Repository of the Sestre milosrdnice University Hospital Center
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Nekonvencionalni čimbenici rizika za moždani udar
No full textVećinu poznatih čimbenika rizika za cerebrovaskularnu bolest čine konvencionalni parametri, no mnoge vaskularne bolesti se javlju kod bolesnika koji nemaju jasne rizične čimbenike. Novije studije su pokazale mogućnost povećanog rizika za cerebrovaskularni incident u prisustvu odreñenih, nekonvencionalnih čimbenika, čije prisustvo je nezavisno od tradicionalnih, konvencionalnih faktora
Nekirurške metode liječenja karotidne bolesti
No full textMoždani je udar i nadalje jedan od najvećih svjetskih javnozdravstvenih problema, treći je najčešći uzrok smrtnosti u razvijenom svijestu i vodeći uzrok invaliditeta. Većina se odnosi na ishemijske moždane udare, a među njima 20% ishemijskih moždanih udara su posljedica aterosklerotske bolesti karotidnih arterija
Bazilarna impresija kao mogući rijetki uzrok ishemijskog moždanog udara malog mozga – još jedan prikaz slučaja
No full textPredstavljamo 69-godišnju bolesnicu primljenu u Kliniku za neurologiju KBC Sestre milosrdnice hitno radi opće slabosti i vrtoglavice, praćene mučninom i povraćanjem. Inače boluje od reumatoidnog artritisa i osteoporoze
Position of Intragastric Balloons in Global Initiative for Obesity Treatment
No full textObesity is chronic disease with multiple health consequences and among the most severe health problems worldwide. According to public health records around 65% of population in Croatia are overweight and 20% obese. National physicians
chamber with support of Health and Social Welfare Ministry gave recommendations on diagnosing and treating of obesity in form of national consensus. Treatment of obesity is complex and enrolls multiple clinical specialties. Change of life style, strenuous physical activity and pharmacotherapy are part of conservative treatments. Patients are treated more efficiently by minimally invasive endoscopic procedures or bariatric surgery depending on starting body mass index score. Implantation of intragastric balloons is conceptually simple method of obesity treatment. Modern devices as Bio-Enterics intragastric balloons (BIB®), (Inamed Health, USA) are gaining wide popularity among both patients and physicians. BIB intragastric offers the best gains with individuals ranging BMI from 35 to 40. Efficiency has relative timeline dependance from 85% at 6 months to 24% at 36 months. BIB offers substantial ameliorative influence on obesity comorbidities, particularly cardiovascular risk. Treatment with BIB is also efficient but transient treatment modality in morbidly and superobese individuals to reduce preoperative risks of general and bariatric surgery. Obesity treatment with BIB is well tolerated and safe, offering better quality of life. Nevertheless, due to relative poor results of conservative obesity treatments on long term follow up further investigations defining new clinical parameters for solving treatment resistance. In order to provide resourcefully individualized approach modern perspectives are focused on endocrine constitutes of obesity. Hormonal effects of BIB treatment in compare to bariatric surgery are potentially interesting for the prospect studies
Pyoderma Chronica Vegetans Treated with Mesh Skin Grafting
No full textPyoderma chronica vegetans is a rare condition clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Although the etiology is unknown, it is generally believed that vegetating reaction is due to an immune system dysfunction or immunosuppressive state. We report on a 72-year-old man with pyoderma chronica of the buttocks. The lesion on the left buttock worsened two years before with gradual onset of fistulas, scarring and verrucous plaques. Laboratory test revealed medium high erythrocyte sedimentation rate, anemia, shift to left in differential white blood cell count, and polyclonal hyperglobulinemia. Streptococcus species and Escherichia coli were detected in tissue samples. T-cell functional tests for mitogens were decreased. Flow cytometry analysis of phagocytic capability of monocytes and granulocytes by was normal. Inflammatory bowel diseases were excluded with clinical and radiological examination. Anti-HIV test was negative. Histology revealed hyperplasia and irregular acanthosis of the epidermis, sinus and abscess formation, fibrosis and diffuse infiltration of inflammatory cells such as plasma cells, lymphocytes, histiocytes, eosinophils and neutrophils. Surgery was chosen as a therapeutic option as conservative treatment proved ineffective. Therefore, complete excision of the lesion was performed and skin grafting was required to close the defect because of extensity of the lesions. The skin-graft donor site was normal skin. Good postoperative result was achieved, without recurrence of the pyodermatic process
Platelet Serotonin Concentration at Term Pregnancy and after Birth: Physiologic Values for Croatian Population
No full textThe aim of this study was to determine physiological value of platelet serotonin (5-HT) and its variations in the group of women in term pregnancy and after birth. Obtained results were compared to the platelet 5-HT level in nonpregnant women group. Determination of normal level of 5-HT in pregnancy and after could help in its further measurement and evaluation of different psychologic and psychiatric disorders related to pregnant and postpartal period, including better understanding of mood changes after the birth. A total of 137 healthy Croatian women were enrolled in the study – 82 of them were pregnant and 55 were not. Their blood was sampled and the platelet serotonin concentration was determined. In pregnant women the blood was sampled twice: at term pregnancy, and soon after birth. The mean value of 5-HT in pregnant women was 1.209 nmol/mgprotein, after the delivery 1.045 nmol/mgprotein, and in non pregnant 1.088 nmol/mgprotein. The concentrations were significantly different in those three groups. We did not find differences in 5-HT levels in groups divided by age
Biochemical Screening of Fetal Aneuploidies and Neural Tube Defects by »Double-Test« in Croatia: A 10 Years’ Experience
No full textThe aim of the study is to investigate the efficiency of the second-trimester biochemical screening, with maternal serum alpha-fetoprotein (MS-AFP) and free b-subunit of human chorionic gonadotropin (free b-hCG), during the ten-year period. The study included 11,292 of pregnant women between the 15th and 18th gestational week, who underwent screening from November 1996 to December 2006. The risk for trisomy 21 and trisomy 18 were calculated by computer software, based on a model which generated the final risk for fetal aneuploidies from the pregnant woman’s a priori age risk and the likelihood ratio of the distribution of the biochemical markers, according to the second-trimester gestation. With the cut-off value of the final risk 1:250, the detection rate for trisomy 21 was 75% (21/28). In women less than or equal to 35, the detection was 57.1% (8/14) and 92.9% (13/14) in those over 35 years, respectively. The detection rate of trisomy 18 was 50% (2/4). The results confirmed that the implementation of double-test, as non-invasive screening for fetal aneuploidies, should be accepted as a complementary method of antenatal care
Infrared thermography and image analysis for biomedical use
No full textInfrared thermography is used for measuring and analyzing physiological functions and pathology related to the body’s thermal homeostasis and temperature. This review provides an overview of the technological advantages of infrared imaging, with the focus on new advances in and opportunities for infrared imaging, as a reliable medical diagnostic tool.
The review has four main parts. Firstly, a short history of thermography development in medicine is given. Secondly, an overview on the clinical and biomedical research results and methodological improvements in established applications of infrared thermography is provided. Thirdly, the details of published research and development results and activities of the last 3 years for time and frequency domain analysis of infrared video
thermography recordings to study some vital functions of human physiology are discussed. Analysis of infrared video thermography streams resulted in important information on microvascular (arteriolar) function of the skin and of vital organs when exposed during an operation. This new set of parameters of microvascular function enhances the assessment of the cardiovascular system in chronic diseases e.g. in hypertension and diabetes. Infrared thermography provides valuable information when an organ’s suitability for transplantation must be assessed based on quantifiable parameters of organ function and viability. Fourthly, a brief overview on a separate, exciting area of infrared imaging is provided as well: the development of a touchless polygraph system. It enables the study of the psychophysiological parameters of stress, by the assessment of breathing and pulse wave patterns by noncontact methodology, for lie detection purposes.
In conclusion, infrared imaging is a non-invasive, non-radiative, low cost detection tool, and its application area is constantly growing, along with technical improvements and advances
Morbidly Obese are Ghrelin and Leptin Hyporesponders with Lesser Intragastric Balloon Treatment Efficiency: Ghrelin and Leptin Changes in Relation to Obesity Treatment
No full textBackground: Ghrelin and leptin recently emerged as the most influential neuroendocrine factors in the pathophysiology of obesity. The said peptides act in reciprocity and are responsible for regulation of appetite and energy metabolism. Intragastric balloons acquired worldwide popularity for obesity treatment. However, the roles of ghrelin and leptin in intragastric balloon treatment were still not systematically studied. Methods: A prospective single-center study included 43 Caucasians treated with BioEnterics intragastric balloon, with age range of 18–60, and divided to non-morbid (body mass index cutoff 40 kg/m2) or morbid type of obesity, with 12 months follow-up. Serum hormonal samples were taken from fasting patients and kept frozen until analyses. Results: Significant differences were observed in anthropometrics and there were no differences between genders or comorbidities. The baseline weight for non-morbid vs. morbid was 104 kg (90–135) vs. 128.5 kg (104–197). Weight loss was statistically different between the studied groups during the study course with a median control weight at 6 months of 92 kg (72–121) vs. 107 kg (84–163), p<0.001. Treatment was successful for 18 (94.7%) vs. 16 (66.7%) patients, p= 0.026. Ghrelin varied from 333.3 to 3,416.8 pg/ml and leptin from 1.7 to 61.2 ng/ml, with a statistically significant time dependent relationship. A significant difference (p=0.04) with emphasized ghrelin peak was found in the 3rd month of treatment for non-morbidly obese subjects. Conclusions: The importance of ghrelin and leptin in treatment-induced changes was reaffirmed. Ghrelin hyperresponse in non-morbidly obese subjects characterized greater short-term treatment efficiency and landmarked an inclination to weight regain. The results suggest a potential pattern of individualization between obese patients according to body mass index towards intragastric balloon or bariatric surgery. Further studies are needed in order to get better insights in the pathophysiologic mechanisms of obesity
Clinical characteristics at presentation of type 1 diabetes mellitus in children younger than 15 years in Croatia
No full textThe aim of the study was to determine the clinical and biochemical characteristics of type 1 diabetes mellitus (DM) at presentation in children younger than 15 years in Croatia during a 9-year period, with special attention to diabetic ketoacidosis (DKA) incidence. The registered data set comprised blood glucose, pH, serum bicarbonate levels, and clinical symptoms at disease manifestation. During the study period, 692 children were diagnosed with type 1 DM. Polydipsia (96.7 % ), polyuria (96.05 % ), and weight loss (82.7 % ) were the most frequent symptoms anticipating disease detection. Enuresis was recorded in 11.55 % . A total of 36.41 % patients had DKA (pH < 7.3) at disease onset. During the 9-year period, the percentage of children presenting with DKA at time of diagnosis decreased from 41.67 % to 33.33 % (z = 1.68, p = 0.046). A positive family history of DM, the only factor with an impact on the DKA incidence rate in our population, lowers the probability of the development of ketoacidosis. This study confirms the importance of the detection of the classic symptoms of polyuria, polydipsia, and weight loss in patients with new-onset type 1 DM. The percentage of patients with DKA at diabetes onset decreased during the observed period but is still high and includes one-third of all patients. This is why in every acutely ill child, especially at a younger age, one should evaluate the possibility of type 1 DM to avoid the development of ketoacidosis