BACKGROUND: The extent of the resection, whether clamped or non-clamping resection is factor that influences the operating time and intraoperative bleeding, the development of modern techniques for vascular control and resection, and determine of lesser blood loss, morbidity, and mortality. AIM: The aim of this study was to determine the experience of General and Hepatobiliary Surgery Clinic at Aleksandrovska Hospital Sofia, Republic of Bulgaria in the treatment of patients with colorectal metastases in the liver and to compare literature reports on the influence of the extent of resection and Pringle maneuver (IPM) on operating time and perioperative bleeding. MATERIALS AND METHODS: This retrospective study covers the time period from January 01, 2006, until December 31, 2015. A total of 239 patients were included, from which: 179 patients were treated with radical surgery, 5 with palliative intervention, and 55 were subjected on operability exploration. RESULTS: The use of the IPM for vascular control insignificantly influenced the prolonged operative time, while intraoperative blood loss was significantly lower in patients with Pringle <15 min. There was no association between IPM and resection type, while intraoperative blood loss and operating time were significantly greater in patients with major resection. CONCLUSION: Resection size is directly proportional to operating time and perioperative blood loss, but it does not significantly influence perioperative morbidity. The IPM does not influence operating time, while blood loss is significantly lower in the group of patients with Pringle <15 min.
BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score <3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score <3 (mean 1.7), and 82 had score ≥3 (mean 3.5), p>0.001. Patients with ST-segment elevation MI had OR 2.1 (p>0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p > 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after MI.
BACKGROUND: Primary stage IV breast cancer accounts about of 3–5% of newly diagnosed breast cancer cases. The management of this patient subset mostly comprises systemic therapy, with additional surgery or radiotherapy to control locoregional symptoms. Some of the retrospective studies showed the benefit of locoregional treatment as the first treatment of choice for overall survival (OS), but the efficacy of primary site surgery remains controversial for OS in prospective, controlled trials. AIM: We aimed to presents series of cases with primary metastatic breast cancer with diffuse bone metastasis. MATERIALS AND METHODS: This study was serial of cases with primary metastatic breast cancer with diffuse bone metastasis and a review of the literature. All of the cases were treated with upfront surgical resection of the primary in the breast. RESULTS: During the follow-up period of 36 months, all of our patients were still alive. CONCLUSION: Retrospective studies about resection of primary tumor as the first treatment of choice are with conflicting results, which may be related to randomization bias, including different biological types of breast cancer, different metastatic sites, and patients with different menopausal status. On the other hand, prospective studies did not show any powerful results that would lead the treatment in de novo stage IV breast cancer because of few limitations such a short follow-up period (between 23 and 40 months), younger patients, ER-positive/HER2 negative tumors, and type of chemotherapy given or not upfront. The effect of upfront surgery in newly metastatic breast cancer patients is still challenging, so there is a need to identify the exact cohort of patients who could benefit from surgery.
INTRODUCTION:Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%.AIM:To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS:This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases.RESULTS:Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION:In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.
Background: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predicting major adverse cardiac events (MACE) following discharge still remains limited. Aim: to identify early predictors of MACE in MI patients, that underwent Primary Percutaneous Coronary Intervention (pPCI), with special emphasis on multiple cardiac biomarkers. Materials and methods: we analysed clinical, LV functional, angiographic variables, as well cardiac troponin, a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study population were 150 consecutive patients treated for acute myocardial infarction. Results: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p=0,07), number of diseased vessels (p=0,027), and need for loop diuretic therapy (p=0,050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve .640, and .658, p=0.025 and 0.011 respectively). Conclusion: The combination of biomarkers for myocardial stress and inflammation improves the prediction of major adverse cardiac events in MI survivors. Keywords: myocardial infarction, cardiac biomarkers, cardiac troponin, natriuretic peptide, prognosis, major adverse cardiac events (MACE), cardiac death
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