Acta clinica Croatica
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Acta clinica Croatica · Mar 2021
Review Meta AnalysisADMISSION CARDIAC TROPONINS PREDICT HOSPITAL MORTALITY IN TYPE A ACUTE AORTIC DISSECTION: A META-ANALYSIS OF ADJUSTED RISK ESTIMATES.
Acute aortic dissection (AAD) is a serious medical emergency that requires early diagnosis and rapid treatment. Whether cardiac troponin could be an independent prognostic marker in patients with type A AAD is still unknown. We systematically searched Medline and Scopus to identify all observational cohort studies published before January 2020 that compared outcome (in-hospital mortality) in patients with type A AAD with and without troponin elevation on admission. ⋯ A total of 124 (30%) patients died during in-hospital stay, and 73% underwent surgery. Elevated troponins (39.6% of patients) were associated with an increased risk of short-term mortality (adjusted odds ratio 1.26; 95% confidence interval 1.08-1.47), with low heterogeneity among studies (I2 =29.81%). Elevated troponins on admission are independently associated with increased in-hospital mortality in type A AAD.
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Cardiac surgery-associated acute kidney injury (CS-AKI) is a major complication associated with increased morbidity and mortality. There are multiple diagnostic criteria for CS-AKI. ⋯ Some risk factors have been identified that can be modified during the course of treatment (use of nephrotoxic agents, duration of cardiopulmonary bypass, type of extracorporeal circulation, postoperative low cardiac output or hypotension). The aim of AKI prevention should always be to prevent aggravation of renal failure and, if possible, to avoid progression to renal replacement therapy, which in turn brings worse long-term outcomes.
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Acta clinica Croatica · Mar 2021
Review Case ReportsMICROSURGICAL MANAGEMENT OF A RARE INCIDENTAL INTRAVENTRICULAR MENINGIOMA: A CASE REPORT AND RELEVANT LITERATURE REVIEW.
Intraventricular meningiomas are rare and make up between 0.5% and 3% of all intracranial meningiomas, representing one of the most challenging tumors in neurosurgery due to their difficult location. Being initially asymptomatic, such tumors usually attain large size before clinical presentation and diagnostic detection. Available literature concerned with their surgical management remains scarce. ⋯ In conclusion, intraventricular meningiomas are rather rare extra-axial tumors and may present with various symptoms depending on their size and difficult location. The development of most modern neuroimaging methods offers the opportunity of their precise and accurate diagnosis, better surgical planning, and favorable outcome. Microsurgical gross resection utilizing intraoperative neuromonitoring and cutting-edge neurosurgical armamentarium remains the treatment of choice for these location-challenging and surgically demanding, predominantly benign intracranial tumors.
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Acta clinica Croatica · Mar 2021
ReviewIS IT TIME TO REDEFINE COGNITIVE DYSFUNCTION AFTER CARDIAC SURGERY? THE IMPORTANCE OF METHODOLOGICAL CONSISTENCY.
High incidence and significance of repercussions on patient health and healthcare system make postoperative cognitive dysfunction (POCD) a major problem following cardiac surgery. POCD frequency drops over time since surgery and its occurrence are related to different aspects of cognitive deterioration that markedly impair the patient quality of life. ⋯ A significant issue in POCD research is the lack of uniformity in defining cognitive impairment among investigators, including unique terminology of cognitive changes, a battery of appropriate neuropsychological tests, timing of assessment, and statistical approach. Thus, the aim of this review is to address the difficulties in establishing POCD definition, with inclusion of specific recommendations based on recent publications.
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Acta clinica Croatica · Mar 2021
Review Case ReportsODONTOMAS: PEDIATRIC CASE REPORT AND REVIEW OF THE LITERATURE.
Odontomas are benign odontogenic tumors formed from epithelial and mesenchymal cells. They are mostly associated with disorders of tooth eruption, causing impaction and/or delayed tooth eruption, and are an accidental finding on routine radiological examination. The aim of this paper is to present current findings in the etiology and treatment of odontomas, as well as the clinical and radiographic features, describing a case that is rarely found in the literature. ⋯ The treatment consisted of surgical enucleation of the multiple complex odontoma with preservation of the impacted tooth, monitoring clinically and radiologically its spontaneous eruption followed by final orthodontic alignment. Odontomas are not an everyday part of clinical practice and given that they are most commonly associated with permanent tooth impaction, it is extremely important to have knowledge of their clinical and radiological features. Early diagnostics and appropriate treatment result in better diagnosis, thus increasing the possibility of preserving the impacted teeth.