Risk factors in the development of postoperative complications after reconstructive surgery on the thoracic aorta.

Aim To determine risk factors responsible for developing postoperative complications after the thoracic aorta reconstructive surgery. Methods Medical records of 100 patients, who had undergone elective or emergency thoracic aorta reconstructive surgery at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, were analysed. Intraoperative data as cross-clamp time (CCT), duration of cardiopulmonary bypass (CPBT) and hypothermic circulatory arrest time (HCAT) were evaluated. Univariate analysis was used to show risk factors for developing postoperative cardiac, respiratory, surgical and renal complications. Results Between May 2019 and April 2021, 48 Bentall procedures (BP), 23 ascending aortic replacements (AAR), 20 BP and coronary artery bypass grafting (CABG) and 9 aortic valve replacements (AVR) with AAR were performed. Incidence of postoperative complications in the elective and emergency groups was as follows: respiratory 20% vs 38% (p=0.049), cardiac 18% vs 70% (p=0.015), renal 16% vs 48% (p=0.027) and surgical 4% vs 6% (p>0.05). Intrahospital 30 days morbidity was 44% with mortality rate of 13%. The results showed that CPBT>180 minutes was a risk factor for respiratory (p=0.034), cardiac (p=0.020) and renal (p=0.027) postoperative complications after acute type A aortic dissection surgery. Conclusion CPBT > 180 min is a risk factor for postoperative development of respiratory, cardiac and renal complications. Postoperative cardiac and renal complications were associated with longer HCAT.

Incidence of Cardiac Dysfunction After Brain Injury.

INTRODUCTION: Cardiovascular complications in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. AIM: The aim of study is to show the incidence and type cardiac complications after traumatic and spontaneous SAH. PATIENTS AND METHODS: The study had prospective character in which included 104 patients, with diagnosed subarachnoid hemorrhage (SAH), in the period from 2014 to 2017. Two groups of patients were formed. Group I: patients with SAH caused by the rupture of a brain aneurysm. Group II: patients with SAH after traumatic brain injury. RESULTS: Electrocardiogram (ECG) abnormalities was predominant after traumatic brain injury 74 %, with statistically significant difference atrial fibrillation 42.5 % (p = 0.043) and sinus bradycardia 31.4 % (p = 0.05). Hypertension are predominant in patients with spontaneous SAH with statistically significant difference (15 (27.7%) vs 36 (72%) p=0.034) and hypotension in group II (10 (18.5%) vs 2 (4%) p = 0.021 ) with traumatic SAH patients. The time in Intensive Care Unit (ICU) for traumatic SAH group was 6.1 ± 5.2 days and 3.9 ± 1.16 for spontaneous SAH group with statistical significance (p = 0.046). Respiratory support time was longer in traumatic SAH group (39.4 ± 23.44 vs. 15.66 ± 22.78) with p = 0.043. CONCLUSION: Cardiac dysfunction in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Early treatment of cerebral injury could be reduce incidence of cardiac complications after traumatic brain injury. Cardiac dysfunction in patients with SAH is still very high, despite substantial qualitative progress in their treatment.

Opiate Analgesia Treatment Reduced Early Inflammatory Response After Severe Chest Injuries.

BACKGROUND: The frequency of severe chest injuries are increased. Their high morbidity is followed by systemic inflammatory response. The efficacy of pharmacological blockade of the response could prevent complications after chest injures. AIM: The aim of the study was to show an inflammatory response level, its prognostic significant and length of hospital stay after chest injures opiate analgesia treatment. METHODS: Sixty patients from Department of Thoracic Surgery with severe chest injures were included in the prospective study. With respect of non opiate or opiate analgesia treatment, the patients were divided in two groups consisted of 30 patients. As a inflammatory markers, serum values of leukocytes, neutrophils, C-reactive protein (CRP) and fibrinogen in three measurements: at the time of admission, 24hours and 48 hours after admission, were followed. RESULTS: Statistically significant differences were found between the examined groups in mean serum values of neutrophils (p=0.026 and p=0.03) in the second and the third measurement, CRP (p=0.05 and 0.25) in the second and the third measurement and leukocytes in the third measurement (p=0.016). 6 patients in group I and 3 in group II had initial stage of pneumonia, 13 patients in group I and 6 in group II had atelectasis and 7 patients from group I and 4 from group II had pleural effusion. The rate of complications was lower in group of patient who were under opiate analgesia treatment but without significant difference. The length of hospital stay for the patients in group I was 7.3±1.15 days and for the patients in group II it was 6.1±0.87 days with statistically significant difference p=0.017. CONCLUSION: The opiate analgesia in patients with severe chest injures reduced level of early inflammatory response, rate of intra hospital complications and length of hospital stay.

Atmospheric pressure changes are associated with type A acute aortic dissections and spontaneous abdominal aortic aneurysm rupture in Tuzla Canton.

AIM: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. PATIENTS AND METHODS: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). RESULTS: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21 (25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found.

Talc pleurodesis in pleuropulmonary diseases treatment.

AIM: To determine the efficiency and safety of talc pleurodesis in treating the malignant pleural effusion and recurrent spontaneous pneumothorax. METHODS: The study included 54 patients with malignant pleural effusion and recurrent spontaneous pneumothorax, who underwent talc pleurodesis using the "talc slurry" method of pleural talc obliteration. RESULTS: Pleurodesis was successful in 52 (96%) patients. The average duration of thoracic drainage was 4.4 days. Procedure complications included higher body temperature, pneumonia and pleural effusion separation. All of the patients had satisfying radiological findings at the point of discharge and three months later. There was no death outcome related to the procedure of pleurodesis itself. CONCLUSION: Our study has proved the efficiency and simplicity of talc pleurodesis in treating symptomatic malignant pleural effusions and cases with recurrent spontaneous pneumothorax.Appropriate patient selection and compliance with surgical principles during the procedure make this method safe, efficient and successful in treating pleuropulmonal diseases. Large particle talc should be used for pleurodesis because of the minimum risk of complications.

The role of fibrin glue polypropylene mesh fixation in open inguinal hernia repair.

UNLABELLED: The aim of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. MATERIAL AND METHODS: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients--Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery--the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient's ability to return to regular activities were followed for 3 months. RESULTS AND DISCUSSION: Statistically significant difference in the duration of surgery, pain intensity and complications (p < 0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh-fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. CONCLUSIONS: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.

Atmospheric pressure changes are associated with type a acute aortic dissections and spontaneous abdominal aortic aneurysm rupture in tuzla canton.

AIM: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. PATIENTS AND METHODS: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). RESULTS: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21(25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found.

The influence of cardiopulmonary by-pass on respiratory function in patients who underwent coronary disease surgery.

AIM: The study is designed to show influence of cardiopulmonary by-pass (CPB) on respiratory function in patients who underwent cardiac surgery. PATIENTS AND METHODS: With respect on operative technique the patients were divided into two groups consisted of 40 patients, who underwent with or without CPB. On the bases of the hemodynamic measurements and counting alveolar arterial oxygen difference (A-a)DO2, saturation of mixed venous blood (SvO2), direct intrapulmonary shunt (V/Q) and hypoxemic score (PaO2/FiO2) preoperative and postoperative respiratory function in these patients is assumed. There were one preoperative and four postoperative measurements. RESULTS AND DISCUSSION: Statistically significant difference is found between the examined groups between mean values of alveolar arterial oxygen difference (A-a)DO2 in three postoperative measurements (p = 0.035, p = 0.015 and p = 0.011), direct intrapulmonary shunt (V/Q) in four postoperative measurements (p = 0.037, p = 0.023, p = 0.014 and p = 0.04), saturation of mixed venous blood (SvO2) in four postoperative measurements (p = 0.01, p = 0.023, p = 0.020 and p = 0.020) and hypoxemic score (PaO2/FO2) in four postoperative measurements (p = 0.018, p = 0.028, p = 0.017 and p = 0.038). The comparative analyses of parameters of respiratory function in both groups showed increased degree of acute lung injury (ALI) in group of patients underwent CPB. CONCLUSION: Early discovering parameters of acute lung injury in early postoperative period in patients underwent cardiac surgery with cardiopulmonary by-pass can prevent development of postoperative complications and duration of hospitalization. Key words:

Incarcerated Morgagni hernia in an octogenarian with incidental right-sided colonic malignancy.

We present an incarcerated Morgagni hernia in an octogenarian with incidental right-sided colonic malignancy who was admitted to clinic due to abdominal pain and symptoms of intestinal obstruction. An 85-old male patient had a history of constipation, abdominal distension, pain, vomiting, nausea and radiographic features of bowel obstruction and mediastinal mass in right lower chest. Under suspicion of acute intestinal obstruction due to transverse colon herniation in thorax through Morgagni foramen, emergent laparotomy was performed. Morgagni foramen was located on the right-sided anterior diaphragm and Morgagni hernia which contained of incarcerated transverse colon, greater omentum and 70 cm small bowel after releasing the adhesions was gently reduced. In the same time right-sided colon malignancy was found. Morgagni foramen measuring 7 cm in diameter was sutured first and decompressive bypass ileocolic anastomosis was created. The role of emergent surgery, even in advanced age, is emphasized.

Influence of Remifentanil/Propofol Anesthesia on Ventilator-associated Pneumonia Occurence After Major Cardiac Surgery.

UNLABELLED: The study is designed to evaluate the influence of remifentanil/propofol anesthesia on ventilator-associated pneumonia (VAP) occurrence and respiratory support (RS) time after major cardiac surgery. MATERIAL AND METHODS: In retrospective-prospective study we investigated the respiratory support time and VAP occurrence in group of 47 patients with remifentanil/propofol and 35 patients with fentanil/midazolam anesthesia after major cardiac surgery in period June 2009-December 2011. Groups are divided in subgroups depending of who underwent cardiac surgery with or without cardiopulmonary by pass (CPB). RESULTS: The time of respiratory support (RS) was the shortest in remifentanil group without CPB (R/Off 63min ± 44.3 vs R/On 94min ± 49.2 p=0,22), but was longer in fentanil group (F/Off 142 min ± 102.2 vs F/On 212 min ± 102.2 p=0.0014). The duration of RS of ON pump remifentanil group was shorter than in ON pump fentanil group (R/On 94 min vs F/On 212 min p=0.0011). The time of RS of OFF pump remifentanil group was lower than in Off pump entangle group (R/Off 63min ± 44,3 vs F/Off 142min ± 102.2 p=0,021) with statistically significance. Ventilator-associated pneumonia was detected in 7 patients (8.5 %). Six patients (17.1%) were from entangle group and one patient (2.1%) from remifentanil group. The most common isolates were Pseudomonas aeruginosa in all patients and both Pseudomonas aeruginosa and Klebsiella pneumonia in one patient. CONCLUSION: The remifentanil anesthesia regimen in cardiac surgery decreases length of respiratory support duration and can prevent development of VAP. The role of remifentanil anesthesia in preventing VAP, as one of the most important risk factor of in-hospital mortality after cardiac surgery is still incompletely understood and should be investigated further.

Effects of postoperative analgesia on acute phase response in thoracic surgery.

The aim of this research is to determine: the influence of continuous opiate and intermittent non-opiate postoperative analgesia on thoracic surgical patients' acute phase response, based on acute phase response protein serum values (IL-6 and C-reactive protein) 24, 48 and 72 hours aftersurgery; to analyze the acute phase responses in those thoracic surgical patients in which the postoperative complications have developed and in those in which they haven't. The study itself has a prospective character involving 60 patients divided into two homogenous groups, 30 patients each, which are of the same age, sex, pathological substrate, and are the patients of the University Clinical Centre in Tuzla. The first group of patients were those to whom the non-opiate intermittent analgesia of methamisol natrium was applied, and the second group were the patients to whom the continuous tramadol chloride opiate analgesia was applied after the thoracic surgical procedure had been performed. According to the examined patients and applied types of analgesia, the following results were obtained: CRP values enhanced in both groups, all three measurements, with no significant statistical differences (p = 0.051; p = 0.054; p = 0.1). While the IL-6 values enhanced in all measurements in group I, in group II they remained within reference range, with a significant statistical difference (p = 0.042; p = 0.039; p = 0.035). This study suggests that CRP enhanced values in both groups are the result of the response to surgery. The enhanced IL-6 values in group I, and maintained IL-6 values within reference range in group II, are the result of continuous tramadol chloride opiate analgesia, which turned out to be more efficient and safer.

Video-assisted thoracoscopic surgery for spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) is a benign disease frequently found in younger and healthy-looking persons. It requires a surgical treatment in about 30-40% of cases. Video-assisted thoracoscopic surgery (VATS) has been recently introduced as a reliable alternative method to the classic thoracotomy. The aim of this paper is to establish and compare the length of surgical procedure, pain intensity, number and kind of postsurgical complications during the procedure for the patients with PNTX treated by VATS in relation to the patients with PNTX treated by thoracotomy. This is a retrospective study. The patients are divided into two groups: the first group of 50 patients treated with VATS and the second group of 50 patients treated with thoracotomy. The results obtained show a significantly shorter surgery duration in the group of the patients treated with VATS in relation to the group of patients treated by thoracotomy (p < 0.01). Video-assisted thoracoscopic surgery is characterized by a significantly low intensity of postsurgical pain in relation to thoracotomy (p < 0.001). The number and kind of postsurgical complications are similar in both target groups (p > 0.05). Only one relapse occurred in the VATS group. Video-assisted thoracoscopic surgery improves patients' life quality in relation to the thoracotomy patients. The patients return to work, or to sport activities after a very short time because of minimal sequels. That is why this method represents an obvious socio-economic interest. Today, in the era of a great video-development, VATS method is a treatment of choice for PSP.

Mediastinal lymph node metastasis pattern in clinically N0 non-small-cell lung cancer patients who underwent surgical resection.

The aim of this study was to evaluate the incidence, clinical data and patterns of mediastinal lymph node metastasis (pN2) in non-small-cell lung cancer patients who underwent systematic mediastinal lymph node dissection (SMLND). We retrospectively studied 140 consecutive patients [125 male and 15 female, mean ages 54.61 +/- 9.23 years (range, 21-75)], underwent SMLND and major lung resections due to non-small lung cancer (NSCLC), from January 2005 till December 2009. Preoperative clinical staging for mediastinal lymph node metastasis was negative (cN0) in all patients. SMLND was defined as a complete removal of mediastinal lymph nodes. Clinicalpathological data were compared according to the pN stage. Lymph node metastasis to the mediastinum was confirmed in 13 (9.28%) patients. In squamous cell cancer pN2 were in 8 (5.71%) cases out of 82 cases with cN0. On the other side in the adenocarcinomas pN2 were in 5 (3.57%) cases out of 48 with cN0. Unvaried analysis revealed central tumor site as predictive factor for mediastinal lymph node involvement. The upper mediastinal compartment was infiltrated in 12 (8.57%) cases, middle in 8 (5.71%) and lower in 3 (2.14%) cases. Pneumonectomy was the most performed surgical procedure in pN2 patients. We concluded that SMLND improves pTNM staging in lung cancer patients who underwent major lung resections with central location of the tumour.

Gastric pull-up reconstruction for the hypopharyngeal and cervical esophageal carcinoma in small thoracic unit.

The objective of this article is to review results of one surgical team for gastric pull-up reconstruction for carcinoma of the hypopharynx and cervical esophagus after pharyngolaryngo-esophagectomy in small thoracic unit. Between July, 2004 and December 2005, four patients underwent pharyngolaryngo-esophagectomy and gastric pull-up reconstruction for carcinoma of hypopharynx and esophagus. There were three female and one male patient with average age at the time of surgery 47 years. The study analyzed complications and mortality in early postoperative period after resections of the carcinoma. Squamous cell cancer in all patients was confirmed. There was no in-hospital mortality and non-fatal complications were occurred in 3 patients. It was recorded two year survival for two patients. Pharyngolaryngo-esophagectomy and gastric pull-up reconstruction can be performed for the patients with carcinoma of the hypopharynx and cervical esophagus with an acceptable operative mortality and morbidity rate even in small thoracic unit. Long term survival despite good early postoperative results still remains poor.

[Dilatation of tracheal stenosis with esophageal balloon dilator]. / Dilatacija stenoze traheje ezofagealnim balon dilatatorom.

The solve of tracheal stenosis is problem which occupied a big number of experts. In this article was reported a case in which the problem of tracheal stenosis was solved by balloon dilatator which was used in a treatment of esophageal stenosis. We are thinking that esophageal balloon dilatation of trachela stenosis would be a one of the first steps in the problem solving.

[Respiratory risk factors in development of postoperative complications after lung resection]. / Respiratorni rizicni faktori u razvoju postoperativnih komplikacija nakon resekcije pluca.

The objectives of the study were to identify possible associated respiratory risk factors and to assess incidence of overall postoperative complications after lung resection. We reviewed 110 patients undergoing lung resections because of malignant neoplasms or benign lung diseases. The risk of postoperative complications was evaluated using unuvariate analysis. Results confirmed that low FEV1, postoperative high PaCO2, ASA-status and advanced age were factors associated with development of postoperative complications.

Respiratory risk factors in development of postoperative complications after the lung resection.

The objectives of the study were to identify possible associated respiratory risk factors and to assess incidence of overall postoperative complications after the lung resection. We reviewed 110 patients who underwent lung resections due to malignant neoplasms or benign lung diseases. The risk of postoperative complications was evaluated using the univariate analysis. Results confirmed that low FEV1, postoperative high PaCO2, ASA-status and advanced age were factors associated with development of postoperative complications.