Ivan Bačić

Negative-pressure in treatment of persistent post-traumatic subcutaneous emphysema with respiratory failure: Case report and literature review

Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published. We report on patient injured in a motor vehicle accident who had serial rib fractures and bilateral pneumothorax managed initially in another hospital. Due to respiratory deterioration, haemodynamic instability and renal failure patient was transferred to our Intensive Care Unit. Massive and persistent subcutaneous emphysema despite adequate thoracic drainage with respiratory deterioration and potentially injurious mechanical ventilation with high airway pressures was the indication for active surgical treatment. Negative-pressure wound therapy dressing was applied on typical blowhole incisions which resulted in swift emphysema regression and respiratory improvement. Negative pressure wound therapy for decompression of severe subcutaneous emphysema represents simple, effective and relatively unknown technique that deserves wider attention.

Laparoscopic Reduction of Intussusception in Children in Restricted Environment: Our Initial Experience Supports Timely Resort to Minimally Invasive Surgery

Address for Correspondence: Nataša Skitarelić, Department for Health Studies, University of Zadar, Zadar, Croatia Department of Pediatrics, Zadar General Hospital, Zadar, Croatia e-mail: Natasa.Skitarelic@xnet.hr ORCID ID: orcid.org/0000-0001-6450-2956 Received: 11 January 2018 Accepted: 1 June 2018 • DOI: 10.4274/balkanmedj.2018.0627 Available at www.balkanmedicaljournal.org Cite this article as: Mihanović J, Karlo R, Bačić I, Skitarelić N. Laparoscopic Reduction of Intussusception in Children in Restricted Environment: Our Initial Experience Supports Timely Resort to Minimally Invasive Surgery. Balkan Med J 2019;36:66-7 ©Copyright 2019 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House. 1Department of Surgery, Zadar General Hospital, Zadar, Croatia 2Department for Health Studies, University of Zadar, Zadar, Croatia 3Department of Pediatrics, Zadar General Hospital, Zadar, Croatia Jakov Mihanović1, Robert Karlo1,2, Ivan Bačić1,2, Nataša Skitarelić2,3

Tumor angiogenesis as an important prognostic factor in advanced non-small cell lung cancer (Stage IIIA)

The aim of the present study was to evaluate angiogenesis by determining the micro vascular density (MVD) and the expression of vascular endothelial growth factor (VEGF-A) in advanced non-small cell lung cancer (NSCLC) tumor samples, and to analyze their associations with clinical parameters and survival. Tumor tissue specimens of fifty patients (41 males and 9 females), who underwent radical surgical treatment for NSCLC in stage IIIA (T1-3N2) were collected for immunohistochemical analysis. MVD evaluation was performed using an anti-CD31 monoclonal antibody and VEGF-A expression using a polyclonal anti-VEGF-A antibody. The results were associated with two-year survival. Statistical analysis revealed significant associations in the level of angiogenesis (high MVD) and shorter survival of patients with NSCLC (P=0.0007). VEGF-A expression showed no association with micro vascular density (P=0.51) or survival (P=0.68). There was no significant association between MVD and VEGF-A. The measurable, clinical MVD parameters could be used as a reliable prognostic factor for the survival of patients with advanced NSCLC.