Acta clinica Croatica
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Acta clinica Croatica · Sep 2012
Case ReportsDifficult airway in advanced Bechterew's disease: case report.
Advanced Bechterew's disease presents with increasing ossification of spinal column, from lower lumbar segments upwards, first causing impossibility to place spinal block in lumbar region, and later, due to stiffness of cervical spine, difficult intubation because of inability to extend and/or flex the neck during direct laryngoscopy and intubation. Mask ventilation, on the other hand, usually is possible. ⋯ The bronchoscope passed easily down to tracheal bifurcation, but placing the endotracheal tube was unexpectedly impossible due to the consequences of broken nose the patient had suffered at the age of 8. Fiber bronchoscope was therefore retracted, and we used the Bonfils rigid fiberscope after induction of general anesthesia, achieving intubation in first attempt.
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The Fourth National Audit Project (NAP4) was set up by the Royal College of Anaesthetists and Difficult Airway Society to provide an insight into major complications of airway management in the United Kingdom. The NAP4 found that one serious airway complication such as death, brain damage, the need for surgical airway or unexpected intensive care admission, was reported for every 5500 general anaesthetics. Most of the events happened during daytime to a senior experienced clinicians. ⋯ Awake fibreoptic intubation was indicated and not performed in a significant number of reported incidents. Thirty percent of serious airway complications were associated with extubation or removal of laryngeal mask airway at the end of anaesthesia. The findings of the NAP4 have the potential to significantly influence airway management practice of all anaesthetists irrespective of where in the world they practice anaesthesia.
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Two clinical forms of the "white spot" syndrome in patients with posterior uveitis in definitive and presumable ocular sarcoidosis were analyzed. Group 1 was characterized by periphlebitis and discrete white spots around the vein of the retina, so-called "candle-wax", whereas group 2 showed yellow-orange solitary nodules located at the choroid, i.e. multifocal choroiditis. Visual acuity and the severity of clinical presentation were assessed in both groups. ⋯ T-test for independent samples yielded a statistically significant difference between the groups (p = 0.02). A statistically significant difference in visual acuity was the result of vasculitis in the group with the "candle-wax" phenomenon, which is associated with retinal vasculitis and causes cystoid macular edema and reduction of visual acuity. Complications such as cataract, glaucoma and neovascularization, which also decrease visual acuity, were more frequent in group 1.
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Acta clinica Croatica · Mar 2012
Case ReportsGiant mixed-type liposarcoma of the mesentery: case report.
Primary mesenteric liposarcomas are very rare, especially when they are of mixed histologic pattern. Patient prognosis is based upon the most aggressive histologic type of liposarcoma. A case is reported of a 77-year-old man with a history of slowly increasing abdominal volume over 3 years. ⋯ Although this type of tumor is rare, tumor tissue should be thoroughly collected and analyzed on histologic examination to reach definitive diagnosis. Recognition of the underappreciated subtype of liposarcoma is important for proper prognosis and treatment of the patient. According to our knowledge, this is the largest size of mixed-type mesenteric liposarcoma described in the English literature.
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Acta clinica Croatica · Mar 2012
Analysis of blood pressure changes in patients undergoing total hip or knee replacement in spinal and general anesthesia.
The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who underwent total hip or knee replacement surgery in the period between July 2010 and February 2011 at Sveti Duh University Hospital were retrospectively evaluated. Seventeen patients underwent the operation in general anesthesia and 63 patients in regional anesthesia. ⋯ The difference between the highest and the lowest intraoperative systolic blood pressure was significantly greater in hypertensive patients undergoing the operation in regional anesthesia compared to normotensive patients (46.41 mm Hg vs. 35.88 mm Hg, P<0.05). The results presented in this paper indicate that the fluctuations of intraoperative blood pressure were greater and the highest intraoperative systolic blood pressure was higher in hypertensive compared to normotensive patients undergoing the operation in regional anesthesia. In our study, there were no significant differences in intraoperative blood pressure between hypertensive and normotensive patients who underwent the operation in general anesthesia.