SAŽETAK: Izvantjelesna membranska oksigenacija (engl. Extracorporeal Membrane Oxygenation, ECMO) postupak je izvantjelesne mehaničke cirkulacijske ili respiracijske potpore koji se primjenjuje primarno u bolesnika sa životno ugrožavajućim oblicima zatajivanja rada srca ili pluća. Dva su osnovna oblika ECMO potpore: vensko-venski (V-V) i vensko-arterijski (V-A) ECMO. V-V ECMO osigurava funkciju izmjene plinova u krvi i primjenjuje se u slučaju teške reverzibilne respiracijske insuficijencije. V-A ECMO podržava funkciju rada srca i pluća, a, osim pri reverzibilnim oblicima oštećenja srčane funkcije, može se rabiti i pri njezinu ireverzibilnom oštećenju, kao premoštenje do transplantacije srca ili ugradnje uređaja za mehaničku cirkulacijsku potporu. ECMO je invazivan i tehnički složen postupak koji se obavlja u kritično bolesnih pa stoga nosi visok rizik od pojave komplikacija. Rezultati liječe-nja ECMO-om razlikuju se ovisno o indikaciji za sam postupak. Bolesnici u kojih je ECMO primijenjen radi respiracijske potpore imaju bolje ishode u usporedbi s onima s kardiogenim šokom ili zastojem srca. Iako nedostaju dokazi temeljeni na velikim randomiziranim studijama koji bi poduprli njegovu primjenu, ECMO je u kliničkoj praksi spasonosna metoda liječenja u dobro odabranih, kritičnih bolesnika. SUMMARY:Extracorporeal membrane oxygenation (ECMO) is a procedure that provides extracorporeal mechanical circulatory or respiratory support and is used primarily in patients with life-threatening forms of heart or respiratory failure. There are two basic types of ECMO support: veno-venous (VV) and veno-arterial (VA) ECMO. VV ECMO ensures blood gas exchange and is applied in cases of severe reversible respiratory insufficiency. VA ECMO supports the function of the heart and lungs; other than in reversible forms of damaged heart function, it can also be used in irreversible forms of heart failure as a bridge to heart transplantation or to the implantation of mechanical circulatory support device. ECMO is an invasive and technically complex procedure that is performed in critically ill patients and thus has a high risk of complications. Results of ECMO treatment vary depending on the indications for the procedure itself. Patients in whom ECMO was applied for respiratory support show better outcomes compared with those with cardiogenic shock or cardiac arrest. Despite a lack of evidence based on large randomized studies to support its application, in clinical practice ECMO represents a life-saving method of treatment in well-selected critical patients.KLJUČNE RIJEČI: izvantjelesna membranska oksigenacija, kardiogeni šok, respiracijska insuficijencija.
Objective: Atypical antipsychotics are a new treatment option for patients with impaired impulse regulation as seen in Cluster B personality disorders. Preliminary data are available on the use of atypical antipsychotics especially in the treatment of impulsivity in borderline personality disorder. The aim of the present study is to investigate efficacy regarding impaired impulse regulation, different psychopathological symptoms and tolerability of quetiapine in a group of patients with Cluster B personality disorder. Methods: Fifteen consecutive patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic personality disorder were treated for 8 weeks with open-label quetiapine at the dose of 400 mg/day. Patients were assessed at baseline, week 1, 2, 3, 4, 6, and week 8. The clinical efficacy and side effects were assessed using the following scales: Hamilton Scales for Depression (HAM-D) and Anxiety (HAMD-A), Beck-Depression Inventory (BDI), Barratt Impulsivity Scale version 10 (BIS-10), Brief Psychiatric Rating Scale (BPRS), and the Dosage Record and Treatment Emergent Symptom Scale (DOTES). Results: Twelve patients completed the study. Three patients (20%) dropped out due to noncompliance. A significant improvement was found for the scores of the following scales: BPRS (anxiety/depression subscale), HAM-D, and BDI. No significant result was found for impaired impulse regulation. Common adverse effects, possibly due to study medication, were mild-to-moderate somnolence, mouth dryness, agitation, nausea, and dizziness. Conclusion: An 8 week open label treatment with 400mg quetiapine daily seems to improve depressive and anxiety, but not impulsivity symptoms in cluster-B personality disorders.
;11(3-4):95. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloških medicinskih sestara i tehničaraIntroduction: Occlusive thrombus due to ruptured or eroded atherosclerotic plaque is the most frequent substrate for ST-segment elevation myocardial infarction (STEMI). Distal embolization of intracoronary thrombus results in microvascular obstruction and compromised TIMI (Thrombolysis In Myocardial Infarction) flow. Forceful coronary injections, passage of intracoronary devices, initial balloon angioplasty and/or stenting induce distal embolization. Intracoronary thrombus additionally may contribute to vessel and stent undersizing increasing the risk of stent malapposition, in-stent restenosis or stent thrombosis. 1-3Case presentation: We present an 81-year-old Caucasian male with STEMI with rapid progression to cardiogenic shock and cardiorespiratory arrest during diagnostic coronary angiography. Severe stenosis of right coronary artery (RCA) with occlusive thrombus of the left main (LM) was found. The patient received a veno-arterial extracorporeal membrane oxygenation (ECMO) device. We performed a standard percutaneous coronary intervention (PCI) of RCA and rheolytic thrombectomy (AngioJet™) of the LM. The patient was successfully weaned from ECMO 29 hours after the procedure, with no inoconstrictor support. After nine days he was fully mobilized with no neurological deficit and a 40% left ventricular ejection fraction on echocardiography. Conclusion:Current evidence does not support the routine use of rheolytic thrombectomy in primary PCI. In specific cases that are involving large occlusive thrombus it may be a therapy of choice.Luka Bastiančić * , Extended Abstract ACUTE CORONARY SYNDROME RECEIVED:
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