PREDICTIVE FACTORS FOR SUCCESSFUL PROSTHETIC REHABILITATION AFTER VASCULAR TRANSTIBIAL AMPUTATION.

Lower extremity amputation is a very common amputation and successful prosthetic rehabilitation is a desirable outcome. The aim of this study was to determine which factors affect the success of prosthetic rehabilitation after transtibial vascular amputation. The study included 61 patients who had undergone transtibial amputation (mean age, 64.2±10.4 years; 50 (82%) males). Patients who were able to walk at least 45 meters without aids or with only one walking stick after rehabilitation program were classified into the group of successful prosthetic users. Age, gender, comorbidities, patency of the popliteal artery, wound healing complications, and presence of the phantom limb pain were used as predictive variables. Multivariate logistic regression analysis was used to identify predictive factors of successful prosthetic rehabilitation. The model included all variables explaining up to 59.8% of variance, however, only age, absence of functional patency of the popliteal artery and compromised wound healing made significant contribution to the model. In conclusion, good general condition of the patient and sustained patency of the popliteal artery reliably led to clinical improvement and realization of full capacity of rehabilitation after below-knee amputation.

Cerebrovacular Reserve Predicts the Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy.

BACKGROUND: Cerebral hyperperfusion syndrome is a rare but potentially severe complication of carotid artery revascularisation that develops under conditions of resistant postoperative hypertension and impaired cerebrovascular autoregulation. OBJECTIVE: Was to determine which preoperative and operative factors affect the development of cerebral hyperperfusion syndrome after carotid endarterectomy. METHODS: This prospective observational study enrolled 93 asymptomatic patients who underwent carotid endarterectomy. Cerebral hyperperfusion was registered in patients who had 100% postoperative increase in mean flow in middle cerebral artery registered by Transcranial Doppler ultrasound. Cerebral hyperperfusion syndrome was diagnosed in patients with cerebral hyperperfusion who postoperatively developed at least one of the symptoms. Pre-operative and operative risk factors for cerebral hyperperfusion syndrome were analysed by multivariate binary logistic regression. RESULTS: Out of 93 operated patients, cerebral hyperperfusion was registered in 23 and cerebral hyperperfusion syndrome in 18 patients. Risk factors for cerebral hyperperfusion syndrome were included in the binary logistic regression model. Incomplete Circle of Willis morphology on 3D TOF magnetic resonance image (p = 0.002), Breath holding index below the 0.69 cut-off (p = 0.006), positive criteria for insufficient collateral flow through circle of Willis registered by TCD (p = 0.03), and poorly controlled hypertension (p = 0.023) showed statistically significant independent predictive value for cerebral hyperperfusion syndrome. The model was statistically significant (p = 0.012) and correctly classified 90.3 % of patients. CONCLUSIONS: Incomplete circle of Willis and insufficient collateral flow, low cerebrovascular reserve, and poorly regulated hypertension are significant predictors of post- carotid endarterectomy hyperperfusion development.

Using blood lactate concentration to predict muscle damage and jump performance response to maximal stretch-shortening cycle exercise.

BACKGROUND: It is well known that eccentric muscle contractions induce delayed onset muscle soreness (DOMS) and exertional rhabdomyolysis (ERB), both of which are related to high blood levels of muscle damage markers after exercise. Creatine kinase (CK) is, together with some other markers (i.e. myoglobin, α-actin, skeletal troponin), widely used in determination of muscle damage. Moreover, DOMS after eccentric exercise has been shown to be associated with altered blood lactate concentration after subsequent submaximal or maximal cycling exercise. However, it is unknown whether blood lactate can predict muscle damage levels after maximal stretch-shortening cycle (SSC) exercise, as due to the differences in types of contractions between the eccentric and SSC protocol. Additionally, we determined the association between blood lactate concentration and CMJ performance after such a protocol. METHODS: Forty-three healthy, physically active young men completed a plyometric training session consisting of maximal countermovement jumps (CMJ) to failure. The blood creatine kinase (CK), myoglobin (Mb) and aspartate aminotransferase (AST) samples were taken pre- and 48 hours post-exercise. Blood lactate concentration was determined directly post-exercise. RESULTS: There was a significant correlation between blood lactate concentration (post) and blood CK (P=0.027), Mb (P=0.007) and AST (P=0.024) (48 hours post), which means that higher blood lactate concentration is associated with higher muscle damage values after exercise. No correlation was found between blood lactate concentration (post) and performance loss which was expressed by the decrease in maximum CMJ height 5 minutes post-exercise. CONCLUSIONS: Blood lactate concentration could be used as a predictor of muscle damage levels after maximal SSC exercise, which supports the results found in other studies, although after eccentric exercise. However, it cannot predict acute performance loss in jump height.

COMPLETENESS OF CIRCLE OF WILLIS IN ASYMPTOMATIC AND SYMPTOMATIC EXTRACRANIAL CAROTID DISEASE.

INTRODUCTION: This research has been aimed at determining whether incomplete Circle of Willis in patients with significant extracranial carotid stenosis is associated with a higher incidence of neurological symptomatology and/or ischemnic cerebral lesions. MATERIAL AND METHODS: The research was conducted as a prospective study which comprised 211 patients who underwent surgical treatment of extracranial carotid disease at the Department of Vascular Surgery in Novi Sad and 102 patients in the control group. Each patient underwent preoperative magnetic resonance imaging and magnetic resonance angiography with visualization of cerebral parenchyma. extracranial and intracranial cerebral circulation. Assessment of Circle of Willis morphology was performed by 3D time-of-fight magnetic resonance angiogram sequence analysis. The patients were divided into two groups: group I - the patients with'complete Circle of Willis and group II - the patients with incomplete Circle of Willis i.e. with the disruption of anterior and/ or ipsilateral posterior circulation - regarding the side of signif icant carotid stenosis. RESULTS: Out of 211 patients who -were operated during a two-year period, 133 had the complete Circle of Willis. while 78 patients had the incomplete Circle of Willis. Out of 111 patients with symptomatic carotid disease or silent cerebral infarction, 52.5% (58) had the complete Circle of' Willis and 47.5% (53) had the incomplete Circle of Willis. It was shown to be statistically different (P = 0.0146) in relation with the asymptomatic group of patients (100), where the frequency of the complete Circle of Willis was 75% (75) while the insufficiency of anterior or ipsilateral posterior collateral ization was found in 25% (25). In the control group there were significantly fewer cases of developed collateral flow and the complete Circle of Willis (41%) compared to the operated patients with extracranial carotid stenosis (63%) (P= 0.0003). CONCLUSION: Incompleteness of Circle of Willis is associated with more frequent occurrence of neurological symptomatology or ischemic lesions of brain parenchyma in operated patients with significant extracranial carotid stenosis. The control group without extracranial carotid stenosis had less developed collaterals of Circle of Willis compared to extracranial carotid patients.

Transplantation of infant kidneys--The surgical technique en bloc and transplant position variation: A case report.

INTRODUCTION: Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called "marginal donors" group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. CASE REPORT: We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. CONCLUSION: The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

Analysis of associated diseases in patients with acute critical lower limb ischemia.

INTRODUCTION: Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. MATERIAL AND METHODS: This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. RESULTS AND DISCUSSION: Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number ofarterial thrombosis demanded more complex "inflow" and "outflow" ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. CONCLUSION: Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

The analysis of the connection between plaque morphology of asymptomatic carotid stenosis and ischemic brain lesions.

BACKGROUND/AIM: A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke by modern imaging methods. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. METHODS: This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 tears. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. RESULTS: Out of 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). CONCLUSIONS: Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.