Objective: To compare the performance of the Glasgow Blatchford score (GBS), pre-endoscopic Rockall score (PRS) and AIMS65 score in predicting specific clinical endpoints following variceal upper ...gastrointestinal hemorrhage (UGIH).
Material and methods: Between January 2008 and December 2013, we retrospectively analyzed 225 consecutive hospitalized patients managed for endoscopically confirmed UGIH.
Results: A total of 225 patients (mean age 61.3 years), mostly diagnosed with alcoholic cirrhosis (195/86.7%), presented with variceal UGIH during the study period. Rebleeding occurred in 22 (9.8%) patients and 30-day mortality was 39 (17.3%). Initial hemostasis was achieved with N-butyl cyanoacrylate (151/79.1%) and endoscopic variceal ligation (40/20.9%), while secondary rebleeding prophylaxis in 110 (48.9%) patients was accomplished using endoscopic variceal ligation (92%). The majority of patients died from the underlying disease, while 12 (30.8%) died from bleeding. Median hospital stay was 6 (1-35) days. There was no statistically significant difference among AIMS65, GBS and PRS in predicting mortality (AUROC 0.70 vs. 0.64 vs. 0.66) or rebleeding rates (AUROC 0.74 vs. 0.60 vs. 0.67). The GBS was superior in predicting the need for blood transfusion compared to AIMS65 score (AUROC 0.75 vs. 0.61, p = 0.01) and PRS (AUROC 0.75 vs. 0.58, p = 0.009).
Conclusions: The AIMS65, GBS and PRS scores are comparable but not useful for predicting outcome in patients with variceal UGIH because of poor discriminative ability. The GBS is superior in predicting the need for transfusion compared to AIMS65 score and PRS.
Packaging is seen as an integral part of the product and it has an important role in attracting consumers’ attention. The role of packaging is to create an expected reaction from the consumers, which ...affects their perception and choice of products in the buying process. The motivation for the research and writing of this paper was to find out which factors influence the purchase of chocolate the most. The research was done with the purpose of showing whether the same food products have a certain advantage in the process of choosing when presented to a potential consumer on two different media (analog and digital). The paper presents research on how the selected attributes and packaging elements, as well as the application of augmented reality (AR), affect the selection and purchase of one of the most popular food products. According to the obtained results, “Packaging appearance”, “Product Price”, “Brand preference” and “Product advertising” have the strongest influence on customers. The conclusion is that, in the process of choosing the chocolate packaging presented in this research, there is not much difference that depends on the medium those chocolates are presented on.
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal
tumors of the digestive tract and are generally asymptomatic. A 39-year-old female patient was hospitalized
in 2012 at Clinical ...Department of Internal Medicine, Sestre milosrdnice University Hospital
Center, for a focal hypodense irregular circular lesion located in segment III of the left hepatic lobe,
accidentally found by ultrasonography and verified by computed tomography. The findings were also
verified with nuclear magnetic resonance and esophagogastroduodenoscopy. A biopsy sample of the
lesion was analyzed by histologic and immunohistochemical methods and identified as GIST. The
patient underwent surgical operation (tumor excision with terminoterminal anastomosis created
between the second segment of duodenum and jejunum and resection of liver segment III). The
histopathologic findings matched GIST with a high probability of relapse according to the localization,
size, mitotic activity and Ki-67 values. Therefore, therapy with imatinib at a dose of 400 mg/day was
administered. Three years after the operation, the patient is still in remission.
In the achromatic White's grid, the grey patches between the grey lines are perceived as darker while the same elements inserted between white lines are perceived lighter than their true measured ...values. A number of authors attempted to calculate the magnitude and direction of this effect using mathematical models based on multiple spatial filters. This paper uses different mathematical model, based on regression analysis, which has shown itself as an excellent tool for prediction of direction and magnitude of White's effect. The psychophysical visual experiment was conducted on 38 subjects of both genders. The differences in lightness perception ∆L00 were calculated in CIE ∆E_2000 system. This paper determined the functional dependence of White's effect magnitude ∆L00 to the lightness L of rectangular elements in White's achromatic grid. The results gave the square polynomial of very high quality (R2 = 0,974). Regression polynomials were also found. The gave numerical values ∆L00 of difference in perception of left and right elements in comparison to their physical values (left R2 = 0,943, right R2 = 0,938) in dependence to variation of lightness parameter L. Results of the research clearly show the mathematical pattern of White's effect based on the lightness of rectangular elements.
Traumatic neuromas (TNs), benign neoplasms that
originate from Schwann cells in the peripheral
nervous system, are rare but well-recognized
complications of hepatobiliary procedures.1-3 They
mainly ...appear at sites previously exposed to surgical
trauma and may result in biliary obstruction and/or
ischemia. With the consideration of the magnitude
of biliary and vascular interventions during
liver transplant (LT), TNs are only sporadically
reported4-9 and most probably underestimated.
Because they do not have specific features, imaging
often fails to recognize TNs preoperatively, and they
are commonly discovered only on pathologic
examination. Given that TNs may lead to irreversible
graft dysfunction, we analyzed all liver allografts
removed at liver retransplant (re-LT) in our center to
identify TNs behind indications for re-LT.
This paper shows the research data of psychophysical visual effect of simultaneous contrast when changing RTV of background lightness in the printing process. An experimental research on graphic ...reproductions made in the offset printing technique with specifically constructed design solutions that cause the above mentioned effect was carried out. Samples were designed as ten various lightness variances of background, with a range from 10% RTV to 100% RTV, on which there are primary stimuli with value of 50% RTV. The visual experiment was performed by using simultaneous binocular harmonization technique, and it involved 20 respondents. The respondents were tasked with harmonizing the primary stimuli from the test reproduction in relation to the referential one, so that they were to be perceived as equal on both reproductions. For statistical data processing, one-way repeated measurements ANOVA was used, which found statistically consequential differences among means of deviations in perceived lightness of primary stimuli. Post-hoc analysis by Fisher shows pairs that are reciprocally different (p < 0,05). The obtained results clearly indicate the regularities of the appearance of simultaneous contrast effect on printed medium, all with the aim of creating a model for predicting it and finding a conceptual design solution in which the effect is pronounced the least.
AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. ...METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTS PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one ’perfect score’ and we suggest that these two tests be used concomitantly.
The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding ...(PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.
As the burden of liver disease in the general populace steadily increases, so does the need for both advanced diagnostic and treatment options. Endoscopic ultrasound is a reliable diagnostic and ...therapeutic method that has an established role, foremost in pancreatobiliary pathology. This paper aims to summarize the growing role of endoscopic ultrasound in hepatology based on the search of the current literature. A number of applications of endoscopic ultrasound are reviewed, including both noninvasive methods and tissue acquisition in focal and diffuse liver disease, portal hypertension measurement, detection and management of gastric and esophageal varices, treatment of focal liver lesions and staging of pancreatobiliary malignancies, treatment of cystic and solid liver lesions, as well as liver abscess drainage. Both hepatologists and endoscopists should be aware of the evolving role of endoscopic ultrasound in liver disease. The inherent invasive nature of endoscopic examination limits its use to a targeted population identified using noninvasive methods. Endoscopic ultrasound is one the most versatile methods in gastroenterology, allowing immediate access with detection, sampling, and treatment of digestive tract pathology. Further expansion of its use in hepatology is immanent.
Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as ...necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries.
The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient's progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries.
The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient's feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient's ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity.
This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management.
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