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Noninvasive recanalization of a coronary chronic total occlusion
Get PDFBACKGROUND:
Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. -----
CASE SUMMARY:
We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. ----- DISCUSSION:
There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization
Postnatalni porast tjelesne mase kao prognostički čimbenik za razvoj retinopatije nedonoščadi [Postnatal weight gain as a prognostic factor for retinopathy of prematurity]
Get PDFExisting screening criteria for neonatal retinopathy (ROP) in our state are defined by two cut-off values: gestational age (GA) ≤ 32 weeks and/or birth weight (BW) ≤ 1500 g. Infants above these limit values with an "unstable clinical course" and at increased risk for ROP development according to neonatologists are exceptionally included.
The aim of this study was to examine the possibility of application of a simple biomarker – a postnatal weight gain as an additional criterion in ROP screening.
Medical records of 267 premature infants followed and screened for ROP at the Clinical hospital Zagreb from January 2009 to December 2010 were retrospectively reviewed.
Postnatal weight gain in the first 28 days in premature infants with a mild or severe ROP was significantly lower in comparison with premature infants without ROP. The cut-off value of postnatal weight gain in first 28 days above which not a single child developed mild or severe ROP was 932 g and 660 g respectively. If these criteria would have been applied with the current criteria (GA ≤ 32 and/or BW ≤ 1500 g) sensitivity would have been 100 %. ROP incidence was 62,2% (166/267). Mean GA of infants who developed ROP was 29,4±2,6 weeks, mean BW 1243,2±341,9 g with wide range of GA (23,4 - 35,0 weeks) and BW (620 – 2360 g. The highest share of severe ROP was shown in the most immature infants with GA ≤ 28 weeks (60,7 %) and BW ≤ 999 g (60,0 %). On the other hand, 33 infants with GA ≥ 32 weeks had ROP (19,9 % of all infants with ROP) of whom seven developed severe ROP. Likewise, 36 infants with BW ≥ 1500 g had ROP (21,7 % of all infants with ROP) of whom eight developed severe ROP. Of all infants screened for ROP, 26,6 % (71/267) developed severe ROP which required laser photocoagulation.
Postnatal weight gain in the first 28 days as a simple biomarker can be applied in ROP screening as follows: for the prediction of any form of ROP in addition to the existing criteria GA ≤ 32 weeks and/or BW ≤ 1500 g a criteria and/or postnatal weight gain in 28 days ≤ 932 g, needs to be included, for the prediction of a severe ROP in addition to the existing criteria GA ≤ 32 weeks and/or BW ≤ 1500 g a criteria and/or postnatal weight gain in 28 days ≤ 660 g needs to be included. An important exception to this rule is the use of mechanical ventilation and oxygen for which the risk of consequent ROP development has to be evaluated by a neonatologist in children of GA ≥ 32 weeks and BW ≥ 1500 g. The aforementioned criteria cannot be applied in premature infants with nonphysiological weight gain
Evaluacija strukture i organizacije spavanja te procjena poremećaja disanja u spavanju u djece s epileptičkim encefalopatijama cjelonoćnom video-polisomnografijom [Evaluation of sleep structure and organisation and assessment of sleep-disordered breathing in children with epileptic encephalopathies using all-night polysomnography]
Get PDFAIM of the study was to assess sleep architecture and respiration in sleep in children with EE using the overnight video-polysomnography (V-PSG), related to the group of healthy children and related to the type of EE, disease onset and comorbidities. -----
MATERIALS AND METHODS: From 2015 to 2017, we prospectively recorded overnight V-PSG for 25 children with EE (15 boys, 10 girls, aged 6.86±4.18 years), and 25 healthy sex, age- and BMI- matched children in the control group. -----
RESULTS: Children with EE compared to the children in the control group had shorter total sleep time, longer wake time after sleep onset, decreased sleep efficiency, increased percent-age of N1, decreased N3 and REM sleep, lower average and minimal sat02 during sleep and longer oxygen desaturation time. Related to the type of EE, there was significant difference in REM latency and REM sleep. Related to disease onset, there was positive correlation with amount of REM sleep and negative correlation with amount of N3 sleep. Related to comor-bidities, there was negative correlation of premature birth and sleep latency and positive cor-relation of central apneas in REM sleep with a) perinatal infection and b) more comorbidities. Children treated with more antiepileptic drugs, had longer REM latency. Children with longer seizures, had higher percentage of N2, REM sleep and decreased N3 sleep. -----
Conclusion: The results of altered sleep architecture and marked oxygen desaturation in chil-dren with EE, point to the benefit of referral of children with EE for overnight video-polysomnography, to improve their clinical management and quality of life
1,3-Β-D-glukan u dijagnostici invazivnih gljivnih infekcija – prva iskustva u Hrvatskoj [1,3-Β-D-glucan in invasive fungal infection diagnostics – first Croatian experience]
Get PDFInvasive fungal infections (IFI) are an important problem of modern medicine. The reason is growing
population of immunocompromised patients and high morbidity and mortality of these infections. Timely
diagnosed
IFI is of utmost importance because the delay of antifungal treatment has impact on treatment
outcome.
Cultivation as a conventional diagnostic method has low sensitivity, long duration and demands obtaining
invasive samples. Therefore, in the last two decades fungal biomarkers are investigated for earlier and more
sensitive diagnostics. 1,3-β-D-glucan (BDG) is a fungal biomarker in patients’ sera that enables detection of the
following fungal pathogens: Candida spp., Aspergillus spp., Acremonium, Coccidioides immitis, Fusarium spp.,
Histoplasma
capsulatum, Trichosporon spp., Sporotrix schenckii, Saccharomyces cerevisiae and Pneumocystis jirovecii.
Low level and absence of BDG in the cell wall unables the detection of Cryptococcus spp. and order Mucorales
with this test. High negative predictive value of BDG can be used when deciding to stop antifungal treatment and
be a part of strategy for antifungal stewardship in intensive care units. In hematological patients BDG can be used
as a screening method or as a part of diagnostic work-up when IFI is suspected. Reliability of test result is higher
when two or more consecutive samples are positive. Influence of antifungal prophylaxis on BDG test results is still
unclear. BDG kinetics and its relation to clinical outcome are still investigated. For pediatric population cut-off
values for interpretation are still not defined, although many studies have been published investigating this issue.
Although still not recommended by pediatric guidelines, this test can help in certain situations having in mind its
limitations. BDG as a fungal marker represents the significant progress in IFI diagnostics. With simultaneous application
of other diagnostic methods, exact interpretation and rational use, it can help earlier and more successful
diagnostics and treatment of IFI
Vrijednost trihoskopije u dijagnostici primarnih ožiljnih alopecija
Get PDFPrimary cicatricial alopecias (PCAs) are a rare and poorly understood group of disorders that result in replacement of pilosebaceous unit with fibrous tissue which leads to permanent hair loss and therefore significantly affects the quality of life. The aim of treatment, currently, remains to reduce symptoms and to slow or stop PCA progression, namely the scarring process. Early treatment is the key to minimizing the extent of permanent alopecia. The diagnosis and therefore treatment are based on the Classification of scarring alopecia created by a group of experts from the North American Hair Research Society (NAHRS) at a meeting organized in February 2001. The classification is based on a clinical picture and a pathohistological analysis of the biopsies from the active phase of the disease. Scalp biopsy is the key diagnostic test for diagnosis of PCA because it determines the dominant inflammatory infiltration in active phase of the disease. However, pathohistological interpretation of scalp biopsy can be a major challenge for the pathologist, especially in the absence of detailed anamnesis, inadequate samples, inadequate tissue cuts and an inadequately chosen biopsy site. Although it is known that the biopsy should be taken from the edge of the active lesion, not all the follicles on the edges of the lesion are affected by the disease, especially at the early stage, when the changes are barely visible to the naked eye. Tools to increase the diagnostic accuracy of scalp biopsy are needed. The hypothesis of this study is that the trichoscopy is useful in determining the optimal site for scalp biopsies in primary scarring alopecia, thereby increasing the probability of exact pathohistological diagnosis. This study investigated the pathohistological interpretation of 60 primary scarring alopecia, of which 30 were taken from the edge of the lesion and the site was chosen by the naked eye, and in 30 cases the biopsy was guided with dermatoscope. Based on the results of the study it can be concluded that the examination and dermoscopy guided biopsy increases the probability of an exact histopathological diagnosis by 48% compared with examination and biopsy without dermoscopy. The results of additional analyzes showed that there is a good potential of trichoscopy to completely rule out the need for biopsy in terms of confirmatory diagnosis LPP and DLE. To conclude, the results of our study confirmed the important role of trihoscopy in determining the biopsy site in order to confirm the diagnosis of primary scarring alopecia. In addition, the results indicate a clear potential of trihoscopy as a possible diagnostic and not just auxiliary method
Spontana osteonekroza koljena (SONK) [Spontaneous osteonecrosis of the knee (SONK)]
Get PDFSpontaneous osteonecrosis of the knee (SONK) is the most common type of knee osteonecrosis. It
causes subchondral bone damage and in the majority of cases leads to cartilage damage and secondary osteoarthritis.
The etiology is commonly explained with two main theories, vascular and traumatic. Vascular theory is
based on disrupture of bone blood supply which causes local ischaemia and subchondral bone necrosis. Traumatic
theory suggests the development of subchondral insufficiency fractures due to mechanical overload, which
causes local oedema, ischaemia and necrosis. SONK typically appears in middle age and older women, with acute
onset of sharp pain in the medial femoral condyle without predisposing trauma. Considering that the characteristic
radiological signs are not seen on conventional radiography until advanced stage, magnetic resonance
imaging is the gold standard in diagnostics. Treatment depends on the size and stage of the osteonecrotic lesion.
Small osteonecrotic lesions are usually successfully treated non-operatively, which is based primarily on protected
weight bearing and physical therapy. Medium osteonecrotic lesions are treated either non-operatively or operatively,
while large osteonecrotic lesions are almost always treated operatively. Most commonly used joint preserving
procedures include arthroscopic bone marrow stimulation using microfracture technique, core decompression,
osteochondral autologous or homologous transplantation, artificial graft transplantation, and medial
opening-wedge high tibial osteotomy. The treatment of choice after subchondral bone collapse is knee
arthroplasty
Škljocavi palac u djece [Trigger thumb in children]
Get PDFThe natural course of the condition in pediatric trigger thumb is still controversial, and accordingly,
the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In
this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic
abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most
common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch
between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal
joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description
of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal
joint flexion crease still bears his name. Medical history and physical examination are used to diagnose this deformity
with ultrasound as a potential early diagnostic tool. It is possible to misdiagnose a fracture, dislocation of the
thumb or thumb-in-palm deformity. Clinical investigation has improved our understanding of the natural history
and its benignancy. Therapeutic treatment depends on parent and physician preference. It can be either conservative,
consisting of splint therapy and passive stretching exercises, or surgical, releasing of the A1 pulley that
reliably
restores thumb interphalangeal joint motion. Although it may take several years for spontaneous resolution,
families willing to wait are given an opportunity to avoid hospitalization stress and surgical intervention
Near-infrared surface-enhanced Raman scattering on silver-coated porous silicon photonic crystals
Get PDFSurface-enhanced Raman scattering (SERS) with near-infrared (NIR) excitation offers a safe
way for the detection and study of fragile biomolecules. In this work, we present the possibility of
using silver-coated porous silicon photonic crystals as SERS substrates for near-infrared (1064 nm)
excitation. Due to the deep penetration of NIR light inside silicon, the fabrication of photonic
crystals was necessary to quench the band gap photoluminescence of silicon crystal, which acts as
mechanical support for the porous layer. Optimal parameters of the immersion plating process
that gave maximum enhancement were found and the activity of SERS substrates was tested
using rhodamine 6G and crystal violet dye molecules, yielding significant SERS enhancement for
off-resonant conditions. To our knowledge, this is the first time that the 1064 nm NIR laser excitation
is used for obtaining the SERS effect on porous silicon as a substrate
Utjecaj supstitucijske terapije i zaraženosti virusom hepatitisa C na kvalitetu života ovisnika o opijatima [Influence of substitution therapy and hepatitis C virus infection on the quality of life of individuals with opioid dependence]
Get PDFOpioid dependence is recognized as a chronic recurrent disorder. Because of
limited possibilities of completely curing the disorder, the attention is increasingly
directed toward outcomes reflecting values, experiences, and wishes of the patient. In
other words, outside of the exclusive focus on socially acceptable goals (like achieving
and maintaining abstinence), comprehensive overall care for those with opioid
dependence is directed today toward goals that are in line with a patient’s needs and
expectations. In that sense, quality of life is singled out as a particularly important goal,
or more precisely quality of life associated with health. Previous research has indicated
that there is an extremely low quality of life of those with opioid dependence prior to
initiation of treatment, with a moderate and time limited influence of substitution therapy
on its improvement. In addition to that, most research has shown that there are no
significant differences in influence on quality of life between those with opioid
dependence who are on buprenorphine and those on methadone substitution therapy.
Because of that, longitudinal research was conducted on a convenience sample of
individuals with opioid dependence treated in University Psychiatric Hospital Vrapče and
Andrija Štampar Teaching Institute of Public Health. In order to control for a number of
factors that might have a significant and independent association with the quality of life
of those with opioid dependence, stringent inclusion and exclusion criteria were used. SF-
36 questionnaire was used to assess quality of life, while BDI questionnaire was used to
assess depression. Participants were assessed twice, at the inclusion in the study and after
six months, and the main aim of the research was to determine the quality of life and
possible factors influencing it in individuals with opioid dependence treated with
methadone or buprenorphine substitution therapy. Also, the quality of life of opioid
dependence patients was compared to the quality of life of the general population, and
the possible influence of the hepatitis C virus infection and previous interferon treatment on the quality of life of opioid dependence patients with substitution therapy was
assessed.
The research finally included 202 participants, 110 of which received
buprenorphine, and 92 methadone substitution therapy in the observed period.
Participants on buprenorphine substitution therapy in this study at both first and second
evaluation had statistically significantly better quality of life than participants on
methadone substitution therapy. Differences observed at the second evaluation were more
pronounced than those seen at the first evaluation (except in the somatic illness domain
they did not reach statistical significance), and in line with that in the observed period
there was an improvement in the quality of life of those with opioid dependence on
buprenorphine substitution therapy. In a significant number of participants from both
substitution therapy groups significantly better quality of life was seen at the second
evaluation compared to the initial evaluation. That effect was especially pronounced in
individuals with opioid dependence on buprenorphine substitution who had improvement
in all domains of quality of life during the observed period. In participants on methadone
substitution, between two evaluations there was an improvement only in the domain of
physical functioning (p = 0.007) and perception of general health (p = 0.040).
Receiving buprenorphine substitution (compared to methadone) in the 6-month
study period was a significant predictor of the improvement of the quality of life
associated with health in following domains: limitations due to physical problems,
limitations due to emotional problems, mental health, vitality, and physical pain.
Furthermore, when cumulatively comparing ratio of participants with improved quality
of life between two evaluations in methadone and buprenorphine group in the total
number of participants, in those who were HCV positive and those previously treated
with interferon, it can be seen that in all three groups significant improvement in the
quality of life occurred in the domain of limitations due to emotional problems, mental
health, and physical pain. In other words, it is these domains that could be specified as
those being influenced by buprenorphine substitution the most , which might reflect the
true differences and benefits of the specific pharmacologic profile of buprenorphine.
The results are greatly in line with the existing scientific literature, but what stood
out is the significant difference in the influence on the quality of life of the buprenorphine
substitution compared to methadone, as well as the result that the quality of life in numerous domains for those on buprenorphine substitution at the second evaluation
equaled that of, and in some proved better (especially in domains associated with physical
health) than that in general population. Contrary to that, quality of life for those
participants receiving methadone substitution was significantly worse than that of general
population, except in the domain of physical functioning.
The results of this research show that the hepatitis C virus infection has a strong
effect on the quality of life of those with opioid dependence, regardless of the substitution
therapy. Also, previous interferon treatment affected the quality of life of those with
opioid dependence significantly, regardless of the substitution therapy and the hepatitis
C virus infection. However, even in those participant subgroups significantly better
quality of life was seen in the participants on buprenorphine substitution.
The results of this research are an important contribution to the understanding of
the relationship of the influence of buprenorphine and methadone on the quality of life of
those with opioid dependence. It is of great significance that in these unique study
conditions buprenorphine substitution proved to have significantly more positive effect
on the quality of life associated with health than the methadone substitution. Also, it was
shown that hepatitis C virus infection and the previous interferon therapy influence the
quality of life of those with opioid dependence in a complex manner independent of the
substitution therapy
Dijagnostička vrijednost širokopojasne timpanometrije u pacijenata oboljelih od otoskleroze [Diagnostic value of wideband tympanometry in patients with otosclerosis]
Get PDFINTRODUCTION: Wideband tympanometry is a new technique for assessing middle ear transfer function in which probe tone of 226 Hz is replaced by a probe “click” that covers the 226 to 8000 Hz range. It is still not clear if otosclerosis could be diagnosed based on wideband tympanometry findings. ----- METHODS: Longitudinal prospective study included 50 patients with surgically confirmed otosclerosis and 50 normal hearing persons. ----- RESULTS: Significant differences between EA in otosclerosis and EA in the control group were found at frequency range 343 Hz-3268 Hz with EA lower in otosclerosis and at frequency range 4238 Hz -7550 Hz with EA higher in otosclerosis than in control group. ROC analysis showed that the best sensitivity and specificity in differentiating otosclerosis from healthy subjects was obtained by observing the average EA at frequency range > 500Hz ≤ 1000Hz. There was no correlation between EA and postoperative hearing improvement. ----- CONCLUSIONS: The results of our study suggest that wideband timpanometry may be useful in the diagnosis of otosclerosis, but it can not replace pure tone audiometry in assessing the degree of hearing impairment and the expected postoperative improvement