Medical archives (Sarajevo, Bosnia and Herzegovina)最新文献

{"title":"Miliary Tuberculosis in a Two-Year-Old Child: A Case Report from a Low-Prevalence Region.","authors":"Gianluca Dini, Sara Ceccarelli, Barbara Vecchi, Federica Celi","doi":"10.5455/medarh.2024.78.247-249","DOIUrl":"10.5455/medarh.2024.78.247-249","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains the leading cause of death caused by a single infectious agent.</p><p><strong>Objective: </strong>We report a case of miliary TB in a 2-year-old child who presented with a history of constipation, weight loss, marked abdominal distension with hepatosplenomegaly.</p><p><strong>Case presentation: </strong>In children, TB often presents with a wide range of non-specific clinical and radiological manifestations, making diagnosis challenging, particularly in regions with low prevalence. We report the case of a two-year-old female with a history of constipation, weight loss, marked abdominal distension with hepatosplenomegaly, who was later diagnosed with miliary tuberculosis.</p><p><strong>Conclusion: </strong>This case highlights an unusual presentation of miliary TB in a very young child, a demographic in which it is infrequently observed. Miliary TB remains a severe and potentially fatal condition, particularly when diagnosis and treatment are delayed. The diagnosis is usually made based on the clinical presentation, supported by a classic miliary pattern on chest X-ray.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 3","pages":"247-249"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between KI67 Expression and Grading with Chemotherapy Response in Triple-Negative Breast Cancer Patients at Haji Adam Malik General Hospital, Medan.","authors":"Edy Anugrah Putra, Dedy Hermansyah, Endi Taris Pasaribu, Putri Chairani Eyanoer","doi":"10.5455/medarh.2024.78.285-289","DOIUrl":"10.5455/medarh.2024.78.285-289","url":null,"abstract":"<p><strong>Background: </strong>The response to chemotherapy in TNBC varies greatly, highlighting the need for predictive factors to estimate the success of the therapy.</p><p><strong>Objective: </strong>The primary aim of this study is to analyze the relationship between Ki67 expression and clinicopathological features with chemotherapy response in locally advanced TNBC.</p><p><strong>Methods: </strong>This retrospective study utilized secondary data from the medical records of locally advanced TNBC patients at Haji Adam Malik General Hospital, Medan. Out of an initial sample of 50 patients, 35 met the inclusion criteria, which required a confirmed TNBC diagnosis through histopathological and immunohistochemical examination, as well as complete clinical data. Chemotherapy response was assessed based on the World Health Organization (WHO) criteria, ensuring a standardized evaluation of treatment outcomes.</p><p><strong>Results: </strong>The majority of patients were aged ≥50 years (54.5%), with a dominant tumor size of 2-5 cm (69.7%) and high histological grading (Grade 3: 60.6%). A total of 45.5% of patients exhibited high Ki67 expression (≥30%). Chemotherapy response was categorized as complete response (12.1%), partial response (45.5%), stable disease (30.3%), and progressive disease (12.1%). Statistical analysis revealed a significant relationship between Ki67 expression and chemotherapy response (p=0.02), with patients exhibiting high Ki67 expression more frequently achieving complete or partial response.</p><p><strong>Conclusion: </strong>High Ki67 expression is a critical indicator for predicting chemotherapy response in TNBC. Integrating Ki67 assessment with other clinicopathological factors is highly recommended to enhance predictive accuracy and optimize therapeutic planning for more effective treatment outcomes.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 4","pages":"285-289"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Injury After Anterior Cervical Spine Fixation: What Can Thoracic Surgeons Offer?","authors":"Humood A Alsadery, Yesser Aljehani, Farouk Alreshaid, Yasser Elghoneimy, Omar A Bamalan, Abdulrahman Alblowi, Jumana Alhelal, Ayman Elbaz, Moustafa Aboollo","doi":"10.5455/medarh.2024.78.290-295","DOIUrl":"10.5455/medarh.2024.78.290-295","url":null,"abstract":"<p><strong>Background: </strong>The anterior approach for cervical spine surgery was introduced in the late 1950's and was then extensively used with a known considered risk for an esophageal injury.</p><p><strong>Objective: </strong>Therefore, we designed this study to look into our institution's experience in the treatment of esophageal injury post cervical spine fixation looking at possible causes, presentation and risk factors.</p><p><strong>Methods: </strong>A retrospective analysis of esophageal perforation cases secondary to cervical spine fixation, encountered in King Fahad hospital of the University (Eastern province, Dammam, Saudi Arabia) in between (2008-2019) were studied.</p><p><strong>Results: </strong>The patients included were 11, in which the most common presenting symptoms were dysphagia, neck pain, persistent discharge from the cervical wound with or without food particles and odynophagia, while the mean period for presentation was 358.9 days (ranging from 4 to 2555 days). The pharyngo-esophageal perforation repair was done in 9 patients, while 2 patients were treated conservatively. In addition, supportive measures (i.e., frequent wound care, broad spectrum intravenous antibiotics, non per oral and adequate feeding via alternative routes) were done for all patients.</p><p><strong>Conclusion: </strong>Esophageal injury, although uncommon in anterior spinal approach, still considered a life-threatening complication and need a low threshold of suspicion.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 4","pages":"290-295"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Cutoff Point Prostate Specific Antigen (PSA) and Prostate Specific Antigen Density (PSAD) in Patients with Suspected Prostate Cancer.","authors":"Besut Daryanto, Rizal Trianto, Kurnia Penta Seputra, Athaya Febriantyo Purnomo","doi":"10.5455/medarh.2024.78.12-15","DOIUrl":"10.5455/medarh.2024.78.12-15","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer is the second leading cause of cancer death in men worldwide. There is no national standard for PSA cut-off levels even through the transrectal prostate biopsy procedure causes many serious complications such as bleeding, infection, and sepsis. Therefore, determining cut-off levels for PSA and PSAD is essential to avoid unnecessary biopsies.</p><p><strong>Objective: </strong>This study aims to determine the Prostate Specific Antigen (PSA) and Prostate Specific Antigen Density (PSAD) cut-off points in patients with suspected prostate cancer.</p><p><strong>Methods: </strong>A retrospective study was conducted from January 2018 until March 2021 in Saiful Anwar General Hospital Malang Indonesia. Inclusion criterias were patients with suspected prostate cancer; > 50 years old; underwent PSA, PSAD, and prostate biopsy. Exclusion criterias were patients refuse to participate in the study and incomplete patient medical record data. Medical records from 53 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsy were reviewed. Statistical analysis was performed using Mann-Whitney U, Chi-Square, Fisher's Exact, and Receiver Operator Characteristic (ROC) curves.</p><p><strong>Results and discussion: </strong>Medical records conducted 53 patients who met inclusion criteria and underwent transrectal ultrasonography (TRUS)-guided prostate biopsy were reviewed. PSA cut off level for prostate biopsy was 19.71 ng/ml with a sensitivity of 69.23% and a specificity of 72.5%. The positive predictive value is 45% and the negative predictive value is 87.87%. PSAD cut off level for prostate biopsy was 0.4113 with a sensitivity of 61.54% and a specificity of 63.16%. The positive predictive value is 36.36% and the negative predictive value is 82.76%.</p><p><strong>Conclusion: </strong>Results from this study, the cut off levels of PSA and PSAD in prostate disease patients is higher than the recommended cut off; prostate cancer is the largest malignancy in men worldwide and has a higher incidence in the older age and high serum PSA levels group.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 1","pages":"12-15"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Factors Influenced on the Effectiveness of Percutaneous Nephrolithotomy.","authors":"Tran Quoc Hoa, Than Thi Minh Nguyet, Nguyen Thanh Van Anh, Le Tuan Linh, Nguyen Minh Duc, Hoang Dinh Au","doi":"10.5455/medarh.2024.78.33-38","DOIUrl":"10.5455/medarh.2024.78.33-38","url":null,"abstract":"<p><strong>Background: </strong>Generally, there are many methods for the treatment of urinary stones, of which percutaneous nephrolithotomy (PCNL) is a minimally invasive and highly effective method, and now become the first-line management for urinary stones, especially in the cases of complex stones and staghorne calculi. Accurate assessment of stone location, stone morphology, degree of hydronephrosis as well as urinary system abnormalities is extremely important in the percutaneous nephrolithotomy strategy.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the S.T.O.N.E score as well as other factors that influenced the effectiveness of PCNL.</p><p><strong>Methods: </strong>Descriptive study on 71 patients with kidney stones, who underwent multi-slice CT scan of the urinary system before PCNL and then PCNL at Hanoi Medical University Hospital from July 2022 to July 2023. All patients received the informed consent and agreed to participate in the study. The factors included the stone area, the track length (from the skin surface to the stone central), the degree of urinary tract dilatation, the number of involved calyces, the density of stone, the renal parenchyma thickness, the ureteral wall thickness and fat infiltration measured on MSCT non-contrast phase. These factors were used to predict the effectiveness of PCNL including the stone clearance rate (SCR) and the operation time.</p><p><strong>Results: </strong>The mean age of the patient group was 53.8±12.3. The male/female ratio was 1.54. There was a significant difference (p<0.05) between the following factors and the operation time: the stone area (<400, 400-799, 800-1599 and >1600 mm2), the degree of urinary tract dilatation (no or might and moderate or severe dilatation), the number of involved calyces (≤ 2, 3 and staghorne calculi), the renal parenchyma thickness (<18 mm and ≥18mm). In contrast, there were no significant differences between the following factors and the surgery time (p>0.05): the track length (<100 and ≥100 mm), and the stone density (<950 and ≥950 HU). Regarding the S.T.O.N.E score (included five factors: Size, Track length, Obstruction, Number of involved calyces, and Evaluation of stone density), there was a strong correlation between S.T.O.N.E score and the surgery time (p<0.001, r=0.94), and the SCR (p=0.001, r=-0.97).</p><p><strong>Conclusion: </strong>The evaluation of these factors played an important role in the prediction of the effectiveness of PCNL.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 1","pages":"33-38"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Different Surgical Approaches on Morbidity and Mortality in Patients with Borderline Resectable Pancreatic Head Carcinoma.","authors":"Edin Hodzic, Sadat Pusina, Mirhan Salibasic, Ajdin Rovcanin, Emsad Halilovic, Naida Herenda","doi":"10.5455/medarh.2024.78.29-32","DOIUrl":"10.5455/medarh.2024.78.29-32","url":null,"abstract":"<p><strong>Background: </strong>Radical surgical resection for pancreatic head carcinoma offers a chance for cure but unfortunately is only available to a limited number of patients. For a significant number of patients, palliative surgery remains the only option. The question of the most effective approach for patients with borderline resectable pancreatic head carcinoma (BRPHC) remains unresolved. Objective: The aim of the study was to compare the morbidity and mortality following R1 duodenocephalic pancreatectomy and double palliative bypass to explore the most optimal surgical treatment for patients with BRPHC.</p><p><strong>Methods: </strong>Our retrospective cohort study included 64 patients with BRPHC who underwent surgery from 2012 to 2019, with postoperative follow-up for three years. Morbidity and mortality parameters were examined based on the type of surgical treatment: R1 duodenocephalic pancreatectomy or palliative double bypass. Chi-square test, univariate regression, and Kaplan-Meier analysis were used as basic statistical methods in the analysis of the results.</p><p><strong>Results: </strong>Patients undergoing R1 duodenocephalic pancreatectomy had a 3.69 times higher risk of developing biliary leak (p=0.039; 95%CI:1.066, 1.181) and shorter survival compared to those undergoing palliative double bypass (p=0.022). No statistically significant association was found between the type of surgical procedure and other postoperative complications.</p><p><strong>Conclusion: </strong>Our study suggests that the double palliative bypass procedure may be a better option than R1 resection for patients with BRPHC.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 1","pages":"29-32"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granulomatous Myocarditis Caused by Candida Spp Infection in a Spontaneously Diabetic Torii Rat.","authors":"Kinuko Uno, Soon Hui Teoh, Keita Sekiguchi, Noriko Suzuki-Kemuriyama, Takeshi Ohta, Katsuhiro Miyajima","doi":"10.5455/medarh.2024.78.177-179","DOIUrl":"https://doi.org/10.5455/medarh.2024.78.177-179","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis refers to myocardial inflammation with necrosis caused by non-infectious of infectious agents such as bacteria, fungi, or drugs. Candida is known to cause myocarditis in healthy and immunocompromised individuals. Diabetes mellitus causes chronic hyperglycemia due to impaired secretion or hypofunction of insulin, induces a compromised state, and increases the risk of contracting various infections.</p><p><strong>Objective: </strong>We report a case of granulomatous myocarditis caused by Candida in a Spontaneously Diabetic Torii rat, a non-obese diabetic model.</p><p><strong>Case report: </strong>A male SDT rat, 61 weeks of age, was housed in conventional environment. The rat was provided a commercial diet and tap water ad libitum. The heart was sampled and prepared the specimen of hematoxylin-and-eosin-, Sirius-red-, Giemsa-, Grocott-stain. Histologically, formation of large granulation tissue was observed in the left ventricular wall. A center of the foci showed necrosis. Moreover, inflammatory cells infiltration and fibrous component were increased surrounding the foci and between myocardial cells. A Grocott and Giemsa staining-positive cell masses occasionally appearing in the foci were considered to be Candida because of their characteristic form.</p><p><strong>Conclusion: </strong>The development and progression of myocarditis were potentially related to a diabetes-induced compromised state.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 2","pages":"177-179"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10983084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and Neonatal Outcomes of Adolescent Pregnancy in Vietnam.","authors":"Nguyen Thi Thu Ha, Phan Thi Huyen Thuong, Dang Hong Hai, Duong Thi Tra Giang, Nguyen Duy Anh","doi":"10.5455/medarh.2024.78.220-225","DOIUrl":"10.5455/medarh.2024.78.220-225","url":null,"abstract":"<p><strong>Background: </strong>Adolescent pregnancy is a global concern worldwide. According to the World Health Organization (WHO), adolescent pregnancy, also known as teenage pregnancy, is defined as pregnancy in girls between the ages of 10 and 19, with those aged 10 to 15 years termed younger adolescents.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the maternal and neonatal outcomes of adolescent pregnancy.</p><p><strong>Methods: </strong>This descriptive cross-sectional study included 333 singleton pregnancies aged under 19 years at the time of delivery, and delivering at Hanoi Obstetrics and Gynecology Hospital from January 2022 to December 2022. The maternal and neonatal outcomes were collected.</p><p><strong>Results: </strong>The rate of at least one maternal or neonatal adverse outcomes was 84.7%. There were 26.4% anemia, 18.9% preterm birth, 1.8% pre-eclampsia, 2.4% gestational diabetes mellitus, 30.9% urinary tract infection, 41.4% cesarean delivery and 21.0% neonatal low birth weight. Comparable to older adolescents (aged 16-19 years), younger (aged under 16 years) were at higher risk for complications regarding maternal anemia (43.8 vs. 24.6%, p < 0.05), threatened abortion (15.6 vs. 5.0%, p < 0.05), and urinary tract infection (50.0 vs. 28.9%, p < 0.05).</p><p><strong>Conclusion: </strong>Almost adolescent pregnancies have at least one maternal or neonatal adverse outcome. In which, anemia, preterm birth, and neonatal low birth weight are of concern. Thus, it is prior to provide various modalities and improve the antenatal quality to reduce pregnant complication for adolescents.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 3","pages":"220-225"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Factors of Preterm Birth After Selective Laser Umbilical Cord Coagulation for Twin-twin Transfusion Syndrome at Hanoi Obstetrics and Gynecology Hospital.","authors":"Do Tuan Dat, Phan Thi Huyen Thuong, Nguyen Thi Thu Ha, Nguyen Duy Anh","doi":"10.5455/medarh.2024.78.215-219","DOIUrl":"10.5455/medarh.2024.78.215-219","url":null,"abstract":"<p><strong>Background: </strong>Twin-Twin Transfusion Syndrome (TTTS) is a serious complication affecting 10-15% of monochorionic diamniotic twin pregnancies, characterized by imbalanced blood flow between fetuses, which can lead to high morbidity and mortality if untreated. Fetoscopic laser photocoagulation has become the standard treatment, offering improved survival rates by interrupting abnormal blood vessel connections.</p><p><strong>Objective: </strong>This paper focuses on creating models for treatment and diagnosis of patients suffering from Ovaria This study evaluates the prognostic factors influencing the risk of preterm birth after selective laser umbilical cord coagulation in cases of Twin-Twin Transfusion Syndrome (TTTS) stages II-IV.</p><p><strong>Methods: </strong>A prospective study was conducted from September 2019 to November 2020 at the Fetal Medicine Center of Hanoi Obstetrics and Gynecology Hospital. Twenty-one monochorionic-diamniotic twin pregnancies diagnosed with TTTS underwent selective laser umbilical cord coagulation. Gestational age, cervical length changes, and surgical outcomes were recorded and analyzed.</p><p><strong>Results: </strong>The mean gestational age at birth was 34.7 ± 4.3 weeks, with an average pregnancy retention of 12.97 weeks post-surgery. Preterm births occurred in 52.6% of cases, with 31.6% before 34 weeks. Surgery performed after 22 weeks of gestation increased the risk of preterm birth by 4.3 times (p = 0.025), while a cervical length reduction of more than 9.5% within 48 hours post-surgery raised the risk by 8.7 times (p = 0.006).</p><p><strong>Conclusion: </strong>Gestational age at surgery and postoperative cervical length reduction are critical factors influencing the risk of preterm delivery following TTTS treatment.</p>","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 3","pages":"215-219"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Bleeding Ulcer in Cases When the Gastroenterological and Radiological Approach is Insufficient or Disabled - Single Center Expirience.","authors":"Zijah Rifatbegovic, Maja Kovacevic, Muharem Zildzic, Amar Kesetovic, Emir Ahmetasevic","doi":"10.5455/medarh.2024.78.211-214","DOIUrl":"10.5455/medarh.2024.78.211-214","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Urgent surgical treatment of bleeding gastric and duodenal ulcer is indicated in cases where there is no treatment by an interventional gastroenterologist and radiologist readily available, or there is no satisfactory response to the applied interventional procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of our study is to show that there is the still large number of patients with massive bleeding gastric or duodenal ulcers who had to undergo emergency surgery, in order to achieve hemostasis, provide survival analisys, and to present a methode of the surgical procedure which we perfomed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study analysed 49 patients in the period of 5 years (2013-2018), who underwent emergency surgery due to bleeding ulcer. All patients had one or more gastroscopies in order to stop the bleeding, which were ineffective. Surgical treatments which are used in managing ulcer bleedings depended on the localization of the lesion and how severe the bleeding is. Indicated treatment is direct compression of a bleeding blood vessel (ulcer niche), truncal vagotomy, pyloroplasty, gastroduodenal artery ligature, ligature of the right gastroepiploic artery. Resection procedures were performed as well: antrectomy, proximal, subtotal and total gastrectomy. All surgical treatments aimed to preserve the patients of gastrointestinal tract where such an approach could be carried out.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were total of 49 patients who underwent surgical treatment of bleeding ulcer of which 31 are male (63,27%) and 18 are female (36,73%). The survival was 38,78% (19 patients); mortality 61,22% (30 patients). The most common surgical treatment was direct suture of a bleeding vessel with a ligature of the gastroduodenal and right gastroepiploic artery. When we observe the results of resection procedures subtotal gastrectomy was most commonly used. Surgical procedure performed were bilateral vagotomy, ligature of gastroduodenal and right gastroepiploic artery if the ulcer is localized in the antral, pyloric or duodenal region and not penetrating showed that there is no need for gastrotomy/duodenotomy and direct suturing of the bleeding vessel significantly reduces operative procedure, and saves the patient from additional surgical trauma and allows the desired hemostasis. In 5-10% of patients with bleeding ulcers, emergency surgery is indicated due to massive bleeding and hemorrhagic shock and then surgery is the only chance of survival. The primary goal of any surgery for bleeding ulcer is to establish bleeding control. massive ulcer bleeding. All these patients did not have the opportunity to avoid surgery and stop the bleeding with the treatment of an interventional gastroenterologist and radiologist. Survival is 38.78%, mortality is still high 61.22% but it is encouraging that without the application of surgical treatment it would be 100% in this group of patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/str","PeriodicalId":94135,"journal":{"name":"Medical archives (Sarajevo, Bosnia and Herzegovina)","volume":"78 3","pages":"211-214"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}