INTRODUCTION Hemostasis is a very important mechanism, whose changes can cause different complications. In the course of surgical interventions some changes in the system of coagulation happen. Laparoscopic cholecystectomy is a method of choice in the treatment of gallbladder calculosis. In the course of the procedure, parameters of hemostasis change, which stimulates a possible appearance of thromboembolic complications. The objective of our research was to reveal the changes in the system of coagulation in patients treated by laparoscopic cholecystectomy. EXAMINEES AND METHODS Total sample involved 60 patients, divided into two groups, who were treated either by classical or laparoscopic method. Parameters of primary and secondary hemostasis were determined for the patients of both groups in Polyclinic for Transfusiology UKC Tuzla, before the operation, in the course, and 24 hours after the operation, and on the 5th day after the surgery. RESULTS Patients from both groups showed changes in the process of coagulation. The changes were more expressed in the group of patients treated by laparoscopic cholecystectomy. Very important result was the increased value of D-dimer measured on the 5th day after the operation in the patients operated by laparoscopic cholecystectomy, where value was 2.5 times higher in the relation to preoperative value (263.5 microg/l, so it was out of referential value). Increase of fibrinogen in both groups were an important result of this study. DISCUSSION AND CONCLUSION Results of the study showed changes in the process of coagulation in both groups, and increased fibrinolytic activity of the organism after laparoscopic cholecystectomy (requires a discussion on longer and thorough prophylaxis of tromboembolism).
This paper describes variations of the appendix vermiformis, found in the course of open appendectomy. Investigations involved surgeries performed in 2008 year in the Regional Hospital TeSanj. Variations in the site of formation and position of appendix vermiformis were established. Dominantly, appendix vermiformis is placed in the pelvic position in 57.71% of cases. In the smallest number of cases (2), or 3.07% lateral (paracecal) position was found. Variations of position of ostium appendicis vermiformis were registered as well. Two types of ostium appendicis vermiformis were found: dorso-medial wall of intestinum caecum below ostium ileocaecale (35.39%), dorso-lateral medial wall of intestinum caecum (30.7%) and lower pole of intestinum caecum (64.61%). Results of this research indicate very large variability of appendix vermiformis anatomy, which together with other factors (age, sex, phase in which is patient at the moment of examination) form a clinical picture of the acute appendicitis.
This describes the indivisible anastomosis of the main stem of median nerve with ulnar nerve through cubital tunnel followed by the anomaly of ulnar artery that appears as superficial ulnar artery. Both anomalies are found during the anatomical dissection of a grown-up male cadaver, on his right arm. Such case is very rare as, in the literature available to us, it has not been described.
Variations of extrahepatic bile ducts are the basis of hepatobilliar surgery, and they may be a problem during the surgical procedures. In this paper we present the results of our research, wich is conducted on 100 human livers. Common hepatic duct wich is formed by connecting of right hepatic duct and left hepatic duct is noticed in 92% of cases, and in 5% of cases was formed by tree bile ducts. Aberant bile ducts was found in 3% of total number of examined.
UNLABELLED Research has been done at a 150 pairs of the human adult kidneys (50 anatomical preparedness plus 100 patients) both sex, randomly chosen. Variations of the kidneys have been analyzed and their respect at a live ones, by clinical tree-dimensional "image"methods and lifeless one by anatomical macro dissection plus corrosive method. CONCLUSION At the most presence of noticed variation had into a size of the kidney, and the lowest one in the number of the kidneys. Technique of magnetic resonance (MR), in relation with computerized tomography (CT) had shown more types of the kidneys variations and more number of the kidney's variations in the form. Percentage of variations of the kidneys at an anatomical preparedness in relation with variations noticed by MR and CT, into a size had relation 44: 4: 0, in the form of 36: 6: 2, in the number 0: 2: 0 and into a location ( rotation) 0: 0: 4. The number and the type of noticed variations of the kidneys show the largest presence at an anatomical matiarials assigned by anatomical macro dissection and corrosive technique in relation with noticed variations of the kidneys by MR and CT. Because of that anatomy finding are set as an imperative into methodological researches of variable anatomy of the kidneys.
In this work the frequency of aberrant and accessory bile ducts on anatomical preparations and clinical radiograms was researched. Aberrant bile ducts were detected in 2.5%.
Having knowledge on models of the bronchial tree branching, is of a special interest for clinical and surgical pulmology, because the hemilobectomy, segmentectomy and subsegmentectomy are always determined by intralobar, intrasegmental and intrasubsegmental bronchial ramification. Investigations were performed on 100 lungs of children and adults of both sexes, one day to 85 years old, randomly chosen. There are two main types of branching of the left upper lobe bronchus: the bifurcation pattern as dominant model in 74% and the trifurcation model found in 26%. Out of 100 lungs studied, 21 lungs had the ventilatory variations of the bronchopulmonary segments. The classification and categorization of the ventilatory of bronchopulmonary segments of the left upper lobe of lung were made. This classification contains 5 categories and 8 subcategories.
The ductus cysticus is variable in the length, position and the site where it enters the ductus hepaticus communis--the cystohepatic junction. The investigations were carried out on 100 livers (50 anatomical preparations and 50 patients) adults of both sexes, randomized trial. Main methods of the research were: anatomical macrodissection and analysis of the clinical radiograms. The ductus cysticus were present as: flat--down course in 70%, flat--horizontal course in 2%, flat--ascendant course in 4%, curved in the shape "J" in 10%, curved in the shape "S" in 12% and curved in the shape "U" in 2%. The cystohepatic junction shows variations in topographic zones.
There were investigated variations of appendix vermiformis in the place of origin and position. The investigations were carried out on 50 human preparations of adults of both sexes, unintentional choice. The position and relation between intestinum caecum and appendix vermiformis were determined by forensic medical and pathoanatomical autopsy. Place of origin of appendix vermiformis, from wall of intestinum caecum is determined by anatomical dissection. Intestinum caecum has a variable shape and it occurs in two forms: conical, which dominates (56%) and square (44%). It has constant position in fossa iliaca dextra in 100% of 50 investigated cases. Appendix vermiformis is fully variable organ as for position and the place of origin from the wall of intestinum caecum. Dominantly (52%) it has rising position, and two subtypes are present: retrocecal (more expressed-38%) related to the retrocolic subtype (14%). Very frequent position of appendix vermiformis is a falling one (32%), in which pelvic position is more frequent (26%) related to descendent position (6%). Appendix vermifirmis is located subcaecaly in 8% of total number of investigated cases, found in three subtypes. It is found out that ostium appendicis vermiformis has a variable position in the wall of intestinum caecum. It is predominantly placed in the middle of the lower pole of the intestinum caecum (58%), in medial wall it is present in 32%, of all investigated, and in the lateral wall in the least number case 10%. The results of these investigations point out how important is to know variable anatomies of appendix vermiformis, for the clinical image of acute appendicitis is undoubtedly caused by the variable anatomical relations.
In this study anatomical variations of shape, size and relation of the kidneys have been analyzed. It has been carried out on 33 pairs of the human adult kidneys of both sex, randomly chosen. It has determined size, width and thickness of the kidney. The kidneys are very variable organs in the size and in the shape. Reduced largeness of the kidney and enlarged kidney are forms of variations of size. Reduced largeness of the left kidney has been found in 18.18%, and enlarged one in 24.24%. Reduced largeness of the right kidney has been found in 24.24% and enlarged one in 21.21%. Two types of the shape were presented: fetal lobularness and lobarnes of the kidney. The shape of left kidney was variable in 39.39%, fetal lobularness was present in 33.33%, and lobarness in 6.06%. The shape of right kidney was variable in 30.30%, foetal lobularness was present in 27.27%, and lobarness in 3.03%. All parameters that determine the size of kidneys show statistically high positive correlation. It means that mutual functional dependence is present, what made it possible from the size of right kidney calculating the size of left kidney and opposite.
In this report is described anomally of arteria ulnaris topography. By anatomical dissection of cadaver of a male new-born, we noticed the ulnar artery, on the right arm, layed superficially, under of fascia antebrachi. The ulnar artery was the branch of brachial artery, and it run directly from the brachial artery, in the level of interepicondilar line, to the madial part of the distal end of antebrachium, and it attached by ulnar nerve before they entered Guyon's canal.
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