[Results and complications of laparoscopic adjustable gastric banding--12 years experience]. / Výsledky a komplikace laparoskopické adjustabilní bandáze zaludku--12 let zkuseností.

INTRODUCTION: Bariatric surgery is currently the only effective treatment for morbid obesity. The main advantage of laparoscopic adjustable gastric banding (LAGB) is that this operation is minimally invazive to the stomach and adjustable to the patient's needs. AIM: Few long-term studies regarding the outcome of LAGB for morbid obesity have so far been publised. We report our 12-year experience with this method. PATIENTS AND METHODS: On list of 100 patients (76% women, 24% men) operated since February 1998 until December 2006 we present results and complications, reoperations. Mean follow up was 5.2 years (0.5-11.8). Patients lost to follow up was 22% at 5 years and 33% at 8 years. Complications occurred in 38% patients. 12% of the patients needed reoperation. There was no mortality. CONCLUSION: From our 12-year experience, we can state that LAGB is an effective bariatric procedure for achieving weight loss. Because of the high complication and reoperation rate, it is necessary to select patients according specific criteria and choose experienced bariatric surgery.

Streptococcus suis infection as a cause of severe illness: 2 cases from Croatia.

Streptococcus suis is a zoonotic agent that can be spread to humans, e.g. butchers, abattoir workers and farmers, by contact with pigs. Human infection is most frequently manifested as purulent meningitis, in combination with deafness and ataxia, but there have been rare reports of septic shock leading to multiorgan failure and death. We report 2 patients with S. suis type 1 infection. One patient suffered an abrupt and severe illness, with septic shock leading to multiorgan failure and death, whereas the other presented with purulent meningitis and deafness. Both patients were immunocompromised. They were most likely infected as a result of handling pork at home. In both cases, the infection was due to S. suis type 1, in contrast to previous reports indicating an association between human infection and S. suis type 2. Epidemiologic surveys of human infection may be of interest, especially among individuals exposed to pigs and pork.

[Pathogenesis of postoperative pain and treatment options]. / Patogeneza postoperacijske boli i mogucnost lijecenja.

This article is a review of acute postoperative pain pathogenesis and treatment options. It is aimed at clinicians involved in postoperative pain management, for better understanding of the pain treatment strategy. Every procedure of antinociception should include modulation of different target points, because acute pain mechanisms and origins are different. There are three main intervention levels: peripheral, spinal and supraspinal. We should choose analgesics with two or more intervention levels simultaneously as well as combination of analgesics with different target points. Optimal analgesia with spinal opioids is achieved thanks to addition of supraspinal and peripheral analgesia components. It is considered that optimal acute pain treatment could prevent nerve system dysfunction and evolution of chronic pain syndromE, which is present in some of postoperative patients.

[Recognition of tissue oxygen debt in clinical settings]. / Prepoznavanje tkivnog duga kisika u klinickim uvjetima.

Despite intensive treatment, a great proportion of ICU patients is resuscitated incompletely. Presence of tissue oxygen debt is the crucial pathophysiologic element of multiple organ failure development and death in these patients. Parameters of oxygen metabolism, monitored in time, except prognostic value give us the possibility of therapeutic intervention, oriented to the prevention of multiple organ failure. In addition to parameters of global oxygen transport and utilization, gastric tonometry has been used in recent years, as a method for organ specific identification of tissue oxygen debt. In the article are considered acceptable and available options of solving this problem in everyday clinical work.