The language management theory is a poststructuralist approach to language regulation which emerged in the late 1980s as a corrective to the theory of language planning. Being based on the assumption ...that no intervention into language is value–free since each reflects particular interests and ideologies, the theory sought to describe and explain spontaneous interventions by users into language and their interactions with organized language regulation. The paper analyses language regulation practices by Council for Standard Croatian Language Norm through the prism of language management theory, with documents published in the journal Jezik (no. 2–4, vol. 60, 2013) being the main source of information on the work of the Council. The analysis focuses on the attitudes towards the interaction of spontaneous and organized interventions into language as well as on the attitudes towards the problems of ideologies and interests. The paper is concluded by an attempt to determine the place of the language regulation practices by the Council in Neustupný’s diachronic typology of modern organized language management.
Introduction: Mitral valve calcifications are frequent finding in the Barlow
disease. This is makinkg mitral repair surgery even more demanding in already
complex valve pathology. Case report: ...Fifty-five year old Barlow disease
patient underwent mitral repair surgery due to posterior leaflet prolapse at
P2 level and extensive posterior leaflet and annular calcifications as well.
Prolapsed scalop was resected, while P1 and P3 scalops were detached from the
annulus. After complete posterior annulus decalcification, so formedlarge
atrio-ventricular defect was reconstructed with autologous pericardial patch
and double suture line technique.P1 and P3 segments were reatched thereafter
by sliding technique, and sutured with no strain. Annuloplasty was performed
with saddle rigid ring No 36. Patient was discharged nine days after the
surgery with just a trace of mitral reguritation. Conclusion: Annular
decalcificaion and reconstruction in patients with calcified Barlow mitral
disease is neccessary for safe and durable mitral valve repair surgery.
nema
Background/Aim. A protection of heart and other organs from ischemic-reperfusion injuries can be provided by remote ischemic preconditioning (RIPC) by brief episodes of ischemia and reperfusion in ...distant tissues. The aim of this study was to assess effects of RIPC on early outcomes in patients underwent coronary bypass surgery (CABG) following acute coronary syndrome without persistent ST segment elevation (NSTEMI ACS). Methods. This trial included 42 patients randomized into two groups: the group 1 received RIPC and the group 2 was without RIPC (control group). Pre-, intra- and postoperative parameters were compared but primary endpoint was myocardial injury reflected as value of troponin I measured preoperatively and 1, 6, 12, 24, 48 and 72 h postoperatively. The secondary endpoints were hemodynamic parameters, blood loss, intensive care unit stay, mortality etc. Results. The groups 1 and 2 were similar in preoperative characteristics including age, New York Heart Association (NYHA) class, EuroSCORE II, left ventricular ejection fraction. The only significant difference between groups was for triple vessel coronary disease with dominance in the RIPC group 20 (100%) vs. 17 (77.3%), p = 0.049. Cardiopulmonary bypass time mean (? standard deviation): 83.0 (22.9) vs. 67.0 (17.4) minutes, p = 0.015, cross clamp time 57.9 (15.4) vs. 44.3 (14.3) minutes, p = 0.005 and number of conduits median (25?75th percentile): 23.5(3?4) vs. 3(2?3), p = 0.002 were different. Other intra- and postoperative variables did not differ between groups. There were no differences in C reactive protein levels and postoperative hemodynamic parameters. Average troponin values in all time points revealed no significant differences between groups (p0h = 0.740, p1h = 0.212, p6h = 0.504, p12h = 0.597, p24h = 0.562, p48h = 0.465 and p72h = 0.715, respectively). Furthermore, there were no significant differences in adverse events, hospital stay and mortality between groups. Conclusion. Treatment with RIPC during CABG following NSTEMI ACS did not provide better myocardial protection and hemodynamics characteristics but further larger randomized studies are needed t. prove its real value.
The purpose of this study was to propose a safe, stepwise, testing system to select radial arteries that are suitable for conduits on the basis of their morphologies and characteristics of the ...collateral circulation.
Before operation, 113 patients underwent the modified Allen test, Doppler ultrasonography, and pulse oximetry testing. Morphologic criteria used for radial artery exclusion were small size of radial or ulnar artery (< 2 mm in inner diameter), diffuse calcifications, and congenital anomalies of forearm arteries. Collateral circulation was interpreted as insufficient if the reverse flow in the anatomic snuffbox was absent or if the increase of the ulnar peak systolic flow velocity was less than 20%.
A positive modified Allen test was found in 10.6% of patients. As assessed by Doppler ultrasonography, 27 patients (23.9%) were not candidates for radial artery harvesting according to morphologic and functional abnormalities of forearm and hand circulation. Pulse oximetry test results were abnormal in 6.2%. After a follow-up period of 8.9 +/- 1.8 months, 23 patients (29.1% of operated patients) were controlled for Doppler ultrasonographic changes in the ulnar artery. The mean peak systolic flow velocity was significantly higher than the preoperative value measured at rest (p < 0 .001).
After preoperative tests, including the modified Allen test, Doppler ultrasonography, and pulse oximetry, 30.1% of patients were not considered candidates for radial artery harvesting. This method provides preoperative radial artery selection according to its morphologies, compensatory capacity of collateral circulation, and anatomic properties of ulnar artery.
Coronary artery by-pass grafting (CABG) with arterial grafts is widely accepted as the procedure of choice in the treatment of coronary ischemic disease. It brings back focus on morphological studies ...of arteries used as conduits in this procedure. One of the most frequently used CABG grafts is the internal thoracic artery with an excellent graft prognosis and patency rate. The aim of the study was a detailed morphological and morphometric description of the internal thoracic artery with an emphasis on its basic histological structure and its changes in aging and atherosclerosis. Therefore, 42 full-length arteries were obtained during forensic autopsies from 27 persons, aged between 20 and 81 years, who had died from non-vascular causes. The arteries were classified into three different age groups. Analysis of the serial arterial segments has shown that the internal thoracic artery is an artery of the transitional type whose media is organized into two layers: the internal, muscular layer and the external layer with spirally oriented elastic lamellae and smooth muscle cells in between. The number of elastic lamellae progressively decreases throughout the length of the examined arteries. As opposed to previous assumptions, we have proven that the grade of atherosclerosis is independent of the number of elastic lamellae in the external media. Perfectly formed elastic lamellae are not a persistent feature of the internal thoracic artery, as previously claimed. We have confirmed that the thickness of elastic lamellae decreases, while the number and the size of their fenestrations steadily increase with aging.
Introduction: Aortic Valve Implantation (TAVI) is less invasive and becomes an alternative therapy reserved for patients with high operative risk. Hemodynamic stability is the main objective of ...anesthetic management during TAVI. Local anesthesia or general anesthesia are both valid alternatives and can be applied according to the patient's characteristics and procedural instances. Case Report: We report a 80-year-old woman who was admitted to our hospital for worsening dyspnea caused by severe aortic stenosis. TAVI was performed under local anesthesia and light sedation without complications. Conclusion: Successful TAVI requires a multidisciplinary team of which cardiac anesthesiologists are a crucial part.
Introduction: Acute hepatotoxicity is a rare but potentially fatal complication of amiodarone use. We report a case of liver injury after intravenous amiodarone administration in a patient with ...atrial fibrillation after heart surgery. Case report: A 62-year-old man with a history of dissection of the ascending aortic aneurysm presented for emergency ascending aorta surgery. Patient underwent a routine aortic ascending surgery. On the 3rd postoperative day, the patient developed rapid atrial fibrillation, which was treated with intravenous amiodarone. Because of hypotension, 12 h later, phenylephrine and norepinephrine were included. The patient's lactate had increased to 3.8 mmol/ L, the international normalized ratio increased to 3.12, alanine aminotransferase rose to 4401 IU/L, aspartate aminotransferase rose to 7355 IU/L, lactate dehydrogenase rose to 30043 IJ/L and creatinine increased from 96 to 190 μg/l. Amiodarone was discontinued. Urine output decreased. On the 5th postoperative day, rhythm converted to the sinus rhythm. Liver parameters significantly improved and returned to normal. On the 13th postoperative day, patient was discharged to a rehabilitation facility. Conclusion: Amiodarone is used to treat life-threatening arrhythmias in the setting of acutely decompensated heart failure. In the presence of hepatic congestion, the intravenous preparation of amiodarone may cause acute liver injury and liver function should be monitored closely in critically ill patients.
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