: 0-4, 5-9, and 10-14 yr. Standardized incidence is calculated using the method of direct standardization according to World Health Organization (WHO) standard world population. The incidence rates by gender, age groups, seasonality, and calendar year, and their interactions were analyzed using Poisson regression model. RESULTS: A total of 1066 cases were ascertained over 2004-2012. The standardized incidence was 17.23/100.000/yr (95% CI: 16.19-18.26), with no significant differences in incidence rates or trends between boys and girls. Statistically significant annual increase of 5.87% (p < 0.001) was found for the whole group, and for the subgroups 5-9 yr (6.82%; p < 0.001) and 10-14 yr (7.47%; p < 0.001). In the youngest subgroup (0-4 yr), annual increase was lower (2.43%; p = 0338) and not statistically significant. CONCLUSION: The incidence of childhood T1DM is increasing in Croatia, thus placing Croatia among countries with high risk for T1DM. The annual increment of 5.87% is considerably lower than 9.0% reported earlier, but still higher than the European average (3.9%). The increase in incidence ceased in youngest children

Smjernice za liječenje benignih bolesti anorektalne regije

Benigne bolesti anorektalne regije, u koje ubrajamo analne apscese, analne fistule, analne fisure i hemoroidalnu bolest, česta su stanja koja susreću liječnici obiteljske medicine kao i bolnički specijalisti. Unatoč rasprostranjenosti patologije, još uvijek ne postoje jasne smjernice za adekvatno liječenje navedenih stanja, koje se još uvijek često svodi na preporuke koje nemaju uporište u medicini temeljenoj na dokazima. Zbog toga je ekspertna skupina, u kojoj su sudjelovali članovi Hrvatskog društva za digestivnu kirurgiju kojima je uže područje interesa koloproktologija, odlučili sastaviti ove smjernice s namjerom da se standardizira liječenje benignih bolesti anorektalne regije, kako na primarnoj tako i na tercijarnoj razini

Transmission disequilibrium analysis for <i>IL12RB, ANXA11, VTCN1</i> and <i>LPP</i> gene SNPs in 265 family trios (T:U – copies of the minor allele transmitted (T) and untransmitted (U) from heterozygous parents to affected offspring<i>).</i>

*<p>Nominal p values are shown uncorrected for multiple testing. The Bonferroni-corrected significance threshold is p = 0.0125.</p