The Epidemiology and Diagnostic Approach to Acute Pulmonary Embolism in the University Hospital

The aim of this retrospective study was to evaluate the demographics and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital during a six-year period, and to assess the impact of several risk factors on patients’ survival. The study included 165 patients, mean age 69.3 ± 13.7 years, predominantly female (70.3%). Dominant symptom was dyspnea (97.0%), the most common sign tachypnea (69.6%). Pulmonary embolism was confirmed by high-probability ventilation/perfusion lung scan or multidetector computed tomography in 71.5% and was regarded as massive in 63 (38.2%), submassive in 23 (13.9%) and non massive in 79 patients (47.9%). Mean hospital stay was 5.7 ± 4.4 days for ICU, and 14.8 ± 9.1 days, overall. The ICU mortality was 26.7% and in-hospital mortality 30.9%. No statistical difference in mortality between male and female patients was observed (30.6% and 31.0%, respectively; p=0.965), but prolonged immobilization (p=0.002), recent operation (p=0.034) or malignancy (p=0.009) were shown to influence the outcome. Although a number of risk factors for developing pulmonary embolism have been identified and heparin prophylaxis along with early mobilization proposed to reduce the incidence, pulmonary embolism remains an important clinical problem with high mortality rate. The diagnostics should not wait and the therapy should start as soon as possible

Survival Analysis of 314 Episodes of Sepsis in Medical Intensive Care Unit in University Hospital: Impact of Intensive Care Unit Performance and Antimicrobial Therapy

Aim: To evaluate epidemiology of sepsis in medical intensive care unit (ICU) in University Hospital, and the impact of ICU performance and appropriate empirical antibiotic therapy on survival of septic patients. Methods: Observational, partly prospective study conducted over 6 years assessed all patients meeting the criteria for sepsis at ICU admission. Clinical presentation of sepsis was defined according to 2001 International Sepsis Definitions Conference. Demographic data, admission category, source of infection, severity of sepsis, ICU or hospital stay and outcome, ICU performance, and appropriateness of empirical antibiotic therapy were analyzed. Results: The analysis included 314 of 5022 (6.3%) patients admitted to ICU during the study period. There were 176 (56.1%) ICU survivors. At the ICU admission, sepsis was present in 100 (31.8%), severe sepsis in 89 (28.6%), and septic shock in 125 (39.8%) patients with mortality rates 17%, 33.7%, 72.1%, respectively. During ICU treatment, 244 (77.7%) patients developed at least one organ dysfunction syndrome. Of 138 (43.9%) patients who met the criteria for septic shock, 107 (75.4) were non-survivors (P<0.001). Factors associated with in-ICU mortality were acquisition of sepsis at another department (odds ratio [OR] 0.06; 95% confidence interval [CI], 0.02-0.19), winter season (OR 0.42; 0.20-0.89), limited mobility (OR 0.28; 0.14-0.59), ICU length of stay (OR 0.82; 0.75-0.91), sepsis-related organ failure assessment (SOFA) score on day 1 (OR 0.80; 0.72-0.89), history of global heart failure (OR 0.33; 0.16-0.67), chronic obstructive pulmonary disease-connected respiratory failure (OR 0.50; 0.27-0.93), septic shock present during ICU treatment (OR 0.03; 0.01-0.10), and negative blood culture at admission (OR 2.60; 0.81-6.23). Microbiological documentation of sepsis was obtained in 235 (74.8%) patients. Urinary tract infections were present in 168 (53.5%) patients, followed by skin or soft tissue infections in 58 (18.5%) and lower respiratory tract infections in 44 (14.0%) patients. Lower respiratory tract as focus of sepsis was connected with worse outcome (P<0.001). Empirical antibiotic treatment was considered adequate in 107 (60.8%) survivors and 42 (30.4%) non-survivors. Patients treated with adequate empirical antibiotic therapy had significantly higher survival time in hospital (log-rank, P=0.001). Conclusion: The mortality rate of sepsis was unacceptably high. The odds for poor outcome increased with acquisition of sepsis at another department, winter season, limited mobility, higher SOFA score on day 1, history of chronic global heart failure, COPD-connected respiratory failure, and septic shock present during ICU treatment, whereas longer ICU length of stay, positive blood culture, and adequate empirical antibiotic therapy were protective factors

Rani početak sindroma karpalnog tunela u trudnoći: Prikaz slučaja

Carpal tunnel syndrome is common during pregnancy and is considered to have a short and benign course. Carpal tunnel syndrome occurs most frequently in third trimester. Patients are usually managed conservatively; symptoms improve after delivery and do not require surgical intervention. We report an interesting case of pregnancy-associated carpal tunnel syndrome in a23-year-old woman, with detailed electrophysiological studies before and after wrist splinting.Sindrom karpalnog tunela često se javlja za vrijeme trudnoće i najčešće ima kratak i benigni tijek. Obično se javlja u trećem tromjesečju trudnoće. Bolesnice se liječe konzervativno i simptomi se povuku nakon poroda te ne zahtijevaju kirurško liječenje. Prikazuje se zanimljiv slučaj sindroma karpalnog tunela koji se javio u dvadeset trogodišnje žene, potkrijepljen detaljnim opisom elektromiografske analize prije i poslije nošenja ortoze za ručni zglob

Rana klinička iskustva sa dugoročnom potporom (Heart Mate II)

Left ventricular assist systems (LVAS) are widely accepted nowadays as a successful tool for bridging the patients with end-stage heart failure to heart transplantation (BTT). The second generations of axial-flow devices, such as the HeartMate II, provide a safe and reliable, as well as an effective hemodynamic support in such patients, offering them an improved quality of life; they are furthermore associated with a very low rate of device malfunction or infection requiring device change. We report here of our first three patients with the implanted HM II LVAS as a BTT .Uređaji za potporu lijevom srcu (LVAS – left ventricular assist system) su danas prihvaćeni kao uspiješno sredstvo za premoštenje bolesnika u završnom stadiju zatajivanja srca do transplantacije. Druga generacija aksijalnih pumpi, kao što je HeartMate II , pruža sigurnu i učinkovitu hemodinamsku potporu takvim bolesnicima, poboljšavajući kvalitetu života. Danas su ti uređaji povezani sa niskom inicidencijom malfunkcije ili infekcije koje bi zahtijevale zamjenu. Prikazujemo naša tri bolesnika kojima je ugrađen HeartMate II LVAS kao premoštenje do transplantacije

The epidemiology and diagnostic approach to acute pulmonary embolism in the university hospital [Epidemiološki pokazatelji i dijagnostički pristup bolesniku s akutnom plućnom embolijom u kliničkoj bolnici]

The aim of this retrospective study was to evaluate the demographics and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital during a six-year period, and to assess the impact of several risk factors on patients' survival. The study included 165 patients, mean age 69.3 +/- 13.7 years, predominantly female (70.3%). Dominant symptom was dyspnea (97.0%), the most common sign tachypnea (69.6%). Pulmonary embolism was confirmed by high-probability ventilation/perfusion lung scan or multidetector computed tomography in 71.5% and was regarded as massive in 63 (38.2%), submassive in 23 (13.9%) and non massive in 79 patients (47.9%). Mean hospital stay was 5.7 +/- 4.4 days for ICU, and 14.8 +/- 9.1 days, overall. The ICU mortality was 26.7% and in-hospital mortality 30.9%. No statistical difference in mortality between male and female patients was observed (30.6% and 31.0%, respectively; p = 0.965), but prolonged immobilization (p = 0.002), recent operation (p = 0.034) or malignancy (p = 0.009) were shown to influence the outcome. Although a number of risk factors for developing pulmonary embolism have been identified and heparin prophylaxis along with early mobilization proposed to reduce the incidence, pulmonary embolism remains an important clinical problem with high mortality rate. The diagnostics should not wait and the therapy should start as soon as possible

The Epidemiology and Diagnostic Approach to Acute Pulmonary Embolism in the University Hospital

The aim of this retrospective study was to evaluate the demographics and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital during a six-year period, and to assess the impact of several risk factors on patients’ survival. The study included 165 patients, mean age 69.3 ± 13.7 years, predominantly female (70.3%). Dominant symptom was dyspnea (97.0%), the most common sign tachypnea (69.6%). Pulmonary embolism was confirmed by high-probability ventilation/perfusion lung scan or multidetector computed tomography in 71.5% and was regarded as massive in 63 (38.2%), submassive in 23 (13.9%) and non massive in 79 patients (47.9%). Mean hospital stay was 5.7 ± 4.4 days for ICU, and 14.8 ± 9.1 days, overall. The ICU mortality was 26.7% and in-hospital mortality 30.9%. No statistical difference in mortality between male and female patients was observed (30.6% and 31.0%, respectively; p=0.965), but prolonged immobilization (p=0.002), recent operation (p=0.034) or malignancy (p=0.009) were shown to influence the outcome. Although a number of risk factors for developing pulmonary embolism have been identified and heparin prophylaxis along with early mobilization proposed to reduce the incidence, pulmonary embolism remains an important clinical problem with high mortality rate. The diagnostics should not wait and the therapy should start as soon as possible

Early Onset of Carpal Tunnel Syndrome during Pregnancy: Case Report

Sindrom karpalnog tunela često se javlja za vrijeme trudnoće i najčešće ima kratak i benigni tijek. Obično se javlja u trećem tromjesečju trudnoće. Bolesnice se liječe konzervativno i simptomi se povuku nakon poroda te ne zahtijevaju kirurško liječenje. Prikazuje se zanimljiv slučaj sindroma karpalnog tunela koji se javio u dvadeset trogodišnje žene, potkrijepljen detaljnim opisom elektromiografske analize prije i poslije nošenja ortoze za ručni zglob.Carpal tunnel syndrome is common during pregnancy and is considered to have a short and benign course. Carpal tunnel syndrome occurs most frequently in third trimester. Patients are usually managed conservatively; symptoms improve after delivery and do not require surgical intervention. We report an interesting case of pregnancy-associated carpal tunnel syndrome in a23-year-old woman, with detailed electrophysiological studies before and after wrist splinting

Early Onset of Carpal Tunnel Syndrome during Pregnancy: Case Report

Sindrom karpalnog tunela često se javlja za vrijeme trudnoće i najčešće ima kratak i benigni tijek. Obično se javlja u trećem tromjesečju trudnoće. Bolesnice se liječe konzervativno i simptomi se povuku nakon poroda te ne zahtijevaju kirurško liječenje. Prikazuje se zanimljiv slučaj sindroma karpalnog tunela koji se javio u dvadeset trogodišnje žene, potkrijepljen detaljnim opisom elektromiografske analize prije i poslije nošenja ortoze za ručni zglob.Carpal tunnel syndrome is common during pregnancy and is considered to have a short and benign course. Carpal tunnel syndrome occurs most frequently in third trimester. Patients are usually managed conservatively; symptoms improve after delivery and do not require surgical intervention. We report an interesting case of pregnancy-associated carpal tunnel syndrome in a23-year-old woman, with detailed electrophysiological studies before and after wrist splinting