Acta clinica Croatica
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Acta clinica Croatica · Jul 2023
ReviewCRUSH SYNDROME IN EARTHQUAKES - STAY AND PLAY OR LOAD AND GO?
Earthquakes are unpredictable natural disasters accompanied by material damage and many victims. In the case of a person remaining trapped under the collapsed material, the development of crush syndrome can occur. Crush syndrome is the result of traumatic rhabdomyolysis and is present in 2%-15% of all injured persons in an earthquake. ⋯ Medical principles, crucial for crush syndrome, are presented regarding the duration of compression and time before or after extraction of the patient. Logistic principles provide an overview of the priorities and modes of transport in relation to distance of health institutions, and the importance of management and education associated with crush syndrome. Each country with recognized disasters (natural or man-made) in which crush-related victims are expected, will benefit if the knowledge about triage, medical and logistic principles for crush syndrome is incorporated in their educational programs and regularly updated.
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Acta clinica Croatica · Jul 2023
ReviewTHE ROLE OF INTERVENTIONAL RADIOLOGISTS IN THE TREATMENT OF COMPLICATIONS IN UROLOGIC PATIENTS.
Higher turnaround of urologic patients in the tertiary clinical center can lead to more accompanying complications, ranging from 1% to 55% for various procedures, with the incidence of vascular injuries varying from 0.43% up to 9.5%. In patients with impaired renal function, it is imperative to prevent the loss of normal kidney function and potential hemodialysis. Being minimally invasive, endovascular procedures such as renal artery embolization (RAE) can treat major and life-threatening complications, but good and prompt communication between urologists and interventional radiologist is necessary for fast and effective treatment. ⋯ RAE procedures are considered to be safe with a low incidence of complications, with non-target embolization being the most serious one. Postembolization syndrome is considered to be the most common adverse effect and it involves around 90% of patients. The overall results show that RAE is a safe, minimally invasive procedure that can effectively treat significant complications caused by other urologic procedures, with the reported success rates of 87%-100%.
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Acta clinica Croatica · Jul 2023
Case ReportsPOINT-OF-CARE DIAGNOSTIC APPROACH IN A CRITICALLY ILL PATIENT WITH SEVERE BLEEDING FROM URINARY TRACT.
Coagulation disorders in critically ill patients presenting with bleeding can be multicausal. The drugs applied can interfere and impair the coagulation cascade. Point-of-care (POC) coagulation assays may resolve difficult therapeutic situations in critical illness. ⋯ Coagulation disorders in intensive care unit patients are often multifactorial. Standard laboratory tests are unreliable in complex refractory bleeding and may result in inappropriate therapeutic decisions. Stepwise approach with assessment of clinical parameters, present therapy, and a combination of POC coagulation tests is the key to optimal therapeutic management.
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Acta clinica Croatica · Jul 2023
THULIUM:YAG LASER ENUCLEATION OF THE PROSTATE (ThuLEP) - OUR EXPERIENCE IN 246 PATIENTS.
New minimally invasive procedures to treat benign prostatic hyperplasia (BPH) have been developed in the last 20 years. With the introduction of laser enucleation techniques in prostate surgery, previous standard surgical procedures (open retropubic or transvesical adenectomy and transurethral resection of the prostate) have become less relevant, especially in case of very large prostates. The objective of this paper is to describe the experience and results of thulium:YAG laser application in BPH treatment in our department. ⋯ A low rate of intraoperative and early postoperative complications and short length of stay proved minimal invasiveness of this procedure, which results in significant improvements in urodynamic parameters and substantially reduces the post-void residual urine volume. The most important surgical and technical characteristics (enucleation and low-power laser application) make ThuLEP a safe and efficient surgical method not limited by the prostate volume. ThuLEP has a potential to displace the current standard surgical procedures to treat BPH.
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Acta clinica Croatica · Jul 2023
ReviewPERCUTANEOUS APPROACH TO THE KIDNEY: SIMILARITIES AND DIFFERENCES OF VARIOUS TECHNIQUES - EXPERIENCE IN OSIJEK UNIVERSITY HOSPITAL CENTER.
Today, percutaneous nephrolithotomy (PCNL) is a standard procedure in the treatment of large kidney stones. Development of the procedure began in 1976 with publication of the first reports, while turning point came in 1985 when the first 250 cases were described. Subsequently, PCNL has become standard in the treatment of kidney stones instead of open surgery. ⋯ With the development of flexible ureteroscopy (FURS), a combined method is also being developed, i.e., Endoscopic Combined IntraRenal Surgery (ECIRS, PCNL + FURS). Furthermore, each procedure can be performed in prone or supine position. The aim of this paper is to point out the similarities and differences, the advantages and disadvantages of different techniques, with an additional aim to present our experience and current standard practice in kidney stone treatment.