Acute renal failure after open heart surgery: prevention and management.

The frequency of acute renal failure (ARF) in the setting of open heart surgery is high, because the patients are frequently elderly, may have atherosclerosis, diabetes mellitus, hypertension, or previous renal disease. The appropriate preoperative patient preparation might be the first step treatment. The choice of renal support used in the care of ARF patients may influence the ultimate outcome, and therefore dialysis treatment must be tailored to each individual patient.

Apoptosis in human gastric polyps and adenocarcinomas: a stereological analysis.

BACKGROUND/AIM: The occurrence of apoptotic cells was analyzed in human normal gastric mucosa, polyps and adenocarcinomas. METHODOLOGY: Histological classification was carried out on hematoxylin and eosin stained slides. The tissue was classified as follows: Normal gastric mucosa or adenomatous polyps. Gastric carcinoma specimens were histologically classified according to Lauren's classification into: A: Diffuse adenocarcinoma without metastasis, B: Diffuse adenocarcinoma with metastasis, C: Intestinal adenocarcinoma without metastasis, D: Intestinal adenocarcinoma with metastasis, E: Mixed adenocarcinoma without metastasis and mixed adenocarcinoma with metastasis. The counting of apoptotic cells was performed using the 40X objective with a calibrated eyepiece Weibel's multi-purpose M 42 stereological test system. Each group was evaluated stereologically, determining numeric density of apoptotic cells. RESULTS: The results show the progressive and statistically significant increase of apoptotic numeric densities from normal gastric epithelium to adenomatous polyp and finally to cancer, which contained the highest number of apoptotic cells. Comparing gastric carcinoma with and without metastasis in intestinal and diffuse adenocarcinoma there was statistically significant difference. In these two groups, carcinomas with metastasis contained higher number of apoptotic cells than without metastasis. Gastric cancer according to numeric densities of apoptotic cells can be separated in tree statistically different groups: A: Intestinal type gastric cancer with metastasis (the highest number of apoptotic cells), B: Intestinal type gastric cancer without metastasis and diffuse gastric cancer with metastasis (medium number), C: Diffuse type gastric cancer without metastasis, mixed gastric cancer with and without metastasis (the lowest number of apoptotic cells). CONCLUSION: These results suggest that numeric densities of apoptotic cells are associated with tumor progression in human gastric carcinogenesis and can be used as prognostic mark.

Hypothermia and acute renal failure in the elderly.

During 1993-1998, in winter time 14 elderly patients: 8 female and 6 male aged 65-88, were treated because of hypothermia. Rectal temperature on admission was 20-34.9 degrees C. Sopor was present in 2 and various grades of coma were present in 10 patients. Arterial hypotension was recorded in 5, and shock in 9 patients. Increased serum creatinine level was found in 8 patients. The mean rectal temperature in the whole group was 31.3 degrees C +/- 4.7, ranging from 20.0 to 34.9 degrees C, and the mean serum creatinine level was 172.2 +/- 93.5, in range of 66.0 to 360.0 mumol/L. Negative correlation between those two parameters was found: r = -0.572. In 2 of them parameters of renal failure were analyzed: urine sodium concentration, creatinine urine/plasma ratio, urine osmolality, urine/plasma osmolality ratio, renal failure index and fractional excretion of filtered sodium. In one of the patients all parameters were within the range of functional oliguria, in an other the urine sodium concentration serum showed acute renal failure, but all other findings showed borderline values between functional oliguria and acute renal failure. Twelve out of 14 patients died within 1-216 hours from admission.

Some structural characteristics of the inguinal region in the northern Croatia.

In studying anatomical samples of both inguinal hernia patients and healthy controls with no changes observable in the inguinal region, the authors aimed at investigating the constitution of the inguinal region in relation to the formation of inguinal hernia. The morphological investigation of 68 anatomical samples and 44 inguinal regions at autopsy, revealed that the length of the interspinal line, independent of sex, varies from 180 to 310 mm and is 63 to 132 mm removed from the pubic tubercle (the height of the anterior pelvic arch). Thus, in 35% of male and 22% of female subjects the height of the anterior pelvic arch exceeded 75 mm indicating a low position of the groin. The research carried out in 640 inguinal hernia patients and 186 controls indicated a shift towards higher values in the interspinal line in inguinal hernia patients as compared with the controls. In addition, the height of the anterior pelvic arch in patients with inguinal hernia conspicuously exceeded that observed in the controls. The present study undoubtedly shows that the number of muscle and connective structure variations of the inguinal region depends upon the position of the groin in relation to the interspinal plane. The authors therefore agree with the classification of these relationships to high, medial and low groin position. The high position of the pubic tubercles up to 75 mm removed from the interspinal spine is accompanied with the firm constitution of the entire inguinal region. Moreover, the medical position of pubic tubercles 75 to 90 mm removed from the interspinal line does not indicate the risk of developing inguinal hernia. On the other hand, the low position of the pubic tubercles more than 90 mm removed from the interspinal line is often due to the inferior constitution of the inguinal region. This group is regularly at higher risk of developing inguinal hernia, particularly with other risk factors being added as well. The identification of structural characteristics of the inguinal region therefore enables the selection of the most appropriate operation procedure, i.e. between the classic hernia repair and endoscopic approach for prosthetic mesh implantation.

Anthropological aspects of alcohol consumption and alcohol related problems.

Authors believe that drinking alcoholic beverages can be associated with customs and habits specific to small communities, societies and even entire nations. The primary family, as the foundation of customs and habits of the first generation, has a role in stimulating drinking and alcoholism. The authors have examined some sociocultural factors, mostly taking into consideration relations in the primary family, by means of a questionnaire filled out by alcoholics (N = 200) and non-alcoholics (N = 100). The alcoholics usually have their first drink earlier, start drinking regularly earlier, and in the primary family there is a high tolerance towards the use of alcoholic beverages. The authors believe that the prevention should be directed primary towards the primary family with a view to changing their customs and habits as well as attitudes towards the use of alcoholic beverages.

Psycho-social characteristics of female alcoholics.

This paper presents the survey and benefits of various questionnaires for the examination of male and female population of alcoholics. It continues to show the results of an investigation carried out at the Department for Psychiatry, Alcoholism and Other Dependences of the University Hospital "Sestre milosrdnice" in Zagreb. The aim of this study was to obtain the most accurate and recent information about alcohol dependence and the socio-psychiatric characteristic of alcoholism in the Croatian urban environment on the basis of a specially prepared questionnaire. The group of 166 treated alcoholic persons consisted of 120 males and 46 females. The age of examinees ranged between 30 to 40. The great difference in psycho-social characteristics between male and female alcoholics was confirmed. Symptomatic alcoholism observed in women was due to primary and secondary family disorders and resulted in the anxious depressive disturbance. The incidence of primary female alcoholism is on the rise. This trend can be ascribed to the changes in the life style of urban female population.

[Perioperative complications in carotid endarterectomy with respect to the stage of the cerebrovascular disease]. / Perioperacijske komplikacije karotidnih endarterektomija s obzirom na stadij cerebrovaskularne bolesti.

Records of perioperative complications following 407 consecutive carotid endarterectomies performed in 366 patients in the 18-year period have been presented. The complications are categorized according to the clinical stage of vascular disease, that is, according to the indications for the surgery. Out of the total number, 46 (11.3%) operations were done in the 1st, asymptomatic stage of disease, for the haemodinamically significant stenoses and ulcerated plaques; 173 (42.5%) in the 2nd clinical stage for hemispheral and nonhemispheral transient ishemic attacks (TIA) and reversible neurologic deficits (RIND); 3 (0.7%) in the 3rd stage which is a progressive cerebrovascular stroke and 185 (45.5%) in the 4th clinical stage of the disease, in patients with previous cerebral infarction and a permanent neurologic deficit. The rate of a temporary and permanent neurologic deficit, as well as mortality in the first stage of the disease equals zero. In the second stage of the disease, the rate of a temporary neurologic postoperative morbidity increases to 1.7%, of a permanent neurologic morbidity to 1.2%, while the rate of mortality is 1.2%. In the 3rd and 4th stage, those rates amount to 66.7%, 0% and 33.3%, and 1.1%, 3.8% and 1.6%, respectively. The rates of perioperative morbidity and mortality are in proportion to the scope of preoperative brain dysfunction. Results of this work suggest the necessity of categorization of patients, candidates for carotid endarterectomy, according to the clinical stage of the disease, which will enable a better comparison with other authors' results, give a more reliable view on the efficacy of the surgical treatment and justify the surgeons' attitude towards indications.(ABSTRACT TRUNCATED AT 250 WORDS)