Browsing by Author "Begovic, Aleksa (57894431500)"

Although the maternal mortality rate has decreased and significant improvements have been made in maternal care, maternal death remains one of the substantial problems of our society. The leading causes of maternal death are postpartum hemorrhage, the most important cause of death in developing countries, and preeclampsia and venous thromboembolism, which are more prevalent in developed countries. To treat these conditions, a variety of therapeutic approaches, including pharmacologic agents and surgical techniques, have been adopted. However, a certain number of pregnant women do not respond to any of these options. That is the main reason for developing new therapeutic approaches. Biological medications are isolated from natural sources or produced by biotechnology methods. Heparin is already successfully used in the therapy of deep venous thrombosis and pulmonary embolism. Blood derivatives, used in an autologous or allogenic manner, have proven to be efficacious in achieving hemostasis in postpartum hemorrhage. Mesenchymal stem cells, alpha-1-microglobulin, and antithrombin exhibit promising results in the treatment of preeclampsia in experimental models. However, it is essential to evaluate these novel approaches' efficacy and safety profile throughout clinical trials before they can become a standard part of patient care. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Background/Objectives: Perforations represent rare but serious complications in ERCP. Although several therapeutic algorithms have been proposed to properly address these potentially life-threatening events, there is still no clear consensus on their management. We conducted a single-center retrospective study in order to assess the incidence of ERCP-related perforations and their management, as well as clinical outcomes. Methods: The hospital’s electronic database was searched in order to identify all the patients who developed ERCP-related perforations in the period 1 October 2018–30 June 2023. Perforations were classified according to the Stapfer classification. Conservative management included frequent abdominal examinations, the monitoring of vital signs, white blood cell count, complete bowel rest, nasogastric tube placement, and the administration of intravenous fluids and antibiotics. Endoscopic management included biliary stent placement and/or closing observed defects with clips. Results: We recorded eight (1.29%) cases of ERCP-related perforations out of the 619 procedures conducted. We observed six (75%) Stapfer type II and two (25%) type IV perforations. In all but one patient (87.5%), the indication for ERCP was bile duct stones. Seven patients (87.5%) were subjected to sphincterotomy (87.5%) and three (37.5%) to “pre-cuts”. All but one patient was treated conservatively (87.5%), with two of them—in which type II perforations were recognized intraprocedurally—also receiving endoscopic treatment with stent placement. On the day of ERCP, one patient with a type II perforation was operated on; suturing of the duodenum followed by duodenal exclusion was applied. Management was successful in all the patients, with a mean hospitalization time of 16.6 ± 4.78 days. Conclusions: Conservative and endoscopic management appear to be associated with good outcomes in Stapfer type II perforations. Nevertheless, an individual multidisciplinary approach involving endoscopists and a hepatobiliary surgeon is essential in order to properly guide the treatment. © 2024 by the authors.