40 research outputs found
Urgent carotid endarterectomy in patients with acute neurological ischemic events in progression
No full textCilj: Analizirati uspešnost neurološkog oporavka ispitanika nakon urgentne karotidne
endarterektomije (UKE), u zavisnosti od vrste akutnog preoperativnog neurološkog
deficita, kao i analiza ranih i udaljenih rezultata UKE u odnosu na rezultate elektivne
karotidne endarterektomije.
Metodologija: U periodu od januara 1998. do decembra 2012. godine, u Institutu za
kardiovaskularne bolesti “Dedinje” učinjeno je 8244 endarterektomije karotidne arterije
everzionom tehnikom. Kod 76 bolesnika, koji su podeljeni u dve grupe, je učinjena
UKE zbog akutnog neurološkog deficita u razvoju. Prvu grupu čini 61 ispitanik koji je
imao krešendo TIA, dok II grupu čine 15 pacijenata sa slikom moždanog udara (MU) u
razvoju. UKE je učinjena u roku do šest sati od početka akutnog neurološkog događaja.
CT endokaranijuma je učinjen pre, kao i postoperativno. Radi procene preoperativnog
neurološkog poremećaja, kao i postoperativnog neurološkog stanja, korišćena je
modifikovana skala Rankin skora (mRS).
Rezultati: Prosečni period praćenja iznosio je 96,3±53,9 meseci za I grupu, odnosno
94,4±51,3 meseca za II grupu. U ranom postoperativnom periodu, svi pacijenti "krešendo
TIA" grupe kao i 11 bolesnika (73,3%) grupe "MU u razvoju" imali su odličan neurološki
oporavak, dok je kod 4 pacijenta (26,7%) druge grupe postoperativni CT mozga bio
pozitivan na ishemiju, ali uz značajan neurološki oporavak kod tri. U ranom
postoperativnom periodu nije registrovan smrtni ishod. Tokom perida praćenja, jedan
bolesnik (1,6%) I grupe imao je manji MU sa uspešnim oporavkom, a kod dva bolesnika
zabeležena je restenoza (>50%) unutrašnje karotidne arterije. Jedan pacijent (6,7%) grupe "MU u razvoju" imao je masivni MU praćen smrtnim ishodom.
Zaključak: UKE je metoda izbora hirurškog lečenja kod bolesnika sa krešendo TIA i
verifikovanom karotidnom stenozom. MU u razvoju je prihvatljiva indikacija za UKE.
Rani i udaljeni rezultati hirurškog lečenja ispitanika kod kojih je učinjena UKE zbog
krešendo TIA, se ne razlikuju od rezultate lečenja pacijenata kod kojih je učinjena
elektivna karotidna endarterektomija.Objective: The aim of this study was to analyze the outcome of urgent carotid
endarterectomy (CEA) with respect to the type of preoperative acute neurogical deficit,
and an analysis of early and late results urgent CEA from the results of elective CEA.
Methods: From January 1998 to December 2012, 8244 eversion CEAs were done at
„Dedinje“ Cardiovascular Institute. In 76 patients urgent CEA was performed for acute
neurologival ischemic events- 61 patients with crescendo TIA (group I) and 15 patients
with stroke in progression (group II). All procedures were performed within 6 hours after
symptoms appeared. Brain CT was done prior and after the surgery. Disability level was
assessed prior to and after urgent CEA using modified Rankin scale (mRS).
Results: Median follow up was 96.3±53.9 months for group I and 94.4±51.3 months for
group II. In the early postoperative period all patients in crescendo TIA group and eleven
patients (73.3%) in stroke in progression group had excellent recovery while in patients
with stroke in progression group 4 patients (26.7%) had brain CT positive for ishemia,
yet neurological status significantly improved in 3 patients. In the early postoperative
period there no lethal outcomes. During the follow-up, on patient (1.6%) of first group
had minor stroke and fully fecovered and in two patients was observed restenosis (>
50%) internal carotid artery. In stroke in progression group one patient (6.7%) had major
stroke followed by lethal outcome.
Conclusions: Based on our results urgent CEA is a safe and effective treatment option
for patients with crescendo TIA. Stroke in evolution is acceptable indication for urgent
CEA. Early and late results of surgical treatment of patients who underwent urgent CEA
for crescendo TIA, do not differ from the results of treatment of patients who underwent
elective CEA
Urgent carotid endarterectomy in patients with acute neurological ischemic events in progression
No full textCilj: Analizirati uspešnost neurološkog oporavka ispitanika nakon urgentne karotidne
endarterektomije (UKE), u zavisnosti od vrste akutnog preoperativnog neurološkog
deficita, kao i analiza ranih i udaljenih rezultata UKE u odnosu na rezultate elektivne
karotidne endarterektomije.
Metodologija: U periodu od januara 1998. do decembra 2012. godine, u Institutu za
kardiovaskularne bolesti “Dedinje” učinjeno je 8244 endarterektomije karotidne arterije
everzionom tehnikom. Kod 76 bolesnika, koji su podeljeni u dve grupe, je učinjena
UKE zbog akutnog neurološkog deficita u razvoju. Prvu grupu čini 61 ispitanik koji je
imao krešendo TIA, dok II grupu čine 15 pacijenata sa slikom moždanog udara (MU) u
razvoju. UKE je učinjena u roku do šest sati od početka akutnog neurološkog događaja.
CT endokaranijuma je učinjen pre, kao i postoperativno. Radi procene preoperativnog
neurološkog poremećaja, kao i postoperativnog neurološkog stanja, korišćena je
modifikovana skala Rankin skora (mRS).
Rezultati: Prosečni period praćenja iznosio je 96,3±53,9 meseci za I grupu, odnosno
94,4±51,3 meseca za II grupu. U ranom postoperativnom periodu, svi pacijenti "krešendo
TIA" grupe kao i 11 bolesnika (73,3%) grupe "MU u razvoju" imali su odličan neurološki
oporavak, dok je kod 4 pacijenta (26,7%) druge grupe postoperativni CT mozga bio
pozitivan na ishemiju, ali uz značajan neurološki oporavak kod tri. U ranom
postoperativnom periodu nije registrovan smrtni ishod. Tokom perida praćenja, jedan
bolesnik (1,6%) I grupe imao je manji MU sa uspešnim oporavkom, a kod dva bolesnika
zabeležena je restenoza (>50%) unutrašnje karotidne arterije. Jedan pacijent (6,7%) grupe "MU u razvoju" imao je masivni MU praćen smrtnim ishodom.
Zaključak: UKE je metoda izbora hirurškog lečenja kod bolesnika sa krešendo TIA i
verifikovanom karotidnom stenozom. MU u razvoju je prihvatljiva indikacija za UKE.
Rani i udaljeni rezultati hirurškog lečenja ispitanika kod kojih je učinjena UKE zbog
krešendo TIA, se ne razlikuju od rezultate lečenja pacijenata kod kojih je učinjena
elektivna karotidna endarterektomija.Objective: The aim of this study was to analyze the outcome of urgent carotid
endarterectomy (CEA) with respect to the type of preoperative acute neurogical deficit,
and an analysis of early and late results urgent CEA from the results of elective CEA.
Methods: From January 1998 to December 2012, 8244 eversion CEAs were done at
„Dedinje“ Cardiovascular Institute. In 76 patients urgent CEA was performed for acute
neurologival ischemic events- 61 patients with crescendo TIA (group I) and 15 patients
with stroke in progression (group II). All procedures were performed within 6 hours after
symptoms appeared. Brain CT was done prior and after the surgery. Disability level was
assessed prior to and after urgent CEA using modified Rankin scale (mRS).
Results: Median follow up was 96.3±53.9 months for group I and 94.4±51.3 months for
group II. In the early postoperative period all patients in crescendo TIA group and eleven
patients (73.3%) in stroke in progression group had excellent recovery while in patients
with stroke in progression group 4 patients (26.7%) had brain CT positive for ishemia,
yet neurological status significantly improved in 3 patients. In the early postoperative
period there no lethal outcomes. During the follow-up, on patient (1.6%) of first group
had minor stroke and fully fecovered and in two patients was observed restenosis (>
50%) internal carotid artery. In stroke in progression group one patient (6.7%) had major
stroke followed by lethal outcome.
Conclusions: Based on our results urgent CEA is a safe and effective treatment option
for patients with crescendo TIA. Stroke in evolution is acceptable indication for urgent
CEA. Early and late results of surgical treatment of patients who underwent urgent CEA
for crescendo TIA, do not differ from the results of treatment of patients who underwent
elective CEA
Association of obesity and diabetes mellitus with early and late outcomes after carotid endarterectomy
No full textUvod: Podaci o povezanosti dijabetesa melitusa (DM) i gojaznosti sa ishodima karotidne endarterektomije (KEA) nisu konzistentni, a uticaj njihovog istovremenog prisustva na rezultate KEA je nedovoljno ispitan. Cilj: Ispitivanje pojedinačnog i zajedničkog uticaja DM i gojaznosti, kao i drugih potencijalnih faktora rizika, na pojavu ranih i kasnih nepovoljnih ishoda KEA. Metod: Kohortnom studijom je obuhvaćeno 1597 KEA urađenih kod 1533 pacijenta Klinike za vaskularnu hirurgiju Instituta za kardiovaskularne bolesti „Dedinje“ u Beogradu, u periodu 2012-2017. Pacijenti su praćeni 4 godine od operacije.
Rezultati: Tip 1 DM (T1DM) nije bio povezan sa ranim nepovoljnim ishodima KEA. Od kasnih nepovoljnih ishoda, pacijenti sa T1DM su češće imali infarkt miokarda, smrtni ishod i restenozu. Pacijenti sa tipom 2 DM (T2DM) su češće imali TIA/moždani udar, smrtni ishod, respiratorne komplikacije i reoperacije od ranih nepovoljnih ishoda, kao i sve kasne nepovoljne ishode izuzev infarkta miokarda. Predgojaznost i gojaznost nisu bili povezani sa ranim i kasnim nepovoljnim ishodima KEA. Jedini izuzetak su bila perioperativna krvarenja koja su bila ređa kod predgojaznih. Gojazni pacijenti sa DM su, u odnosu na pacijente bez DM, češće imali TIA/moždani udar, smrtni ishod i respiratorne komplikacije od ranih nepovoljnih ishoda, kao i moždani udar i restenozu od kasnih. Između gojaznih i negojaznih pacijenata sa DM nije bilo razlike u učestalosti ni ranih ni kasnih komplikacija posle KEA. Prediktori glavnih ranih nepovoljnih ishoda KEA bili su prethodna perkutana koronarna intervencija i povišeni trigliceridi, dok su aspirin i ACEI u terapiji na otpustu bili protektivni. Prediktori glavnih kasnih nepovoljnih ishoda KEA bili su T1DM, uzrast, periferna arterijska bolest, kontralateralna karotidna stenoza i OAK u terapiji na otpustu. Rekreativna fizička aktivnost pre operacije identifikovana je kao protektivni faktor za pojavu kasnog infarkta miokarda/moždanog udara.
Zaključak: Identifikovani prediktori nepovoljnih ishoda KEA ukazuju na potrebu korekcije životnih navika i precizniji odabir medikamentne terapije.Introduction: Data on the association of diabetes mellitus (DM) and obesity with carotid endarterectomy (CEA) outcomes are inconsistent, and the effect of their simultaneous presence on the results of CEA is insufficiently investigated.
Aim: To investigate the individual and simultaneous effect of DM and obesity, as well as the effect of other potential risk factors on the occurrence of early and late adverse outcomes of CEA.
Method: The cohort study included 1597 CEA performed in 1533 patients at the Clinic for Vascular Surgery, Institute for Cardiovascular Diseases "Dedinje" in Belgrade, from 2012-2017. Patients were followed for 4 years after surgery.
Results: Type 1 DM (T1DM) was not associated with early adverse outcomes of CEA. Regarding the late adverse outcomes, patients with T1DM had myocardial infarction, death and restenosis more frequently. Patients with type 2 DM (T2DM) had more freaquently TIA/stroke, death, respiratory complications and reoperations as early adverse outcomes, as well as all late adverse outcomes except myocardial infarction. Overweight and obesity were not associated with early and late adverse outcomes of CEA. The only exception was perioperative bleeding, which was less frequent in overweight patients. Obese patients with DM, compared to patients without DM, had more freaquently TIA/stroke, death and respiratory complications as early adverse outcomes, as well as stroke and restenosis as late adverse outcomes. Between obese and non-obese patients with DM there were no differences in the frequency of neither early nor late complications after CEA. Predictors of the early major adverse outcomes of CEA were previous percutaneous coronary intervention and higher triglyceride levels, while aspirin and ACEI in discharge therapy were protective. Predictors of the late major adverse outcomes of CEA were T1DM, age, peripheral arterial disease, contralateral carotid stenosis and OAK in discharge therapy. Preoperative recreational physical activity has been identified as a protective factor for the occurrence of late myocardial infarction/stroke.
Conclusion: Identified predictors of adverse CEA outcomes indicate the need for correction of lifestyle habits and more precise selection of medical therapy
Donating
No full textPrimarno književnik, Stojević se nije ustručavao niti prelaziti u druge medije, niti upisivati druge medije u književnost, u skladu s postmodernom otvorenošću, s postmodernom sklonosti nivelaciji visokoga i niskoga, prošloga i sadašnjega i u konačnici u skladu s postmodernim dokidanjem hijerarhija i propitivanjem granica. Naglašena usmjerenost na jezik i diskurzivne učinke povezna je tema gotovo cijela njegova opusa, a plod je intelektualne klime u desetljeću u kojem je Stojević formativno stasavao u autora.Primarily a man of letters, Stojević has not been afraid of using or importing other media into literature in accordance with the open-ended postmodernism and its tendencies to even the high and the low, the past and the present as well as to question boundaries and abolish any type of hierarchy. Special focus on language and discursive effects is the main topic of his almost entire oeuvre and is the result of the intellectual climate during the decade of Stojević’s formative years as an author
Narration or Story as an Instrument or Knot of (De)humanization or ...
No full textU znanosti i nastavi humanističke orijentacije sve je vidljivija favorizacija kvantifikacije, mjerljivosti, birokratizirane organizacije sadržaja i neopozitivizma, neo u smislu statističke obradivosti podataka, čime se evidentno prati logika računalne prezentacije informacija (umjesto znanja), a preko toga kapitalističko discipliniranje i nadziranje Gorzovog „nematerijalnog rada“. Internetom, filozofijom mreže, hipertekstom i hiperinformacijskim overloadom fragmentirana, disperzirana i dekontekstualizirana digitalna kultura zaziva u teoriji i praksi opozicijsku reakciju u pravcu reafirmacije klasične priče ili storytellinga kao arhetipske forme humaniziranja, organiziranja i osmišljavanja ljudskoga iskustva i znanja. Međutim, kada Amazon najavljuje da će autora honorirati onoliko koliko je stranica njegova teksta pročitano zahvaljujući aplikacijama za praćenje takvih rezultata, kada Christian Salmon otkriva storytelling kao novi instrument korporativnog businessa, kada storytelling postaje imperativ komercijalne književnosti i sredstvo industrijalizirane standardizacije književnosti, čemu se izlazi u susret trendom radionica za kreativno pisanje, pitanje je kome i čemu priča danas služi. Nije li prošlostoljetna (post)modernistička dekonstrukcija teksta i dezintegracija njegova ideologiziranog smisla bila onoliko humanija koliko se činila nečitljivom, za razliku od današnjeg zavođenja konzumerističkog objekta atrakcijama fabuliranja iz pera „dobavljača sadržaja“?In science and humanistic teaching, the precedence of quantification, measurability, bureaucratic content organization, and neopositivism – neo in terms of statistical data processing – is increasingly visible. It evidently follows the logic of a computerized presentation of information (instead of knowledge), and thus the capitalist disciplining and controlling of Gorz’s “intangible labor.” With the Internet, network philosophy, hyper- text, and hyperinformation overload, a fragmented, dispersed, and decontextualized digital culture invokes in both theory and practice an oppositional reaction towards reaffirming the classic story or storytelling as an archetypal form of humanizing, organizing, and conceiving human experience and knowledge. However, when Amazon announces that the author will be paid an amount corresponding to the amount of pages of his text that are read through apps for tracking such results, when Christian Salmon discovers storytelling as a new instrument of corporate business, when storytelling becomes an imperative of commercial literature and a means of industrialized standardization of literature, all facilitated by the trend of creative writing workshops, the question is to whom and to what purpose the story serves today. Was the last century’s (post)modernist deconstruction of the text and the disintegration of its ideologized meaning not as humane as it was unreadable, as opposed to today’s seduction of the consumerist object through fabrications from the pen of “content providers”
What is the purpose of human rights, from the perspective of the current and future constitutional system of Serbia
No full textThis contribution debates on its main theme primarily in the context of amendment of fundamental principles of the constitution of a political community. Further on, the deficiencies of the current constitutional system of respect and protection of human rights are analysed. In the end, the author recommends some directions for revisions of constitutional rules on human rights in the perspective of passing of a new constitutional document
Direktni oralni antikoagulantni lekovi u profilaksi i terapiji tromboembolijskih bolesti
No full textMore than 50 years ago, vitamin K antagonists were the only available oral anticoagulants. Since their application involves a number of limitations, it was necessary to develop new oral anticoagulant drugs and introduce them into clinical practice. These drugs have many advantages over vitamin K antagonists, including rapid onset/offset, a small number of interactions with other drugs and food, simplified dosing and predictable pharmacokinetics, eliminating the need for daily laboratory monitoring. In addition, new oral anticoagulant drugs act selectively on a single coagulation factor. Currently, the following drugs are approved for use: direct thrombin inhibitor, dabigatran etexilate, direct factor Xa inhibitor, rivaroxaban, apixaban and edoxaban. Dabigatran etexilate and apixaban are approved for the primary prevention of venous thromboembolism in adult patients undergoing elective surgery of total hip or knee replacement, while in addition to these anticoagulants edoxaban is approved for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation. For the treatment and prevention of recurrent deep vein thrombosis dabigatran etexilate, rivaroxaban and edoxaban are approved. In addition, rivaroxaban is approved for the secondary prevention of atherothrombotic events in patients with acute coronary syndrome.Više od 50 godina, antagonisti vitamina K bili su jedini dostupni oralni antikoagulantni lekovi. S obzirom na to da njihova primena podrazumeva brojna ograničenja, bilo je neophodno razviti i uvesti u kliničku praksu nove oralne antikoagulantne lekove. Ovi lekovi imaju brojne prednosti u poređenju s antagonistima vitamina K, koje uključuju brz početak i prestanak dejstva, mali broj interakcija s drugim lekovima i hranom, pojednostavljen način doziranja, kao i predvidivu farmakokinetiku, čime se eliminiše potreba za svakodnevnim laboratorijskim praćenjem. Osim toga, novi oralni antikoagulantni lekovi deluju selektivno samo na jedan faktor koagulacije. Trenutno su odobreni za upotrebu direktni inhibitor trombina, dabigatran eteksilat, kao i direktni inhibitori faktora Xa, rivaroksaban, edoksaban i apiksaban. Dabigatran eteksilat i apiksaban odobreni su za primarnu prevenciju venske tromboembolije kod odraslih pacijenata koji se podvrgavaju elektivnom hirurškom zahvatu totalne zamene kuka ili kolena, dok je za prevenciju moždanog udara i sistemske embolije kod odraslih pacijenata sa nevalvularnom atrijalnom fibrilacijom, pored navedenih antikoagulantnih lekova, odobren i edoksaban. Za terapiju i prevenciju rekurentne duboke venske tromboze odobreni su dabigatran eteksilat, rivaroksaban i edoksaban. Osim toga, rivaroksaban je odobren i za sekundarnu prevenciju aterotrombotičkih događaja nakon akutnog koronarnog sindroma
Abdominal aorta coarctation: The first three case reports in our literature
No full textIntroduction. Congenital coarctation of the thoracic aorta at the ligamentum arteriosum or the aortic arch is well recognized. But a much less common variety (0.5-2.0%) of aortic coarctation is located in the distal thoracic aorta or abdominal aorta or both and is often called 'middle aortic syndrome' or 'midaortic dysplastic syndrome'. This represents serious pathological condition and indicates multidisciplinary therapy approach. Outline of Cases. From 1996 to 2007, at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, three patients were treated due to abdominal aorta coarctation, two females aged 55 and 50 and a 4-year-old child. The patients were treated surgically (by-pass with a prosthetic graft and patch angioplasty) and endovascular-percutaneous transluminal angioplasty (PTA) with and without a stent. The follow-up period was 3-70 months. In the 50-year-old patient, angiography showed severe narrowing of the suprarenal segment of the abdominal aorta. Thoraco-abdominal bypass with a 16 mm dacronic tubular graft was performed. In the 4-year-old patient angiography also showed a suprarenal aorta narrowing. In the first act patch angioplasty was performed and after PTA of the visceral arteries was done on several occasions. In the 55-year-old patient, after diagnostic angiography, infrarenal aorta coarctation was registered. PTA was performed with stent placement. All patients were asymptomatic on control check-ups. Conclusion. Abdominal coarctation is a pathological disease which is seldom found in vascular surgery. Angiography is of major importance for setting the diagnosis and for the control of the results of surgical and nonsurgical treatment. The combination of surgical and endovascular treatment in our patients showed very good results in the studied period.</jats:p
