Myocardial bridging as one of the causes of atypical chest pain in young women.

INTRODUCTION: Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear. METHODS: We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography. RESULTS: Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women. CONCLUSION: Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain.

Drug-Eluting Balloons-A New Tool in the Treatment of Cardiac Allograft Vasculopathy: A Case Series.

Percutaneous coronary intervention in patients with cardiac allograft vasculopathy is burdened with a lot of difficulties. Although they have allowed significant progress in comparison with plain balloon angioplasty and bare metal stents, drug-eluting stents have not fully overcome problems of diffuse lesions and small-vessel disease that are so common in transplant coronary artery disease. There is growing evidence that drug-eluting balloons might be a better choice for patients with small vessel atherosclerotic coronary disease and yet there is no experience with this technology in patients with cardiac allograft vasculopathy. Herein we report a case series of successful percutaneous coronary interventions in patients with cardiac allograft vasculopathy.

[Computerized management of medical documentation for use in the surgery department: what, where and how?]. / Kompjutorizirano vodenje medicinske dokumentacije za potrebe kirurskog odjela: sto, gdje i kako?

Actual medical recording shows to be inadequate for daily use as well as for computer elaboration. The problem oriented medical records are being used worldwide. They consist of a problem list, data base, initial plan and course of cure. All the parts need to be acceded permanently and in the proper way. Computer elaboration of data enables the physical diminution and easier understanding of immense amount of data, especially if the input mode differs from the output one. The same relevance have what- and where-factors for any moment of usage. That depends on medical processing, so this article treats the problem of medical recording at a typical Department of Surgery.

Psycho-organic symptoms as early manifestation of adult onset POMT1-related limb girdle muscular dystrophy.

We report two siblings of Croatian consanguineous healthy parents with a novel homozygous missense mutation in the POMT1 gene, presenting with intellectual disability and psychotic, in particular hallucinatory symptoms and abnormal brain MRIs, preceding classical symptoms of limb-girdle muscular dystrophy by several years. Weakness became apparent in early adulthood and both siblings remained ambulant into the 3rd and 4th decade of life. The muscle biopsy showed reduced α-dystroglycan compatible with the POMT1 defect. This case report extends the phenotypic spectrum of POMT1 associated muscular dystrophies to the adult onset limb girdle muscular dystrophies with psycho-organic deficits.

Mechanical revascularization for acute ischemic stroke: a single-center, retrospective analysis.

BACKGROUND: Endovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. METHODS: A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. RESULTS: The mean age of the patients was 63.1 ± 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5-19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS ≤2) 30 days after stroke. Overall, significant neurological improvement (≥4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of ≥4 or death occurred in three (5 %) patients. CONCLUSIONS: The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

[Evaluation of the use of the CO2 laser in 134 patients with expansive processes in the central nervous system]. / Evaluacija primjene CO2--lasera na 134 bolesnika s ekspanzivnim procesima CNS-a.

The laser began to be used in neurosurgery towards the end of the 60s. The early experience of their clinical use did not promise much; but from the first half of the 70s with the improvement of the laser and the accumulation of laboratory and clinical experiences, the new technology began irrepressibly to spread throughout the world. Three lasers are in use today: CO2, ND.YAG and Argon laser. Each one of them, due to their different wave length and electromagnetic radiation, gave separate characteristics of employment, i.e., the interaction between the biologic tissues and the radiation is different. Depending upon the type of intraoperative needs we will choose one of the lasers. Presently the CO2-laser is the most used in neurosurgery due to its characteristics of low penetration into the tissue and the vaporization of the tissue which is exposed to the radiation. That is why such a laser (Sharplan 1060) has been acquired by our clinic. During one year we performed 134 operations due to expansive processes in the CNS with a partial or complete use of the laser during every phase of the operation. The accumulated experiences showed that the laser is a fairly useful new tool during the various surgical situations with a wide use of the everyday work of the neurosurgeon; with its implementation we have significantly improved the surgical technique in the tumors of the CNS, both in terms of radicality as well as in sparing the healthy tissue. We believe that the laser has an absolute indication in all the glioma tumors regardless of the localization, thereafter in all remaining tumors which are not extremely supplied by blood, while at the same time reducing the time needed for the surgical procedure. In time we spread the use of the laser on arteriovenous malformations as well, which, until now, has not been suggested in literature. Our results on 4 smaller superficial angiomas fully justified the use of a laser in such cases. But it also showed us that generally the laser is still a fairly unresearched surgical innovation, and that in the future wil bring about the wider implementation of this technology in the neurosurgical operating rooms. The final results of our operations and the experiences the other neurosurgical centers in the world that use the laser, regardless of which kind have justified investment of this new surgical technology.