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Background: Postoperative nausea and vomiting (PONV) are one of the most common complaints following anesthesia and surgery. This study was designed to evaluate the efficacy of dexamethasone, metoclopramide, and their combination to prevent PONV in patients undergoing laparoscopic cholecystectomy.Methods: A total of 160 ASA physical status I and II patients were included in this randomized, double blind, placebo-controlled study. Patients were randomly assigned to 4 groups (n = 40 each): group 1 consisting of control patients administered 0.9% NaCl; group 2 patients received metoclopramide 10 mg just before the end of anesthesia; group 3 patients received dexamethasone 8 mg after the induction of anesthesia; and group 4 patients received dexamethasone 8 mg after the induction of anesthesia and metoclopramide 10 mg before the end of anesthesia. The incidence of PONV, mean visual analog pain scores at rest and on movement, time to the first request for analgesia, side effects, and well-being score were recorded during the first 24 h postoperatively.Results: Data were analyzed using one-way analysis of variance (ANOVA) and the chi2 test, with p < 0.05 considered statistically significant. The total incidence of PONV was 60% with placebo, 45% with metoclopramide, 23% with dexamethasone, and 13% with the combination of dexamethasone plus metoclopramide. None of the dexamethasone plus metoclopramide group patients (p < 0.05 versus groups 1 and 2) and one dexamethasone group patient (p < 0.05 versus group 1) required antiemetic rescue, as compared with four patients in the metoclopramide group and six patients in the placebo group. Pain scores, the time to the first request for analgesia, and side effects were similar across the study groups.Conclusions: Dexamethasone and the combination of dexamethasone plus metoclopramide were more effective in preventing PONV than metoclopramide and placebo. [ABSTRACT FROM AUTHOR]

We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical re moval of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor.

The aim of this study is to show our experience with umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, both in the same act. During last 10 years we operated 89 patients with cholecystitis and pre-existing umbilical hernia. In 61 of them we performed standard laparoscopic cholecystectomy and additional sutures of abdominal wall, and in 28 patients we performed in the same act laparoscopic cholecystectomy and herniorrhaphy of umbilical hernia. We observed incidence of postoperative herniation, and compared patients recovery after herniorrhaphy combined with laparoscopic cholecystectomy in the same act, and patients after standard laparoscopic cholecystectomy and additional sutures of abdominal wall. Patients, who had in the same time umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, shown better postoperative recovery and lower incidence of postoperative umbilical hernias then patients with standard laparoscopic cholecystectomy and additional abdominal wall sutures.

The optimal anesthetic technique for peripheral vascular surgery remains controversial. The purpose of this study was to evaluate the effect of spinal versus general anesthesia on postoperative pain, analgesic requirements and postoperative comfort in patients undergoing peripheral vascular surgery. A total of 40 patients scheduled for peripheral vascular surgery were randomly assigned to two groups of 20 patients each to receive general anesthesia (GA) or spinal anesthesia (SA). In GA group, anesthesia was induced using thiopental and fentanyl. Vecuronium was used for muscle relaxation. Anaesthesia was maintained with isoflurane and nitrous oxide. In the SA group, hyperbaric 0.5% bupivacaine was injected into the subarachnoid space. Postoperative pain was assessed for 24 hours by a visual analog scale during three assessment periods: 0-4, 4-12 and 12-24 h as well as analgesic requirements. Patients were also asked to assess their postoperative state as satisfactory or unsatisfactory with regard to the pain, side effects and postoperative nausea and vomiting. Visual analogue scale (VAS) pain score was significantly lower in the group SA compared with group GA. This effect was mainly due to the lower pain score during the first study period. The patients received general anesthesia also reported a significantly higher rate of unsatisfactory postoperative comfort than those receiving spinal anesthesia. We conclude that spinal anesthesia is superior to general anesthesia when considering patients' satisfaction, side effects and early postoperative analgesic management.

Acute compartment syndrome of the muscle is condition in which prolonged increase of tissue pressure in closed unyelding fascial compartments reduces capillary perfusion below a level necessary for tissue viability leading to muscle and nerve ischaemia for few hours. There are wide variety different clinical settings associated with compartment syndrome. Acute lower limb compartment syndrome that occur during and after prolonged surgical procedures in Lloyd Davies position is rare but potentially devastating complication that can lead serious local complications and life threatening situations as, rabdomyolysis, kidney failure and death. In this article we summarize pathophysiology, clinical staging and diagnostic procedures of acute compartment syndrome in Lloyd Davies position. We present female patient developed limb compartment sindrome after surgical procedure which lasted 6,5 hours in the Lloyd Davies position for extensive rectovaginal endometriosis. In this article we rewiev different contributing factors that may predispose to compartment syndrome during Lloyd Davies position and undescore importance of recognise the risk factor and prevent the esthablishment of acute compartment syndrome during and after surgery in the Lloyd Davies position.

This study compared Triclosan coated polyglactin 910 (Vicryl* Plus) with polyglactin 910 (Vicryl*) on abdominal wall healing in colorectal surgery patients. 184 patients with colorectal cancer were included in the study. In 91, the abdominal wall was closed with the Vicryl* Plus, and in 93 patients with Vicryl*. Demographic characteristics, biochemical inflammatory parameters, wound appearance, length of hospital stay, postoperative wound complications and post-incisional hernia were recorded. In the Vicryl* Plus group there was a shorter hospital stay (13.2 +/- 1.3 days; 21.4 +/- 2.8 respectively). In the Vicryl* Plus group inflammatory parameters decreased to normal within the first week whereas in the Vicryl* group remained increased. In the Vicryl* Plus group four patients had a wound discharge, seven had inflammatory reactions to the skin sutures. One dehiscence was noticed. In the Vicryl* group 12 patients had an SSI, 14 patients had inflammatory reactions to the skin sutures and 7 patients had a wound dehiscence. Closure of the abdominal wall using Vicryl* Plus decreases postoperative wound complications, length of hospital stay and is associated with a more rapid return of inflammatory markers to normal.

This is a case report of a 71-year-old man, who presented to emergency department with elevated temperature, vomiting and epigastric pain. Computed tomography of the abdomen revealed a large fistulous tract extending from the gallbladder to the duodenal bulb, as well as a large calculus obstructing the second part of the duodenum. The patient subsequently underwent successful surgical therapy.

Effects of pneumoperitoneum on liver function during laparoscopic procedures in most patients have no clinical relevance. However, with increasing number and types of surgical procedures the laparoscopic operation is now performed in high-risk patients, including patients with pre-existing liver disease. In these patients laparoscopic procedures may lead to serious complication, including acute liver failure. Because postoperative liver damage induced by pneumoperitoneum has been underestimated, the aim of this article is to review the numerous factors influencing liver damage during laparoscopy and review of therapeutic options for their reduction.

Tracheal stenosis, a well-known complication of endotracheal intubation and artificial ventilation, is most likely to occur in critically ill patients requiring prolonged mechanical ventilation. Although a rare complication, and despite technological improvements and better patient care in intensive care units, tracheal stenosis still constitutes a serious clinical problem which can also develop after a short period of mechanical ventilation. In this article, we present a very rare case report of a patient who developed a long-segment tracheal stenosis localized at the posterior wall after a relatively short period of endotracheal intubation with a high-volume, low-pressure cuffed endotracheal tube, and a review of the literature.

In this study is demonstrated our experience in single incision laparoscopic cholecystectomy (SILS), compared to standard laparoscopic cholecystectomy. There were 48 single incision laparoscopic cholecystectomies (SILS) performed during one-year period (A group) and results have been compared with a group of 50 patients who underwent standard laparoscopic cholecystectomy (B group). Outcome measures included operative time, need for conversion, complications, additional analgesia for pain control after procedure, hospital stay and cosmetic outcome. The mean operative time was 46 +/- 3.5 min in A group, and 43 +/- 4 min in B patients group. Early postoperative complications were not detected. The mean hospitalization period was 2 days in both groups. Our experience suggests that SILS cholecystectomy can be performed with outcome similar to standard laparoscopic surgery while affording better cosmesis.

Experimental studies indicate that oxidative stress during and after laparoscopic surgery may cause liver ischemia-reperfusion injury. The aim of the study was to assess the effect of ischemic preconditioning against liver damage during pneumoperitoneum on oxidative stress. Twenty one New Zealand rabbits were divided into three groups of seven animals. Control group (C) rabbits received anesthesia for 60 min alone; 15 mm Hg intra-abdominal pressure with CO2 for 60 min was used in the pneumoperitoneum group animals (PNP); and 15-min insufflation and 10-min desuflation followed by 60-min pneumoperitoneum were used in the ischemic preconditioning group animals (IP). Venous blood samples were obtained at different time points to measure lipid hydroperoxide, glutathione reductase and total antioxidant status as indicators of increased oxidative stress. Aspartate transaminase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) levels were evaluated as indicators of hepatocellular injury. The Kruskal-Wallis and Mann-Whitney U tests were used on statistical analysis. Elevated intra-abdominal pressure was found to produce significant increase in lipid hydroperoxide at the end of pneumoperitoneum and 30 min after desuflation in comparison with pre-insufflation period, and with both C and IP groups at the same time points. Total antioxidant status level decreased significantly in the PNP group at 24 h of desuflation. At 24h of desuflation, the AST, ALT and LDH levels were significantly increased in the PNP group in comparison with the levels measured before induction of anesthesia, and with the C and IP groups. Study results demonstrated that ischemic preconditioning prevented hepatocyte injury and oxidative stress during CO2 pneumoperitoneum.

Unlabelled: One of the complications of gastroduodenal ulcer disease is gastrointestinal hemorrhage; it is a cause of a substantial mortality. Standard therapy of gastroduodenal hemorrhage consists of endoscope sclerosation, over sewing or resection. The aim of this study is to analyze our results and methods in treatment of life threatening patients with gastroduodenal hemorrhage., Patients and Methods: A series of 47 life treating patients was surgically treated in General Hospital Sveti Duh in Zagreb for gastroduodenal hemorrhage during the period of 10 years and were retrospectively analyzed. Massive gastroduodenal hemorrhage was endoscopically confirmed, and after insufficient endoscopic therapy, surgically treated. For a treatment in 47 patients (which could not survive gastric resection) we used ulcer over sewing in 20 of them combined with gastroduodenal artery (GDA) or left gastric artery (LGA) ligation., Results: Patients which were treated with combination of artery ligation and ulcer oversewing, had better results in stopping gastroduodenal hemorrhage, lower mortality and recidivism when they were compared with group which was treated only with standard ulcer oversewing, without artery ligations., Conclusions: Combination of artery ligation (LGA or GDA) and ulcer oversewing shows better results in stopping gastroduodenal hemorrhage than standard ulcer suture itself.

Background: The aim of this study was to investigate the effect of low-pressure pneumoperitoneum and pentoxifylline, a methylxanthine derivative, in the prevention of injury caused by free oxygen radicals generated during CO(2 )pneumoperitoneum., Methods: Twenty-eight rabbits were allocated randomly to 4 groups. Control group rabbits (group 1) were subjected to anesthesia for 60 min; group 2 and 3 animals were subjected to a CO(2) pneumoperitoneum (15 or 7 mm Hg); and group 4 rabbits received 50 mg/kg pentoxifylline, followed by a 15-mm-Hg pneumoperitoneum. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), lipid hydroperoxide, glutathione reductase and total antioxidant status were measured., Results: Compared with group 1, a significant increase in lipid hydroperoxide levels at the end of the pneumoperitoneum and 30 min after deflation and a significant decrease in total antioxidant status 24 h after deflation were recorded in group 2. In addition, a significant increase was observed in ALT, AST and LDH levels. These changes were attenuated by low-pressure pneumoperitoneum, whereas pentoxifylline pretreatment appeared to attenuate only transaminase levels., Conclusion: Low-pressure pneumoperitoneum could attenuate ischemia/reperfusion injury induced by CO(2 )pneumoperitoneum in a rabbit model whereas pentoxifylline pretreatment appeared to attenuate only transaminase levels. Pentoxifylline did not prevent the development of oxidative stress., (2009 S. Karger AG, Basel.)

Acute rhabdomyolysis is a syndrome characterized by the lesion of skeletal muscle resulting in subsequent release of intracellular contents into the circulatory system, which can cause potentially lethal complications. These contents include myoglobin, creatine phosphokinase, potassium, aldolase, lactate dehydrogenase and glutamic-oxaloacetic transaminase. There are numerous causes that can lead to acute rhabdomyolysis and many of patients present with multiple causes. The most common potentially lethal complication of rhabdomyoloysis is acute renal failure. In this article we present a case of a patient that developed clinical signs of acute rhabdomyolysis after consumption of heroin and alcohol. After approximately nine hours of alcohol and heroin induced coma he had acute compartment syndrome of the right arm, and clinical and laboratory signs of acute rhabdomyolysis with acute renal failure as a complication of rhabdomyolysis. Acute rhabdomyolysis developed in the patient as the result of acute compartment syndrome, with direct toxic activity of alcohol and diamorphine. During the period of coma, due to lying in particular position over a long period of time, pressure upon the certain part of the body caused muscle compression and capillary occlusion in fascial compartments, which led to ischemia. Upon pressure relief and beginning of tissue recovery, post ischemic compartment syndrome occurred with subsequent rhabdomyolysis. Getting out of coma the patient started to complain of severe pain in the right arm, which clinically worsened on passive stretching of the limb, with the loss of sensation and weakness. Laboratory findings showed high levels of creatine phosphokinase as the most sensitive marker of muscular damage. The peak of creatine phosphokinase level can be predictive for the development of acute renal failure because myoglobin level may return to normal within 6 hours after muscle injury. The peak of creatine phosphokinase (186.080 U/L; normal range 0-177) was recorded at 12 hours of admission. Other pertinent laboratory results such as urea, creatinine, prothrombin time, alanine aminotransferase and aspartate aminotransferase were also changed significantly. The peak of potassium level before dialysis was 6.8 mmol/L. Emergency fasciotomy of the anterior and posterior compartment syndrome was performed by a team of physicians after clinical examination. The second look debridement was performed at 48 and 72 hours. The plastic surgical procedure was performed 4 weeks later. On admission the patient also had oliguria with dark brown pigment in his urine. Arterial blood gases revealed metabolic and respiratory acidosis. The patient was hypovolemic and IV rehydratation with crystalloids, sodium bicarbonate and mannitol started immediately upon admission. Despite therapy his urine output decreased. Hemodialysis was initiated at serum potassium level of 6.8 mm/L and continued until his urine output returned to normal in three weeks. The patient was discharged from the hospital after six weeks, with normal urine output, without functional abnormality in his upper right limb. Acute rhabdomyolysis should be considered as a possibility in any patient with prolonged imobilization while in coma as well as in any intoxicated patient. Of course, creatine phosphokinase is the most sensitive indicator of muscle injury and the degree of creatine phosphokinase elevation correlates with the amount of muscle injury and disease severity. Other laboratory findings can help identify common complications of rhabdomyolysis such as acute renal failure, metabolic derangements and disseminated intravascular coagulopathy.

Introduction: There is an increased risk of cardiovascular morbidity and mortality in patients with nocturnal intermittent hypoxaemia., Objective: The aim of this study was to evalute the influence of nocturnal hypoxaemia on ventricular arrhythmias and myocardial ischaemia in patients with myocardial infarction (MI)., Method: We studied 77 patients (55.8 +/- 7.9 years) with MI free of complications, chronic pulmonary diseases, abnormal awake blood gases tension. All patients underwent overnight pulse oximetry and 24-hour electrocardiography. Patients were divided into two groups according to nocturnal hypoxaemia. Total number of ventricular premature complex (VPC); maximal VPC/h; incidence of VPC Lown class > 2 and occurrence of ST-segment depression were analysed for nocturnal (10 PM to 6 AM), daytime (6 AM to 22 PM) periods and for the entire 24 hours., Results: Both groups were similar in age, gender, standard risk factors, myocardial infarction size and did not differ in VPC during the analysed periods. The number of nocturnal maximal VPC/h was insignificantly greater in group 1 (with hypoxaemia) compared to group 2 (without hypoxaemia), (p = 0.084). Maximal VPC/h did not differ significantly either for daytime or for 24 hours among the groups. Nocturnal VPC Lown > 2 were significantly more frequent in group 1 (25% vs 0%, p = 0.002). The incidence of VPC Lown > 2 was similar during the daytime, and during 24 hrs in both groups. Occurrence of ST-segment depression did not differ between groups 1 and 2., Conclusion: Nocturnal hypoxaemia was associated with complex nocturnal ventricular arrhythmias in patients with MI.

Dyslipidemia is one of the possible risk factors for advanced atherosclerosis in patients with chronic renal failure. Abnormal phospholipid metabolism may play an important role in the progression of atherosclerosis in patients with renal failure. The aim of this study was to determine specific characteristics of plasma and erythrocyte phospholipid content and fatty acid composition in 37 patients with chronic renal failure on hemodialysis (HD). The results were compared with the characteristics of healthy subjects. Briefly, plasma triglyceride (p < 0.001), total cholesterol (p < 0.05), and total phospholipids (p < 0.01) levels were significantly higher and HDL-cholesterol level significantly lower (p < 0.01) in HD patients. Plasma phosphatidylcholine and phosphatidylethanolamine concentration were significantly higher (p < 0.001) in HD patients. The plasma phospholipid fatty acids composition indicated significantly (p < 0.01) higher level of oleic (18:1 n-9) and lower levels of eicopentaenoic (20:5 n-3 EPA) and docosahexaenoic (22:6 n-3 DHA) acids (p < 0.05). However, in HD patients, the relative concentration of plasma phospholipid n-6 polyunsaturated fatty acid (PUFA) was significantly lower (p < 0.05). The fatty acid composition of erythrocyte phospholipid in HD patients was modified with EPA and DHA levels significantly lowered (p < 0.05). Our results demonstrate an abnormal phospholipid metabolism and deficiency of n-3 PUFA in plasma and erythrocyte phospholipids in hemodialyzed patients.

Background: Postoperative nausea and vomiting (PONV) is one of the most significant problems in laparoscopic surgery. The antiemetic effects of metoclopramide and droperidol used alone or in combination for prevention of PONV after laparoscopic cholecystectomy (LC) were assessed in this prospective, double blind, placebo controlled randomized study., Patients and Methods: A series of 140 patients, ASA physical status I or II, were included in the study. Patients were randomized to one of the following groups: 1, placebo; 2, metoclopramide 10 mg after the induction of anesthesia and placebo at 12 h postoperatively; 3, droperidol 1.25 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively; and 4, droperidol 1.25 mg plus metoclopramide 10 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively. Patients were observed for 24 hours for PONV, pain, need for rescue analgesics, and adverse events., Results: Data were analyzed using the Student's t-test and chi-square test, with P < 0.05 considered statistically significant. The mean incidence of PONV was 54% with placebo, 42% with metoclopramide, 14% with two doses of droperidol alone, and 11% with a combination of metoclopramide plus droperidol. The patients receiving a combination of metoclopramide and droperidol had a significantly lower rate of PONV than those administered metoclopramide alone (P < 0.05) or placebo (P < 0.001). Those receiving two-dose droperidol alone also had a significantly lower incidence of PONV compared with metoclopramide (P < 0.05) and placebo (P < 0.001). There was no statistically significant difference between the metoclopramide and placebo groups. Sedation was significantly greater in patients administered droperidol 12 h postoperatively., Conclusion: The combination of metoclopramide and droperidol, and two-dose droperidol alone, were found to significantly decrease the incidence of PONV after LC, whereas metoclopramide alone proved inefficient.

The familial adenomatous polyposis syndrome is an autosomal dominant inherited disease characterized by progressive development of multiple adenomatous polyps throughout the colon and rectum. Due to the malignant potential of adenomatous polyps, colorectal cancer develops in 100% of cases, approximately 10-15 years after the onset of symptoms. Extracolonic manifestations of the disease including adenomatous polyps of the stomach, duodenum, small intestine and periampullatory region are rare. The etiology of the disease is germline mutation at the site of tumor suppressor gene located on chromosomes 5q21-22. A case is described of a 48-year-old man hospitalized at the Department of Abdominal Surgery, Sveti Duh General Hospital in Zagreb for the treatment of familial adenomatous polyposis syndrome. For some time the patient reported occasional abdominal pain, frequent stools and diarrhea with blood, anemia and body weight loss. Laboratory, radiology and endoscopy examinations verified multiple adenomatous polyps of the colon and rectum, also with polyps of the stomach, duodenum and jejunum. Histopathology confirmed the polyps to show moderately poorly differentiated cylindric epithelium and moderate to severe dysplasia. Radical surgery was required, so proctocolectomy with Brook ileostomy was performed. The postoperative recovery and wound healing were normal. The patient was discharged twelve days of the surgery for home care. Oncologic treatment was suggested. Verified extracolonic manifestations of the disease require periodical endoscopic follow up and possible treatment.

Dyslipidemia causes development of atherosclerosis in chronic hemodialysis patients. The goal of this study was to determine values of serum lipids in hemodialysis patients. The study comprised 45 patients, whereas the control group consisted of 45 healthy persons of corresponding age and sex. We determined triacyglycerols, total cholesterol, HDL (high density lipoprotein) and LDL (low density lipoprotein) cholesterol in the serum of patients on an empty stomach. There were 51% of patients with normal findings, and 49% with hyperlipoproteinemia type IV. In regard to the control group triacyglycerol was increased both in patients with hyperlipoproteinemia type IV and in patients with normolipemia. Levels of total cholesterol were higher in patients with hyperlipoproteinemia type IV, while values of HDL cholesterol were decreased in both subgroups of patients in regard to the control group. Values of total cholesterol in relation to HDL cholesterol > 4.5 occurred in 38% of patients. Lipid profile of hemodialysis patients, including those with normolipidemia, points to high risk of cardiovascular diseases.

The first laparoscopic appendectomy was performed by Senn in 1982. Since then, the dilemmas about the validity of this operation in relation to open operation have persisted. Many authors presented the technique modifications and results that are very different. The retrospective results, cost, duration of hospital stay and postoperative recovery analyses for fifty patients in each group were done in this study. Laparoscopic operations were done by "two-handed" technique and in different ways of appendix and mesoappendix closing and cutting. Endoscopic linear cutters were used in the second part of the study. When comparing parameters, laparoscopic operation in relation to open operation is equally safe; quicker; with less postoperative pain; with less wound infections rate; with shorter hospital stay; with less staff time involved; with faster recovery and return to work; more expensive; with better cosmetic effect. In conclusion, laparoscopic appendectomy is better, although more expensive, than open operation, so it should be recommended.

From May 1992, when the first laparoscopic cholecystectomy was performed at University Department of Surgery, Sveti Duh General Hospital, till October 1994, the authors performed more than 1000 procedures. Laparoscopic approach was successfully used in 965 (96.5%) patients. Thirty-five (3.5%) cases were converted to open surgery. Dangerous anatomy, some technical problems and perioperative bleeding were the most often reasons for conversion. Further, liver metastases and perioperatively recognized common bile duct lesion necessitated conversion in one case each. In total, there were 18 (1.8%) abdominal complications. Common bile duct lesion, postoperative common bile duct stricture and duodenal perforation occurred in one patient each. Major bleeding was present in eight and bile leak in seven patients. The mean duration of hospitalization was 2.8 days. Analyses of the results show laparoscopic cholecystectomy to be safe procedure with low perioperative and postoperative complications.

In this prospective study, laparoscopic cholecystectomy was performed in patients with previous abdominal surgery of the lower part of abdomen. According to authors experience, the usual method of 'blind' beginning of the laparoscopic procedure, with safety tests, is a safe and reliable method to start the laparoscopic procedure, even in these patients. This method does not carry a higher risk of intra-abdominal injury.

The aim of this investigation was to determine concentrations of total and single phospholipids and to examine distribution of phospholipid fractions in serum of chronic hemodialysis patients. The investigation included 21 patients, 10 with normal lipid level in serum and 11 with hyperlipoproteinemia type IV. The control group consisted of 17 healthy normolipidemic persons. The gathered results show that in hemodyalisis patients the level of phospholipids (3.10 +/- 0.66 mmol/L) is higher than the level of phospholipids in the control group (2.25 +/- 0.35 mmol/L). Dialysis patients with hyperlipoproteinemia type IV have an increased level of serum phospholipids (3.51 +/- 0.43 mmol/L) in regard to dialysis patients with normolipidemia (2.46 +/- 0.57 mmol/L). The distribution of phospholipid fractions, that is proportional occurrence of lysophosphatidylcholine, sphingophospholipids and phosphatidylcholine is disturbed in dialysis patients no matter what their lipid status is.

In this study doppler ultrasound methods were evaluated from the point diagnostical values, and were compared with the standard X-ray methods (angiography). One of the basic question was, whether noninvasive doppler ultrasonic methods could replace the invasive contrast angiography i. e. in what relations and volume. The investigations were done by CW Doppler and angiodynography, and the results obtained, were compared with the ones of angiography that was taken as the referent method. The 264 segments of blood vessels of lower extremities arterial three were analyzed, and then ranged into the advance defined categories, on the basis of the degree of obstruction. The evaluation of the data obtained was statistically accomplished by the means of "decision matrix" test, and results were displayed by positive predictive values. Positive predictive value for the CW Doppler was 94.07 (in groups varied from 93.10-100) and for angiodynography was 97.35 (in groups varied from 93.15 to 100). From the data obtained, it could be concluded that Doppler's methods are very accurate in a way of diagnostical interpretation (96.03%). The advantages of the Doppler's methods against the conventional standard radiological researches reflect in the following facts: they enable dynamic indicators in real time, they are noninvasive, very exact, and the possibility of verification of stenosis is enabling us to apply the adequate diagnosic (angiography) and therapeutic methods in time.