Manifestation of an undifferentiated uterine sarcoma in a 51 years old patient and its prognosis: A case report.

INTRODUCTION: Undifferentiated uterine sarcoma is a rare histological subtype of uterine sarcoma. This study aimed to summarize the clinical and pathological presentation of this case. CASE REPORT: A 51-years-old patient was admitted to the clinic because of severe pain in the lower abdomen, and scanty bleeding from the genitals. Gynecological examination revealed an enlarged uterus. Conventional and Doppler transvaginal sonography detected a tumorously altered uterus with a maximum diameter of 20 cm a tumefaction with unclear borders and a diameter of 10 cm, with hyperechoic and hypoechoic fields within the tumefaction, presenting pathological vascularization and reduced values of the (Pulsatile index  ≤ 1) and (Resistance index  ≤ 0.40). Preoperatively, the chest, abdomen, and pelvis were examined. The patient underwent surgery and total abdominal hysterectomy with bilateral salpingo-oophorectomy, and partial omentectomy, with complete removal of the tumor. A pathohistological diagnosis, of undifferentiated uterine sarcoma, was made by excluding other types of uterine sarcomas. At the control examination after completion of chemotherapy, recurrence was ascertained. CONCLUSION: undifferentiated uterine sarcoma is an aggressive malignant tumor that in most cases shows rapid progression of the disease after complete resection of the tumor, with a poor prognosis.

Effects of mistletoe (Viscum album L., Loranthaceae) extracts on arterial blood pressure in rats treated with atropine sulfate and hexocycline.

Acute effects of different extracts of mistletoe stem (Viscum album) were investigated on values of arterial blood pressure in Wistar rats. Arterial blood pressure was registered by direct method in the left carotid artery and the investigated extracts (total ethanol, ether and ethyl acetate) of mistletoe stem were administered into the right jugular vein. The total ethanol extract exhibited the best effect even on the lowest applied concentration (3.33 x 10(-5) mg kg(-1)) and significantly decreased the blood pressure after applied concentration 1.00 x 10(-3) mg kg(-1). On the contrary, the ether and ethyl acetate extracts exhibited notable activity only by higher administered doses. Atropine as a nonselective blocker of muscarinic receptors reduced the hypotensive effects of ethanol extract of mistletoe. Hexocycline, a selective blocker of muscarine receptors, significantly raised blood pressure and decreased the hypotensive effect of ethanol extract of mistletoe on arterial blood pressure in rats.

Protective effects of celery juice in treatments with Doxorubicin.

The aim of this work was to investigate possible protective effect of celery juice in doxorubicin treatment. The following biochemical parameters were determined: content of reduced glutathione, activities of catalase, xanthine oxidase, glutathione peroxidase, peroxidase, and lipid peroxidation intensity in liver homogenate and blood hemolysate. We examined influence of diluted pure celery leaves and roots juices and their combinations with doxorubicine on analyzed biochemical parameters. Celery roots and leaves juices influenced the examined biochemical parameters and showed protective effects when applied with doxorubicine.

History of alcohol abuse after major non-cardiac surgery and postoperative cognitive dysfunction.

INTRODUCTION: The risk factors for postoperative cognitive dysfunction (POCD) after non-cardiac surgery include advanced age and preexisting cognitive impairment. MATERIAL AND METHODS: Data was collected in a prospective manner on 220 patients of both genders. Patients were triaged into three groups, with American Society of Anesthesiologists-ASA Physical Classification System levels I-IV. Patients were 55 years of age and older, with self-reported alcohol abuse and were matched to age-, sex-, and education-matched nonalcoholic controls. They were tested using a neurocognitive battery before and two weeks after elective surgery or after a corresponding time interval without surgery. Verbal memory, visuospatial memory, and executive functions were assessed. Neurologic examination was performed in order to exclude subjects with potential cerebrovascular damage. Standard laboratory analyses were done and findings recorded. Significant predisposing factors for developing POCD were noted. RESULTS: From the total number of participants involved in the study, 135 (67.5%) patients belonged to ASA class III. Among all patients, 168 (84%) patients were chronic alcohol users. Pearson's χ(2) test shows a statistically significant difference regarding the use of alcohol (χ(2)=19.220, df=1, p=0.000, p<0.05). Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery. DISCUSSION: In the study by Mason which involved 255 elderly patients that were postoperatively admitted to the intensive care unit following a major abdominal surgery, development of POCD was two times greater in urgent cases (~40% of cases), when compared to elective interventions. CONCLUSION: Our results complement the data given by the World Health Organization and results of similar studies.

An experience with colistin applied in treatment of imunocompromised patients with peritonitis on peritoneal dialysis.

INTRODUCTION: Immunocompromised patients, such as those with multiple myeloma on peritoneal dialysis, are particularly susceptible to the occurrence of peritonitis. CASE REPORT: We presented a 56-year-old female patient with a 10-year history of multiple myeloma. The patient was on peritoneal dialysis since 2010. During 2012 the patient had the first episode of peritonitis that was successfully managed, but in 2013 the second episode of peritonitis occured. Analysis of dialysate culture and exit site swab revealed the presence of multiresistant Acinetobacter spp., which was susceptible only to colistin. Prompt colistin therapy was administered at the doses of 100,000 units/day during six days, which resulted in complete recovery of the patient, as well as improvement of local abdominal findings. Gram-negative bacteria (genus Acinetobacter) are common causative agents in hospital-acquired infections. Studies confirmed susceptibility of Acinetobacter to colistin, which was also the case with the presented patient. Intravenous administration of colistin resulted in a complete remission of this severe, life-threatening peritonitis. CONCLUSION: Patients with multiple myeloma and renal failure are highly prone to severe life-threatening infections.

[Peripheral Primitive Neuroectodermal Tumor of the Small Bowel Mesentery - Report of a Case].

INTRODUCTION: Primitive neuroectodermal tumor or Ewing's sarcoma is a tumor of undifferentiated small round cells that arise from the soft tissues, and is believed to be of neural origin. It occurs most often in children, followed by adolescents and young adults. CASE OUTLINE: A case of a 24-year-old patient with ulcerostenosans Ewing's sarcoma of the initial part of the small intestine is presented in our paper. Reviewing the literature and using as an example the case of a female patient with signs of sideropenic anemia caused by primitive neuroectodermal tumor of the small intestine, an attempt was made to clarify the etiology, clinical presentation, diagnosis and therapy with the aim of its rapid detection and treatment. CONCLUSION: Mesenteric primitive neuroectodermal tumor is a rare neoplasm in adults, while it usually occurs in children and young adults. Surgical resection of the lesions with the application of chemotherapy is the main form of treatment of patients suffering from this disease.

Preoperative evaluation in the era of laparoscopic surgery.

To confirm the importance of preoperative evaluation of a patient's health state, to reduce perioperative morbidity and mortality after laparoscopic surgery. A total number of 1,070 patients were selected into groups based on a type of intervention, gender, ASA and NYHA classification. The most common laparoscopic procedure that was performed was cholecystectomy in 920 (86%) patients. Cardiovascular disease had been presented in 952 (89%) patients, 1006 (94 %) of patients were ASA class I- III, while 1049 (98%) patients were NYHA class I and II. Frequency of lethal outcome was 0.1% due to postoperative thromboembolic complications. A lower mortality rate is a result of prescribed protocol and adequate preoperative examination.

Blunt trauma of the thoracic aortic isthmus.

Blunt trauma of the thoracic aorta is the second leading cause of death in traffic accidents, after head injuries. A polytraumatized patient, aged 40, was admitted, with trauma of the thoracic aortic isthmus, after a traffic accident. Adequate resuscitation and intensive therapy, angiographic and MSCT diagnostics enabled the urgent surgical treatment. On the sixty-seventh day of surgery, the patient was successfully transferred to a regional health center in good general condition. Blunt aortic injury occurs in 1% of casualties in traffic and causes 16% mortality. More than 80% of patients die before arrival to hospital. In conclusion, we point out with satisfaction the successful surgical treatment and survival of injured patients admitted to our hospital.

Acute posterior multifocal placoid pigment epitheliopathy-retinal "white dot syndrome".

Acute posterior multifocal placoid pigment epitheliopathy- APMPPE is an acquired idiopathic inflammatory disease of the chorioretina. This case report presents a typical clinical manifestation of a very rare condition: a twenty ive-year old female complained of a sudden bilateral decrease of vision. She reported lu-like symptoms and taking antibiotics therapy. Fundus examination revealed numerous discrete yellow-white lesions at posterior pole involving the macula. After a period of 7 days oral prednisone treatment she was completely recovered. Usage of steroids is recommended for treating APMPPE in cases where macula is involved and in recurrent cases.

Autologous blood transfusion in total knee replacement surgery.

BACKGROUND/AIM: Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. METHODS: During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. RESULTS: In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p < or = 0.01). The patients whose blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p < 0.01). CONCLUSION: Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

Ocular findings in patient with primary familial pulmonary hypertension.

Exudative retinal detachment as subretinal fluid accumulation occurs due to chorioretinal eye disease (inflammation, infection, tumor, vascular abnormalities) and in systemic diseases too. The aim of this case report was to emphasize connection between the ophthalmological pathology and other systemic conditions. This is a case report of a 45-year old woman who suffered from pulmonary hypertension caused by many recurrent thromboembolic events. During one of eight previous hospitalizations she complained of blurred vision. Bilateral exudative detachment is diagnosed by an ophthalmologist. Parenteral steroids and acetazolamide provided quick recovery.

A surgical thread as a nidus for the common bile duct stone formation.

A 68-year old patient, who had had cholecistectomy when he was 30 years old and had been hospitalized in several occasions, with clinical presentation of recidivant cholangitis was admitted to county hospital. Computed tomography was performed, where a bile duct dilatation was noted, with suspected 12 mm concrement. After that the patient was referred to the hospital in order to undergo therapeutic endoscopic retrograde cholangiopancreatography. After performing the procedure, the presence of the concrement, 12x25mm in size was confirmed. It was evacuated during mechanical lithotripsy along with a part of surgical thread, which could not have been extracted entirely. A surgery had to be performed because the patient developed cholestasis. Forming of choledocholith most likely developed on the matrix of surgical thread, which is a rare cause of choledocholithiasis.

Intraoperative air testing of colorectal anastomoses.

INTRODUCTION: Intraoperative anastomotic air testing of stapled colorectal anastomosis is performed by filling the pelvis with saline solution and insufflating the rectum with air through a sigmoidoscope. The presence of air bubbles indicates anastomotic leaks which are resolved during surgery. OBJECTIVE: The aim of this prospective, randomized study was to perform a comparative analysis regarding the number of anastomotic dehiscences in patients checked by air leak testing and in the control group without air testing. METHODS: After stapled colorectal anastomosis was performed, patients were randomized into two groups of 30 patients. The first group patients underwent intraoperative anastomotic air testing, whereas in the control group this procedure was not performed. The two groups were matched for age, sex, diagnosis and surgical procedure. RESULTS: Intraoperative air tests were positive in seven cases and anastomotic defects were repaired. After surgery, there were three clinical leaks in this group of patients. In the control group, there were six leaks (Unilateral Fischer's exact test, p = 0.24). The incidence of colorectal anastomotic dehiscences in the study group was lower than in the control group by 50%. However, this finding was not statistically significant in our sample. CONCLUSION: In our opinion, intraoperative air testing of colorectal anastomosis is a good method for prevention of anastomotic dehiscence.

[Out-of-hospital treatment in case of drowning].

INTRODUCTION: Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. FIRST AID: The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. BASIC LIFE SUPPORT: The first and most important treatment option of a drowning victim is the provision of ventilation which increases the chances of survival. As soon as the unresponsive victim is removed from the water, the lay rescuer should immediately begin chest compressions and provide cycles of ventilations and compressions. Some recent investigations have revealed that exterior compression of the chest is a necessary measure even in a situation when bystanders cannot provide airway. It is recommended to train bystanders to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early as possible. ADVANCED LIFE SUPPORT: In drowning, the victim with cardiac arrest requires advanced life support, including an early intubation. Extended medical measures, which are primarily provided by medical professionals, include cervical spine immobilization in case a spinal injury is suspected, or, establishment of the ventilation with oxygen, emergency transport, application of reanimation and advanced vital support measures.

Sudden death of a swimmer in water caused by heterotopic intracranial ossification and anomaly of the skull base.

BACKGROUND: Expression of immersion syndrome implies sudden and unexpected death of swimmer in water. A drowned swimmer is still a riddle for the forensic and clinical doctors. Pathophysiological mechanisms which cause immersion syndrome may be divided into vegetatively regulating and mechanical ones. CASE REPORT: We presented heterotopic intracranial ossification with the anomaly of the skull base bones development in a young man, a swimmer, drowned after entering water and where the circumstances required expertise in forensic medicine. CONCLUSION: Intracranial heterotopic ossification with or without a disorder in the development of skull bones may be one of the causes of immersion syndrome.

Preoperative assessment and preparation of patients with diseases affecting the central nervous system.

PURPOSE OF REVIEW: This review will examine the most important issues of preoperative evaluation and preparation in relation to patients with deseases affecting the central nervous system. Those patients may undergo various forms of surgery unrelated to the central nervous system disease. We discuss the effect of physiologic and pharmacological factors on cerebral autoregulation and control of intracranial pressure alongside its clinical relevance with the help of new evidence. RECENT FINDINGS: Regardless of the reason for surgery, coexisting diseases of brain often have important implications when selecting anesthetic drugs, procedures and monitoring techniques. Suppression of cerebral metabolic rate is not the sole mechanism for the neuroprotective effect of anaesthetic agents. There are certain general principles, but also some specific circumstances, when we are talking about optimal anesthetic procedure for a patient with coexisting brain disease. Intravenous anesthesia, such as combination of propofol and remifentanil, provides best preservation of autoregulation. Among inhaled agents isoflurane and sevoflurane appear to preserve autoregulation at all doses, whereas with other agents autoregulation is impaired in a dose-related manner. During maintenance of anesthesia the patient is ventilated by intermittent positive pressure ventilation, at intermediate hyperventilation (PaCO2 25-30 mmHg). SUMMARY: Intraoperative cerebral autoregulation monitoring is an important consideration for the patients with coexisting neurological disease. Transcranial Doppler based static autoregulation measurements appears to be the most robust bedside method for this purpose.

Preoperative preparation of patients with pituitary gland disorders.

This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients. Pituitary function manages almost the entire endocrine system using the negative feedback mechanism that is impaired by these diseases. The cause of acromegaly is a pituitary adenoma, which produces growth hormone in adults. Primary therapy of acromegaly is surgical, with or without associated radiotherapy. If a patient with acromegaly as comorbidity prepares for non-elective neurosurgical operation, then it requires consultation with brain surgeons for possible delays of that operation and primary surgical treatment of pituitary gland. If operative treatment of pituitary gland is carried out, the preoperative preparation (for other surgical interventions) should consider the need for perioperative glucocorticoid supplementation. Panhypopituitarism consequences are different in children and adults and the first step in diagnosis is to assess the function of target organs. Change of electrolytes and water occurs in the case of pituitary lesions in the form of central or nephrogenic diabetes insipidus as a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Preoperative preparation of patients with pituitary dysfunction should be multidisciplinary, whether it is a neurosurgical or some other surgical intervention. The aim is to evaluate the result of insufficient production of pituitary hormones (hypopituitarism), excessive production of adenohypophysis hormones (acromegaly, Cushing's disease and hyperprolactinemia) and the influence of pituitary tumours in surrounding structures (compression syndrome) and to determine the level of perioperative risk. Pharmacological suppressive therapy of the hyperfunctional pituitary disorders can have significant interactions with drugs used in the perioperative period.