Nikolina Smokovska, J. Masin‐Spasovska, D. Mladenovska, Anastazija Spasovska, G. Spasovski
Abstract Introduction. Kidney transplantation from a living donor is a superior method for treatment of end-stage renal disease (ESRD). The aim of this report is to show that the intellectual inferiority should not be an obstacle for the success of this treatment modality. Case report. We present a 25-year-old female patient with physical and intellectual impairment, with focal-segmental glomerulonephritis diagnosed in 2006 as primary cause of ESRD, regularly followed up at the Department of nephrology. She was initiated on hemodialysis (HD) since July 2014. Although with a bad compliance and hypertension, a good dialysis adequacy was managed with a reduction of the extracellular volume (ECV) and kidney transplantation was indicated as a more convenient treatment option. With psychological assessment of the intellectual inferiority being not contraindication for kidney transplantation and highly motivated family she was transplanted in March 2015. Postoperatively, she was with prolonged hospitalization because of the delayed graft recovery and a couple of perioperative urinary and surgical site infections. In the following months she was slowly adapting to a regular hygienic and diet regimen and intake of medication, with a number of consultations at the Department along with the family. At present, the patient has an excellent health condition and significantly better quality of life. Conclusion. The physical handicap of a moderate degree and mild intellectual impairment are not a contraiidication for treatment of the terminal kidney disease. A successful kidney transplantation reduces the morbidity and mortality from the primary disease, and improve patient’s overall quality of life.
{"title":"Successful Kidney Transplantation in Patient on Hemodialysis and Intellectual Inferiority","authors":"Nikolina Smokovska, J. Masin‐Spasovska, D. Mladenovska, Anastazija Spasovska, G. Spasovski","doi":"10.1515/MMR-2015-0009","DOIUrl":"https://doi.org/10.1515/MMR-2015-0009","url":null,"abstract":"Abstract Introduction. Kidney transplantation from a living donor is a superior method for treatment of end-stage renal disease (ESRD). The aim of this report is to show that the intellectual inferiority should not be an obstacle for the success of this treatment modality. Case report. We present a 25-year-old female patient with physical and intellectual impairment, with focal-segmental glomerulonephritis diagnosed in 2006 as primary cause of ESRD, regularly followed up at the Department of nephrology. She was initiated on hemodialysis (HD) since July 2014. Although with a bad compliance and hypertension, a good dialysis adequacy was managed with a reduction of the extracellular volume (ECV) and kidney transplantation was indicated as a more convenient treatment option. With psychological assessment of the intellectual inferiority being not contraindication for kidney transplantation and highly motivated family she was transplanted in March 2015. Postoperatively, she was with prolonged hospitalization because of the delayed graft recovery and a couple of perioperative urinary and surgical site infections. In the following months she was slowly adapting to a regular hygienic and diet regimen and intake of medication, with a number of consultations at the Department along with the family. At present, the patient has an excellent health condition and significantly better quality of life. Conclusion. The physical handicap of a moderate degree and mild intellectual impairment are not a contraiidication for treatment of the terminal kidney disease. A successful kidney transplantation reduces the morbidity and mortality from the primary disease, and improve patient’s overall quality of life.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"45 - 47"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deska Dimitrievska, M. Zdraveska, Dejan Todevski, E. Janeva, S. Arbutina, Angela Debreslioska
Abstract Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been viewed as distinct clinical entities. Recently, however, much attention has been focused on patients with overlapping features of both asthma and COPD: those with asthma COPD overlap syndrome (ACOS). A significant proportion of patients who present with symptoms of a chronic airways disease have features of both asthma and COPD. Several diagnostic terms, most including the word “overlap”, have been applied to such patients, and the topic has been extensively reviewed. However, there is no generally agreed term or defining features for this category of chronic airflow limitation, although a definition based upon consensus has been published for overlap in patients with existing COPD. In spite of these uncertainties, there is broad agreement that patients with features of both asthma and COPD experience frequent exacerbations, have poor quality of life, a more rapid decline in lung function and high mortality, and consume a disproportionate amount of healthcare resources than asthma or COPD alone. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared to asthma or COPD alone. Patients with ACOS often have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than in COPD alone. Pharmacotherapeutic considerations require an integrated approach, first to identify the relevant clinical phenoltype( s), then to determine the best available therapy. The authors discuss the array of existing and emerging classes of drugs which patients with ACOS could benefit from and share their therapeutic approach. A consensus international definition of ACOS is needed to design prospective. Randomized clinical trials are necessary to evaluate specific influence of drug interventions on important outcomes such as lung function, acute exacerbations, quality of life and mortality.
{"title":"Asthma and COPD Overlap Syndrome (ACOS)","authors":"Deska Dimitrievska, M. Zdraveska, Dejan Todevski, E. Janeva, S. Arbutina, Angela Debreslioska","doi":"10.1515/mmr-2015-0002","DOIUrl":"https://doi.org/10.1515/mmr-2015-0002","url":null,"abstract":"Abstract Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been viewed as distinct clinical entities. Recently, however, much attention has been focused on patients with overlapping features of both asthma and COPD: those with asthma COPD overlap syndrome (ACOS). A significant proportion of patients who present with symptoms of a chronic airways disease have features of both asthma and COPD. Several diagnostic terms, most including the word “overlap”, have been applied to such patients, and the topic has been extensively reviewed. However, there is no generally agreed term or defining features for this category of chronic airflow limitation, although a definition based upon consensus has been published for overlap in patients with existing COPD. In spite of these uncertainties, there is broad agreement that patients with features of both asthma and COPD experience frequent exacerbations, have poor quality of life, a more rapid decline in lung function and high mortality, and consume a disproportionate amount of healthcare resources than asthma or COPD alone. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared to asthma or COPD alone. Patients with ACOS often have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than in COPD alone. Pharmacotherapeutic considerations require an integrated approach, first to identify the relevant clinical phenoltype( s), then to determine the best available therapy. The authors discuss the array of existing and emerging classes of drugs which patients with ACOS could benefit from and share their therapeutic approach. A consensus international definition of ACOS is needed to design prospective. Randomized clinical trials are necessary to evaluate specific influence of drug interventions on important outcomes such as lung function, acute exacerbations, quality of life and mortality.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"11 - 8"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction. Subarachnoid hemorrhage is unfortunately the most common manifestation of intracranial aneurysms. Methods. Very frequently there is a dilemma on whether patient should be operated on early i.e. in the first 72 hours or late i.e. two weeks after the bleeding. Many factors influence this decision, some of them being neurological condition at admission, age of the patient, eventual compressive intracerebral hematoma. We present our experiences in treatment and decision making of these patients as well as the outcome of early versus late surgically treated patients. Results. Patients were divided in five groups according to the grade of neurological condition on admition. Within each group statistical analysis was conducted to compare early versus late surgery. Results have show difference within each group of patients. Conclusion. In our study, patients that have been admitted in good clinical condition and operated on early had better outcome than patients operated late.
{"title":"Outcome of Early Versus Late Operated Patients Due to Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm","authors":"V. Filipče, Aleksandar Caparoski, Tomi Kamiloski","doi":"10.1515/MMR-2015-0006","DOIUrl":"https://doi.org/10.1515/MMR-2015-0006","url":null,"abstract":"Abstract Introduction. Subarachnoid hemorrhage is unfortunately the most common manifestation of intracranial aneurysms. Methods. Very frequently there is a dilemma on whether patient should be operated on early i.e. in the first 72 hours or late i.e. two weeks after the bleeding. Many factors influence this decision, some of them being neurological condition at admission, age of the patient, eventual compressive intracerebral hematoma. We present our experiences in treatment and decision making of these patients as well as the outcome of early versus late surgically treated patients. Results. Patients were divided in five groups according to the grade of neurological condition on admition. Within each group statistical analysis was conducted to compare early versus late surgery. Results have show difference within each group of patients. Conclusion. In our study, patients that have been admitted in good clinical condition and operated on early had better outcome than patients operated late.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"30 - 34"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Golubović, Bekim Tatesi, Igor Isjanovski, K. Buzarovska
Abstract Introduction. The concept of retinoschisis means splitting of the layers of neural retina. It can happen equally at the peripheral part of retina, as well as in the region of macula when we talk about macular retinoschisis. Macular retinoschisis appears as one of the characteristics of a few hereditary diseases. According to the ophthalmoscopes’ picture it can easily be mixed with cystoid macular edema. Even though macular changes, in both cases, during time lead to decrease of visual acuity, distinction of macular changes is of semiotic significance in differential diagnosis of retinal diseases, which is important from a broader medical aspect. The aim of this paper is, by presenting a case with a rare hereditary disorder, to show the importance and complementarities of diagnostic methods, especially OCT and its meaning in establishing the correct diagnosis. Case report. The paper presents a patient with macular retinoschisis, as a part of Goldmann-Favre vitreoretinal degeneration. It is a hereditary disorder, which in addition to schisms changes in the macula is characterized by changes in the pigmented epithelium at the medial part of retina. OCT finding in our patient showed cystic hyporeflexive change in the fovea, with palisade oriented smaller hyporeflexive changes, between plexiform layers and in the inner granular layer of the macula. On fluorescein angiography the leakage of the fluorescein in the macular region was absent, but the changes on the level of pigmented epithelium in the area of medial retina were evident. However, perimetry did not show defect in the visual field. Conclusion. Newer diagnostic methods, such as optical coherence tomography, proved their importance in the decision making process and in making the right diagnosis in macular lesions. Beside the fact that the correct diagnosis of the disorder frequently has no importance in the sense of therapeutic possibility of the disease, its value can be seen in proper information of possibility of disease transmission as well as in prediction of affected person’s life perspective, associated with the decrease of visual acuity.
{"title":"Macular Retinoschisis and Its Semiotic Importance: A Case Report","authors":"M. Golubović, Bekim Tatesi, Igor Isjanovski, K. Buzarovska","doi":"10.1515/mmr-2015-0008","DOIUrl":"https://doi.org/10.1515/mmr-2015-0008","url":null,"abstract":"Abstract Introduction. The concept of retinoschisis means splitting of the layers of neural retina. It can happen equally at the peripheral part of retina, as well as in the region of macula when we talk about macular retinoschisis. Macular retinoschisis appears as one of the characteristics of a few hereditary diseases. According to the ophthalmoscopes’ picture it can easily be mixed with cystoid macular edema. Even though macular changes, in both cases, during time lead to decrease of visual acuity, distinction of macular changes is of semiotic significance in differential diagnosis of retinal diseases, which is important from a broader medical aspect. The aim of this paper is, by presenting a case with a rare hereditary disorder, to show the importance and complementarities of diagnostic methods, especially OCT and its meaning in establishing the correct diagnosis. Case report. The paper presents a patient with macular retinoschisis, as a part of Goldmann-Favre vitreoretinal degeneration. It is a hereditary disorder, which in addition to schisms changes in the macula is characterized by changes in the pigmented epithelium at the medial part of retina. OCT finding in our patient showed cystic hyporeflexive change in the fovea, with palisade oriented smaller hyporeflexive changes, between plexiform layers and in the inner granular layer of the macula. On fluorescein angiography the leakage of the fluorescein in the macular region was absent, but the changes on the level of pigmented epithelium in the area of medial retina were evident. However, perimetry did not show defect in the visual field. Conclusion. Newer diagnostic methods, such as optical coherence tomography, proved their importance in the decision making process and in making the right diagnosis in macular lesions. Beside the fact that the correct diagnosis of the disorder frequently has no importance in the sense of therapeutic possibility of the disease, its value can be seen in proper information of possibility of disease transmission as well as in prediction of affected person’s life perspective, associated with the decrease of visual acuity.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"40 - 44"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction. Acute kidney injury is a serious condition which damages the kidney as a central mediator of the homeostasis of bodily fluids and electrolytes. It is not a rare problem in the intensive care units, particularly in the neonatal population. Perinatal asphyxia is a common predisposing factor associated with neonatal kidney injury. The aim of this study was to determine the characteristics of acute kidney injury in newborns from neonatal intensive care unit and to explore the association with perinatal asphyxia. Methods. The study was conducted at the Children’s University Hospital in Skopje, R. Macedonia. It was a clinical, prospective study. In the period of two years (January 2013 to December 2014) 29 patients hospitalized at the Neonatal Intensive Care Unit (NICU) with documented neonatal kidney injury were analyzed. Medical data records of admitted neonates with kidney injury were analyzed. The material was statistically analyzed using methods of descriptive statistics. Results. We evaluated 29 neonates with documented acute kidney injury who at the period of 2 years were treated in NICU. The prevalence of kidney injury was 6.4%. Most of involved neonates were born at term (66%). Prerenal injury was evaluated in 80% of cases. Perinatal asphyxia was the most common predisposing factors for kidney injury in our study, revealed in 56% of cases with predominance of term-infants and male gender. Sepsis was present in 44% of cases, prematurity in 34%, and congenital malformation in 27% of cases. Mortality rate was 27.5% and it was higher in patients with assisted ventilation and sepsis. Conclusion. Perinatal asphyxia is a dominant predisposing factor associated with neonatal kidney injury. Often, the occurrence of kidney damage in the neonatal population is multifactorial (more than 40%) and caused by several associated comorbidities
{"title":"Characteristics of Acute Kidney Injury in Neonatal Age At - Intensive Care Unit","authors":"Silvana Naunova-Timovska","doi":"10.1515/mmr-2015-0004","DOIUrl":"https://doi.org/10.1515/mmr-2015-0004","url":null,"abstract":"Abstract Introduction. Acute kidney injury is a serious condition which damages the kidney as a central mediator of the homeostasis of bodily fluids and electrolytes. It is not a rare problem in the intensive care units, particularly in the neonatal population. Perinatal asphyxia is a common predisposing factor associated with neonatal kidney injury. The aim of this study was to determine the characteristics of acute kidney injury in newborns from neonatal intensive care unit and to explore the association with perinatal asphyxia. Methods. The study was conducted at the Children’s University Hospital in Skopje, R. Macedonia. It was a clinical, prospective study. In the period of two years (January 2013 to December 2014) 29 patients hospitalized at the Neonatal Intensive Care Unit (NICU) with documented neonatal kidney injury were analyzed. Medical data records of admitted neonates with kidney injury were analyzed. The material was statistically analyzed using methods of descriptive statistics. Results. We evaluated 29 neonates with documented acute kidney injury who at the period of 2 years were treated in NICU. The prevalence of kidney injury was 6.4%. Most of involved neonates were born at term (66%). Prerenal injury was evaluated in 80% of cases. Perinatal asphyxia was the most common predisposing factors for kidney injury in our study, revealed in 56% of cases with predominance of term-infants and male gender. Sepsis was present in 44% of cases, prematurity in 34%, and congenital malformation in 27% of cases. Mortality rate was 27.5% and it was higher in patients with assisted ventilation and sepsis. Conclusion. Perinatal asphyxia is a dominant predisposing factor associated with neonatal kidney injury. Often, the occurrence of kidney damage in the neonatal population is multifactorial (more than 40%) and caused by several associated comorbidities","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"20 - 25"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Filipče, Aleksandar Caparoski, Tomi Kamiloski, D. Daskalov
Abstract Intracerebral hematoma and intraventricular hemorrhage can significantly worsen the neurological condition of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm. They also significantly affect the outcome of this patiens. We present a case in which early surgery had a significant effect on the outcome of this patient. Early decompression of the brain and subsequent clipping of the aneurysm as presented in our case has lead to a successful outcome.
{"title":"Excellent Outcome after Early Surgery for Ruptured Middle Cerebral Artery Aneurysm Complicated with Intracerebral and Intraventricular Hemorrhage: A Case Report","authors":"V. Filipče, Aleksandar Caparoski, Tomi Kamiloski, D. Daskalov","doi":"10.1515/mmr-2015-0010","DOIUrl":"https://doi.org/10.1515/mmr-2015-0010","url":null,"abstract":"Abstract Intracerebral hematoma and intraventricular hemorrhage can significantly worsen the neurological condition of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm. They also significantly affect the outcome of this patiens. We present a case in which early surgery had a significant effect on the outcome of this patient. Early decompression of the brain and subsequent clipping of the aneurysm as presented in our case has lead to a successful outcome.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"48 - 50"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The treatment of choice of mangled extremities continues to be a subject of debate among surgeons. Nowadays, much of the extremities that used to be amputated are saved, which is due to the progress in the fields of resuscitation, microvascular techniques, and advancements in fracture fixation. However, even if technical possibility of extremity salvage exists, the surgeon must always keep in mind that the final goal of the treatment is good functional outcome and to choose the modality of treatment in accordance to the principle. It is well-known that the final outcome following the treatment of the mangled extremities is influenced by plenty of factors. Until now, there are many scoring systems that are intended to guide the surgeon during the decision-making process in the acute phase of the treatment of mangled extremities. Nonetheless, many agree that the predictive value of these systems is still questionable. The process of limb salvage is lengthy, challenging and expensive, and in certain instances reoperations are necessary. Yet, morbidity and mortality are still significant. The aim of our review was to present the current knowledge regarding the mechanism of injury and initial treatment of the mangled extremity and the scoring systems available. Furthermore, we are going to discuss the controversies concerning definitive treatment and complications following these injuries.
{"title":"Contemporary Management of Mangled Extremity: A Review","authors":"I. Kaftandziev, M. Spasov, Bisera Pendovska","doi":"10.1515/mmr-2015-0003","DOIUrl":"https://doi.org/10.1515/mmr-2015-0003","url":null,"abstract":"Abstract The treatment of choice of mangled extremities continues to be a subject of debate among surgeons. Nowadays, much of the extremities that used to be amputated are saved, which is due to the progress in the fields of resuscitation, microvascular techniques, and advancements in fracture fixation. However, even if technical possibility of extremity salvage exists, the surgeon must always keep in mind that the final goal of the treatment is good functional outcome and to choose the modality of treatment in accordance to the principle. It is well-known that the final outcome following the treatment of the mangled extremities is influenced by plenty of factors. Until now, there are many scoring systems that are intended to guide the surgeon during the decision-making process in the acute phase of the treatment of mangled extremities. Nonetheless, many agree that the predictive value of these systems is still questionable. The process of limb salvage is lengthy, challenging and expensive, and in certain instances reoperations are necessary. Yet, morbidity and mortality are still significant. The aim of our review was to present the current knowledge regarding the mechanism of injury and initial treatment of the mangled extremity and the scoring systems available. Furthermore, we are going to discuss the controversies concerning definitive treatment and complications following these injuries.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"12 - 19"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The use of intravenous lipid emulsions (ILEs) as antidote in local anesthetic systemic toxicity has gained widespread support following convincing data from animal models, and successful case reports in humans. An injection of a simple, intravenous nutritional solution could be acutely life-saving for a patient with severe drug overdose. But dozens of published case reports support this observation, the first ones made more than a decade ago in a rodent model of bupivacaine toxicity. It is even more surprising that such a simple formulation can rapidly reverse severe clinical toxicity from a variety of vastly disparate medications with distinct pharmacodynamics and mechanisms of action. This review will focus on the clinical application of lipid emulsion therapy in resuscitation from drug-related toxicity and will provide an introduction to the development of a method, guidelines for its use, and insights into potential controversies and future applications [1].
{"title":"Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose","authors":"D. Chaparoska, N. Baneva","doi":"10.2478/mmr-2014-0014","DOIUrl":"https://doi.org/10.2478/mmr-2014-0014","url":null,"abstract":"Abstract The use of intravenous lipid emulsions (ILEs) as antidote in local anesthetic systemic toxicity has gained widespread support following convincing data from animal models, and successful case reports in humans. An injection of a simple, intravenous nutritional solution could be acutely life-saving for a patient with severe drug overdose. But dozens of published case reports support this observation, the first ones made more than a decade ago in a rodent model of bupivacaine toxicity. It is even more surprising that such a simple formulation can rapidly reverse severe clinical toxicity from a variety of vastly disparate medications with distinct pharmacodynamics and mechanisms of action. This review will focus on the clinical application of lipid emulsion therapy in resuscitation from drug-related toxicity and will provide an introduction to the development of a method, guidelines for its use, and insights into potential controversies and future applications [1].","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"68 1","pages":"71 - 75"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2478/mmr-2014-0014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69234142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction. One of the most important factors for prognosis in patients with colorectal cancer (CRC), especially the 5-year survival is the status of regional lymph nodes (RLN). Threfore, today’s recommendations for systematic lymphadenectomy in CRC operations are very important. For correct staging and accepted by all international recommendations, at least 12 LN must be analyzed microscopically. The sentinel lymph node (SLN) is the first lymph node that drains lymph from the tumor and thus represents a LN that has the greatest chance to be the bearer of metastatic disease. Tests to locate the SLN in CRC have started recently and so far there is no consensus on the method for its localization or its significance. The main aim of this study was to improve the tracing of SLN by using radioactive colloid. The secondary aims were to investigate the accuracy, sensitivity and rate of method’s identification. Especially important for the analysis is the significance of SLN and its correlation with other RLN. Methods. The study is performed at the University Clinic for Digestive Surgery from January 2013 and is still ongoing. A day before the surgery endoscopically around the tumor is injected radioactive colloid with Technetium 99 (Sentiscint Tc 99m Mediradiofarma Ltd) in the amount of 4 ml, which corresponds to 4 mCi (mill curie). Immediately after that, at the Institute of Pathophysiology using a Gamma camera (Mediso DHV nucline spirit), the distribution of the colloid is monitored, which as expected is mostly accumulated in the first LN, that is the genuine sentinel lymph node, thus making lymphatic mapping that is important for identifying possible aberrant drainage. On the day of surgery at 8:00 am, a rerecording with the Gamma camera is made that shows the late distribution of contrast. All patients are operated with standard surgical technique by making resection with systematic lymphadenectomy. Promptly after removing the preparation a Gamma detector probe (Europrobe) is used to determine the radioactivity of the lymph pool and it finds the right SLN which has the highest radioactivity and it is separately sent for complete pathohistological analysis. At the Institute of Pathology all lymph nodes are first treated standardly with HE and then with immunohistochemical method. Results. So far the study includes 10 patients, 6 men and 4 women, mean age 63 years (59-77). Until now the identification rate is 100%, which means that SLN has been found in all procedures. Only in 2 patients two sentinel lymph nodes have been revealed while the in the remaining only 1, average 1.2. At PH analysis, an average of 14.2 lymph nodes have been isolated (6-25). Only in one patient false negative 1 SLN has been revealed. The number of patients with real negative SLN is 2, which means the SLN is negative and also all the other lymph nodes. The total number of patients with real positive SLN is 7, which means SLN is positive and also some of the other ly
{"title":"The Significance of the Sentinel Lymph Node in Colorectal Cancer and its Isolation with Radioactive Colloid-A Pilot Study","authors":"S. Antović, N. Jankulovski, S. Stojanovski","doi":"10.2478/mmr-2014-0018","DOIUrl":"https://doi.org/10.2478/mmr-2014-0018","url":null,"abstract":"Abstract Introduction. One of the most important factors for prognosis in patients with colorectal cancer (CRC), especially the 5-year survival is the status of regional lymph nodes (RLN). Threfore, today’s recommendations for systematic lymphadenectomy in CRC operations are very important. For correct staging and accepted by all international recommendations, at least 12 LN must be analyzed microscopically. The sentinel lymph node (SLN) is the first lymph node that drains lymph from the tumor and thus represents a LN that has the greatest chance to be the bearer of metastatic disease. Tests to locate the SLN in CRC have started recently and so far there is no consensus on the method for its localization or its significance. The main aim of this study was to improve the tracing of SLN by using radioactive colloid. The secondary aims were to investigate the accuracy, sensitivity and rate of method’s identification. Especially important for the analysis is the significance of SLN and its correlation with other RLN. Methods. The study is performed at the University Clinic for Digestive Surgery from January 2013 and is still ongoing. A day before the surgery endoscopically around the tumor is injected radioactive colloid with Technetium 99 (Sentiscint Tc 99m Mediradiofarma Ltd) in the amount of 4 ml, which corresponds to 4 mCi (mill curie). Immediately after that, at the Institute of Pathophysiology using a Gamma camera (Mediso DHV nucline spirit), the distribution of the colloid is monitored, which as expected is mostly accumulated in the first LN, that is the genuine sentinel lymph node, thus making lymphatic mapping that is important for identifying possible aberrant drainage. On the day of surgery at 8:00 am, a rerecording with the Gamma camera is made that shows the late distribution of contrast. All patients are operated with standard surgical technique by making resection with systematic lymphadenectomy. Promptly after removing the preparation a Gamma detector probe (Europrobe) is used to determine the radioactivity of the lymph pool and it finds the right SLN which has the highest radioactivity and it is separately sent for complete pathohistological analysis. At the Institute of Pathology all lymph nodes are first treated standardly with HE and then with immunohistochemical method. Results. So far the study includes 10 patients, 6 men and 4 women, mean age 63 years (59-77). Until now the identification rate is 100%, which means that SLN has been found in all procedures. Only in 2 patients two sentinel lymph nodes have been revealed while the in the remaining only 1, average 1.2. At PH analysis, an average of 14.2 lymph nodes have been isolated (6-25). Only in one patient false negative 1 SLN has been revealed. The number of patients with real negative SLN is 2, which means the SLN is negative and also all the other lymph nodes. The total number of patients with real positive SLN is 7, which means SLN is positive and also some of the other ly","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"68 1","pages":"89 - 92"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69233715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Dolnenec-Baneva, D. Nikodijevic, G. Kiteva-Trenchevska, I. Petrov, D. Petrovska-Cvetkovska, S. Lazarova, D. Chaparoska, Niko Bekarovski
Abstract Introduction. Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage. Methods. An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2). Results. CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rd day (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5th day (R=0.3). Conclusion. In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rd day, a moderate correlation on admission and on the 5th day, which means that high cysLT and hematoma values were associated with high/moderate edema values.
{"title":"Intracerebral Hematoma, Perihemorrhagic Edema and Urinary Excreted Cysteinyl Leukotrienes Correlation Study","authors":"N. Dolnenec-Baneva, D. Nikodijevic, G. Kiteva-Trenchevska, I. Petrov, D. Petrovska-Cvetkovska, S. Lazarova, D. Chaparoska, Niko Bekarovski","doi":"10.2478/mmr-2014-0017","DOIUrl":"https://doi.org/10.2478/mmr-2014-0017","url":null,"abstract":"Abstract Introduction. Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage. Methods. An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2). Results. CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rd day (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5th day (R=0.3). Conclusion. In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rd day, a moderate correlation on admission and on the 5th day, which means that high cysLT and hematoma values were associated with high/moderate edema values.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"68 1","pages":"85 - 88"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69233704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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