Acta clinica Croatica
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Acta clinica Croatica · Dec 2010
Review Case ReportsManagement of fournier's gangrene: case report and literature review.
A 65-year-old man was referred to our department with clinical signs of septic shock and necrotizing soft tissue infection of the scrotal, perianal and right inguinal region. Initial presentation was a typical Fournier's gangrene. Because of the life-threatening condition, the initial treatment was extensive removal of necrotic tissue. ⋯ Although rare, it remains a life-threatening disease. Rapid and accurate diagnosis remains the key component in achieving successful outcome. Early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics is the essential management to reduce mortality.
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Acta clinica Croatica · Dec 2010
Changes in intra-abdominal, iliac venous and central venous pressures in patients undergoing abdominal surgery due to large tumors of the colon--a pilot study.
Changes in intra-abdominal pressure during bowel tumor surgery have not been documented. The purpose of the present study was to analyze changes in intra-abdominal pressure (IAP), central venous pressure (CVP) and iliac venous pressure (IVP) in patients undergoing laparotomy due to large tumor of the bowel. Twenty-one adult patients undergoing elective abdominal surgery were examined. ⋯ There was a strong overall correlation between IAP and CVP (P = 0.0000; r = 0.7779), as well as between IAP and IVP (P = 0.0000; r = 0.8635). Moreover, IAP correlated with IVP immediately after anesthesia and one hour after anesthesia. In conclusion, induction of anesthesia decreased IAP; excision of large bowel tumors decreased IAP; and IAP strongly correlated with CVP and IVP.
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Acta clinica Croatica · Sep 2010
Case ReportsResuscitation of a polytraumatized patient with large volume crystalloid-colloid infusions--correlation between global and regional hemodynamics: case report.
Aggressive large volume resuscitation is obligatory to achieve necessary tissue oxygenation. An adequate venous preload normalizes global hemodynamics and avoids multiorgan failure (MOF) and death in patients with multiple injuries. Large volume resuscitation is associated with complications in minimally monitored patients. ⋯ We present a 24-year-old man with multiple injuries resuscitated with large volume infusions and monitored by transpulmonary thermodilution technique and gastric tonometry. It is very important to monitor regional hemodynamics that enables clinician to maintain the required relations between global and regional hemodynamics. It prevents the development of MOF and patient death.
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Acta clinica Croatica · Mar 2010
Historical ArticleMedical expertise as a historical phenomenon and academic discipline.
Based on secondary literature, a survey of particular forms of medical expertise over history is presented. The state-to-individual interaction in terms of personality and physical integrity protection, health care, etc., was observed. It was only after the 16th century that the development of anatomy was found to have become a decisive argument for convincing expertise in various trials. ⋯ During centuries, medical expertise has been formed in conjunction with advances in medicine and science, and with the development of civil society. Medical expertise had gradually grown into a multidisciplinary field requiring high professionalism, ethical approach, continuous training and collaboration with various professions. This resulted in a compact and polyvalent discipline, in Croatia gradually formed as a special course in medical curriculum.
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Acta clinica Croatica · Mar 2010
Case ReportsWellens' syndrome in a female patient presenting to emergency room after resolving exercise-induced chest pain.
Wellens' syndrome, also known as the left anterior descending (LAD) coronary T wave syndrome, is a potentially under-recognized syndrome in emergency room, which can have potentially fatal consequences. It usually consists of typical electrocardiography (ECG) finding in precordial leads that represents significant stenosis of the proximal LAD. Although the syndrome is not included in indications for primary percutaneous coronary intervention (patients with typical ECG findings are usually pain free at the time of recording), every patient with suspicion of typical Wellens' syndrome should be seen by interventional cardiologist and considered for emergency cardiac catheterization. A case is reported of a patient with no previous medical history of coronary disease and with only one risk factor for cardiovascular disease that presented to emergency room with typical Wellens' syndrome.