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A Successful Early Gore-tex Reconstruction of an Abdominal wall Defect in a Neonate with Cantrell Pentalogy: a case Report and Literature Review
No full textA surgical technique, materials used for abdominal wall reconstruction, and postoperative care are important for patient outcomes. We report the first case of neonate with Cantrell's pentalogy surviving early reconstruction of abdominal, diaphragmal and pericardial defects. Several recent investigations suggest that intraabdominal pressure monitoring may improve outcomes in this patient category
Cardiopulmonary Resuscitation, Chest Compression only and Teamwork from the Perspective of Medical Doctors, Surgeons and Anesthesiologists
No full textBACKGROUND: New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals.
OBJECTIVES: We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims.
PATIENTS AND METHODS: An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of < 0.05 was considered statistically significant.
RESULTS: The only difference between groups was regarding the male and female ratio, with more male surgeons (45, 55, and 11, P < 0.001). All doctors considered CPR as important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely surgeons call their departmental colleagues and nurses to help in CPR.
CONCLUSIONS: An insufficient formal education in CPR was registered for all groups, reflecting the lack of familiarity with new CPR methods. A team education, involving doctors and nurses may improve familiarity with CPR and patient outcomes
Red Blood Cell Distribution Width as a Simple Negative Prognostic Factor in Patients With Diffuse Large B-cell Lymphoma: a Retrospective Study
No full textAim to determine the prognostic value of baseline red blood cell distribution width (RDW) in diffuse large B cell lymphoma (DLBCL) patients.
Methods: data from 81 DLBCL patients diagnosed from 2006 to 2013 at the University Hospital Center Osijek, Osijek, Croatia, were reviewed. We evaluated disease outcome, overall survival (OS) and event-free survival (EFS), an demographic, clinical and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used.
Results: median age of patients was 64 years, 29 were men (35.8%). Higher RDW levels (%) were found in patients with advanced Ann Arbor clinical stage (14.94 ± 1.82 vs 13.55 ± 1.54, P = 0.001) and in those with poor response to therapy (14.94 ± 1.82 vs 13.55 ± 1.54, P = 0.001). Patients with RDW>15% (cut-off was calculated by receiver operating characteristics) had significantly worse OS (median [range], 33 months [20-46] vs 74 months [65-82], P 15% was an independent prognostic factor for OS (HR 3.654, 95% CI 1.128-11.836) and EFS (HR 2.611, 95% CI 1.012-6-739).
Conclusion: high baseline RDW is an independent prognostic marker of poor outcome in patients with DLBCL. RDW could be an easily available and inexpensive marker for the risk stratification in patients with DLBCL
Syphilitic Hepatitis: Rare or just Unrecognized?
No full textoai:repozitorij.kbco.hr:kbco_213Syphilis is a chronic, infectious, sexually transmitted disease caused by Treponema pallidum and can affect all tissues and all organs. Untreated syphilis progresses through four stages: primary, secondary, latent and tertiary. Among the less common manifestations of the secondary stage is syphilitic hepatitis; syphilis remains one of the unrecognized etiologies of liver dysfunction. Timely treatment as well as effective control of disease are only possible with the early diagnosi
Management and Prognosis of Primary Cerebral Melanocytic Tumors. A Case Report and Systematic Review
No full textPrimary melanocytic cerebral tumors form a spectrum of different lesions that range from benign to extremely malignant, such as an intracranial melanoma. This article points out some characteristics of primary melanocytic cerebral tumors and discusses their management and prognosis, based on a systematic literature review and a case of primary cerebral malignant melanoma. Because the biological characteristics of primary melanocytic cerebral tumors remain unclear, it appears that total surgical resection of the tumor followed by oncologic treatment is the mainstay of the management. The prognosis still depends on the degree of malignancy
A Retrospective, Case-control Study on Traditional Environmental risk Factors in Inflammatory Bowel Disease in Vukovar-Srijem County, North-eastern Croatia, 2010.
No full textBACKGROUND: Traditional environmental risk factors in inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD), were examined as part of the retrospective epidemiologic study conducted in Vukovar-Srijem County, north-eastern Croatia in 2010. The geographical variations in the frequency of IBD in Croatia have been observed, which is also the trend in the Central Eastern European region and Europe as a whole, indicating the influence of environmental and lifestyle factors. However, the data on the spread of environmental IBD risk factors are still limited. The purpose of this study was to analyse the traditional environmental risk factors in IBD on our cohort sample, including measles virus infection and vaccination (MMR vaccine-Mumps, Measles, Rubella), tonsillectomy, appendectomy, current and former cigarette smoking and use of oral contraceptives in women.
METHODS: This retrospective, case-control study was performed as a part of a wider epidemiologic study aimed at assessing the incidence, prevalence and clinical expression of IBD, in Vukovar-Srijem County (population: 204,768; 2001), which is a lesser developed part of the continental Croatia that experienced deep demographic changes in the recent past. IBD patients were identified according to the hospital's patient records. There were 119 UC patients and 31 CD patients of a total of 150 patients in the cohort. A total of 150 individuals, volunteers, not having a diagnosis of IBD, age- and sex-matched, were used as the control group. Information on examined risk factors were obtained from all subjects in a previously conducted interview. Patients were contacted personally or by phone and interviewed by a gastroenterologist.
RESULTS: There were no differences in the number of smokers, former smokers and non-smokers, between UC and CD patients and the controls, nor in the duration of smoking (years), in current smokers and ex-smokers. Only marginally significant longer time of non-smoking, in ex-smokers was found in IBD patients, compared to the controls, more pronounced in CD patients (p = 0.05). No difference was found in relation to tonsillectomy and risk of IBD. There was no difference in the number of female IBD patients and women from the controls using oral contraceptives. Duration (years) of oral contraceptives use was longer in women from the controls than in female IBD patients (p < 0.001). Frequency of appendectomy was the lowest in UC patients, compared to the controls and CD patients (3.4, 12.0 and 38.7%, respectively) (p < 0.001). No difference was found in relation to measles virus infection and risk of IBD. MMR vaccination rates were higher in CD patients (90.3%), compared to UC patients and the controls (74.8 and 67.3%, respectively) (p = 0.026).
CONCLUSIONS: No association was found between smoking and tonsillectomy and risk of IBD. Our results do not support the idea of oral contraceptives use as a risk factor for IBD. Frequency of appendectomy was the lowest in UC patients, suggesting that appendectomy decreases the risk of UC, contributing the earlier results. MMR vaccination seemed to be associated with Crohn's disease. These results can add value to our understanding of the increasing incidence of IBD in Croatia and other Central Eastern European countries and can be introductory to future large-scale research
Cryoglobulinemic vasculitis as a manifestation of paraneoplastic syndrome – a case report
No full textKrioglobulinemija predstavlja prisutnost cirkulirajućih krioglobulina u serumu koji mogu dovesti do organskih oštećenja te sistemskog odgovora karakteriziranog umorom, artralgijama, purpurom, neuropatijom i glomerulonefritisom. Bolest uglavnom zahvaća male i srednje krvne žile i uzrokuje vaskulitis zbog stvaranja imunokompleksa koja sadrže krioglobuline. Miješane krioglobulinemije (tip I. i II.) najčešće su povezane s infekcijama, naročito hepatitisom C (HCV), ali se mogu javljati u sklopu limfoproliferativnih bolesti te autoimunih bolesti. Prikazali smo 75-godišnjeg bolesnika s akrocijanozom i nekrozom distalnih falangi 2. i 4. prsta lijeve šake te purpuroznim promjenama donjih ekstremiteta. Od 2001. bolesnik je liječen po hematologu zbog non-Hodgkinova limfoma želuca (MALT), a od 2002. godine kontrolira se zbog primarnog Sjogrenova sindroma. Učinjenom opsežnom obradom nađena je krioglobulinemija tip II., ali bez dokaza HCV-infekcije ili relapsa limfoproliferativne bolesti. Naknadnom obradom dokazan je slabo diferencirani adenokarcinom prostate i započeto liječenje antiandrogenom. Oko godinu dana nakon pojave simptoma akrocijanoze i digitalne nekroze kontrolnom endoskopskom obradom dokazan je i adenokarcinom želuca, bez tumorskih presadnica, te je provedeno kirurško liječenje. Međutim, postoperativno se razvija kliničko pogoršanje uz pojavu novih digitalnih nekroza na rukama te ubrzo dolazi do smrtnog ishoda pod slikom višesustavnog organskog zatajenja. Povezanost krioglobulinemije i solidnih tumora rijetko je opisana u literaturi, stoga je od izuzetnog značenja detaljna dijagnostička obrada radi što ranijeg otkrivanja osnovne bolesti.Cryoglobulinemia refers to the presence of circulating cryoglobulins in the serum which may lead to organ damage and systemic response characterized by fatigue, arthralgias, purpura, glomerulonephritis and neuropathy. Th e disease mainly aff ects small and medium-sized blood vessels and causes vasculitis due to cryoglobulin-containing immune complexes. Mixed cryoglobulinemia (type I and II) are most oft en associated with infections, especially hepatitis C virus (HCV), but may occur as part of lymphoproliferative and autoimmune diseases. We present a 75 -yearold male patient with acrocyanosis and digital necrosis of the left hand and purpura of the lower extremities. Since 2001 the patient was treated for Non- Hodgkin’s lymphoma of the stomach (MALT) and since 2002 for Sjogren’s syndrome. Extensive diagnostic procedures revealed cryoglobulinemia type II, but without evidence of HCV infection or relapse of lymphoproliferative disorder. Furthermore, poorly diff erentiated prostate adenocarcinoma was diagnosed and antiandrogen treatment was initiated. One year aft er the onset of symptoms acrocyanosis and digital necrosis, gastric adenocarcinoma was diagnosed, without metastatic disease, and surgical treatment was performed. However, postoperatively recurrence of new digital necrosis of the hands occurred along with clinical deterioration and multiple organ failure leading to lethal outcome. Association of cryoglobulinemia and solid tumors is rarely described in the literature, so it is very important to perform comprehensive diagnostic evaluation and detect potential underlying disease as soon as possible
Incidencija moždanog udara i tranzitorne ishemijske atake u hrvatskoj: populacijska studija
No full textThe aim of this population based neuroepidemiological study was to establish the real incidence rate of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the Republic of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.39, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100 000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.Cilj ove populacijske neuroepidemiološke studije bio je utvrditi stvarne stope incidencije akutne cerebrovaskularne bolesti (CVB): moždanog udara (MU) i tranzitorne ishemijske atake (TIA) na području Republike Hrvatske (RH). Multicentričnom studijom obuhvaćena je populacija od 89.501 osoba svih životnih dobi u četiri regionalna središta RH (Zagreb, Osijek + Slavonski Brod, Rijeka i Split). Utvrđene su slijedeće stope incidencije MU izražene na 100.000 stanovnika: Zagreb 290,52, Osijek + Slavonski Brod 302,14, Rijeka 219,65, Split 195,82. Stopa incidencije MU za cijelo područje RH iznosi 251,39. Utvrđene su slijedeće stope incidencije TIA: Zagreb 87,15, Osijek + Slavonski Brod 156,53, Rijeka 90,11, Split 59,10. Stopa incidencije TIA za cijelo područje RH iznosi 100,55. Na kontinentalnom području RH (Zagreb, Osijek + Slavonski Brod) stopa incidencije MU veća je za 45%, a stopa incidencije TIA veća je za 82% u odnosu na priobalni dio RH, vjerojatno zbog razlika u načinu života i okolišnih čimbenika. Studijom su utvrđene relativno visoke stope incidencije akutne CVB (MU i TIA) u RH što potvrđuje da su cerebrovaskularne bolesti veliki javnozdravstveni problem
Adrenergic System Activation Mediates Changes in Cardiovascular and Psychomotoric Reactions in Young Individuals after Red Bull Energy Drink Consumption
No full textObjectives. To assess the effect of Red Bull© on (1) blood glucose and catecholamine levels, (2) cardiovascular and respiratory function changes before, during, and after exercise, (3) reaction time, (4) cognitive functions, and (5) response to mental stress test and emotions in young healthy individuals ( = 38). Methods. Heart rate (HR) and arterial blood pressure (ABP), blood glucose, adrenaline, and noradrenalin plasma levels were measured before and after Red Bull© intake. Participants were subjected to 4 different study protocols by randomized order, before and 30 minutes after consumption of 500 mL of Red Bull©. Results. Mean ABP and HR were significantly increased at rest after Red Bull© intake. Blood glucose level and plasma catecholamine levels significantly increased after Red Bull© consumption. Heart rate, respiration rate, and respiratory flow rate were significantly increased during exercise after Red Bull© consumption compared to control condition. Intake of Red Bull© significantly improved reaction time, performance in immediate memory test, verbal fluency, and subject’s attention as well as performance in mental stress test. Conclusion. This study demonstrated that Red Bull© has beneficial effect on some cognitive functions and effect on cardiovascular and respiratory system at rest and during exercise by increasing activity of the sympathetic nervous system
Differences in the Prevalence and Characteristics of Metabolic Syndrome in Rheumatoid Arthritis and Osteoarthritis: a Multicentric Study
No full textThe purpose of the study was to examine whether rheumatoid arthritis (RA) patients have higher prevalence of metabolic syndrome (MetS) than osteoarthritis (OA) patients in association with a higher level of chronic systemic inflammation in rheumatoid arthritis. A total of 583 RA and 344 OA outpatients were analyzed in this multicentric study. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A 1.6-fold higher prevalence of MetS was found in patients with OA compared with the RA patients. Among the parameters of MetS, patients with OA had significantly higher levels of waist circumference, systolic blood pressure, fasting blood glucose and triglycerides, whereas HDL cholesterol and diastolic blood pressure values were similar in both groups of patients. Higher values of inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)] in MetS than in non-MetS patients and higher prevalence of MetS in patients with CRP level ≥5 mg/L in both RA and OA patients were found. In multivariate logistic regression analysis, significant predictors of MetS were type of arthritis (OA vs. RA; OR 2.5 [95 % CI 1.82-3.43]), age (OR 1.04 [95 % CI 1.03-1.06]) and ESR (OR 1.01; [95 % CI 1.00-1.01]). The significant association between OA and MetS was maintained in the regression model that controlled for body mass index (OR 1.87 [95 % CI 1.34-2.61]). The present analysis suggests that OA is associated with an increased risk of MetS, which may be due to a common underlying pathogenic mechanism