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Perioperative blood loss and diclofenac in major arthroplastic surgery
Get PDFIntroduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg) and also as intramuscular injection (75 mg) preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05) compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac) before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised
A retrospective study of surgical treatment of spinal injuries with rehabilitation program
Get PDFIntroduction: Traumatic injuries of the spinal column are among the most devastating injuries in orthopedics. The primary goals of rehabilitation of these injuries are prevention of secondary complications, maximizing physical functioning and reintegration into the community. Rehabilitation after spinal injury reqires multidisciplinary team approach. Team members include, but are not limited to, physical therapists, occupational therapists, nurses, psychologists, health care managers and social workers, with each member having role and responsibility in their area of expertise. This study aimed to determine the difference in the occurrence of spinal injuries according to gender, age, cause of injury, neurological phenomenon in injured patients, the treatment and physical procedures used in the early stages of rehabilitation.Methods: The study was conducted as a retrospective and comparative at the Department of Orthopedics and Traumatology of Clinical Center University of Sarajevo. Medical records of 100 patients, treated at from January 1st 2007 till June 30th 2008, were processed and data about outpatient protocols and surgery protocols analyzed.Results: The results obtained from the data showed greater proportion of women (56%) compared to men (44%). Most patients were in the age group between 41 and 60. Injuries were most often due to falls from height and make 32%, fall from a tree 25%, traffic accidents 12% (²=17.94, p=0.0061). 88% of patients were without neurologic events, while the neurological disturbances occurred 12% (χ²=3.397, p=0.3343). 56% of patients with spinal injuries were treated surgically, while 41% were treated conservatively (χ ²=7.264, p= 0.00153). 73% patient had physical therapy program of early rehabilitation exercises, with at least at least only a massage in 4% of patients X² = 6.573, p = 0.04270).Conclusion: The adoption of national protocols is necessary for future treatment of patients with spinal fractures
Dural tail sign adjacent to different intracranial lesions on contrast-enhanced MR images
No full textIntroduction: The aim of this study is to determine the prevalence of dural tail sign (DTS) in meningiomas, glioblastomas multiforme, metastasis, pituitary macro-adenomas, acoustic neuromas, medulloblastomas, lymphomas and Wegener’s granulomatosis, and to reveal if DTS is specifi c for meningiomas.Methods: In this retrospective, cross sectional study 96 patients were included with 95 intracranial and 1 extracranial lesions. The study was conducted in the period from January 2008 to May 2010 and the group pattern was made consecutively. The patients underwent surgery and all 96 lesions were examined by histopathology analysis. DTS was analysed on contrast T1- weighted spin echo images after injection of 0.1 mmol/kg gadolinium contrast medium. The presence of this sign was defi ned using Goldsher et al’s criteria.Results: Histopathology results of the 96 lesions revealed the presence of: 35 meningiomas, 25 glioblastomas multiforme, 13 metastasis, 10 pituitary adenomas, 5 acoustic neuromas, 4 medulloblastomas, 3 lymphomasand 1 Wegener’s granulomatosis. On the contrast-enhanced T1 MR images, DTS was noted in 31 (32.3%) lesions, in the following histological samples: meningioma, GBM, adenoma, schwannoma, medulloblastoma and Wegener’s granulomatosis, while in the cases of metastasis and lymphomas DTS was not noted. We found the dural tail sign to have a sensitivity of 68.6% and specifi city of 88.5% in the diagnosis of meningioma.Conclusion: The dural tail is a common but not a pathognomic sign of meningioma on contrast-enhanced T1 MR images. Other intracranial lesions, such as glioblastoma multiforme, pituitary adenoma, schwannoma,medulloblastoma and Wegener’s granulomatosis may also be represented with this sign
Lumbosacral pain caused by blockage of dynamic vertebrogenic segments of thoracolumbar transition
Get PDFIntroduction: In the case of the Thoraco-lumbar Junction Syndrome the pain is located in the region of the lumbo-sacral junction. Sudden torsion movements and lifting of objects while the spine is in position of torsion is the cause in most cases. In those cases, a blockade on the Th11-Th12-L1 vertebrae occurs. The aim of this research was to determine the number of patients with the Low Back Pain whose origin is in the thoracic vertebral dynamic segments, in relation to the total number of patients according to gender, age and profession.Methods: In this retrospective, descrtiptive study we have analyzed patients treated for Lumbosacral syndrome of thoracic origin in private specialist ambulant “Cebic” in Zavidovici during one year period. We analyzed data from patients medical records and history.Results: Total of 1882 patients were treated for the Low Back Pain, of which 67 (3.56%) had an origin of the pain in the Thoraco-lumbar Junction. In the analyzed group, there were 49 (73.1%) man and 18 (26.8%) women. The largest number of males, 21 (42.8%), were between 40-49 years old, while the largest number of woman, 9 (50%), was 20 to 29 years old. Largest number of male patients, 35 (71.8%), were physical workers, while most of the female subjects, 7 (38.8%), were of ce workers.Conclusions: Our research concludes that the number of patients with Low Back Pain of the thoracic origin (3.56%) is not disregarded, but these facts are usually overlooked. Therapy for those kinds of patients is in most cases concentrated to the lower segments of the lumbar spine, which gives unsatisfactory therapeutic results
The value of Pap test in women with endometrial cancer
Get PDFIntroduction: Endometrial cancer is the second most common gynecological tumor. There is still no recommended screening method for endometrial cancer. The application of transvaginal sonography, hysteroscopy and Pap test may prove useful in screening for this disease. Atypical glandular cells represent an important finding in Pap tests and they are related to histopathological verification of the endometrium. The aim of the study was to determine the usefulness of the Pap test in assessing the cervical infiltration, as well as to determine the significance of hormonal status and histopathological type of tumor in a pathological Pap test in patients with endometrial cancer.Methods: The study was retrospective. The analysis included the data obtained from 62 operated patients diagnosed with enometrial cancer, medical history (menopausal status), histopathological findings after surgery (type and stage of the disease) and a preoperative Pap smear. The chi squared and Fisher’s test were used.Results: The difference in the prevalence of pathological Pap test in premenopausal and postmenopausal group of patients was not statistically significant. The difference in the prevalence of pathological Pap test in the group of endometrioid and non-endometrioid tumours of the uterine corpus had statistical significance. The difference in the prevalence of pathological Pap test compared to the present stage (I and II) was not statistically significant.Conclusion: Pap smear does not correlate with menopausal status in women with endometrial carcinoma. Abnormal Pap test is more commonly found in cases of non-endometroid tumours. Pap smears cannot beused to assess cervical involvement