For 13 patients with subacute and 4 patients with chronic occlusion, magnetic resonance imaging (MRI) of occlusive arterial thrombi in the superficial femoral artery were performed in vivo. The ...patients with subacute occlusion were treated with catheter-directed thrombolysis. The frequency of MR signal intensity and its distribution in thrombi were studied for 11 successfully and 2 unsuccessfully treated patients and patients with chronic occlusion. Intra-arterial thrombi were MRI inhomogenous in all of the patients, but the MR signals from lysable and chronic thrombi were significantly different than those from nonlysable ones. The MRI of occlusive arterial thrombi is probably usable to predict the therapeutic outcome of thrombolytic treatment.
Background: Emergency postpartum hysterectomy (PH) is generally performed in the situation of lifethreatening haemorrhage. Incidence according to the literature is between 1/300 and 1/5000 labours. ...The leading cause in developed world is placenta accreta. Besides standard methods (aplication of drugs, revision of uterus, bimanual compression of uterus etc.), conservative surgical methods and embolization of vessels are increasingly used. We wanted to establish the incidence of PH in the Ljubljana Maternity Hospital, use of conservative surgical methods and matching of histological and operative diagnosis. We wanted to check the possibilities for embolization of vessels.Methods: Retrospective analysis of PH in the years 1992–2002 in the Ljubljana Maternity Hospital was done and the incidence of PH was calculated. We analysed patients regarding indications for PH, sort of operation and matching of histological and operative diagnose. We checked the possibilities for embolization of uterine vessels.Results: In the mentioned period 20 labours ended with PH (incidence 1/3124 labours). 17 patients were multiparas, PH was done after caesarean section in 9 cases. The most common indication was rupture of the uterus (6 cases), followed by inflammation of the uterus (5 cases) and atony (4 cases). Among conservative methods, application of 15-metil PGF2alpha and oxytocin were most commonly used, the next two were manual exploration of uterine cavity and uterine packing. None of conservative surgical methods were used. Histological and operative diagnosis matched in 16 cases. There were no maternal and neonatal deaths.Conclusions: The incidence of PH in the Ljubljana Maternity Hospital is low. The leading two causes are uterine rupture and inflammation of uterus. None of conservative surgical methods were used. There are good possibilities for embolization of uterine vessels.
Background/Aims: Though hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors in the world, the optimal therapeutic strategy is still poorly defined. This is mainly due to ...geographic differences in HCC which may affect the validity of treatment regimens in differents areas of the world. The aim of the present study was to analyze the natural course of the disease as well as to assess the efficacy of different therapeutical schemes in HCC observed in Ljubljana (Slovenia) and Trieste (Italy), two cities in Western Europe situated close to each other.
Methods: During the period from January 1988 to December 1993, 224 consecutive patients (132 in Trieste and 92 in Ljubljana) with HCC were enrolled in the study. Patients were treated with the following 3 schemes: surgery 39 (17.4%), transcatheter chemo-embolization (TACE) 116 (51.8%), and no treatment 69 (30.8%). The tumor was classified by Okuda staging and the liver disease by Child-Pugh score. Patients were followed up for 12–60 months, with an average of 40 months. The response rate to TACE and recurrence following surgery were evaluated. Comparative analysis of survival between different treatment groups was performed.
Results: The natural course of the disease, and other characteristics of the HCC, showed a typical Western type of tumor. Liver disease was scored as Child A in 58%, Child B in 30% and Child C in 12%, and the tumor was staged as Okuda I in 52%, Okuda II in 37% and Okuda III in 11%, respectively. Treatment with TACE was followed by an objective response in 27%, with a median survival of 31 months. Surgery was followed by a recurrence rate of 77% within 19.5 months and median survival of 49 months. The overall median survival of nontreated patients was 8 months. Survival in each group of patients differed significantly between all three consecutive stages of Okuda (
p<0.001). In contrast, the differences in survival were significant only between Child A and B (
p<0.02). The differences between Child B and C were not significant.
Conclusions: This study emphasizes the importance of staging in the choice of treatment modality and diffusion of HCC in affecting an overall response to treatment and survival. Surgery is highly effective in monofocal HCC of Okuda I and II without cirrhosis. TACE is effective in Okuda I and II and Child A cirrhosis only. The treatment of HCC in Child B cirrhosis needs further studies. In Child C and/or Okuda stage II of HCC, any treatment except pure symptomatic relief is detrimental and should not be used.
Retrospektivno smo analizirali rezultate liječenja ishemije donjih udova u 63 bolesnika sa šećernom bolešću (27 žena i 36muškaraca, prosječne dobi 73,5 god.) izdvojenih iz skupine od 138 slučajno ...odabranih bolesnika me.u onima kojima je tijekom 1998. god. za vrijeme hospitalizacije na Odjelu vaskularne medicine Odjela za radiologiju Kliničkog centra u Ljubljani učinjena arteriografija donjih udova. Razlozi za arteriografiju donjih udova bili su: klaudikacija u 18 (29%), kronična kritična ishemija u 42 (66%) i akutna ishemija u 3 (5%) bolesnika. Poslije arteriografije, postupak revaskularizacije proveden je u 32 (51%) bolesnika, od kojih je u troje bolesnika s akutnom ishemijom uspješno provedena embolektomija, 24 bolesnika liječeno je endovaskularno, a 5 bolesnika liječeno je kirurški. Tridesetoro (47%) bolesnika liječeno je konzervativno, a u jednoga je učinjena primarna amputacija. Status bolesnika ponovno je ocijenjen u prosjeku nakon 24 mjeseca (raspon 19-33 mjeseca). Od 18 bolesnika s klaudikacijom dvoje je umrlo, jedan zbog moždanog udara, a drugi zbog pogoršanja kronične opstrukcijske plućne bolesti sa zatajenjem respiracije. U svih su bolesnika u razdoblju preživljenja ili tijekom praćenja udovi bili očuvani, u 15 nakon postupka revaskularizacije, a u 18 uz konzervativno liječenje. U 9 (21%) bolesnika učinjena je amputacija (u 4 bolesnika ispod koljena, a u 5 iznad koljena). Jedna je amputacija bila primarna, 2 su uslijedile poslije endovaskularnog liječenja, a 6 poslije konzervativne terapije. Tijekom razdoblja praćenja umrlo je 13 (31%) bolesnika s kroničnom kritičnom ishemijom (5 zbog moždanog udara, 3 zbog akutnog infarkta miokarda, a 5 zbog nepoznatih uzroka). Naši rezultati potvrđuju da se ishemija donjih udova u bolesnika sa šećernom bolešću može liječiti razmjerno uspješno, no smrtnost je i dalje visoka, poglavito među bolesnicima s kroničnom kritičnom ishemijom.
Karotidna endarterektomija (CEA) u širokoj je uporabi pri liječenju karotidne stenoze visokog stupnja. Kirurški zahvat obavlja se u općoj anesteziji, a primjenjuje se samo pri oštećenjima na račvištu ...karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaćaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srčane komplikacije. Rizik komplikacija povećan je u bolesnika s recidivirajućom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u području vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su liječnike da potraže alternativne načine liječenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za liječenje recidivirajućih stenoza nakon prethodne CEA te za liječenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opća anestezija, a u bolesnika s teškom kardiopulmonalnom bolesti pobol i smrtnost su manji. U komplikacije CAS pripadaju moždani udar zbog distalne embolizacije plaka ili odvajanja tromba tijekom postupka, nagla okluzija krvne žile zbog tromboze, disekcija ili vazospazam te ponovna stenoza zbog hiperplazije intime. CAS je razmjerno nov postupak, pa je nužno utvrditi njegovu djelotvornost i sigurnost prije nego što se uvede u široku kliničku uporabu. U Sloveniji smo započeli s istraživanjem karotidne angioplastike u okviru projekta “Slovenian Carotid Angioplasty Study (SCAS)”. Prema našim prvim iskustvima u 17 bolesnika, CAS bi se mogao pokazati važnim u prevenciji moždanog udara, uz dobar odabir bolesnika s moždanom ishemijom i uz bolju cerebralnu zaštitu tijekom postupka.
The aim of the study was to find out whether in patients (n = 24) with one-vessel coronary artery disease, reversibility of related left ventricular (LV) wall motion abnormalities after successful ...percutaneous transluminal coronary angioplasty (PTCA) can be predicted by the immediate effect of calcium antagonist nicardipine. Dynamic quantitative left cineventriculography performed four times successively (as the control, 30 minutes after oral nicardipine, 10 minutes after PTCA, and 6 months after PTCA) and hemiaxis method (mean relative hemiaxis shortening or Xdeltar%) were used for wall motion analysis of 48 poststenotic LV myocardial segments divided into three groups: hypokinetic noninfarcted (PNHS, n = 25), infarcted (PIS, n = 12), and normokinetic noninfarcted (PNNS, n = 11) and of 24 normal LV myocardial segments (NS). In PNHS and PIS close correlation (r = 0.75, P < 0.0001 and r = 0.71, P < 0.005) was demonstrated between postnicardipine improvement (21 +/- 4% to 37 +/- 9%, P < 0.0001, and 16 +/- 7% to 20 +/- 8%, P < 0.0005) and 6 months after PTCA improvement (21 +/- 4% to 33 +/- 7%, P < 0.0001, and 16 +/- 7% to 19 +/- 9%, P < 0.0005) of wall motion. It was loose in PNNS and absent in all three groups immediately after PTCA. The sensitivity of the nicardipine test for 6 months after PTCA reversible LV segmental hypokinesia was high in PNHS (95%) and lower in PIS and PNNS (67% and 60%, respectively). The specificity was 100% in PIS, lower in PNNS (67%), and absent in PNHS (owing to lack of true nonresponders). Immediately after PTCA, contraction significantly improved only in PNHS; the nicardipine test was 100% sensitive but nonspecific. Significant improvement of contraction of all groups of poststenotic LV wall segments is expected 6 months after successful PTCA of related artery stenosis, being well predictable by the pre-PTCA effect of nicardipine, at least in PNHS and in PIS. Immediately after PTCA, only in PNHS can significant improvement of contraction be expected.
