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Value of tourniquet use in anterior ankle arthroscopy: a randomized controlled trial
Get PDFBACKGROUND: A tourniquet is usually used during anterior ankle arthroscopy to allow for improved visibility and reduced operation time. However, this has not been demonstrated to be true in clinical studies on knee arthroscopy, while limited tourniquet time has been described as a possible factor to lower the complication rate of ankle arthroscopy. The purpose of this randomized controlled trial was to examine the effect of tourniquet use on arthroscopic visualization, operative time, postoperative intra-articular bleeding, postoperative pain scores, and outcome of anterior ankle arthroscopy. ----- METHODS:
A consecutive series of 50 patients who were scheduled for anterior ankle arthroscopy were randomized to have the surgery done either without the tourniquet inflated (25 patients) or with the tourniquet inflated (25 patients). The patients were evaluated by the course of the surgery, postoperative intra-articular bleeding, and pain during the early postoperative period, and subjective and objective functional scores were used to evaluate the condition of the ankle before and 3 and 6 months after the surgery. Forty-nine patients were present at the final follow-up, 6 months after the surgery. ----- RESULTS:
The results between the groups were comparable regarding the duration of the operative procedure, consumption of sterile saline, visualization, and functional scores. A notable difference between the groups in favor of the nontourniquet group was present regarding postoperative bleeding but was not statistically significant. A statistically significant difference in favor of the nontourniquet group was found regarding postoperative pain during several days in the early postoperative period. ----- CONCLUSION:
Our study showed that anterior ankle arthroscopy was performed adequately without the use of a tourniquet and that it had the same operative course as cases in which the tourniquet was used and functional outcomes that were not worse than cases in which the tourniquet was used. ----- LEVEL OF EVIDENCE:
Level I, prospective randomized controlled trial
Unusual scrotal and penile ulcerations together with palmar-plantar erythrodysesthesia syndrome in a patient with metastatic colon carcinoma treated with capecitabine
Get PDFZnačenje jednofotonske emisijske tomografije i kompjuterizirane tomografije u otkrivanju limfnog čvora "čuvara" u bolesnika s karcinomom dojke i malignim melanomom [The value of single photon emission tomography and computed tomograpy in detection of sentinel lymph node in breast cancer and melanoma patients]
Get PDFIntroduction: lymph node status is one of the most important prognostic factors for recurrence and survival in malignant melanoma and breast cancer patients in early stage disease. Sentinel node biopsy is a standard procedure in staging regional lymph nodes in those patients. SPECT/CT is new, hybrid imaging technique that can improve visualization and localization of sentinel node. The aim of this prospective study was to assess the contribution and additional value of SPECT / CT imaging in detection and biopsy of the sentinel lymph node in malignant melanoma and breast cancer patients.
Method: from December 2010 to September 2015, the study included 166 patients, 79 patients with breast cancer and 87 patients with malignant melanoma of the skin. After intradermal or peritumoral administration of radiopharmaceuticals (99mTc - colloid) all patients underwent planar scintigraphy (dynamic and static imaging) according to usual protocol (one-day or two-day protocol) and SPECT / CT immediately after the last planar imaging. All participants signed an informed consent.
Result: SPECT/CT showed statistically higher number of sentinel lymph nodes in relation to the number of sentinel nodes detected by planar scintigraphy in both groups. In the group of patients with malignant melanoma SPECT / CT showed a 17.5% sentinel nodes more than planar scintigraphy in 37.9% of patients and in the group of patients with breast cancer 13% sentinel nodes more in 20.3% of patients. Identification and localization of sentinel lymph nodes was more accurate by SPECT/CT imaging than planar scintigraphy. We noted identical findings of SPECT/CT and planar scintigraphy in 52.9% of melanoma patients and 72.1% breast cancer patients. The positive impact of SPECT / CT was observed in 42.5% of malignant melanoma and 48.1% of breast cancer patients.
Conclusion: Hybrid tomographic imaging technique that combines two imaging methods, SPECT and CT, has significant advantages over planar scintigraphy in the detection of sentinel lymph node. We recommend it to be a part of the standard protocol for sentinel lymph node detection and biopsy in all melanoma and breast cancer patients
Smjernice za liječenje stenoze karotidne arterije [Guidelines for treatment of carotid artery stenosis]
Get PDFCarotid artery stenosis is a risk factor for developing a stroke. Large randomized studies have shown that carotid endarterectomy (CEA) plays a significant role in preventing a stroke. Carotid endarterectomy decreases the risk of stroke and increases the quality of life after surgery. During the past decades carotid artery stenting (CAS) has evolved as a less invasive way of treating extracranial artery stenosis. Carotid artery stenting is supposed to be less invasive but equally successful and durable (randomized studies are expected to support this statement). Carotid artery stenting is being performed by vascular surgeons, general surgeons, neurosurgeons, cardiologists, radiologists etc1. In addition to these guidelines we provide indications for CEA (especially within 2 weeks after the onset of symptoms) and indications for the treatment of restenosis after CEA or CAS. Indications were presented and accepted by the members of the Croatian Society for Vascular Surgery (CSVS) during the meeting in Vodice in May, 2016. Making of these guidelines is not financially supported. The guidelines are primarily intended for vascular surgeons and interventional radiologists to provide a unified stance in the treatment of patients with a significant narrowing of the internal carotid artery
Hrvatski medicinski časopisi i standardi dobre uređivačke prakse: analiza uputa autorima [Croatian medical journals and standards for good editing practice: an author instructions analysis]
Get PDFBackground & aims. Author instructions in medical jounals inform on key elements of the manuscript preparation and submission, authorship and author responsibilities, copyright, permissions for use etc. In most cases, the publishers are following the international recommendations, like those of ICMJE. The aim of this study was to find to what extent the Croatian medical journals follow these recommendations. Methods. The sample included 38 journals listed in the biomedical and health care category at the national open access platform Hrčak. The analysis was done in June 2016. Results. The results showed that 60% of the analysed journals mentioned ICMJE recommendations in their author instructions. The signed statement of authorship is required by 47% of journals while half of them mentioned the ICMJE authorship criteria explicitly. Authors are asked to confirm that the submitted manuscript has not already been published or submitted to another journal by 68% of journals. A statement on disclosure of conflicts of interests was found in 45% of guidelines. Transfer of copyright is required by 45% of journals. Conclusion. Strict adherence to the international recommendations regarding authorship, peer review and manuscript selection could increase the quality of journals
Hypopituitarism after gamma knife radiosurgery for pituitary adenoma
Get PDFPURPOSE:
The aim of the study was to investigate the incidence of and risk factors for hypopituitarism after gamma knife radiosurgery (GKRS) for pituitary adenoma. -----
MATERIALS AND METHODS:
We conducted a retrospective analysis of the pituitary function of 90 patients who underwent GKRS for pituitary adenoma at the University Hospital Centre Zagreb between 2003 and 2014. Twenty seven of them met the inclusion criteria and the others were excluded from the study due to pituitary insufficiency which was present before GKRS. Eighteen patients had non-functioning and 9 patients had secretory adenomas. Median patients' age was 56 years (24-82). GKRS was performed using the Leksell gamma knife Model C. The median prescription radiation dose was 20 Gy (15-25) and the median tumor volume size was 3.4 cm3 (0.06-16.81). New onset hypopituitarism was defined as a new deficit of one of the three hormonal axes (corticotroph, thyreotroph, or gonadotroph) ≥3 months following GKRS. SPSS was used for statistical analysis, with the significance level at P<0.05. -----
RESULTS:
During the median follow-up period of 72 months (range 6-144), 30% of patients developed new hypopituitarism after GKRS. This corresponds to incidence of one new case of hypopituitarism per 15 patient-years. Age, gender, tumor function, tumor volume, suprasellar extension, prescription dose of radiation, as well as dose-volume to the pituitary gland, stalk and hypothalamus were not predictive factors for the development of hypopituitarism. -----
CONCLUSIONS:
In our cohort of patients with pituitary tumors who underwent GKRS, 30% developed new hypopituitarism during the follow-up period
Utjecaj estetskih rezultata poštedne operacije karcinoma dojke na kvalitetu života i pojavu simptoma depresivnih poremećaja
Get PDFBreast cancer is the leading malignancy in females in the western world as well as in Croatia. In the last 20 years, the standard method of treatment disease was a complete mastectomy with lymphadenectomy of axillary lymph nodes. Modern treatment includes a conservative resection of the breast and is the standard choice at the Clinical Hospital Center Rebro where over 60% of all breast cancer operations are done with conservative methods including techniques such as quadrantectomy, and sentinel lymph node biopsy. Frequently during surgery oncoplastic techniques are used. Other than surgical treatment, mandatory adjuvant therapies such as radiotherapy, and depending on the histological features of the tumor and the extent of invasion and distant metastasis, chemotherapy and/or hormonal therapy is used. When approaching the patient, other than oncologic treatment which is the main concern for the surgeon, the disease is must be viewed from a wider perspective which includes the patient's quality of life. Quality of life depends directly on the method and outcome of treatment. Our observations and research has shown that better aesthetic results increases the patients quality of life. Quality of life is worse in patients who on the personality tests rank higher in the section for neuroticism. Neuroticism is closely associated with a higher score on the Beck depression test. Extroversion is not associated with the occurrence of depression, nor with the result of the quality of life questionnaire. From anthropometric measurements before and after surgery, we found a statistically significant association with the difference of the distance between the nipple and inframammary fold. The larger the distance, the lower quality of life. Research results suggest that based on the conducted testing and measurements, we can predict patients with an increased risk for developing symptoms of depression and reduced quality of life. Early psychological treatment and support within the hospital or psychological consultation which are offered by organisations for patients suffering from breast cancer could reduce morbidity and improve quality of life. It is also to be expected that patients who are recognized as high risk and treated earlier due to dissatisfaction of the aesthetic result would use less sick days and thus reduce the total financial cost of treatment
Tvrdoća benignih i malignih promjena dojke mjerena sonoelastografijom posmičnoga vala [Shear-wave sonoelastography stiffness of benign and malignant breast lesions]
Get PDFIntroduction: Shear wave elastography is a novel method in ultrasound diagnostics of breast disease. The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of various breast lesions.
Methods: We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and median stiffness - Emax, Emin, Emean, lesion-to-fat ratio, lesion size), of 375 women in a four-year period.
Results: Among 387 lesions, histopathological findings showed 114 benign, 34 high risk breast lesion, 29 ductal carcinomas in situ, and 210 invasive carcinomas. Benign lesions showed lower stiffness than other groups. High risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however only E-ratio showed statistically significant difference in comparison with DCIS. All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and its stiffness. We found a positive correlation between the stiffness of invasive carcinomas and size and lymph node invasion.
Conclusion: Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions
Primjena intrakardijalnih elektrograma u optimizaciji resinkronizacijskoga elektrostimulatora srca
Get PDFIntracardiac delay optimization of biventricular pacing devices currently relies on timeconsuming
echocardiographic measurements. Automatic intracardiac electrogram (IEGM)
method for atrioventricular (AV) and interventricular (VV) delay optimization was developed by
St. Jude, which can be performed during routine device follow-up. Some manufacturers do not
provide automated intracardiac electrogram (IEGM) systems for AV and VVdelay optimization
in cardiac resynchronization therapy (CRT). We aimed to evaluate the diagnostic accuracy of
manual IEGM method in patients undergoing CRT.
We included 48 patients previously implanted with Medtronic Syncra, cardiac resynchronization
therapy devices. One month after CRT implantation all patients underwent standard device
interrogation followed by optimization of the CRT pacemaker settings by IEGM method and by
echocardiography.
Patients had a mean age of 60,7 ± 11,8 years and 33 (68,8%) were males. After the CRT
implantation, ejection fraction of the left ventricle increased from 28,0 ± 7,9 % to 39,1 ± 11,0 %
(P<0.001). Optimal aortic velocity time integral (AVTI) was obtained when VV was set to 20 –
50 ms left ventricular pre-activation. There was a strong correlation between VV values
determined by echocardiography and IEGM (ρ = 0.823, P<0.001). We found no significant
difference in sensed atrioventricular interval, paced atrioventricular interval, LVOT VTI and VV
values between echocardiography and IEGM method. However, IEGM was significantly less
time consuming than echocardiography [20 (10 – 28) vs. 40 (35 – 60) minutes, P<0.001].
The automated programmer-based IEGM method provides a reliable and simpler alternative
to standard techniques for CRT optimization. Our study indicates that manual IEGM method may
be good alternative to echocardiography and automated IEGM method. It also emphasizes the
need for implementation of automated IEGM systems by all CRT device manufacturers
Ambulantna kirurgija dnevne bolnice kirurške klinike [Ambulatory procedures in day surgery departmen]
Get PDFDay surgery and ambulatory surgery are two modalities of outpatient treatment carried out in day surgery department in Croatia. The purpose of this study, conducted in day surgery department, was to collect and analyze indicators of patient structure, diagnoses, performed procedures and organization of ambulatory surgery. This study analyzes 3409 ambulatory procedures and histological diagnoses of removed tissue in 2736 patients (1457 female and 1279 male). The indications for treatment were in 408 (14.9%) cases set by dermatologists while others were referred by primary healthcare physicians. According to the referral diagnosis, 2522 (92%) patients had benign, 47 (2%) dysplastic, and 167 (6%) malignant changes. The average patient age was 52.8 years. Patients with benign changes were, in average, significantly younger (44.2) than those with malignant ones (66.5). The most common referral diagnosis was D-22 melanocytic nevus. From a total of 38, 10 most common diagnoses constitute 87% of all referral diagnoses. According to International Classification of Diseases, Tenth Edition (ICD-10), these are: D22 (33.9%), D23 (21.3%), D21 (13.4%), D17 (6.9%), D21.0 (3.2%), C44 (2.4%), D21.1 (1.7%), L02 (1.6%), L08 (1.6%), B07 (1.3%). The main surgical procedures include extirpation, excision and biopsy of pigmented changes or skin neoplasms. When a procedure was performed because of a suspected benign lesion, pathohistological diagnosis confirmed 94.6% of such referral diagnoses as benign, whereas only 48% of clinically suspected malignant neoplasms were pathohistologically malignant. Out of patients referred with a clinically diagnosed benign lesion, 114 (4.5%) patients had a pathohistologically confirmed malignant skin tumor. The total number of malignant neoplasms was 219 (8.0%), and of melanoma 24 (0.8%). Out of 16 anatomical regions of the human body surgical procedures performed in three localizations make 56% of all localizations of performed procedures. These are: back (750), head (520) and chest (260). The procedures were performed by 22 physicians of various specialties, mostly by general surgeons (64.2%). Plastic and reconstructive surgeons performed 458 (16%), pediatric surgeons 381 (13.9%) and others 130 (4.8%) procedures. Ambulatory surgery is the surgery of skin, subcutaneous and soft tissue, usually affected by benign tumors or pigmentary changes, located mostly on the head and trunk. Only 43.8% of patients with verified malignancy were clinically recognized, which indicates, along with the higher incidence of malignancy in pathohistological (8%) than referral (6%) diagnoses, that a significant number of patients did not undergo a thorough diagnostic procedure