Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective.

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach.

Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre.

Introduction: The aims of this study were (1) to assess the incidence of ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI), (2) to identify risk factors for developing VAP, and (3) to assess the prevalence of the pathogens responsible.

Patients And Methods: The following data were collected prospectively from patients admitted to a 24-bed intensive care unit (ICU) during 2013/14: the mechanism of injury, trauma distribution by system, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Abbreviated Injury Scale (AIS) score, the Injury Severity Score (ISS), underlying diseases, Glasgow Coma Scale (GCS) score, use of vasopressors, need for intubation or cardiopulmonary resuscitation upon admission, and presence of pulmonary contusions. All patients were managed with a standardized protocol if VAP was suspected.

Interleukin-12 as a predictor of outcome in patients with severe acute pancreatitis.

Background/aims: The aim of this study was to determine the role of serum Interleukin-12 level as early marker of severity of the SAP and correlation between IL12, SIRS score, APACHE II and Ranson score in prediction of illness severity as well as of outcome of SAP.

Methodology: We evaluated a total of 234 patients with first onset of SAP, appears in last 24 hours, admitted in surgical Intensive care unit (ICU). Severe Acute Pancreatitis was diagnosed with an APACHE II score of 8 or higher, and/or a Ranson score of 3 or higher, and/or Balthazar scores of 5 or higher.

Spontaneous rupture of giant liver hemangioma: case report.

Introduction: Hemangioma is the most frequent benign solid tumor of the liver. It is well known that a giant liver hemangioma carries the risk of spontaneous rupture, followed by hemoperitoneum and hemorrhagic shock with possible fatal outcome.

Case Outline: This is a case report of the spontaneous rupture of a giant cavernous hemangioma of the liver in an 85-year old patient.

Alpha-lipoic acid upregulates antioxidant enzyme gene expression and enzymatic activity in diabetic rat kidneys through an O-GlcNAc-dependent mechanism.

Purpose: The combined hyperglycemia lowering and antioxidant actions of α-lipoic acid (LA) contribute to its usefulness in preventing renal injury and other diabetic complications. The precise mechanisms by which LA alters diabetic oxidative renal injury are not known. We hypothesized that LA through its hypoglycemic effect lowers O-GlcNAcylation which influences the expression and activities of antioxidant enzymes which assume important roles in preventing diabetes-induced oxidative renal injury.

Distal ileal endometriosis as a cause of ileus: a case report.

Introduction: Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common, it is rarely manifested as an acute bowel obstruction secondary to ileal endometriosis. Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction.

Glissonean pedicle approach in major liver resections.

Background/aims: Liver resections are still one of the most challenging operations. The aim of this study was to analyze the efficiency and safety of the intrahepatic Glissonean pedicle approach vs. classical Hilar dissection in major hepatectomies.

The efficacy of three transection techniques of the liver resection: a randomized clinical trial.

Background/aims: Liver resection is a demanding procedure due to the risk of massive blood loss. Different instruments for liver transection are available today. The aim of this randomized clinical trial was to analyze the efficacy of three different parenchyma transection techniques of liver resection.

Diagnosis of mesh infection after abdominal wall hernia surgery - role of radionuclide methods.

Background/aims: The aim of this investigation was to evaluate the role of detection of late mesh infection following incisional hernia repair with radiolabeled antigranulocyte antibodies.

Methodology: Mesh infection diagnoses were set up with clinical examination and laboratory analysis and confirmed by ultrasonography (US), computerized tomography (CT), scintigraphy with 99mTc-antigranulocyte antibodies and microbiological examination.

Results: Of the 17 patients investigated, 6 had a late mesh infection, and 11 had both mesh infection and recurrent incisional hernia.

Decompressive laparotomy with temporary abdominal closure versus percutaneous puncture with placement of abdominal catheter in patients with abdominal compartment syndrome during acute pancreatitis: background and design of multicenter, randomised, controlled study.

Background: Development of abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) has a strong impact on the course of disease. Number of patients with this complication increases during the years due more aggressive fluid resuscitation, much bigger proportion of patients who is treated conservatively or by minimal invasive approach, and efforts to delay open surgery. There have not been standard recommendations for a surgical or some other interventional treatment of patients who develop ACS during the SAP.

SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

Background/aims: Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP).

Methodology: We evaluated 234 patients with first onset of SAP appears in last twenty four hours.

[Transfusion practice in trauma patient].

Anemia is common in critically ill patients and carries risk of reduced oxygen carriage and worse outcomes. Transfusion, however, carry their own risk, and the physician must balance the risks of anemia with the risk of transfusion in each patient. Some recent studies compared a liberal with a restrictive approach to transfusion, and a clinical practice guidelines were made.

[Oversights in the care of severe injuries].

Question of missed injuries is more often a question of human errors: task execution errors, procedural errors, communication errors, decision errors and noncompliance. Missed injuries are those which are not idetified in the first three days of hospitalisaation. This theme is not popular among physicians.

[Abdominal compartment sydrome in trauma patients].

Intra-abdominal compartment syndrome (ACS) are increasingly recognised to be a contributing cause of organ dysfunction and mortality in critically ill patients. The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra abdominal pressure (IAP). This syndrome is most commonly observed in the setting of severe abdominal trauma.

[Damage control surgery--our experience].

Damage control surgery represents widely implemented technique of treatment of seriously injured patients all over the world. In medical facilities with large number of seriously injured patients, type of injuries often imposes method of damage control surgery as ultimate way in treating such patients. In Emergency center from 2005-2009.

[Liver injuries].

The liver is the most commonly injured abdominal organ. Severe hepatic trauma continue to be associated with high mortality. Management of liver injuries has changed significantly over the last two decades.

[Hanging manuever in liver trauma].

The phylosophy of aggressive surgical approach, its complete implementation in liver trauma surgery did not appear efficient. No matter of permanenent development of diagnostic imaging methods, anesthesia, intensive therapy, medical technology and suture materials, operational theater and operative tchniques, major liver resections in trauma had mortality rate up to 60%. With introduction of computerized tomography (CT, 1981) in everyday clinical praxis and with better evaluation of trauma patients, the whole approach to liver trauma patient has been redesigned.

[Surgical treatment of injuries of the stomach and duodenum in abdominal trauma].

Injuries of the stomach and duodenum have an important place in abdominal trauma, even though that the isolated injuries are rare. This kind of injury is most commonly associated with injuries of other abdominal organs. This retrospective study has been done at the Department of Emergency Surgery, Clinical Centre of Serbia, during the period from January 2004.

[Laparoscopy in the evaluation of blunt abdominal trauma].

Laparoscopic diagnostics provides fast, reliable, clear, and obvious information on extent and depth of abdominal organs injury with minimizing additional trauma to the patient. It is performed without any specific preparations and, if needed, it may be promptly converted into conventional laparotomy. Through use of optical equipment with various refraction angles and through variable patient positioning, laparoscopic technique enables visualization of whole abdominal cavity.

[Acute lung injury and acute respiratory distress syndrome--what should we know?].

Acutelunginjury (ALI) and its more severe form acute respiratory distress syndrome (ARDS) are syndromes with a spectrum of increasing severity of lung injury defined by physiologic and radiographic criteria. There are many clinical disorders as sociated with the development of ALI/ARDS and can be divided into those associated with direct or indirect lung injury. Early detection and protective lung ventilation strategy contribute to lowering the mortality rate.

[Surgical treatment of pancreatic injuries in severe abdominal trauma].

In spite of its low incidence, pancreatic injuries hold important place in abdominal trauma because of diagnostic difficulties, severe potential complications, therapeutic challenges, and high mortality rates. These injuries are related with specific morbidity and are very often accompanied with injuries of other organs. This retrospective study included 31 patients treated at The Clinic for Emergency Surgery of Clinical Center of Serbia during the period of 2004-2009 with intraoperativelly confirmed diagnosis of pancreatic trauma.

[Operative treatment of flexor pollicis longus tendon with Krackow suture, functional results--preliminary results].

Introduction: Surgical treatment of the injuried flexor tensons is the important part of hand surgery. Tendon adhesions, ruptures, joint contcatures-stifness are only one part of the problem one is faced during the tendon treatment. In spite of improvement in surgical technique and suture material, the end result of sutured flexor tendons still represent a serious problem.

[Surgical treatment of liver injury--5-year experience].

Due to improved methods of treatment and management of hemorrhage, the mortality from liver injuries has decreased significantly over the past few decades. In spite of that, liver injuries still represent diagnostic and therapeutic challenge. This retrospective study included 197 patients surgically treated because of trauma of the liver at The Clinic for Emergency Surgery, during the period 2004-2009.

Patellofemoral disorders and instability.

Originally the main idea was to obtain a stable patella, i.e., to stabilize the "slipping patella".

Laser-induced damages of different types of human gallbladder stones.

Background/aims: Today, treatment of human calculi, and particularly those of gallbladder, is, to a large extent, less invasive procedure due to numerous non-invasive methods that have been developed.

Methodology: CO2 laser of pulse (output 5W)(W-watt, SI unit system) and continual mode (output 15W) and diode laser (808 nm-nanometer, SI) were used for tests of fragmentation of gallbladder calculi in vitro.

Results: A total of 15 human gallbladder calculi of known size were examined, which had been collected during surgical interventions.