Reactive cholecystitis as the leading sign of subacute perforation of the right ventricle with the electrode of an implantable cardioverter defibrillator

Subacute lead perforation of the right ventricle caused acute, reactive, acalculous cholecystis, which initially distracted the attention of physicians from the development of hematopericard. Implantation of a cardioverter defibrillator in a young patient after sudden cardiac arrest, but before treatment of significant stenosis of the proximal left anterior descending artery, resulted in a life-threatening condition only 36 days after arrest. After removing the implantable cardioverter defibrillator, there was no sign of pathological cardiac rhythm disorders

Refraktorna bradikardija – rijetka komplikacija karboprost trometamina za induciranje pobačaja

We report a first case of refractory several-hour sinus bradycardia, a rare but already described side effect of intramuscular administration of carboprost tromethamine to induce abortion for medical indication in a patient without cardiovascular and other diseases. After administration of atropine sulfate 3x0.5 mg intravenously without effect, the patient‘s sinus rhythm spontaneously normalized as carboprost was eliminated from the body (it has a 3-hour half-life). It is reasonable to believe that the specific prostaglandin underlay the etiology of bradycardia.Autori prikazuju prvi slučaj refraktorne višesatne sinusne bradikardije, rijetke komplikacije intramuskularne aplikacije karboprost trometamina za induciranje pobačaja iz medicinske indikacije u bolesnice bez srčanožilnih i ostalih bolesti. Nakon davanja 3x0,5 mg atropin sulfata intravenski učinak je izostao, no ritam se spontano normalizirao u sinusni nakon tri sata, što se može smatrati kao vrijeme poluraspada prostaglandina i njegova rijetkog učinka na srčanožilni sustav

TREATMENT OF GASTROINTESTINAL ILLNESS IN PALLIATIVE CARE

U ovom preglednom radu naveden je pristup u palijativnoj skrbi s najčešćim gastrointestinalnim simptomima koje prate bolesnika s terminalnom malignom bolešću: mučnina, povraćanje, proljev, opstipacija, konstipacija, sindrom kaheksija-anoreksija. Uz etio-patogenetske mehanizme nastanka navedenih simptoma i holistički pristup bolesniku u terminalnom razdoblju života navedeni su terapijski postupnici u rješavanju gastrointestinalnih smetnji.This review article describes access to palliative care for patients with gastrointestinal illness in terminal phase of malignant disease, manifesting with vomiting, nausea, diarrhea, obstipation, constipation, and cachexia/anorexia syndrome. Along with the etiopathogenesis of the above symptoms and holistic approach to the patient in terminal period of life, therapeutic protocols for dealing with gastrointestinal illness are presented

Treatment of the pregnancy hypertensive disorders

Liječenje hipertenzivne bolesti u trudnoći uključuje antihipertenzivnu terapiju, antikonvulzivnu profilaksu, kontroliranu ekspanziju volumena (onkotsku terapiju), liječenje poremećaja koagulacije, te dovršenje trudnoće. Ciljevi antihipertenzivne terapije jesu: smanjiti povišeni periferni otpor, povećati perfuziju tkiva, uključujući uteroplacentarnu i fetalnu perfuziju, te spriječiti eklamptični napad, razvoj progresije bolesti i HELLP sindroma. Preporučljivi antihipertenzivi jesu urapidil, nifedipin, labetalol, metildopa, dihidralazin i magnezijev sulfat. Oprezno onkotsko liječenje 6% hidroksietilškrobom ili dekstranima ima za cilj poboljš nje reducirane mikroperfuzije uteroplacentarnog bazena, izovolemičnu hemodiluciju, te tromboprofilaksu. Liječenje aspirinom nije pokazalo poboljšanje u perinatalnom ishodu. Niskomolekularni heparin se profilaktički preporučuje kod teške preeklampsije, teške kronične hipertenzije, nefropatije, transplantacije bubrega i antifosfolipidnih protutijela. Liječenje zahtijeva praćenje hemodinamskog i koagulacijskog statusa, te statusa fetoplacentarne jedinice biofizikalnim profilom i doplersonografskim nadzorom.The management of preeclampsia includes antihypertensive therapy, anticonvulsant prophylaxis, controlled volume expansion (oncotic therapy), treatment of coagulation disorders and termination of pregnancy. Antihypertensives include nifedipin, urapidil, labetalol, methyldopa, dihydralazine and magnesiumsulfat. Oncotic treatment with 6% hydroxyethyl starch or dextrans is used to improve the reduced microperfusion of the uteroplacental unit, isovolemic hemodilution, and thromboprophylaxis. Aspirin therapy failed to show any perinatal outcome improvement. Low molecular heparin is recommended as prophylaxis in severe preeclampsia, severe chronic hypertension, nephropathy, kidney transplantation, and antiphospholipid antibodies. The treatment requires monitoring of the maternal hemodynamic and coagulation status, and of the fetoplacental unit status by biophysical profile and doppler sonography control

MASSIVE RECTORRHAGIA MIMICKING POSSIBLE GENITAL HAEMORRHAGE

Autori prikazuju slučaj 76-godišnje žene za koju se primarno smatralo da ima masivno genitalno krvarenje, no isključenjem pregledom i obradom dokazana je masivna rektoragija. Zbog ireverzibilnog hemoragičnoga urušaja nastupila je smrt bolesnice, a obdukcijom dokazan razdor rektalne angiodisplazije.A case is presented of a 76-year-old woman who was initially considered to have massive genital hemorrhage, but exclusion examination and treatment proved it to be massive rectorrhagia. The patient died due to irreversible hemorrhagic shock and rupture of rectal angiodysplasia was proved on autopsy

Prim. Dr Franjo pl. Fanton and Diseases at the Internal Medicine Ward of the Bjelovar Hospital 1930–1931

Cilj je rada na temelju samo malog dijela očuvanih povijesti bolesti Internog odjela bjelovarske Bolnice 1930.–1931. godine i mrtvarnika iz istog vremena prikazati ondašnji pobol i pomor hospitaliziranih bolesnika na tom odjelu bjelovarske Bolnice. Uzrok smrti bile su dominantno infektivne bolesti, a internistički pobol i pomor sukladan je ondašnjem načinu života, epidemičnim bolestima i prijeantibiotskom razdoblju. Broj bolesnika po jednom specijalistu i različitost patologije daje još jednu novu dimenziju s obzirom na već poznati rad prim. dr. Franje pl. Fantona (1897.– 1970.), koji je bio je prvi internist u bjelovarskoj Županijskoj bolnici i šef Odjela za interne i zarazne bolesti s Pedijatrijskim odsjekom (1925.–1958.).The objective of the paper is to present – based on only fragmentarily preserved case histories from the Internal Medicine Ward of the Bjelovar Hospital 1930–1931, and the mortuary from the same period – the massive dying of the patients hospitalised at the Internal Medicine Ward of the Bjelovar Hospital at that time. The predominant causes of death were infectious diseases. This massive dying was a reflection and a result of the way of life and the epidemic diseases of that time, and the pre-antibiotic era. The number of patients in care of one specialist and the diversity of pathologies add another dimension to the already well-known work of Prim. Dr Franjo pl. Fanton (1897–1970), the first internist at the Bjelovar County Hospital and head of the Department for Internal and Infectious Diseases with Paediatric Section (1925–1958)

Are we giving up on adequate statin doses too easily?

Koronarna bolest srca vodeći je uzrok mortaliteta u razvijenim zemljama, a hiperkolesterolemija jedan je od značajnih čimbenika rizika za razvoj ateroskleroze. U nastojanjima reduciranja učestalosti neželjenih kardiovaskularnih događaja, nužnost je efikasno sniziti koncentraciju serumskog LDL kolesterola, posebice stoga što je to čimbenik rizika koji, uz terapiju, možemo znatno modificirati. Statini su temeljni lijekovi za primarnu i sekundarnu prevenciju kardiovaskularnih bolesti, a njihovo djelovanje dovodi do sniženja ukupnog i LDL kolesterola u plazmi, ali usporivanju procesa ateroskleroze i stabilizaciji ateroma pridonose i brojni drugi učinci statina, povrh samo sniženja razine kolesterola. Upravo iz metaboličkog učinka statina razjašnjena je i moguća etiologija miopatije koja se pojavljuje kao relativna česta pritužba bolesnika, zbog čega se smanjuje doza lijeka ili prekida liječenje, čime se bolesnik izlaže ponovno povišenom riziku za razvoj neželjenoga kardiovaskularnog događaja. Stoga su ovdje navedene i dosadašnje spoznaje o etiologiji i liječenju spomenute nuspojave.Coronary heart disease is the leading cause of mortality in developed countries, and hypercholesterolemia is one of the significant risk factors for the development of atherosclerosis. Attempts to reduce the incidence of cardiovascular events necessitate efficient lowering of LDL cholesterol concentrations, especially since this is a risk factor that we can significantly modify through treatment. Statins are basic drugs for the primary and secondary prevention of cardiovascular diseases, and their activity leads to a reduction in plasma levels of total and LDL cholesterol, but other numerous effects of statins beyond just the reduction of cholesterol levels contribute to atheroma stabilization and slowing down the process of atherosclerosis. It is the metabolic effect of statins that explains the possible etiology of myopathy, which is a relatively common patient complaint leading to reduction in dosage or treatment termination, which once again exposes the patient to increased risk of the development of unwanted cardiovascular events. Thus, the current knowledge on the etiology and treatment of this side effect is also addressed in this article

Maternal and umbilical homocysteine in preeclampsia

Background and purpose: Were to assess the association between homocysteine levels and development of preeclampsia, to determine homocysteine levels in fetal circulation, to differentiate homocysteine levels in mild and severe preeclampsia and to compare homocysteine levels in pregnant women with preeclampsia with homocysteine levels measured in the same group of women six months after delivery. Material and methods: The study included 55 pregnant women with mild or severe preeclampsia (hypertensia with proteinuria), while control group of 50 healthy pregnant women. Maternal and umbilical blood homocysteine levels were determined by the fluorescence polarization immunoassay. Shapiro-Wilks, Mann-Whitney and Wilcoxon statistical tests performed for statistical analysis. Results: In women with preeclampsia, the mean homocysteine level was by 0.744 μmol/L higher than in control women; with mild preeclampsia, the level was by 2.752 μmol/L lower as compared to the women with severe preeclampsia (p < 0.0001). In women with preeclampsia, the mean umbilical blood homocysteine level was by 0.268 μmol/L lower than the respective level measured in control group (p < 0,0001). In women with preeclampsia, the mean homocysteine level was by 0.878 μmol/L lower in the same group of women six months after delivery (p < 0.0001). Conclusion: Homocysteine are lower in preeclamptic women six months after delivery. The neonates born to mothers with preeclampsia are not at a higher exposure to homocysteine