Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Modern medical technology (ultrasonography, intraoperative radiologic contrast methods, ERC, CT and NMR) help in performing laparoscopic cholecystectomy and operative procedures on bile ducts. The safe performance of these operative procedures requires good knowledge of clinical anatomy. In spite of excellent laparoscopic visualization, perioperative lesions of vascular structures or extrahepatic (especially accessory) bile ducts during laparoscopic cholecystectomy are a frequent cause of intra- and postoperative complications. Therefore, we wish to point to the potential risk of running into accessory bile ducts on dissection within or around the cystohepatic triangle, which may entail some overlooked and untreated lesions. ⋯ Besides technical skill and experience, good knowledge of the clinical anatomy of accessory bile ducts is required to reduce the incidence of postoperative biliary secretion. Based on our own experience, lesions to accessory bile ducts are the most common cause of postoperative complications.
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Numerous studies of the population prevalence of asthma, allergic rhinitis, and atopic eczema revealed some international differences. However, the International Study of Asthma and Allergies in Childhood (ISAAC) was the first one using a standardized methodology to evaluate the prevalence of these diseases, and to make comparisons within and between countries. The results showed marked variations in 12-month prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema symptoms with 20-fold (range 1.6-36.8%), 30-fold (range 1.4-39.7%), and 60-fold (range 0.3-20.5%) differences between the centres with the highest and the lowest prevalence, respectively. ⋯ According to our results, Zagreb is a city with relatively low prevalence of allergic diseases symptoms. Larger sample size of at least 3000 subjects is required to provide sufficient precision for estimates of symptom severity, and to generate adequate number of subjects with particular disorders for further analyses. Therefore, we recently increased our sample size to more than 3000 subjects, and started ISAAC Phase two (clinical examination, measures of bronchial hyperresponsiveness, measures of atopy, measures of environmental exposure to aeroallergens, and genetic analyses) in Zagreb, Croatia.
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Hypotension is the major cause of morbidity during hemodialysis (HD), occurring in about 20% of HD patients. Hypovolemia generated from blood volume (BV) contraction dependent on the ultrafiltration rate (UFR) and on the plasma refilling rate, is a major factor in the pathogenesis of intradialytic hypotension (IDH). Hemocontrol biofeedback system (Hemocontrol, Hospal, HBS), incorporated in the bicarbonate HD, modulates BV contraction rate by adjusting the UFR and dialysate conductivity (DC) in order to obtain predetermined BV trajectories. In the present study, HBS treatment was compared with carbonate HD to assess the efficacy in lowering the hypovolemia-associated morbidity. ⋯ Compared to HD, HBS is effective in lowering IDH incidence. Intradialytic measurement and modeling of BV to trajectories is a useful method for lowering hypovolemia-associated morbidity in patients with dialysis cardiovascular instability.
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One of the most important achievements in the contemporary intensive care management is introduction of continuous renal replacement therapy (CRRT). The most common indications for CRRT are acute renal failure complicated with heart failure, volume overload, hypercatabolism, acute or chronic liver failure, and/or brain swelling. Less common indications include systemic inflammatory response (SIRS), sepsis, multiorgan failure (MOF), adult respiratory distress syndrome, crush syndrome, tumor lysis syndrome, lactacidosis, and chronic heart failure. ⋯ Besides the convection, cytokines could be removed from the plasma with adsorption on the membrane of dialyzer or hemofilter. Prophylactic use of CCRT in patients with normal renal function, without disturbances in fluid excretion and with normal hemodynamics is still controversial, while the possible benefit is not higher than the risks of invasive therapeutic method, and there is no evidence that prophylactic CCRT could prevent development of acute renal failure in these patients. However, current knowledge of MOF pathophysiology justifies the use of CRRT in patients with signs of heart failure, disturbances in metabolic and fluid homeostasis and sepsis, and in patients with the risk of developing acute respiratory failure or MOF, despite the mild impairment of renal function according to laboratory results.