Operative complications and results of the "SPARC" procedure for stress urinary incontinence [Operativne komplikacije i ishod metode SPARC u liječenju statičke inkontinencije mokraće]

The aim of this study was to determine the efficacy and operative complications of the suprapubic arc (SPARC) procedure in stress incontinent women with and without previous anti-incontinence surgery. One-hundred and twenty-one patients with stress urinary incontinence (SUI) were treated with SPARC for correction of urethral hypermobility (N = 65) and intrinsic sphincter deficiency (N = 56) between August 2002 and February 2007. The long-term surgical results, operative complications (bladder injury, retropubic hematoma, de novo urgency and urinary infection) and patients' satisfaction were assessed. The overall complication rate was 9.9% (12/121). The perioperative complication rate was 1.7% including 2 urinary bladder injuries. Significant difference in the overall complications rate was detected between women with and without previous surgery (23/45, 51.1% vs. 6/108, 5.5%, chi2 = 49.89, P < 0.001). The overall postoperative complication rate was 8.3% (10/121) including 4 de novo urgencies, 4 urinary infections and 2 retropubic hematomas. There were 3 patients with postoperative urinary retention managed conservatively, without voiding difficulties on control visits. The objective cure rate after the follow-up was 86.8% (105/121). In patients with SUI and without preceding vaginal operations SPARC is a good method with low incidence of perioperative complications, promising long-term results and high patient satisfaction

Varicella complications: Is it time to consider a routine varicella vaccination?

Background/Aim. Varicella is a common and benign disease of childhood. Complications are rare, but in some patients, even without risk factors, severe, life threatening complications could be seen. The aim of this study was to establish the type and frequency of varicella complications among hospitalized patients over an 8-year period. Methods. This retrospective analysis included medical charts of the patients hospitalized in the Infectious Disease Clinic, Belgrade, Serbia, from 2001-2008 (4.85% of all registered patients with varicella in Belgrade, 2001-2008). Among hospitalised patients dermografic characteristics were analyzed: hospitalisation lenght, presence and type of complications, presence of immunocompromising conditions and outcome of the disease. The diagnosis of varicella was made on clinical grounds, and in persons &gt; 40 years, with negative epidemiological data of contacts, serological confirmation (ELISA VZV IgM/IgG BioRad®) and avidity of IgG antibodies were done to exclude the possibility of disseminated herpes zoster. Results. A total of 474 patient were hospitalized over an 8-year period. The age of patients was from 5 months to 75 years (mean 22.4 ± 16.1, median 23.5 years). The majority of patients were adults (n = 279; 58.9%) and 195 (41.1%) patients were ≤ 15 years old. Complications were found in 321/474 (67.7%) patients. The registered complications were: varicella pneumonia (n = 198; 41.38%), bacterial skin infections (n = 40; 8.4%), cerebelitis (n = 28; 5.9%), bacterial respiratory infection (n = 21; 4.4%), viral meningitis (n = 10; 2.31%), encephalitis (n = 9; 1.9%), thrombocytopenia (n = 2; 0.4%); 11 (2.3%) patients had more than one complication, among them were sepsis, myopericarditis and retinal hemorrhages. When complications were analyzed according to the age, there were no statistical significance, but when type of complication was analyzed statistical significance was found (p &lt; 0.05). In adults, pneumonia was the most common complication: 173/279 (62%), followed by skin infections (2.9%), bacterial respiratory infections (2,2%), and more than one complication (2.3%). Pneumonia was more common in adults than in children (7 : 1). In children skin infections were the most common complications (16.4%), followed by cerebelitis (13.3%), viral pneumonia (12.8%), bacterial respiratory infections (7.7%), encephalitis (3.6%), and more than one complication (4.1%). Neuroinfections were more common in children than in adults (6:1), as well as bacterial skin infections (4 : 1). Two patients died (0,4%). Conclusion. There was no difference in the incidence of varicella complication in children and adults, but the type of complication differed. In children the most common complications were skin and neurological infections, while in adults it was varicella pneumonia. These data provide a baseline for estimating the burden of varicella in Belgrade and support the inclusion of varicella vaccine in childhood immunisation program in Serbia

Sestrinska skrb pacijenata sa spinalnom ozljedom s osvrtom na komplikacije gastrointestinalnog trakta

Ozljeda kralježnične moždine je ozljeda koju je teško liječiti, a osobe koje je dožive čeka dugotrajan rehabilitacijski program. Njezine medicinske, psihološke, socijalne i ekonomske posljedice su katastrofalne za stradalu osobu, obitelj, te užu i širu zajednicu. Specijaliziranim rehabilitacijskim pristupom multidisciplinarnog tima posljedice mogu biti ublažene, uz maksimaliziranje preostalih sposobnosti. Posljedice ozljede leđne moždine najčešće su vrlo teške i kao takve imaju mnogostruke značaje. Od samog stradalog i njegove obitelji koja se mora suočiti s novonastalom situacijom svoga najbližega, preko medicinskog osoblja koje je odgovorno za liječenje i njegu, pa sve do raznih čimbenika društva koji snose društvene i finacijske terete zbog radne nesposobnosti i teške invalidnosti. Često se dogodi da se u rehabilitacijskom procesu doživi i svojevrsni neuspjeh, što zbog pogrešnog pristupa i ustrajnosti kod članova multidisciplinarnog tima ili najčešće zbog otpora stradale osobe prema samom procesu a sve kao posljedica teškog prihvačanja novonastalog stanja. U radu je opisan značaj rehabilitacije osobe s ozljedom leđne moždine kao i način na koji multidisciplinarni tim a posebice medicinska sestra ili tehničar doprinose u procesu izlječenja ili umanjenja tegoba kod pacijenata s ovom vrstom ozljede. Uz mnogobrojne zdravstvene i socijalne komplikacije koje se događaju kod pacijenta s ozljedom leđne moždine poseban osvrt u ovom radu pridodat će se na sprječavanje komplikacija gastrointestinalnog trakta koji predstavlja ozbiljan problem u rehabilitaciji ali i nakon nje. Uz kvalitetnu edukaciju samog pacijenta i njegove obitelji ta vrsta komplikacija i svi problemi koji idu uz nju mogu se svesti na najmanji postotak.Spinal cord injury is an injury that is difficult to treat and requires people a long-term physical rehabilitation. Its medical, psychological, social and economic consequences are disastrous for the patient, the family and the immediate and wider community. The consequences of spinal cord injury can be reduced by specialized rehabilitation approach of the multidisciplinary team by focusing on maximizing physical functioning. The consequences are usually very heavy and as such have multiple symptoms. The injured and the family must face the new situation with the help of the medical staff responsible for the treatment and care, and various social factors bearing the social and financial burdens due to severe disability. The rehabilitation process often leads to failure because of the inappropriate approach and dedication of the members of the multidisciplinary team, or most often because of the patient’s refusal of medical process by denying the new situation. This paper describes the importance of rehabilitation of the people with spinal cord injury as well as the way in which a multidisciplinary team, especially the nurse or the technician, contributes to the healing process and decreases complications in patients with this type of injury. In addition to many health and social complications that occur in patients with spinal cord injuries, a special focus in this paper is on the prevention of complications of the gastrointestinal tract which is a serious problem during or after the rehabilitation process. By educating the patient and the family this kind of complications and all resulting problems can be reduced to the lowest percentage

Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure

Background/Aim. Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA). Methods. A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who undewent vaginal repair with implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. Results. All the patients had a stage 3 or stage 4 prolapse according to the POP-Q system of ICS. Total mesh was used in 12 (13%) patients isolated anterior mesh in 52 (54%) patients and isolated posterior mesh in 32 (33%) patients. We reported one intra-operative bladder injury and no other serious complications. At 3 months, all 96 patients were available for follow-up. Vaginal erosion occured in 9 (9.3%) patients, shrinkage of mesh in 6 (6.2%) patients and de novo urinary incontinence in 5 (5.2%) patients. Failure rate was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic). Conclusion. Our study suggests that transvaginal polypropylene mesh applied with a tensionfree technique is a safe and effective method with low intraoperative complications and low morbidity rates. However, some complications are serious and require highly specialised management

Incidence of diabetic ketoacidosis in patients with type 2 diabetes

Dijabetička ketoacidoza je jedna od najopasnijih akutnih komplikacija šećerne bolesti te može rezultirati visokom stopom smrtnosti ako nije odgovarajuće ili na vrijeme liječena. Glavni uzrok ovog stanja su nedostatak inzulina i povišene razine protu-regulatornih hormona (glukagona, hormona rasta, katekolamina i kortizola). Do nedavno se smatralo da je ketoacidoza gotovo isključivo vezana uz tip 1 šećerne bolesti, ali sve više istraživanja prikazuju njenu prisutnost u tipu 2 šećerne bolesti. Cilj ovog istraživanja je bio odrediti učestalost i moguće razloge nastanka ketoacidoze u bolesnika sa šećernom bolešću tipa 2. Istraživanje je uključivalo pretraživanje baze podataka Kliničke bolnice Dubrava u razdoblju od 1. srpnja 2010. godine do 1. srpnja 2015. godine te analizu podataka o kliničkom profilu pacijenata. Kod novodijagnosticiranih bolesnika odredila se koncentracija glukoze u krvi, acidobazni status te vrijednosti glikiranog hemoglobina. Od 72 pacijenta, njih 27 (37.2%) imalo je tip 1 šećerne bolesti i 45 (62.5%) tip 2 šećerne bolesti. U skupini pacijenata sa šećernom bolešću tipa 1, osam pacijenata (27.5%) su imala epizodu ketoacidoze kao prvi znak šećerne bolesti, dok je u skupini bolesnika sa šećernom bolešću tipa 2, trinaest pacijenata (28.8%) imalo je dijabetičku ketoacidozu kao prvi znak šećerne bolesti. Nepridržavanje terapije i infekcije bili su najčešći uzroci ketoacidoze.Diabetic ketoacidosis is one of the most dangerous acute complications of diabetes, responsible for significant mortality if not treated properly and on time. The main features of this condition are insulin deficiency and increased levels of counter-regulatory hormones (glucagon, growth hormone, catecholamines and cortisol). Until recently it was thought that ketoacidosis is present only in type 1 diabetes, but more studies reported its presence in type 2 diabetes. Aim of this study was to establish the frequency and precipitating factors for the occurrence of diabetic ketoacidosis in patients with type 2 diabetes. The research involved searching data bases in the period from July 1st 2010 until July 1st 2015 and clinical profile of patients were analyzed. In newly diagnosed patients, concentration of blood glucose, acid-base status and the values of glycated hemoglobin were determined. Out of 72 patients, 27 (37.2%) had type 1 and 45 (62.5%) had type 2 diabetes. Among patients with type 1 diabetes, 8 (27.5%) patients had an episode of ketoacidosis as the initial case of diabetes, whereas among patients with type 2, 13 (28.8%) patients had mentioned complication as a first sign of disease. Non-compliance to treatment and infection were the most common causes of ketoacidosis

Gripa

Svjedoci smo ekspanzije raznoraznih zaraza, kao što su razne vrste gripe i ostale virusne bolesti. Ovi izrazito opasni virusi postaju velika opasnost za moderno društvo. Znanstvenici sa svih strana svijeta i iz mnogih područja sve više surađuju, te pristupaju ovom problemu na razne načine ne bi li uspjeli otkriti na koji se način zaraza širi, te kako ju spriječiti. Influenca je akutna, lako prenosiva, po toku teška i kratkotrajna infektivna bolest koju uzrokuju virusi influence. Praćena je prije svega općim simptomima, osobito vrućicom, malaksalošću, glavoboljom, bolima u mišićima te drugim znakovima teške toksemije. Respiratorni simptomi u početku bolesti nisu izraženi, obično se javljaju tek u dijelu bolesti kad već popuštaju opći simptomi, unatoč činjenici da su respiratorni organi osnovno i glavno mjesto infekcije[1]. Gripu karakterizira nagli početak, nešto sporiji oporavak i mogućnost razvoja brojnih komplikacija. Na vrstu, težinu bolesti i komplikacija utječe dob oboljelog, cjelokupno zdravstveno stanje i poglavito kronične bolesti od kojih je osoba bolovala prije gripe. Pojava komplikacija određuje konačni ishod razbolijevanja od gripe: nekomplicirana bolest izaziva kratkotrajni prolazni opći zdravstveni poremećaj, a komplikacije mogu rezultirati i smrtnim ishodom. Gripa je zarazna bolest koja se vrlo lako prenosi s čovjeka na čovjeka, a od nedavno i sa životinja na čovjeka, kapljičnim putem. To znači da se svatko može zaraziti ako boravi u prostoru u kojem je i oboljela osoba. Nije važno kašlje li oboljela osoba ili ne. Tijekom epidemije mogućnost zaraze virusom gripe je izrazito velika, pa se samo stroga izolacija može smatrati dostatnom mjerom sprječavanja zaraze virusom. Provjetravanje prostorije ima nesiguran učinak kao i nošenje zaštitne maske. Naravno, i imunitet ovdje ima svoju ulogu. Redovite higijenske mjere i zdrava ishrana, koji utječu na opći imunitet, mogu se smatrati korisnim mjerama u sprječavanju obolijevanja[2].We are witnessing the expansion of various diseases, such as various types of influenza and other viral diseases. These extremely dangerous viruses have become a big threat to modern society. Scientists from all over the world and from many areas are increasingly working together and addressing this problem in various ways in order to manage to discover the way the disease spreads and how to prevent it. Influenza is an acute, highly portable, heavy-current and short-term infectious disease caused by influenza viruses. Accompanied primarily general symptoms, especially fever, malaise, headache, pains in muscles and other signs of severe toxemia. Respiratory symptoms in the beginning of the disease are not expressed, usually occur only in the area where the disease is already weakening general symptoms, despite the fact that the respiratory organs primary and principal place of infection. Influenza is characterized by sudden onset, slower recovery and the possibility of developing a number of complications. The type, severity of illness and complications affecting patient age, health, and especially chronic diseases of which the person had before the flu. Complications are determined by the final outcome of get sick from the flu: uncomplicated disease causes short-lasting temporary general medical condition, and complications can result in death. Influenza is a contagious disease that is easily transmitted from person to person, and most recently from animals to humans, via droplets. This means that anybody can get it if you stay in a place where the sick person. It doesn't matter if an infected person coughs or not. During the epidemic of influenza virus infection possibility is very big, and the only confinement can be considered a sufficient measure of preventing infection. Ventilation of the room has uncertain effect as wearing protective masks. Of course, the immune system plays a role here. Regular hygienic and healthy diet, which affect the general immunity, can be regarded as useful measures to prevent contracting the disease

Specificities of prosthetic and orthotic rehabilitation in amputees with head injury

Background/Aim. The prosthetic-orthotic rehabilitation (POR) of amputees with head injury within the polytrauma presents a specific entity. The number of traumas caused by the traffic and the low-intensity war conflicts, increases constantly. The aim of our study was to examine the influence of complications on the POR duration and outcome in polytrauma amputees with head injury (PTAHI) recording complications at the beginning and during the POR. Methods. The study was carried out on the patients divided into two groups of 35 polytrauma male patients each of corresponding age with unilateral transfemoral amputation caused by the war injury. The experimental group consisted of the amputees with head injury. Standard clinical techniques and procedures, as well as special functional evaluation techniques were used. Results. The PATHI started POR with a greater number of complications (average rate 7.29 vs 5.11 per patient; W = 928.000: Z = 3.730: p = 0.000). There was a highly significant positive correlation between this number and the Barthel Score value change (Fx, H, p &lt; 0.01), and negative significant correlation considering prosthetic use and functional capacity test values (Fx, H p &lt; 0.05). On admision, the amount of complications defined for the value 4 of POR outcome was significantly higher than values 2 and 3, respectively (H = 8.948; df = 2; p = 0.011). The PTAHI developed significantly more frequently complications during rehabilitation (X2 = 1.061; df = 1; p &lt; 0.01). The proportion of the examinees with the value 4 who developed complications during rehabilitations was significantly higher than those with value 2 (Fp = 3.406; df1 = 2; df2 = 67; p = 0.038). The rehabilitation of the PTAHI lasted significantly longer (average 259.09 vs 183.63 days; W = 923.500; Z = -3.748; p = 0.000). Conclusion. The PTAHI including head injuries started prostheticorthotic rehabilitation with more prosthetic complications and their psychological status was worse, resulting in the longer duration of rehabilitation whereas the outcome itself was poor. The value 4 of the prosthetic-orthotic rehabilitation outcome can be expected more often in patients developing complications during rehabilitation

The application of ultrasound in neuroendoscopic procedures: first results with the new tool »NECUP-2« [Upotreba ultrazvuka u neuroendoskopskim procedurama: prvi rezultati s novim uređajem »NECUP-2«]

In this paper, our experience with originally constructed Neurosurgical Endoscopic Contact Ultrasound Probe »NECUP-2« in neuroendoscopy is reported. Between June 1997 and June 2007, 132 neuroendoscopic procedures have been performed: 102 endoscopic thrid ventriculostomies (ETV), 15 arachnoid cysts and 5 intraventricular tumours operations. The »NECUP-2« was applied effectively in all cases in which blunt perforation was not possible: 38/102 ETV, 10/10 septostomies, 15/15 arachnoid cysts. In five cases of intraventricular tumours, neuroendoscopic procedure was combined with open microsurgery for tumour removal with preservation of vascular structures. There were no »NECUP-2« related complications. Of postoperative complications, we had liquorrhea (9 patients), and symptoms of meningitis (6 patients). In the follow-up period (6 months to 6 years), we had a patency rate of 80% (50/63 patients). All patients improved in clinical status. According to the first results, it seems that ultrasonic contact probe NECUP-2 presents a new device in neurosurgical armamentarium that can be used in various fields of neurosurgery. With minimal and controlled lesion that is produced at the tip of the probe, it can be used in highly demanding operations such as third ventriculostomy and tumour resection

External fixation in the treatment of open tibial shaft fractures

Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%). The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25%) open tibial fractures of the I degree, 31 (32.29%) of the II degree, 25 (26.05%) of the III A degree, 8 (8.33%) of the III B degree and 2 (2.08%) of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04%) healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation). Ther were nine (9.38%) soft tissue pin track infections and six (6.25%) superficial wound infections. The mean time of union was 21 (14-36) week. Among severe local complications associated with open tibial fractures, in eight patients (8.33%) was registered osteitis, and in nine patients (9.38%) fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13%) had more than 10 degree valgus malunion. In one patients (1.04%) deep pin track infection developed. Two patients (2.08%) had below the knee amputation (one primary in patient with type III C open fracture and one secondary after the development of deep infections). Conclusion. Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures