Characteristics of Acute Appendicitis before and during the COVID-19 Pandemic: Single Center Experience.

The aim of the study was to investigate whether the COVID-19 pandemic caused an increased incidence of complicated appendicitis due to the late presentation when compared to the pre-COVID-19 period. Summary Background Data. Acute appendicitis is one of the most common surgical emergencies. During the coronavirus-19 (COVID-19) pandemic, there has been a reported delay in the presentation of some urgencies to the emergency hospital departments. Methods. A total of 427 patients who underwent surgical treatment due to suspected acute appendicitis from June 2019 to November 2020 were retrospectively included in this study. The patients were divided into two groups: the first (pre-COVID-19) group consisted of patients who had surgery before the onset of COVID-19 pandemic (n = 240), while the second (COVID-19) group consisted of those who were operated during the COVID-19 pandemic (n = 187). The primary outcome of the study was to compare the incidence of perforated appendicitis before and during the onset of COVID-19. Results. Overall, 84 patients (19.67%) were diagnosed with perforated appendicitis. We found a weak significance (p=0.085) in the rate of perforated appendicitis between the pre-COVID-19 (17.08%) and the COVID-19 era (22.99%). Conclusions. We did not observe any significant difference in the complications of acute appendicitis before and during the COVID-19 pandemic in a university hospital in Rijeka. An emergent medical care should always be accessible.

Video-Assisted Anal Fistula Treatment for Treatment of Complex Cryptoglandular Anal Fistulas with 2 Years Follow-Up Period: Our Experience.

Aim: The aim of this prospective, nonrandomized, observational study was to present our results in operative treatment of complex anal fistulas using video-assisted anal fistula treatment (VAAFT) procedure with a curative intent in 2 years follow-up period. Materials and Methods: Between March 2016 and March 2018, 73 patients underwent the VAAFT procedure. Postoperative follow-up was 2 years, up to March 2020. Only patients with complex cryptoglandular anal fistulas were included. All patients were referred for magnetic resonance imaging of the pelvis. Fecal incontinence severity index score was used to assess any continence disturbance prior operation and postoperatively. Result: Primary healing occurred in 52 cases (71.23%) after first operation. From 21 patients who had recurrence or who had persisting disease, 16 patients accepted reoperation with second VAAFT procedure and additionally 10 patients achieved healing. From a total number of 73 patients who were included in study healing ultimately occurred in 62 cases (84.93%). In the first operation internal opening was identified in 47 cases (64.38%) and was closed with mattress suture, rectal advancement flap or ligation of intersphincteric fistula tract technique depending on its extent and type of fistula. Median primary healing rate was 6 weeks. There were no serious intra- or postoperative complications. None of the patients reported any type of continence disturbance. Discussion: VAAFT has been shown to offer good rates of healing, low morbidities, possibilities of multiple attempts in case of first failure and this series adds to the literature.

Endogenous gas gangrene after laparoscopic cholecystectomy.

Clostridial gas gangrene of the abdominal wall is rare, and it is usually associated with organ perforation, immunosuppression or gastrointestinal malignancies. In this paper we present a case of fulminant, endogenous gas gangrene in a 58-year old diabetic female with arterial hypertension and atherosclerosis, following uneventful laparoscopic cholecystectomy. She developed gas gangrene of the abdominal wall 12-hours after cholecystectomy and died 24-hours after the onset of the first symptoms, in spite of treatment.

Dynamic changes in the common bile duct after laparoscopic cholecystectomy: a prospective longitudinal sonographic study.

PURPOSE: The aim of this prospective study was to assess the dynamics of potential common bile duct (CBD) dilatation and to find the best predictors in patients after laparoscopic cholecystectomy due to gallstones. MATERIALS AND METHODS: Fifty patients (36 women, 14 men) with gallstones scheduled for laparoscopic cholecystectomy underwent preoperative sonography one day prior to surgery and again within 24 hours of cholecystectomy. In all patients, the diameter of the CBD was measured again on the 7 (th), 90 (th) and 180 (th) day after cholecystectomy. The luminal diameter was measured just below the bifurcation of hepatic ducts, at the level of intersection with the hepatic artery and at the level of the pancreatic head. The control group consisted of 50 healthy individuals (35 women and 15 men) with normal biochemistry and sonography, and without a history of hepatobiliary disease, clinical symptoms or surgery. RESULTS: The mean preoperative CBD diameter at three locations was 2.27 ± 0.18, 3.49 ± 0.23 and 4.31 ± 0.30, respectively. The mean diameter of the common bile duct measured within 24 hours of surgery and on the seventh postoperative day did not significantly change with respect to the preoperative measurement. Three months after cholecystectomy, the CBD was statistically wider at all three locations (p < 0.05). Six months after cholecystectomy, the CBD remained significantly wider at the proximal and distal part when compared to the preoperative measurements. CONCLUSION: The CBD showed an overall trend towards a slight, but significant, dilatation after cholecystectomy. The common bile duct dilates significantly 3 months after cholecystectomy. Familiarity with these patterns prevents ultrasound misdiagnosis when examining patients within 6 months of cholecystectomy.

Bouveret's syndrome--case report.

BACKGROUND: Bouveret's syndrome is a rare complication of cholecystolithiasis with gastric outlet obstruction caused by a gallstone migrating through a biliogastric or bilioduodenal fistula. Gallstone ileus is mainly treated by surgery, either enterolithotomy or gastrotomy, with some cases being treated by endoscopic extraction. CASE REPORT: We report on an 80-year-old woman without previous episodes of biliary colic, and known cholecystolithiasis who underwent emergency surgery due to pyloric obstruction caused by a large, 7-cm stone, after failure of endoscopic treatment. The stone was removed through pylorotomy, which was closed transversely in multiple layers and patched with omentum. The patient's postoperative course was complicated by operative wound infection. She was discharged on postoperative day 22 and had no complaints at the 6-month follow-up.

Leiomyoma of the left renal vein. A report of a case.

Only a few cases of leiomyoma of the vena cava or iliac vein and, according to our knowledge, only one case of renal vein leiomyoma have been reported. We report a patient with leiomyoma of the left renal vein. Tumour resection was performed by resecting a part of the vein along with the tumour and by ligation of the vein. Left kidney drainage was established through the preserved ovarian vein. In order to establish a diagnosis, careful pathologic examination of multiple sections has to be done and because of the potentially malignant behaviour, long-term follow-up after total resection is necessary.

Thoracodorsal artery as a free graft for coronary artery bypass grafting.

Arterial myocardial revascularization using different arterial conduits as mammary, radial, gastroepiploic, subscapular and epigastric arteries are well documented. This report describes a preparation and use of thoracodorsal artery as a free graft for coronary artery bypass grafting. The preparation and removal of thoracodorsal artery were performed through right axilla. The artery was used as a free conduit for left anterior descending artery (LAD) in a 58-year-old female for the second revascularization. The saphenous veins, mammary arteries, right radial artery and epigastric artery were not available. The perioperative course was uneventful and we can recommend the graft as an alternative for such cases.

Minimally invasive coronary surgery--our experience.

Minimally invasive coronary artery surgery (MICS) has been defined as proceeding myocardial revascularization without cardiopulmonary bypass. Between January 1996 and August 1997, 19 patients (18 males, 1 female), aged 47-67 years (mean age 57.2 +/- 5.1 years), were operated on. All patients had single vessel coronary disease. In 11 (57.9%) patients, the operation was performed through median sternotomy, in 5 (26.3%) through left anterior small thoracotomy (the LAST procedure). In two (10.5%) patients, the operation began as a LAST, but conversion to median sternotomy was required due to lateroposition of the left anterior descending artery (LAD). In one (5.3%) patient, a minimal procedure was converted in to conventional cardiosurgical procedure with thrombendarterectomy and anastomosis of the left internal mammary artery (LIMA) to LAD. Anastomosis of LIMA to LAD was performed in 9 (47.4%) cases and of right internal mammary artery (RIMA) to right coronary artery (RCA) in four (21.1%) cases. In two (10.5%) cases, saphenous vein was used as a graft to RCA, and in four (21.1%) cases, to LAD. One (5.3%) patient died on the fourth postoperative day. One patient developed perioperative myocardial infarction, and one patient was reoperated on due to postoperative bleeding. Permanent pacemaker was implanted in one (5.3%) patient because of slow atrial fibrillation. The ischemic time was 8 to 25 minutes, and the whole procedure was completed in 90-175 minutes. Intensive care unit stay was up to 18 hours in 12 (63.2%) patients. The whole duration of hospitalization took from 7 to 14 days (mean 10.6 +/- 2.4 days). Minimally invasive coronary surgery is a safe and effective method in the surgical treatment of one-vessel coronary artery disease.

Croatian experience in the treatment of 629 urogenital war injuries.

During the war in Croatia, from April 1991 until November 1993, 33,468 wounded persons were reported, and 24,865 of them were hospitalized. Out of the total number of the hospitalized persons 588 wounded suffered 629 injuries of the urogenital system. This study reports on the experience in the treatment of such injuries at 17 urological and surgical institutions.

Organ transplantation at the Rijeka Clinical Medical Center--from kidney to pancreas.

From January 1971 to January 1994 the authors performed 560 kidney, and two simultaneous pancreas and kidney, transplantations at the Rijeka Clinical Medical Center. Three hundred and nine kidneys (55%) were from a related living donor (two from unrelated living donors), while 253 (45%) kidney and two pancreas grafts were from cadaveric donors. Analyzing the mean patients' age at the time of transplantation the authors noticed its steady increase over five-year periods, a decrease of chronic glomerulonephritis from 76% to 60%, and a gradual increase in diabetic nephropathy from 0 to 6%. Cumulative 1- and 5-year patient survival rates after living donor transplants including conventional immunosuppression were 95 and 83%, respectively; with Cs the survival rates were 94% and 90% (N. S.). For living donor kidney grafts the 1- and 5-year survival rates with conventional immunosuppression were 76% and 50%, respectively. With Cs the survival rates were considerably higher: 88% after 1 year and 71% after 5 years (p < 0.01). Cumulative survival rates of patients with cadaveric transplants receiving conventional immunosuppression were 82% and 71%, respectively; with Cs they were 87% and 78% (N.S.). The survival rate of cadaveric transplants was 51% after one year and 38% after five years in the first period, but it improved significantly after introduction of Cs. increasing to 81% and 52%, respectively (p < 0.001). Renal transplantation in diabetics does not preclude the recurrence of diabetic nephropathy in the graft; successful pancreas and kidney transplantation does, however, and thus offers the patient a better quality of life.