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Jaksic Jurinjak S, Kovac D, Reskovic Luksic V, Lovric Bencic M, Bulum J, Ostojic Z, Glavas Konja B, Brestovac M, Separovic Hanzevacki J. Impact of mitral annular calcification on hemodynamic effect in mitral stenosis in multiple valve disease: relevant or not. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Prevalence of mitral annulus calcification (MAC) and degenerative mitral stenosis thus elevated transmitral gradient (TMG) is increased with age and multivalve involvement. The management of degenerative multivalve disease is challenging, as is identification of the presence of multivalve involvement and its hemodynamic impact because of interaction between two or more valve lesions especially in degenerative valve disease. Hemodynamic interaction between significant aortic stenosis and mitral annular calcification is often combined with diastolic disfunction which can result in LA enlargement and abnormal atrioventricular coupling and left atrial and ventricular remodeling.
Purpose
Study aimed to assess the effect of MAC on mitral valve stenosis in patients with multiple valve disease of degenerative origin.
Method
We retrospectively analyzed 78 patients with elevated transmitral gradient defined as an elevated TMG >4mmHg, MAC in multivalve involvement, mainly degenerative significant aortic valve stenosis who were treated in our clinic from 2018 to 2021. We excluded patients with prior cardiac surgery, congenital heart disease, hypertrophic obstructive cardiomyopathy and with heart rate >100 bpm at time of study and significant mitral regurgitation. Baseline demographic data were extracted from the electronic medical record and echocardiographic data were analyzed from electronic saved data.
Results
Study identified a total of 78 patients (average age 71,89 years, 64% females). Of 57 analyzed patients 32% patients had severe MAC and calcification of chordae, and 68% patients had MAC and mild or no significant chordae calcification. Patients with aortic gradients, severe aortic stenosis (AVAi 0,80 cm/m2) were observed more often in patients with severe MAC and significant chordae calcification than in those with nonsevere MAC (p < 0.043).There was no significant difference in mitral annular distension between groups. Baseline mean MV gradients were 6,5+-1.5 mm Hg. Mean MVA (continuity equation) was 1,5+-0.4 cm2, and MVAi 0,8+-0,2 cm/m2, mean LA volume 70 ml/m2, mean E/e 35, mean EF LV 68% and mean GLS -14.
Conclusion
Result suggest that increasing transmitral gradient if superimposed on severe MAC with only modest mitral stenosis will result in a high mean transmitral gradient. The presence of elevated pressure transmitral gradient in patients with more severe aortic stenosis and more severe MAC combined with chordae calcification may imply hemodynamic effect or stress on mitral valve degeneration in multiple valve involvement. Other imaging modalities and further investigation for better understanding effect of hemodynamic stress in multiple valve disease are needed. These observations need to be evaluated on larger cohorts of patients during a longer period of time.
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Affiliation(s)
| | - D Kovac
- University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - J Bulum
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Z Ostojic
- University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - M Brestovac
- University Hospital Centre Zagreb, Zagreb, Croatia
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Haler ZV, Kovac D, Tomazic J, Lindic J. Cytomegalovirus Infection Associated Neutropenia and Acute Kidney Graft Rejection. Nephrol Ther 2017. [DOI: 10.4172/2161-0959.1000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo‐Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, Crespo‐Leiro M, Anker S, Coats A, Ferrari R, Filippatos G, Maggioni A, Mebazaa A, Piepoli M, Amir O, Chioncel O, Dahlström U, Jimenez JD, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Otljanska M, Seferovic P, Kostovska ES, Temizhan A, Tousoulis D, Andarala M, Ferreira T, Fiorucci E, Gracia G, Laroche C, Pommier C, Taylor C, Cuculici A, Gaulhofer C, Casado EP, Szymczyk E, Ramani F, Mulak G, Schou IL, Semenka J, Stojkovic J, Mehanna R, Mizarienne V, Auer J, Ablasser K, Fruhwald F, Dolze T, Brandner K, Gstrein S, Poelzl G, Moertl D, Reiter S, Podczeck‐Schweighofer A, Muslibegovic A, Vasilj M, Fazlibegovic E, Cesko M, Zelenika D, Palic B, Pravdic D, Cuk D, Vitlianova K, Katova T, Velikov T, Kurteva T, Gatzov P, Kamenova D, Antova M, Sirakova V, Krejci J, Mikolaskova M, Spinar J, Krupicka J, Malek F, Hegarova M, Lazarova M, Monhart Z, Hassanein M, Sobhy M, El Messiry F, El Shazly A, Elrakshy Y, Youssef A, Moneim A, Noamany M, Reda A, Dayem TA, Farag N, Halawa SI, Hamid MA, Said K, Saleh A, Ebeid H, Hanna R, Aziz R, Louis O, Enen M, Ibrahim B, Nasr G, Elbahry A, Sobhy H, Ashmawy M, Gouda M, Aboleineen W, Bernard Y, Luporsi P, Meneveau N, Pillot M, Morel M, Seronde M, Schiele F, Briand F, Delahaye F, Damy T, Eicher J, Groote P, Fertin M, Lamblin N, Isnard R, Lefol C, Thevenin S, Hagege A, Jondeau G, Logeart D, Le Marcis V, Ly J, Coisne D, Lequeux B, Le Moal V, Mascle S, Lotton P, Behar N, Donal E, Thebault C, Ridard C, Reynaud A, Basquin A, Bauer F, Codjia R, Galinier M, Tourikis P, Stavroula M, Tousoulis D, Stefanadis C, Chrysohoou C, Kotrogiannis I, Matzaraki V, Dimitroula T, Karavidas A, Tsitsinakis G, Kapelios C, Nanas J, Kampouri H, Nana E, Kaldara E, Eugenidou A, Vardas P, Saloustros I, Patrianakos A, Tsaknakis T, Evangelou S, Nikoloulis N, Tziourganou H, Tsaroucha A, Papadopoulou A, Douras A, Polgar L, Merkely B, Kosztin A, Nyolczas N, Nagy AC, Halmosi R, Elber J, Alony I, Shotan A, Fuhrmann AV, Amir O, Romano S, Marcon S, Penco M, Di Mauro M, Lemme E, Carubelli V, Rovetta R, Metra M, Bulgari M, Quinzani F, Lombardi C, Bosi S, Schiavina G, Squeri A, Barbieri A, Di Tano G, Pirelli S, Ferrari R, Fucili A, Passero T, Musio S, Di Biase M, Correale M, Salvemini G, Brognoli S, Zanelli E, Giordano A, Agostoni P, Italiano G, Salvioni E, Copelli S, Modena M, Reggianini L, Valenti C, Olaru A, Bandino S, Deidda M, Mercuro G, Dessalvi CC, Marino P, Di Ruocco M, Sartori C, Piccinino C, Parrinello G, Licata G, Torres D, Giambanco S, Busalacchi S, Arrotti S, Novo S, Inciardi R, Pieri P, Chirco P, Galifi MA, Teresi G, Buccheri D, Minacapelli A, Veniani M, Frisinghelli A, Priori S, Cattaneo S, Opasich C, Gualco A, Pagliaro M, Mancone M, Fedele F, Cinque A, Vellini M, Scarfo I, Romeo F, Ferraiuolo F, Sergi D, Anselmi M, Melandri F, Leci E, Iori E, Bovolo V, Pidello S, Frea S, Bergerone S, Botta M, Canavosio F, Gaita F, Merlo M, Cinquetti M, Sinagra G, Ramani F, Fabris E, Stolfo D, Artico J, Miani D, Fresco C, Daneluzzi C, Proclemer A, Cicoira M, Zanolla L, Marchese G, Torelli F, Vassanelli C, Voronina N, Erglis A, Tamakauskas V, Smalinskas V, Karaliute R, Petraskiene I, Kazakauskaite E, Rumbinaite E, Kavoliuniene A, Vysniauskas V, Brazyte‐Ramanauskiene R, Petraskiene D, Stankala S, Switala P, Juszczyk Z, Sinkiewicz W, Gilewski W, Pietrzak J, Orzel T, Kasztelowicz P, Kardaszewicz P, Lazorko‐Piega M, Gabryel J, Mosakowska K, Bellwon J, Rynkiewicz A, Raczak G, Lewicka E, Dabrowska‐Kugacka A, Bartkowiak R, Sosnowska‐Pasiarska B, Wozakowska‐Kaplon B, Krzeminski A, Zabojszcz M, Mirek‐Bryniarska E, Grzegorzko A, Bury K, Nessler J, Zalewski J, Furman A, Broncel M, Poliwczak A, Bala A, Zycinski P, Rudzinska M, Jankowski L, Kasprzak J, Michalak L, Soska KW, Drozdz J, Huziuk I, Retwinski A, Flis P, Weglarz J, Bodys A, Grajek S, Kaluzna‐Oleksy M, Straburzynska‐Migaj E, Dankowski R, Szymanowska K, Grabia J, Szyszka A, Nowicka A, Samcik M, Wolniewicz L, Baczynska K, Komorowska K, Poprawa I, Komorowska E, Sajnaga D, Zolbach A, Dudzik‐Plocica A, Abdulkarim A, Lauko‐Rachocka A, Kaminski L, Kostka A, Cichy A, Ruszkowski P, Splawski M, Fitas G, Szymczyk A, Serwicka A, Fiega A, Zysko D, Krysiak W, Szabowski S, Skorek E, Pruszczyk P, Bienias P, Ciurzynski M, Welnicki M, Mamcarz A, Folga A, Zielinski T, Rywik T, Leszek P, Sobieszczanska‐Malek M, Piotrowska M, Kozar‐Kaminska K, Komuda K, Wisniewska J, Tarnowska A, Balsam P, Marchel M, Opolski G, Kaplon‐Cieslicka A, Gil R, Mozenska O, Byczkowska K, Gil K, Pawlak A, Michalek A, Krzesinski P, Piotrowicz K, Uzieblo‐Zyczkowska B, Stanczyk A, Skrobowski A, Ponikowski P, Jankowska E, Rozentryt P, Polonski L, Gadula‐Gacek E, Nowalany‐Kozielska E, Kuczaj A, Kalarus Z, Szulik M, Przybylska K, Klys J, Prokop‐Lewicka G, Kleinrok A, Aguiar CT, Ventosa A, Pereira S, Faria R, Chin J, De Jesus I, Santos R, Silva P, Moreno N, Queirós C, Lourenço C, Pereira A, Castro A, Andrade A, Guimaraes TO, Martins S, Placido R, Lima G, Brito D, Francisco A, Cardiga R, Proenca M, Araujo I, Marques F, Fonseca C, Moura B, Leite S, Campelo M, Silva‐Cardoso J, Rodrigues J, Rangel I, Martins E, Correia AS, Peres M, Marta L, Silva GF, Severino D, Durao D, Leao S, Magalhaes P, Moreira I, Cordeiro AF, Ferreira C, Araujo C, Ferreira A, Baptista A, Radoi M, Bicescu G, Vinereanu D, Sinescu C, Macarie C, Popescu R, Daha I, Dan G, Stanescu C, Dan A, Craiu E, Nechita E, Aursulesei V, Christodorescu R, Otasevic P, Seferovic P, Simeunovic D, Ristic A, Celic V, Pavlovic‐Kleut M, Lazic JS, Stojcevski B, Pencic B, Stevanovic A, Andric A, Iric‐Cupic V, Jovic M, Davidovic G, Milanov S, Mitic V, Atanaskovic V, Antic S, Pavlovic M, Stanojevic D, Stoickov V, Ilic S, Ilic MD, Petrovic D, Stojsic S, Kecojevic S, Dodic S, Adic NC, Cankovic M, Stojiljkovic J, Mihajlovic B, Radin A, Radovanovic S, Krotin M, Klabnik A, Goncalvesova E, Pernicky M, Murin J, Kovar F, Kmec J, Semjanova H, Strasek M, Iskra MS, Ravnikar T, Suligoj NC, Komel J, Fras Z, Jug B, Glavic T, Losic R, Bombek M, Krajnc I, Krunic B, Horvat S, Kovac D, Rajtman D, Cencic V, Letonja M, Winkler R, Valentincic M, Melihen‐Bartolic C, Bartolic A, Vrckovnik MP, Kladnik M, Pusnik CS, Marolt A, Klen J, Drnovsek B, Leskovar B, Anguita MF, Page JG, Martinez FS, Andres J, Genis A, Mirabet S, Mendez A, Garcia‐Cosio L, Roig E, Leon V, Gonzalez‐Costello J, Muntane G, Garay A, Alcade‐Martinez V, Fernandez SL, Rivera‐Lopez R, Puga‐Martinez M, Fernandez‐Alvarez M, Serrano‐Martinez J, Crespo‐Leiro M, Grille‐Cancela Z, Marzoa‐Rivas R, Blanco‐Canosa P, Paniagua‐Martin M, Barge‐Caballero E, Cerdena IL, Baldomero IFH, Padron AL, Rosillo SO, Gonzalez‐Gallarza RD, Montanes OS, Manjavacas AI, Conde AC, Araujo A, Soria T, Garcia‐Pavia P, Gomez‐Bueno M, Cobo‐Marcos M, Alonso‐Pulpon L, Cubero JS, Sayago I, Gonzalez‐Segovia A, Briceno A, Subias PE, Hernandez MV, Cano MR, Sanchez MG, Jimenez JD, Garrido‐Lestache EB, Pinilla JG, Villa BG, Sahuquillo A, Marques RB, Calvo FT, Perez‐Martinez M, Gracia‐Rodenas M, Garrido‐Bravo IP, Pastor‐Perez F, Pascual‐Figal D, Molina BD, Orus J, Gonzalo FE, Bertomeu V, Valero R, Martinez‐Abellan R, Quiles J, Rodrigez‐Ortega J, Mateo I, ElAmrani A, Fernandez‐Vivancos C, Valero DB, Almenar‐Bonet L, Sanchez‐Lazaro I, Marques‐Sule E, Facila‐Rubio L, Perez‐Silvestre J, Garcia‐Gonzalez P, Ridocci‐Soriano F, Garcia‐Escriva D, Pellicer‐Cabo A, Fuente Galan L, Diaz JL, Platero AR, Arias J, Blasco‐Peiro T, Julve MS, Sanchez‐Insa E, Aured‐Guallar C, Portoles‐Ocampo A, Melin M, Hägglund E, Stenberg A, Lindahl I, Asserlund B, Olsson L, Dahlström U, Afzelius M, Karlström P, Tengvall L, Wiklund P, Olsson B, Kalayci S, Temizhan A, Cavusoglu Y, Gencer E, Yilmaz M, Gunes H. In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the
ESC‐HFA
Heart Failure Long‐Term Registry. Eur J Heart Fail 2016; 19:54-65. [DOI: 10.1002/ejhf.679] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Cécile Laroche
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
| | | | | | | | | | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research E.S: Health Science Foundation Cotignola Italy
| | - Stephan Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Andrew Coats
- Monash University Australia and University of Warwick Coventry UK
| | | | - Maria G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna CHUAC La Coruna Spain
| | - Alexandre Mebazaa
- Inserm 942, Hôpital Lariboisière Université Paris Diderot Paris France
| | - Massimo F. Piepoli
- Department of Cardiology Polichirurgico Hospital G. da Saliceto Piacenza Italy
| | - Aldo Pietro Maggioni
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
- ANMCO Research Center Florence Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research E.S. Health Science Foundation Cotignola Italy
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Heisterkamp M, Titze S, Lorenzen J, Eckardt KU, Koettgen A, Kielstein JT, Bouquegneau A, Vidal-Petiot E, Vrtovsnik F, Cavalier E, Krzesinski JM, Flamant M, Delanaye P, Anguiano L, Riera M, Pascual J, Barrios C, Betriu A, Valdivielso JM, Fernandez E, Soler MJ, Denys MA, Viaene A, Goessaert AS, Delanghe J, Everaert K, Kim YS, Choi MJ, Deok JY, Kim SG, Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L, Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L, Piskunowicz M, Hofmann L, Zurcher E, Bassi I, Zweiacker C, Stuber M, Narkiewicz K, Vogt B, Burnier M, Pruijm M, Rusu E, Zilisteanu D, Atasie T, Circiumaru A, Carstea F, Ecobici M, Rosca M, Tanase C, Mihai S, Voiculescu M, Kim YS, Jeon YD, Choi MJ, Kim SG, Polenakovic M, Pop-Jordanova N, Hung SC, Tarng DC, Tuta L, Stanigut A, Mesiano P, Rollino C, Ferro M, Beltrame G, Massara C, Quattrocchio G, Borca M, Bazzan M, Roccatello D, Maksudova A, Urasaeva LI, Khalfina TN, Zilisteanu D, Rusu E, Atasie T, Ecobici M, Circiumaru A, Carstea F, Rosca M, Tanase C, Mihai S, Voiculescu M, Tekce H, Kin Tekce B, Aktas G, Alcelik A, Sengul E, Lindic J, Purg D, Skamen J, Krsnik M, Skoberne A, Pajek J, Kveder R, Bren A, Kovac D, Kin Tekce B, Tekce H, Aktas G, Delgado G, Drechsler C, Wanner C, Blouin K, Pilz S, Tomaschitz A, Kleber ME, Willmes C, Krane V, Marz W, Ritz E, Van Gilst WH, Van Der Harst P, De Boer RA, Scholze A, Petersen L, Hocher B, Rasmussen LM, Tepel M, De Paula EA, Vanelli CP, Caminhas MS, Soares BC, Bassoli FA, Da Costa DMN, Lanna CMM, Galil AGS, Colugnati FAB, Costa MB, Bastos MG, De Paula RB, Santoro D, Zappulla Z, Alibrandi A, Tomasello Andulajevic M, Licari M, Baldari S, Buemi M, Cernaro V, Campenni A, Pallet N, Chauvet S, Levi C, Meas-Yedid V, Beaune P, Thevet E, Karras A, Santos S, Malheiro J, Campos A, Pedroso S, Santos J, Cabrita A, Mayor MM, Ayala R, Ramos C, Franco S, Guillen R, Kim JS, Yang JW, Han BG, Choi SO, Tudor MN, Navajas Martinez MF, Vaduva C, Maria DT, Mota E, Clari R, Mongilardi E, Vigotti FN, Consiglio V, Scognamiglio S, Nazha M, Roggero S, Piga A, Piccoli G, Mukhopadhyay P, Patar K, Chaterjee N, Ganguly K. CKD LAB METHODS, PROGRESSION & RISK FACTORS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gubensek J, Buturovic-Ponikvar J, Kandus A, Arnol M, Kovac J, Marn-Pernat A, Lindic J, Kovac D, Ponikvar R. Plasma Exchange and Intravenous Immunoglobulin in the Treatment of Antibody-Mediated Rejection After Kidney Transplantation: A Single-Center Historic Cohort Study. Transplant Proc 2013; 45:1524-7. [DOI: 10.1016/j.transproceed.2012.09.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/11/2012] [Indexed: 10/26/2022]
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Kovac J, Kovac D, Slobodnikova L, Kotulova D. Enterococcus faecalis and Candida albicans in the dental root canal and periapical infections. BRATISL MED J 2013; 114:716-720. [PMID: 24329511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the present study was to examine the prevalence of Enterococcus faecalis and Candida albicans in endodontic infections. METHODS Samples for microbiological examination were collected from 32 patients with deep dental caries, infected dental root canal, or periapical infection. RESULTS Cultivation of the dental samples yielded four strains of Enterococcus faecalis (12.5 %), and three strains of Candida albicans (9.4 %). All Enterococcus faecalis isolates were susceptible to ampicillin, one isolate was resistant to tetracycline, two to erythromycin and azithromycin (additional 2 had intermediate susceptibility), and one strain had intermediate susceptibility to ciprofloxacin and moxifloxacin. CONCLUSION We conclude that Enterococcus faecalis and Candida albicans can participate in the dental root canal and periapical infections, and the use of effective irrigant solutions and intracanal medicaments active against these microbes is important in order to prevent endodontic therapy failures. Unexpected was the isolation of C. albicans from a nine-year-old child with periodontitis apicalis. This finding must draw attention to the possibility that even at such a young age, this microorganism could be a potential etiological agent in endodontic infections (Tab. 2, Ref. 34). Text in PDF www.elis.sk.
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Kovac J, Kovac D. Neonatal teeth. BRATISL MED J 2011; 112:648-650. [PMID: 22180994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Teeth that are present at birth are called natal teeth, and teeth that emerge through the gingiva during the first 4 weeks of life are called neonatal teeth. The incidence of the appearance of natal and neonatal teeth has been reported to be between once every 800 and once every 6000 births. Natal and neonatal teeth may be uncomfortable for a nursing mother and present a risk of aspiration and swallowing by the infant if they are loose. Also, they may cause irritation and trauma to the infant's soft tissues. Under these circumstances, natal and neonatal teeth need to be extracted. In this article, a case report of two neonatal teeth in a five week old girl is presented. The teeth were present in the mandibular incisor region and were excessively mobile and caused discomfort for the nursing mother. They were extracted because of the fear of aspiration (Fig. 4, Ref. 10).
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Affiliation(s)
- J Kovac
- Department of Stomatology and Maxilofacial Surgery, Comenius University, St. Elisabeth's Hospital, Bratislava, Slovakia.
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8
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Kovac J, Kovac D. Effect of irrigating solutions in endodontic therapy. BRATISL MED J 2011; 112:410-415. [PMID: 21744739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The primary goal of endodontic therapy is the reduction or elimination of micro-organisms and their by-products from the root canal system. Although a number of instrumentation and irrigation techniques exist, debris is often left behind in the root canal system, therefore proper canal cleaning, shaping and irrigation is essential to significantly reduce and sometimes eliminate bacteria from canals. However, complete elimination of bacteria is not always achieved in clinical practice due to the anatomical complexities of root canals and consequent limitations of access by instruments and irrigators, the use of antimicrobial medication has been advocated to disinfect the root canal system and because root tissues are closely related to the periodontal apparatus. The aim of this paper is to review current information on the topic of bacterial infection in endodontics with an emphasis on combined mechanical and chemical treatment of root canals. It focuses on available irrigation agents, provides their short overview, mechanism of action and possible unwanted side effects on periodontal tissues (Fig. 2, Ref. 19).
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Affiliation(s)
- J Kovac
- Department of Stomatology and Maxilofacial Surgery, Comenius University, St. Elisabeth's Hospital, Bratislava, Slovakia.
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9
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Borstnar S, Erzen B, Gmeiner Stopar T, Kocjan T, Arnol M, Kandus A, Kovac D. Treatment of Hyperparathyroidism With Cinacalcet in Kidney Transplant Recipients. Transplant Proc 2010; 42:4078-82. [DOI: 10.1016/j.transproceed.2010.09.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/16/2010] [Indexed: 11/24/2022]
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10
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Zelic M, Uravic M, Petrosic N, Dobrila-Dintinjana R, Ivanis N, Kovac D, Miletic D. Leiomyoma of the left renal vein. A report of a case. Acta Chir Belg 2009; 109:782-4. [PMID: 20184069 DOI: 10.1080/00015458.2009.11680537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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11
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Gunawan B, von Heydebreck A, Sander B, Schulten HJ, Haller F, Langer C, Armbrust T, Bollmann M, Gasparov S, Kovac D, Füzesi L. An oncogenetic tree model in gastrointestinal stromal tumours (GISTs) identifies different pathways of cytogenetic evolution with prognostic implications. J Pathol 2007; 211:463-70. [PMID: 17226762 DOI: 10.1002/path.2128] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To model the cytogenetic evolution in gastrointestinal stromal tumour (GIST), an oncogenetic tree model was reconstructed using comparative genomic hybridization data from 203 primary GISTs (116 gastric and 87 intestinal GISTs, including 151 newly analysed cases), with follow-up available in 173 cases (mean 40 months; maximum 133 months). The oncogenetic tree model identified three major cytogenetic pathways: one initiated by -14q, one by -1p, and another by -22q. The -14q pathway mainly characterized gastric tumours with predominantly stable karyotypes and more favourable clinical course. On the other hand, the -1p pathway was more characteristic of intestinal GISTs, with an increased capacity for cytogenetic complexity and more aggressive clinical course. Loss of 22q, more closely associated with -1p than -14q, appeared to initiate the critical transition to an unfavourable cytogenetic subpathway. This -22q pathway included accumulation of +8q, -9p, and -9q, which could all predict disease-free survival in addition to tumour site. Thus, insights into the cytogenetic evolution obtained from oncogenetic tree models may eventually help to gain a better understanding of the heterogeneous site-dependent biological behaviour of GISTs.
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Affiliation(s)
- B Gunawan
- Institute of Pathology, Department of General Surgery, University of Göttingen, Germany, and Department of Clinical Pathology and Cytology, Merkur University Hospital, Zagreb, Croatia.
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12
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Kandus A, Grego K, Arnol M, Kovac D, Lindic J, Buturović J, Ponikvar R, Bren AF. Effective Immunoprophylaxis With Basiliximab Plus Triple Therapy in Renal Transplantation: Five-Year Single-Center Experience. Transplant Proc 2006; 38:2853-5. [PMID: 17112847 DOI: 10.1016/j.transproceed.2006.08.142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Indexed: 11/29/2022]
Abstract
We studied prospectively the efficacy and safety of basiliximab combined with triple immunosuppression in adult recipients of > or = 1 HLA-mismatched deceased donor renal grafts. All studied patients received equal immunosuppressive drugs: 20 mg infusion of basiliximab on day 0 and on day 4, cyclosporine microemulsion (Neoral), mycophenolate mofetil, and methylprednisolone. An analysis of 1-year data assessed the incidence of acute rejection episodes, safety of this therapy, renal graft function, and patient and graft survivals. One hundred seventy-two patients were studied. The HLA-antigen mismatches were 2.9 +/- 0.9 (mean +/- SD), and the cold ischemia time was 22.0 +/- 7.5 hours. Fifty-three (31.5%) patients experienced delayed graft function. At 12 months, 5 (3.0%) patients experienced acute rejection. Six renal grafts were lost, but not from rejection. Two patients died. Sixty-six infections required treatment in the hospital. One carcinoma of cervix (in situ) and two basal cell carcinomas of skin were detected. Hypersensitivity reactions and cytokine-release syndrome were not observed. At 12 months, serum creatinine was significantly higher (119 +/- 46 micromol/L; P < .001) in patients with delayed graft function than in patients with immediate graft function (99 +/- 26 micromol/L). Patient and graft survivals were 98.8% and 97.1%, respectively. Basiliximab combined with this triple therapy was an efficient and safe immunosuppression strategy, demonstrated with very low incidence of acute rejections, an acceptable adverse event profile, excellent graft function, and high short-term survival rates in adult recipients of deceased donor renal transplant.
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Affiliation(s)
- A Kandus
- University Medical Center, Department of Nephrology, Ljubljana, Slovenia.
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Mijandrusić Sincić B, Kovac D, Jasić M, Grbas H, Uravić M, Depolo A. Crohn's disease and a gastrointestinal stromal tumor in an 81-year-old man--a rare coincidence. Zentralbl Chir 2006; 130:597-9. [PMID: 16382412 DOI: 10.1055/s-2005-918206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entities: gastrointestinal stromal tumor (GIST) and Crohn's disease. Within Meckel's diverticulum a polypous tumor, 3 cm in diameter, with preserved lumen was found. In the area of the terminal ileum, coecum and colon ascendens inflamed bowel loops were fixed together with fibrous adhesions. Partial resection of the ileum with end-to-end anastomosis and right hemicolectomy with resection of the terminal ileum and end-to-end ileotransverse anastomosis were performed. Pathohistological and immunohistochemical examination revealed the polypous tumor as GIST. Changes in terminal ileum, coecum and colon ascendens were referred as Crohn's disease. Although adenocarcinoma is well known in chronic, long-standing inflammatory bowel disease, other primary intestinal tumors are rare in those patients. Furthermore, Crohn's disease can be a part of differential diagnosis of ileus, also in such an old man.
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Affiliation(s)
- B Mijandrusić Sincić
- Department of Gastroenterology, University Hospital Centre Rijeka, Kresmirova 42, 51000 Rijeka, Croatia
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Kovac D, Kotnik V, Kandus A. Basiliximab and Mycophenolate Mofetil in Combination With Low-Dose Cyclosporine and Methylprednisolone Effectively Prevent Acute Rejection in Kidney Transplant Recipients. Transplant Proc 2005; 37:4230-4. [PMID: 16387086 DOI: 10.1016/j.transproceed.2005.11.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of the study was to analyze whether immunosuppressive treatment with basiliximab and mycophenolate mofetil (MMF), allowed a reduction in methylprednisolone and cyclosporine dosages without increasing the incidence of acute rejection episodes, reducing 1-year graft and patient survivals, or increasing the rates of infections and malignancy in the first year. The two groups were group A (n = 72), treated with methylprednisolone and cyclosporine and in the first 2 weeks with azathioprine; group B (n = 72), treated with basiliximab, MMF, and low-dose cyclosporine and methylprednisolone. The patients were followed for 1 year. The incidence of acute rejection episodes in the first year was significantly lower in group B (2.8%) than group A (12.5%; P < .05). The cumulative methylprednisolone dose, the daily dose, and the average cyclosporine trough blood level were significantly lower in group B (P < .001). One-year serum creatinine was significantly lower in group B (112 +/- 45 micromol/L) than group A (138 +/- 51 micromol/L; P < .01). One-year graft survival was 91.7% in group A and 98.6% in group B. One-year patient survival was 98.6% in group A and 100% in group B. The groups did not differ significantly in the incidence of bacterial, viral, or fungal infections. Immunosuppression with basiliximab and MMF allowed a reduction in cyclosporine and methylprednisolone dosages and was associated with significantly lower incidences of acute rejections episodes with better graft function in the first year as opposed to immunosuppression with higher doses of cyclosporine and methylprednisolone alone. Both immunosuppressive regimens showed the same infection rates and did not differ significantly in the occurrence of malignant diseases within the first year.
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Affiliation(s)
- D Kovac
- Department of Nephrology, University Medical Centre, and Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia.
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Kandus A, Grego K, Arnol M, Kovac D, Kovac J, Lindic J, Buturovic-Ponikvar J, Ponikvar R, Bren AF. 36 Prevention of Early Acute Rejection with Basiliximab and Triple Immunosuppression in Cadaveric Renal Allograft Recipients. Ther Apher Dial 2005. [DOI: 10.1111/j.1526-0968.2005.222_36_36.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Kandus A, Grego K, Arnol M, Kovac D, Kovac J, Lindic J, Bren AF. 37 Prevention of Early Acute Rejection with Daclizumab and Triple Immunosuppression in Cadaveric Renal Allograft Recipients. Ther Apher Dial 2005. [DOI: 10.1111/j.1526-0968.2005.222_37_37.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Legan M, Benedik M, Kovac D, Cor A. 8 Mixed Uremic Osteodystrophy - a Predominant Form of Renal Bone Disease in Slovenia. Ther Apher Dial 2005. [DOI: 10.1111/j.1526-0968.2005.222_8_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Kovac D, Gasparović I, Jasic M, Fuckar D, Dobi-Babić R, Haller H. Endometrial stromal sarcoma arising in extrauterine endometriosis: a case report. EUR J GYNAECOL ONCOL 2005; 26:113-6. [PMID: 15755017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We report a rare case of a 46-year-old woman developing endometrial stromal sarcoma (ESS) on the grounds of extrauterine endometriosis. The patient presented with symptoms of stenosis of the rectosygmoid colon. The tissue samples were submitted to histological and immunohistochemical analyses using antibodies for indirect staining. The trial showed multiple foci of endometriosis and mesenchymal malignant tissue described as ESS in the bowel wall, mesentery and in the remnants of the left adnexae. According to our findings, we suspect that ESS might have arisen in colon endometriosis.
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Affiliation(s)
- D Kovac
- Department of Pathology, Medical School, University of Rijeka, Croatia
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19
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Von Heydebreck A, Gunawan B, Kovac D, Bollmann M, Vingron M, Füzesi L. Maximum likelihood estimation of mathematical models for genetic development in gastrointestinal stromal tumors. Pathol Res Pract 2004. [DOI: 10.1016/s0344-0338(04)80768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Kovac D, Lindic J, Kandus A, Bren FA. Quantitative ultrasound of the calcaneus and dual X-ray absorptiometry of the lumbar spine in assessment and follow-up of skeletal status in patients after kidney transplantation. Osteoporos Int 2003; 14:166-70. [PMID: 12730786 DOI: 10.1007/s00198-002-1360-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2002] [Accepted: 11/12/2002] [Indexed: 10/20/2022]
Abstract
Bone loss after kidney transplantation is a significant complication of immunosuppressive treatment leading to a high prevalence of bone fracture in these patients. The purpose of this study was to determine the usefulness of quantitative ultrasound (QUS) of the calcaneus in comparison with dual X-ray absorptiometry (DXA) of the lumbar spine in determining bone status and mineral changes in patients in the first 6 months after transplantation. Forty-six patients participated in the study (25 men and 21 women; age range 26-62 years, 102+/-66 months previously on dialysis). They were treated with cyclosporine, methylprednisolone, mycophenolate mofetil, and basiliximab. The 6-month cumulative steroid dose was 24.9+/-3.7 mg/kg body weight. Calcaneal QUS (Sahara, Hologic, Waltham, Mass.) and DXA (Hologic QDR 4500) of the lumbar spine were done in all patients within 3 weeks after transplantation and 6 months thereafter. Bone mineral density (BMD) of the lumbar spine measured by DXA decreased from 0.892+/-0.137 to 0.837+/-0.126 g/cm2 (p<0.0001) and the T score decreased from 1.84+/-1.29 standard deviation (SD) to 2.35+/-1.19 SD (p<0.0001) in the first 6 months after transplantation. The QUS parameters of the calcaneus were broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound index (QUI). The QUS parameters did not change significantly after the first 6 months. All QUS parameters correlated significantly with DXA BMD of the lumbar spine immediately after transplantation and 6 months thereafter. Significant decrease of the lumbar spine BMD in the first 6 months after transplantation was not accompanied by significant changes of calcaneal QUS parameters. The calcaneal QUS does not reflect bone mineral changes occurring in the lumbar spine and could not be a substitute for a direct-site DXA of the lumbar spine in the early period after kidney transplantation.
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Affiliation(s)
- D Kovac
- Department of Nephrology, University Medical Center, Zaloska 7, 1000, Ljubljana, Slovenia.
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Bren AF, Kandus A, Koselj M, Buturovic J, Lindic J, Kovac D, Ponikvar R, Vizjak A, Ferluga D. Outcome and prognosis of cyclosporine-related hemolytic-uremic syndrome in kidney graft recipients: clinical and histopathologic study of 13 cases. Transplant Proc 2002; 34:3005-6. [PMID: 12431685 DOI: 10.1016/s0041-1345(02)03516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A F Bren
- Department of Nephrology, University Medical Center, Ljubljana, Slovenia
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Affiliation(s)
- A Bren
- Department of Nephrology, University Medical Center, Ljubljana, Slovenia
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Zupan IP, Varl J, Kovac D, Cernelc P, Mlakar U, Andoljsek D, Pretnar J, Zver S, Modic M. Indices of iron status in patients treated by chronic haemodialysis. Pflugers Arch 2002; 442:R202-3. [PMID: 11678340 DOI: 10.1007/s004240100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Iron deficiency in patients with end stage renal disease (ESRD) treated by haemodialysis (HD) is difficult to diagnose. The reticulocyte hemoglobin content (CHr) and the percentage of hypochromic red cells (%hypo) are sensitive novel assays for the detection of functional iron deficiency in patients treated with erithropoietin (EPO). In our study thirty-nine chronically hemodialyzed patients were evaluated to determine the value of these two parameters in comparison to the conventional biochemical indicators of iron metabolism. There were significant correlations between CHr and transferrin saturation, CHr and weekly dosage of EPO, and also between %hypo and weekly dosage of EPO. Our data represent superior value of %hypo and CHr to the transferrin saturation and ferritin concentration in detecteng of iron deficiency in HD patients.
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Affiliation(s)
- I P Zupan
- Department of Haematology, University Medical Centre, Ljubljana, Slovenia
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Affiliation(s)
- D Kovac
- University Medical Centre, Department of Nephrology, Ljubljana, Slovenia.
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Bren AF, Kandus A, Lindic J, Kovac D, Buturović J, Vizjak A, Ferluga D. Cyclosporine-triggered hemolytic-uremic syndrome in kidney graft recipients: a series of 12 cases. Transplant Proc 2001; 33:3691-2. [PMID: 11750572 DOI: 10.1016/s0041-1345(01)02505-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A F Bren
- Department of Nephrology, University Medical Center, Ljubljana, Slovenia
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Kandus A, Kovac D, Buturović-Ponikvar J, Ponikvar R, Koselj M, Lindic J, Kmetec A, Bren AF. Absence of acute rejection using basiliximab with triple immunosuppression in cadaveric kidney recipients in first three months. Transplant Proc 2001; 33:3207-8. [PMID: 11750376 DOI: 10.1016/s0041-1345(01)02365-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Kandus
- Department of Nephrology, University Medical Center, Ljubljana, Slovenia
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Altarac S, Glavas M, Drazinić I, Kovac D, Celović R, Matosević E, Jerin L. Experimental and clinical study in the treatment of sigmoid volvulus. Acta Med Croatica 2001; 55:67-71. [PMID: 11505630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The aim of the study was to introduce an alternative surgical procedure for the treatment of primary volvuius of the sigmoid colon. Sigmoid colon plication was performed in 42 dogs, and afterwards in six patients. The procedure consists of systematic plaiting the sigmoid colon wall with interrupted serosubmucosal 3/0 Vicryl sutures along the whole circumference, except on the mesenteric border. Five parallel circular folds were done in dogs, and 20-30 folds in patients, with appropriate bowel length reduction. In the experimental study, dogs were randomly divided into three experimental and one control group of 14 animals each. The group 1 dogs were sacrificed on day 8, group 2 dogs on day 15, and group 3 and control group dogs on day 30 postoperatively. On exploration, sigmold colon adhesions were found in 6 (14.3%) animals. Intestinal wall and lumen were normal. In the clinical study, six patients with sigmoid volvulus were operated on within 6-8 hours of admission. A viable colon was a prerequisite for the sigmoid plication procedure. The operating time was 60-90 minutes. Recovery was uneventful, with average hospitalization 11 (range 8-15) days. No volvulus recurrence was recorded during the three-year follow-up. Based on our experimental and clinical data, we believe that the plication procedure could be appropriate treatment in some selected patients with volvulus of the sigmold colon.
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Affiliation(s)
- S Altarac
- Department of Surgery, Pula General Hospital, Pula, Croatia
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Melato M, Sidari L, Rizzardi C, Kovac D, Stimac D, Baxa P, Jonjic N. Gastric epithelium proliferation in early Hp+ and Hp- gastritis: a flow cytometry study. Anticancer Res 2001; 21:1347-53. [PMID: 11396211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Helicobacter pylori increases cellular turn-over causing hyperproliferation and possible assumption of neoplastic characteristics by the gastric epithelial cells. To verify whether patients at risk of cancer can be identified at the very first stages of gastric disease, we studied a sample of patients affected by early Hp+ and Hp- gastritis by flow cytometry and assessed the methods commonly adopted to study gastric cell proliferation. METHODS 48 fresh biopsies taken from the gastric antrum and body of 24 patients who had undergone endoscopy for dyspepsia, and 48 paraffin-embedded antrum and body biopsies taken from the files of our Department were studied by flow-cytometry. The following markers and parameters were considered: S-phase, proliferation index, PCNA and ploidy. RESULTS No correlation was found between Hp+ or Hp- gastritis and gastric cell proliferation and no cases of aneuploidy were observed. Gastric proliferation was found to vary depending on the methods, markers and type of biopsy employed. Furthermore, proliferation expressed by PCNA was significantly different in antrum and body. CONCLUSIONS The commonly studied proliferation markers do not allow the early detection of patients at risk of gastric cancer by flow cytometry. Proliferation differences between body and antrum must be taken into account in the investigation of gastric diseases.
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Affiliation(s)
- M Melato
- Department of Pathological Anatomy, University of Trieste, Italy.
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Affiliation(s)
- M Persić
- Department of Pediatrics, Clinical Hospital Center Rijeka, Croatia
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31
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Affiliation(s)
- D Kovac
- University Medical Centre, Department of Nephrology, Ljubljana, Slovenia.
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33
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Sustić A, Kovac D, Zgaljardić Z, Zupan Z, Krstulović B. Ultrasound-guided percutaneous dilatational tracheostomy: a safe method to avoid cranial misplacement of the tracheostomy tube. Intensive Care Med 2000; 26:1379-81. [PMID: 11089770 DOI: 10.1007/s001340000589] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this investigation was to evaluate the role of ultrasonography in avoiding cranial misplacement of the tracheostomy tube and tracheal ring fractures during percutaneous dilatational tracheostomy (PDT). The tracheas of 26 consecutive ICU patients who had undergone PDT but who later died were removed en bloc at autopsy. The tracheas were opened along the membranous portion and the condition of tracheal rings and the site of tracheostomy macroscopically evaluated. The patients were divided in two groups: group A with 15 patients who underwent "blind" PDT and group B with 11 patients who underwent ultrasound-guided PDT. In five (33%) patients from group A, autopsy revealed that the tracheostomy tube was placed between the cricoid cartilage and the first tracheal ring (cranial misplacement) and in six (43%) patients a fracture of one tracheal ring was found. Cranial misplacement of the tracheostomy tube in patients from group B was not found (P < 0.05) and four (36%) patients had a broken tracheal ring (P = NS). The authors maintain that by using ultrasound-guided PDT cranial misplacement of the tracheostomy tube may be entirely avoided.
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Affiliation(s)
- A Sustić
- Department of Anaesthesiology and ICU, University Hospital Rijeka, Croatia.
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Persić M, Kilvain S, Kapitanović S, Saina G, Roganović J, Rubinić M, Kovac D. [Familial adenomatous colonic polyposis]. Lijec Vjesn 2000; 122:132-5. [PMID: 11040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
We described two patients (brother and sister) with familial adenomatous polyposis of the colon. It is an inherited disease with autosomal dominant pattern of inheritance. The incidence is 1:8.000, with usual onset of polyps development late in the first decade of life or during adolescence, and malignant alteration up to the fourth decade of life. APC gene located on long arm of chromosome 5 is responsible for occurrence of the disease that presents with onset of multiple adenomatous polyps in the colon (from some of them to 1000). The treatment includes chemoprevention by sulindac or aspirin that prevents or reverse process of carcinogenesis. Surgical approach is preventive colectomy up to 20 (25) years of life. APC gene mutation (deletion at codon 1309-1311) was proven by DNA analysis from blood and polyp in both patients. There was no evidence of mutations of genes p53 and K-ras. Preventive colectomy is planned as soon as possible.
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Affiliation(s)
- M Persić
- Klinika za djecje bolesti Kantrida, KBC Rijeka
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35
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Vukic M, Negovetic L, Kovac D, Ghajar J, Glavic Z, Gopcevic A. The effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome. Acta Neurochir (Wien) 1999; 141:1203-8. [PMID: 10592121 DOI: 10.1007/s007010050419] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors retrospectively analysed two groups of consecutive patients who were similarly matched for brain injury severity. From a total of 39 severe head injury patients, 23 were treated according to the Guidelines for the Management of Severe Head Injury with intracranial pressure (ICP) monitoring ("Guidelines group"). Such an approach allowed the maintenance of ICP within normal values, especially in patients with intraventricular ICP monitoring allowing the release of cerebrospinal fluid (CSF) from the ventricular system. In the Guidelines group only two patients were administered barbiturates, after all other means of ICP lowering had been exhausted. The second group consisted of 16 patients who were not monitored for ICP ("non-Guidelines group"). In this group, management consisted of the prophylactic administration of barbiturates, high dose osmotic diuretics and hyperventilation usually at levels below 25 mm Hg. In the Guidelines group the mortality rate was 30% compared to 44% in the non-Guidelines group. Almost twice as many patients achieved a "favourable" (good recovery and moderate disability) outcome (49%) compared to the non-Guidelines treated patients (25%). Furthermore, there was a 32% decrease in severe neurological disabilities in those patients in the Guidelines group. It seems that the implementation of "Guidelines" in the treatment of severe head injury, based on the result of our clinical study, reduces death and disability rates in patients with severe head injury. The administration of therapy based on the "Guidelines principles" and monitoring of ICP, can minimise the application of those therapeutic modalities (barbiturate coma and prolonged hyperventilation) which, in addition to favourable effects, may also have harmful effects on patients with severe head injury.
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Affiliation(s)
- M Vukic
- Department of Neurosurgery, Sisters of Mercy University Hospital, Zagreb, Croatia
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36
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Vcev A, Vceva A, Takac B, Dmitrović B, Stimac D, Stimac T, Kovac D, Pezerović D, Blazanović A, Ivandić A, Karner I. Omeprazole, azithromycin and amoxicillin or amoxicillin plus clavulanic acid in eradication of Helicobacter pylori in duodenal ulcer disease. Acta Med Croatica 1999; 52:209-14. [PMID: 9988898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Treatment with omeprazole (OME), azithromycin (AZI) and amoxicillin (AMO) resulted in encouraging Helicobacter pylori cure rates in pilot and control studies. The aim of this study was to establish whether OME + AZI in combination with either AMO or ACA (amoxicillin plus clavulanic acid) are effective in curing H. pylori infection. A hundred patients with active duodenal ulcer and H. pylori infection were treated with OME (day 1-10: 2 x 40 mg/day, day 11-24: 40 mg/day, day 25-42: 20 mg/day) plus AZI 500 mg/day for the first 6 days. Patients were randomly assigned to either AMO 2 x 1000 mg/day (group A, n = 50) or ACA 2 x 1250 mg/day (group B, n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before and 6 weeks after completion of therapy. Ninety-five patients completed the study. H. pylori infection was eradicated in 85.4% (41/48) patients from group A (intention-to-treat (ITT) analysis: 82%) versus 91.5% (43/47) patients from group B (ITT) analysis: 86%) (NS). All ulcer had healed after 42 days of omeprazole treatment. Side effects, usually minor, were recorded in 12.5% (group A) and 14.9% (group B) of patients (NS). Therapy had to be discontinued in two patients (one in group A and one group B) only. Ten-days treatment with OME and AZI (for the first 6 days) with AMO or ACA are simple and highly effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.
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Affiliation(s)
- A Vcev
- Department of Medicine, Osijek University Hospital, Croatia
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37
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Kovac D, Negovetić L, Vukić M, Klanfar Z, Jajić Z. [Surgical treatment of lumbar disc hernias in athletes]. Reumatizam 1999; 46:35-41. [PMID: 9921008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In a 7-year period (1988-1995) a series of 55 patients was surgically treated at our Department for lumbar disk herniation following a certain sports activity, i.e. sports injury. The above number accounts for 2% of the total number of lumbar disk patients operated upon at our Department. The majority of patients in our series were amateur athletes, whereas a few of them were active or professional athletes. The most common cause of disk herniation among our patients was playing soccer (13 cases), which is followed by basketball (8), field athletics (7), tennis (6) and handball (4). In most cases our surgical method of choice was flavectomy (interlaminectomy). Most commonly seen intraoperative finding was intervertebral disk extrusion. In some athletes the onset of symptoms was due to a change of their usual sports activity, for example a tennis player who was injured in skiing. We believe that the onset of disk herniation in athletes is a consequence of numerous micro traumas of the intervertebral disk which are further compounded by the syndrome of overstraining. In the case of a positive indication, surgical treatment leads to a faster recovery in professional athletes.
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Affiliation(s)
- D Kovac
- Klinika za neurokirurgiju Klinicke bolnice Sestre milosrdnice, Zagreb
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38
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Kovac D, Lindic J, Lejko-Zupanc T, Bren AF, Knap B, Lesnik M, Gucek A, Ferluga D. Treatment of severe Paecilomyces varioti peritonitis in a patient on continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 1998; 13:2943-6. [PMID: 9829510 DOI: 10.1093/ndt/13.11.2943] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Kovac
- Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
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39
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Kovacević D, Kovacević D, Kovac D, Topalov V. [Shock]. Med Pregl 1998; 51:449-55. [PMID: 9863338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
UNLABELLED Shock is a consequence of disturbed circulation and decreased blood perfusion of tissues which, on the whole, cause functional and morphological impairments of organic systems. Occurrence of shock is not high, but it is significant due to bad prognosis and high mortality rate. CLASSIFICATION This is one of the classifications of shock: cardiogenic, extracardiogenic-obstructive, oligentic and distributive shock. PATHOPHYSIOLOGIC MECHANISMS OF SHOCK: Regardless of the cause of shock, the clinical picture is dominated by hypotension mostly caused by decrease of minute volume (septic shock may be an exception--minute volume might be high). Due to hypotension a lot of compensatory mechanisms are activated and in the beginning showing the compensatory phase of disease and if nothing is done decompensatory and in the end irreversible phase of shock occurs with fatal outcome. The clinical picture depends on the etiology of shock, type of shock, but it also has certain specificities. PROGNOSIS The prognosis depends on the clinical picture dominated by the following symptoms: hypotension, decreased diuresis, acidosis, consciousness disorders, tachypnea, peripheral cyanosis, cold and damp skin. MANAGEMENT These patients are managed in intensive care units, where the following parameters are followed-up: arterial pressure, central venous pressure, minute heart volume, systemic vascular resistance, diuresis, continual follow-up of heart rate, breathing and consciousness. In treatment of shock it is necessary to: normalize the circulatory volume, establish electrolyte balance, regulate glycemia and acid-base status, compensate the volume, calm the patient and alleviate pain.
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Affiliation(s)
- D Kovacević
- Institut za kardiovaskularne bolesti, Sremska Kamenica, Medicinski fakultet, Novi Sad
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40
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Kandus A, Kovac D, Cerne D, Koselj M, Kaplan-Pavlovcic S, Buturović J, Ponikvar R, Kveder R, Lindic J, Bren AF. Therapy of hyperlipidemia with lovastatin in kidney transplant patients on cyclosporine A immunosuppression: three-year experience. Transplant Proc 1998; 30:1307-9. [PMID: 9636530 DOI: 10.1016/s0041-1345(98)00253-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Kandus
- Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
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41
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Bren AF, Kandus A, Buturovic J, Koselj M, Kaplan Pavlovcic S, Ponikvar R, Kovac D, Lindic J, Vizjak A, Ferluga D. Cyclosporine-related hemolytic-uremic syndrome in kidney graft recipients: clinical and histomorphologic evaluation. Transplant Proc 1998; 30:1201-3. [PMID: 9636487 DOI: 10.1016/s0041-1345(98)00209-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A F Bren
- Department of Nephrology, University Medical Center, Ljubljana, Slovenia
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42
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Vcev A, Vceva A, Stimac D, Takac B, Dmitrović B, Kovac D. Omeprazole, azithromycin and either amoxycillin or metronidazole in eradication of Helicobacter pylori in duodenal ulcer patients. Aliment Pharmacol Ther 1998; 12:453-6. [PMID: 9663725 DOI: 10.1046/j.1365-2036.1998.00332.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Azithromycin is a new generation, acid stable, macrolide antibiotic that achieves remarkably high concentrations in gastric tissue (above the minimal inhibitory concentration for Helicobacter pylori) after oral administration. AIM To establish whether azithromycin plus omeprazole in association with either amoxycillin or metronidazole are useful in curing H. pylori infection in patients with a duodenal ulcer. METHODS One hundred patients with active duodenal ulcers and H. pylori infection were treated with omeprazole (days 1-10, 40 mg b.d.; days 11-24, 40 mg o.m.; days 25-42, 20 mg o.m.) plus azithromycin 500 mg o.m. for the first 6 days. Patients were randomly assigned to receive either amoxycillin 1 g b.d. (OAzA group: n = 50) or metronidazole 400 mg t.d.s. (OAzM group: n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before the treatment and 6 weeks after completion of therapy. RESULTS Ninety-seven patients completed the study. H. pylori infection was eradicated in 85% (41/48) of patients in the OAzA group (intention-to-treat analysis 82%) vs. 74% (36/49) of patients in the OAzM group (intention-to-treat analysis: 72%) (N.S.). All ulcers had healed after 6 weeks of omeprazole treatment. Side-effects, usually minor, were recorded in 13% (OAzA group) and 47% (OAzM group) of patients (P < 0.001), but therapy was discontinued for only one patient in the OAzA group (N.S.). CONCLUSION Ten days of treatment with omeprazole plus (for the first 6 days) azithromycin and either amoxycillin or metronidazole provides effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.
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Affiliation(s)
- A Vcev
- Internal Clinic and Department of Pathology, Clinical Hospital Osijek, Croatia
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43
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Persić M, Lenac T, Rubinić M, Saina G, Kovac D. [Nodular lymphoid hyperplasia of the colon and terminal ileum. Case report]. Lijec Vjesn 1998; 120:62-4. [PMID: 9769629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A patient admitted to our hospital because of diarrhea and hematochesia is presented. These complaints appeared eight months before, and were not accompanied by other disturbances. All hematological, biochemical and microbiological findings were normal, but endoscopic, x-ray and histologic examination of the gastrointestinal tract showed nodular lymphoid hyperplasia of the colon and terminal ileum. Since an immunological derangement was not verified, this seems to be a rare benign disorder as a response to repeated antigenic stimuli. In our patient these were recurrent parasitoses. The treatment is not needed, but due to the possibility of late onset hypogammaglobulinemia. Long-term patient follow up is required.
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Affiliation(s)
- M Persić
- Klinika za djecje bolesti Kantrida, KBC Rijeka
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44
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Radic I, Bozic B, Negovetic L, Kogler A, Kovac D, Skarica R. Intradural lumbar disc herniation. Clin Neurol Neurosurg 1997. [DOI: 10.1016/s0303-8467(97)82032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Uravić M, Stimac D, Rubinić M, Kovac D, Zilli M, Petrosić N, Prica M. Duodenal obstruction from chronic pancreatitis. MINERVA CHIR 1997; 52:885-9. [PMID: 9354077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The fibrosclerosing process of the pancreas in the chronic pancreatitis may constrict not only the pancreatic duct but also the bile duct, splenoportal venous system and duodenum. In our retrospective study we analysed 24 patients with duodenal obstruction associated with chronic pancreatitis. Duodenal obstruction was suspected whenever repeated vomiting occurred or large volumes of nasogastric aspirate were obtained. The diagnosis was confirmed by barium meal and endoscopic examination. Duodenal obstruction was relieved by gastrojejunostomy in eight patients, gastrojejunostomy and vagotomy in eight patients, gastroduodenostomy and vagotomy in two patients, vagotomy with Finney pyloroplasty in one patient, duodenoplasty with vagotomy in one patient and Whipple procedure in four patients. We concluded that vagotomy and gastroenterostomy are the procedures of choice. Bypass surgery is helpful to relieve the obstruction of the common bile duct and pancreatic duct. Whipple procedure should be reserved for the small duct form of chronic pancreatitis and for the cases in which there is high suspicion of malignancy.
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Affiliation(s)
- M Uravić
- Department of Digestive Surgery, University of Rijeka, Croatia
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46
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Nola M, Babić D, Ilić J, Marusić M, Uzarević B, Petrovecki M, Sabioncello A, Kovac D, Jukić S. Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus. Cancer 1997. [PMID: 8952563 DOI: 10.1002/(sici)1097-0142(19961215)78:12<2543::aid-cncr14>3.0.co;2-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malignant mesenchymal uterine neoplasms are the most aggressive type of primary uterine tumors, with most patients dying within a few years of diagnosis. Thus, it would be very important to define prognostic factors for predicting the malignancy potential of at least some of their subtypes. METHODS Flow cytometric cell cycle analysis (proliferative activity, DNA ploidy, and DNA index) was performed on archival paraffin embedded blocks from 80 patients with malignant mesenchymal uterine neoplasms (endometrial stromal sarcomas, malignant smooth muscle tumors, and malignant Müllerian mixed tumors). The Cox proportional hazards regression model was used to assess relative effects of the following factors on patient survival: clinical stage, mode of therapy, DNA+proliferative activity, DNA index, histologic type, cellularity, degree of atypia, mitotic activity, and depth of myometrial invasion. RESULTS There were 9 low grade stromal sarcomas, 17 high grade stromal sarcomas, 8 smooth muscle neoplasms with uncertain malignant potential, 23 leiomyosarcomas, and 16 homologous and 7 heterologous malignant Müllerian mixed tumors. In univariate analysis for stromal sarcomas, statistical significance was found for DNA ploidy+proliferative activity (P < 0.001), histologic type (P = 0.005), and DNA index (P < 0.001). In multivariate analysis, DNA index appeared to be the only significant parameter influencing patient survival (P = 0.005). In univariate analysis for malignant smooth muscle neoplasms, statistical significance was detected for mitotic activity (P = 0.049) and International Federation of Gynecology and Obstetrics classification (P = 0.021), but in multivariate analysis, clinical stage appeared to be the only significant parameter influencing patient survival (P = 0.032). In univariate analysis for malignant Müllerian mixed tumors, statistical significance was found for the depth of myometrial invasion (P = 0.039), DNA index (P = 0.037), and clinical stage (P = 0.013), but in multivariate analysis, only the depth of myometrial invasion (P = 0.036) and clinical stage (P = 0.025) were of statistical significance. CONCLUSIONS The most powerful prognostic indicator for stromal sarcomas was the DNA index, for malignant smooth muscle neoplasms it was the clinical stage, and for malignant Müllerian mixed tumors it was the depth of myometrial invasion.
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Affiliation(s)
- M Nola
- Department of Gynecological and Perinatal Pathology, Zagreb University School of Medicine, Croatia
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47
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Vecerina Volić S, Kovac D, Seiwerth S, Manojlović S. Correlation between instability of fundamental voice frequency and malignant infiltration of vocal fold nerve endings. Acta Otolaryngol Suppl 1997; 527:131-3. [PMID: 9197502 DOI: 10.3109/00016489709124055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Performing systematically acoustical objective voice analysis in patients with chronic chorditis and glottic cancer we detected a certain number of cases with exceptional acoustical pattern. In 7 of 50 patients with chronic chorditis this acoustical pattern was highly specific demonstrating frequent changes of fundamental frequency in short time interval. In 31 of 50 patients with glottic cancer the same phenomenon was recorded. Histology revealed in 6 of those 7 patients with clinical diagnosis of chronic chorditis invasive cancer of the vocal fold. Detailed and more sophisticated techniques (PAF Halmi for elastic and collagen fibres and neurohistochemical technique S-100 and NSE for nerve elements) demonstrated mainly preserved layer structure of vocal fold lamina propria and infiltrated nerve endings. Such histological findings strongly suggest that cancer infiltration is responsible for rapid changes of fundamental frequency (via mucosal reflexes) although vibratory segments are regular because of preserved layer structure. Such findings could contribute to better understanding of laryngeal control mechanisms and laryngeal mucosal reflexes in human. Also this acoustical sign may be a useful diagnostical parameter for very early diagnosis of glottic cancer. This is possible because of the great sensitivity and complexity of phonatory function.
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Affiliation(s)
- S Vecerina Volić
- ENT Department and Institute of Pathology, School of Medicine, Zagreb, Croatia
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48
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Vecerina-Volić S, Kovac D, Gulić R. [Smokers' edema of the vocal cords]. Lijec Vjesn 1997; 119:1-4. [PMID: 9213723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was the analysis of the etiology, clinical and phonatory characteristics in the subjects with Reinke's oedema. The research was done on 105 subjects, of whom 95 women and 10 men of the age between 28 and 83. The results show that according to the sex, the frequency of the Reinke's oedema is higher in women than in men. The disturbances, not according to the sex, appear mostly in the age between 40 and 60. The voice disturbances last usually for some years. Most of the subjects were smokers (80%) which confirms that smoking (with great intensity and for many years) is the main etiological factor in the development of Reinke's oedema. Less important are considered the voice loadings of long duration, while allergy and acute respiratory infection are mentioned as the possible factors. The values of the phonatory index show less effective air usage during the phonation in the subjects. From the tridimensional spectral analysis of voice that was done on 44 women and 4 men, the data about the frequency of the fundamental laryngeal tone (f degree) were taken. Analysing these data, the lower values of the frequency of the fundamental laryngeal tone were found. The elaboration with the Student's t-test was obtained a statistically important difference of the mentioned parameter in both sexes among the subjects and persons with normal voice. We can conclude that the alteration of the phonatory function is present and in consequence of that, the voice is not effective in communication and less valorous in the media.
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Affiliation(s)
- S Vecerina-Volić
- Fonijatrijski centar Klinike za bolesti uha, nosa i grla Salata, Zagreb
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49
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Abstract
BACKGROUND Malignant mesenchymal uterine neoplasms are the most aggressive type of primary uterine tumors, with most patients dying within a few years of diagnosis. Thus, it would be very important to define prognostic factors for predicting the malignancy potential of at least some of their subtypes. METHODS Flow cytometric cell cycle analysis (proliferative activity, DNA ploidy, and DNA index) was performed on archival paraffin embedded blocks from 80 patients with malignant mesenchymal uterine neoplasms (endometrial stromal sarcomas, malignant smooth muscle tumors, and malignant Müllerian mixed tumors). The Cox proportional hazards regression model was used to assess relative effects of the following factors on patient survival: clinical stage, mode of therapy, DNA+proliferative activity, DNA index, histologic type, cellularity, degree of atypia, mitotic activity, and depth of myometrial invasion. RESULTS There were 9 low grade stromal sarcomas, 17 high grade stromal sarcomas, 8 smooth muscle neoplasms with uncertain malignant potential, 23 leiomyosarcomas, and 16 homologous and 7 heterologous malignant Müllerian mixed tumors. In univariate analysis for stromal sarcomas, statistical significance was found for DNA ploidy+proliferative activity (P < 0.001), histologic type (P = 0.005), and DNA index (P < 0.001). In multivariate analysis, DNA index appeared to be the only significant parameter influencing patient survival (P = 0.005). In univariate analysis for malignant smooth muscle neoplasms, statistical significance was detected for mitotic activity (P = 0.049) and International Federation of Gynecology and Obstetrics classification (P = 0.021), but in multivariate analysis, clinical stage appeared to be the only significant parameter influencing patient survival (P = 0.032). In univariate analysis for malignant Müllerian mixed tumors, statistical significance was found for the depth of myometrial invasion (P = 0.039), DNA index (P = 0.037), and clinical stage (P = 0.013), but in multivariate analysis, only the depth of myometrial invasion (P = 0.036) and clinical stage (P = 0.025) were of statistical significance. CONCLUSIONS The most powerful prognostic indicator for stromal sarcomas was the DNA index, for malignant smooth muscle neoplasms it was the clinical stage, and for malignant Müllerian mixed tumors it was the depth of myometrial invasion.
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Affiliation(s)
- M Nola
- Department of Gynecological and Perinatal Pathology, Zagreb University School of Medicine, Croatia
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50
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Stimac D, Rubinić M, Lenac T, Kovac D, Vcev A, Miletic D. Biochemical parameters in the early differentiation of the etiology of acute pancreatitis. Am J Gastroenterol 1996; 91:2355-9. [PMID: 8931417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We undertook a retrospective study to define the usefulness of various biochemical parameters in differentiation between alcoholic and nonalcoholic acute pancreatitis. METHODS One hundred sixty-seven patients were divided into groups A (alcoholic pancreatitis) and NA (nonalcoholic pancreatitis). Group NA was further subdivided into groups B (biliary pancreatitis) and NANB (nonalcoholic, nonbiliary pancreatitis). The values of serum and urine amylase, serum lipase, AST, ALT, alkaline phosphatase, gamma glutamyl transferase, bilirubin, lipase/amylase ratio, and erythrocyte mean corpuscular volume were investigated. RESULTS Serum amylase, ALT, AST, alkaline phosphatase (p < 0.001), and urine amylase (p < 0.01) were significantly lower in patients with alcoholic pancreatitis. Erythrocyte mean corpuscular volume and lipase/amylase ratio were significantly higher in patients with alcoholic pancreatitis (p < 0.001). There were no differences in lipase, bilirubin, and gamma glutamyl transferase between patients with alcoholic pancreatitis and those with nonalcoholic pancreatitis. Multivariate analysis showed that a combination of three variables (lipase/amylase ratio, erythrocyte mean corpuscular volume, and alkaline phosphatase) differentiated between alcoholic and nonalcoholic pancreatitis. CONCLUSIONS Various biochemical parameters used together and with other clinical features can help in the early differentiation between alcoholic and nonalcoholic acute pancreatitis.
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Affiliation(s)
- D Stimac
- Internal Clinic, Clinical Hospital Center Rijeka, Croatia
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