Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion. Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
Salivary gland tumors are neoplasms characterized by a high level of pleomorphism and histological overlap. One tumor may contain several cell types; therefore, it is necessary to include immunohistochemical staining, as well as morphometric analysis of tumor cells as prerequisites for an appropriate diagnosis. Our research included 120 tumors, such as pleomorphic adenoma, Warthin tumor, basal cell adenoma, myoepithelioma, adenoid cystic carcinoma, mucoepidermoid carcinoma, salivary duct carcinoma, polymorphous low-grade carcinoma and myoepithelial carcinoma. The aim of the study was to differentiate benign and malignant tumors based on the characteristics of nuclei. The expression of Ki67 and the morphometric nuclear parameters - area, perimeter, Feret diameter, integrated optical density, circularity, and roundness, were analyzed. It was observed that the Ki67 proliferative index was statistically significantly higher in malignant tumors (P<0.001). Adenoid cystic carcinoma exhibited the highest value, whereas the lowest value was exhibited in basal cell adenoma. Morphometric analysis showed statistically significantly increased values of integrated optical density (P<0.001) and nuclear size parameters (P<0.05) in malignant tumors. The determination of the Ki67 proliferative index and morphometric analysis of the integrated optical density and area can differentiate benign from malignant tumors with high precision. The presented values suggest the obtained results as cut-off values.
Introduction. Some patients with clinical symptoms and signs of acute myocardial and coronary artery occlusion have atypical electrocardiographic presentations-ST elevation myocardial infarction equivalents. Rapid recognition of these patterns is imperative, because the condition requires prompt reperfusion therapy following actual guidelines. De Winter pattern. Diagnostic criteria are: tall, prominent, symmetrical T-waves in the precordial leads, upsloping ST segment depression > 1 mm at the J-point in the precordial leads, absence of ST elevation in the precordial leads, ST segment elevation (0.5 mm-1 mm) in aVR. ST Elevation in aVR. Electrocardiographic criteria include ST segment elevation in aVR ≥ 1 mm, ST segment elevation in aVR ≥ V1, and diffuse ST segment depression in lateral leads. Wellens syndrome. Wellens syndrome describes deeply inverted or biphasic T-waves in leads V2-V3, highly specific for significant stenosis of the left anterior descending artery. Posterior infarction. Posterior infarction is confirmed with ST segment depression ≥ 0,5 mm in leads V1-3 and ST segment elevation ≥ 0.5 mm in posterior leads (V7-V9). Conclusion. There are many electrocardiographic patterns that physicians should promptly recognize as clinical myocardial infarction with ST segment elevation equivalents in order to perform urgent reperfusion therapy for better prognosis and survival in these patients.
Introduction/Objective A mucocele is a benign cystic but extremely expansive change in paranasal cavities, first described in literature by Langenbeck in 1820. The etiology of mucoceles is still a subject of debate. It is assumed that the obstruction of the frontal sinus duct and drainage impairment into the middle nasal meatus, as a consequence of a chronic infection, trauma, or tumor, represent one of the main causes of their occurrence. The aim of this study was to describe ophthalmological and clinical properties of frontal sinus mucoceles. Methods Our retrospective study covered a period of 10 years during which seven patients with mucocele in the frontal sinus were operated on. Results Predisposing factors for the appearance of frontal sinus mucoceles were observed in six out of seven patients -the existence of a previous surgical intervention in two patients, the existence of a previous injury in four, and one patient did not exhibit the existence of predisposing factors. Four out of seven mucoceles were located in the rear segments of the frontal sinus. The destruction of the anterior sinus wall was observed in one patient, while the process propagation toward the endocranium and the orbit was present in three out of the seven patients. Postoperative epistaxis was noted in two out of three patients treated with transfacial approaches. Conclusion Transcranial and transfacial approaches are treatment methods for advanced mucoceles with a present intraorbital, intracranial, and endonasal process propagation.
Introduction/Objective Nasolacrimal duct obstruction with consequent epiphora and the development of dacryocystitis (DC) represents a common pathological entity in the clinical practice of ophthalmologists and maxillofacial surgeons. The etiology of DC is multifactorial and still has not been clarified in detail. It is considered that ascending infections from the nasal cavity and paranasal sinuses, injuries and surgical interventions in the middle third of the face, dacryoliths, tumors of the lacrimal sac and surrounding structures may be some of the etiological factors of nasolacrimal duct obstruction. The aim of this study is to present clinical characteristics and surgical treatment of DC. Methods A retrospective study was carried out. It covered a period of 10 years during which 49 patients with clinically verified DC were treated after surgical examination and complete diagnostics. Out of the total number, 37 patients underwent surgery. Results The occurrence of predisposing factors was present in 80% of the patients-rhinitis and the inflammation of paranasal sinuses in 27 patients (72%), injuries and surgical interventions in the middle third of the face in nine patients (24%), whereas lacrimal sac and nasolacrimal duct tumors were noted in three patients (8%). Surgical failure, which was manifested in terms of recurrent DC and epiphora, was noted in six cases (16%). Conclusion Regarding the possible complications of inadequately administered antibiotic therapy and a broad spectrum of pathological entities which comprise the differential diagnosis, dacryocystorhinostomy with an adequate histopathological analysis and appropriate antibiotic therapy in the acute stage represents a right way for the treatment of DC.
Metastatic cancers of the parotid are very rear and hard to diagnose neoplasms. They can be classified into two major groups: tumors with supraclavicular and inflaclavicular primary localization. Squamous cell carcinoma of the skin is the most common histological type found; it is followed by melanoma, Merkel cell carcinoma and adenocarcinoma of the lungs. We analyzed 420 patients that were diagnosed with parotid gland tumors at the department of Maxillofacial surgery, Clinic of Dentistry in Niš, from 2007 to 2017. In 121 patients pathohistological findings showed malignant tumors out of which 21 were metastatic. Radical parotidectomy with adjuvant radiotherapy of the head and neck region was the most common type of treatment. Neck dissection was performed in all of the patients but the extent of it depended on the clinical findings. Lymph nodes were negative for the metastatic disease in only 4 patients. Survival rate is very different among patients ranging from 8 to 138 months.
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