Infrarenal inferior vena cava agenesis presenting as acute abdomen and hydronephrosis - case report.

The inferior vena cava agenesis (IVCA) is a rare and often asymptomatic malformation due to the abundant development of the collateral circulation. However, it is frequently found in young people and carries a significant risk of deep venous thrombosis (DVT). It is estimated that about 5% of patients under 30 years of age presenting with DVT have this condition. We report a case of a previously healthy 23-year-old patient presenting with signs of acute abdomen and hydronephrosis due to the thrombophlebitis of an unusual iliocaval venous collateral, which developed secondary to IVCA. After treatment, the iliocaval collateral and hydronephrosis completely regressed on a 1-year follow-up. To our knowledge, this is the first such case reported in the literature.

Successful management of the superior mesenteric artery occlusion in 86-year-old female: case report.

Chronic superior mesentery ischemia often presents a clinically asymptomatic diffuse atherosclerotic process. There are no compelling recommendations on the benefits of early revascularization strategy besides antithrombotic prophylaxis and statin treatment. Conversely, long-term prevalence of symptomatic cases in surgical patient cohorts is rarely reported in the literature. Acutization of chronic ischemia has a severe clinical course, so timely recognition may be considered lifesaving. We present a case of an 86-year-old woman hospitalized for acutized atherosclerotic narrowing of superior mesenteric artery. The patient was urgently operated on by aorto-mesenteric ring prosthesis revascularization. Postoperative course was uneventful and the patient regained 10 kilograms in the next few months.

Recommendations for the management of patients with carotid stenosis.

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.

The vascular hybrid room--operating room of the future.

The last two decades have seen a paradigm shift in the treatment of vascular related diseases from once traditional open surgical repairs to the entire vascular tree being amenable to percutaneous interventions. Neither the classic operating room nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues for the vascular hybrid operating room include quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. The most important feature of working in a dedicated hybrid vascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. Establishment of an endovascular operating room suite has the benefit of a sterile environment, and the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. Consequently, better quality and service can be provided to the individual patient. These changes in the treatment of vascular disease require that a new type of vascular specialist, named 'vascular hybrid surgeon', trained to perform both endovascular and open surgical procedures in this highly complex patient group.

Increased donor rate at Sestre milosrdnice University Hospital.

The rate of organ donation reflects the level of the respective society and country development. In Croatia, attempts have been made to increase this rate. As a consequence, the number of potential donors with confirmed brain death was observed to have steadily increased during the 2004-2008 period. Data on all potential donors where the confirmation procedure for brain death was completed were retrieved and analyzed. The percentage of donors out of all persons diagnosed with brain death and all deaths recorded at the Central Intensive Care Unit and at all Hospital departments was calculated. The mean number or organs per donor was also calculated. During the 2004-2008 period, the number of donors perbrain death persons was 5/unknown, 6/10, 8/13, 11/13 and 18/20; mean age 51, 50, 39, 48 and 44; donor rate per Central Intensive Care Unit deaths 5.9%, 5.6%, 5.8%, 10.4% and 12.1%; donor rate per all hospital deaths 0.4%, 0.5%, 0.5%, 1.5% and 1.9%; and number of organs per donor 1.6, 2.4, 2.6, 3.0 and 2.7, respectively. Study results showed a steady increase in the number of donors and organs per donor at Sestre milosrdnice University Hospital during the 2004-2008 period. More intensive education should be organized at medical schools and for medical professionals to identify brain death persons and potential donors. In addition, mass media campaigns should improve public awareness and perception of the issue.

[Usefulness of transcranial Doppler in brain death confirmation]. / Uporabljivost transkranijskog doplera u potvrdi mozdane smrti.

Brain death is a clinical diagnosis and must be confirmed by one paraclinical test. This report presents the usefulness of paraclinical tests applied during a 4-year period. Forty-four patients with severe brain lesions leading to brain death were treated during the 2004-2007 period. The appropriate test was chosen according to test availability and patient condition, appreciating restrictions according to the test protocol. Since the results of some tests were inconclusive, some patients underwent repeat testing with the same or different methods. Among 44 patients, 19 had neurotrauma, 11 massive aneurysmal subarachnoid hemorrhage, 1 massive arteriovenous subarachnoid and parenchymal hemorrhage, 12 hypertensive parenchymal hemorrhage, and 1 ischemic stroke. As a primary test, transcranial Doppler (TCD) was used in 30, brain scintigraphy in 2, multislice computed tomography angiography (MSCTA) in 10, and cerebral angiography in 2 patients; the diagnosis was confirmed in 26, 3, 9 and 2 patients, respectively. Due to inconclusive test results, MSCTA had to be repeated in 4 patients twice, and in one patient three times. Four patients where TCD was used died during the observation period, and in one patient the hemodynamic spectrum was inconclusive. In most patients (65%), TCD confirmed the clinical diagnosis of brain death, and in 61% the diagnosis was confirmed within a 2-hour period. TCD was the most useful confirmatory test for cerebral circulatory arrest in brain death diagnosis.

Small and large bowel manifestation of leukocytoclastic vasculitis.

Leukocytoclastic vasculitis is a disease mostly limited to the skin. Extracutaneous manifestations that include visceral involvement are normally self-limiting and not life-threatening. We describe a 44-year-old man with palpable purpura, polyarthritis and microhematuria who developed severe vasculitis of the small and large bowel. Initial laboratory tests confirmed leukocytosis, slightly elevated C-reactive protein and mildly increased erythrocyte sedimentation rate. Skin biopsy revealed histological features typical of leukocytoclastic vasculitis. The search for trigger factors revealed urogenital infection with Ureaplasma urealyticum. Severe abdominal pain followed cutaneous symptoms eight days after admission. Abdominal x-ray showed several air-fluid levels in the lower right abdomen and an abdominal CT scan revealed thickening of the intestinal wall in several segments of jejunum, ileum and colon. C-reactive protein rose from 32 mg/l to 107 mg/l. Methylprednisolone pulse therapy rapidly improved gastrointestinal, cutaneous and articular symptoms. The aim of this report is to show the unpredictability of vasculitic disease and the difficulties in its classification. The report emphasizes the importance of adapting diagnosis and treatment according to disease severity rather than to the type of vasculitis. The specific etiological trigger remains unknown in this case, although a causal relationship with U. urealyticum infection is speculated.