Extramedullary Plasmacytoma Imitating Neoplasm of the Gallbladder Fossa after Cholecystectomy

Extramedullary plasmacytomas are plasma cell tumors that arise outside of the bone marrow. They account for approximately 3% of plasma cell neoplasms and are most frequently located in the head and neck region. Five months after undergoing cholecystectomy, a 69-year-old patient presented with the pain under the right costal margin and a 12 kg weight loss. Computed tomography of the abdomen demonstrated irregular, vascular mass in the gallbladder fossa that dents towards the duodenum and the pylorus and lowers caudally to the hepatic flexure. His laboratory tests indicated normocytic anemia and showed elevated sedimentation rate. During operative procedure, a tumorous mass in the gallbladder fossa was found, inseparable of the peritoneum of the hepatoduodenal ligament and the IVb liver segment. Histopathological examination and immunohistochemical staining determined the diagnosis of the plasmacytoma. Total resection of the tumor was achieved and after 24-month follow-up patient showed no signs of local recurrence or dissemination of the disease

Seroprevalencija na viruse iz herpes grupe u bolesnika na hemodijalizi

Herpes group viruses (herpes simplex virus, HSV; varicella-zoster virus, VZV; cytomegalovirus, CMV; and Epstein-Barr virus, EBV) remain an important cause of morbidity in immunocompromised persons. The aim of the study was to analyze the prevalence of HSV-1, HSV-2, VZV, CMV and EBV in patients undergoing hemodialysis. During a three-year period (2013-2015), 152 consecutive serum samples from hemodialysis patients and 150 healthy subjects (control group) were tested for the presence of IgM/IgG antibodies to herpes group viruses. Serologic tests were performed using a commercial enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunofluorescent assay (ELFA). Hemodialysis patients showed significantly higher CMV IgG seropositivity compared to controls (88.2% vs. 78.7%, p=0.011). In addition, seroprevalence rates of HSV-1 and VZV were higher in hemodialysis patients; however, these differences did not reach statistical significance (85.5% vs. 80.0%, p=0.054 and 99.3% vs. 96.0%, p=0.051, respectively). The prevalence of HSV-2 and EBV was similar in both groups (12.5% vs. 12.7%, p=0.137 and 98.0% vs. 95.3%, p=0.113, respectively). There was no difference in IgG seropositivity according to gender and place of residence. Logistic regression showed that older age was a significant predictor for CMV and EBV IgG seropositivity (increase in age by one year: CMV OR=1.055; 95%CI=1.030-1.080 and EBV OR=1.075, 95%CI=1.023-1.130).Virusi iz herpes grupe (herpes simpleks virus, HSV; varičela-zoster virus, VZV; citomegalovirus, CMV; Epstein-Barrov virus, EBV) su značajan uzrok smrtnosti u imunokompromitiranih osoba. Cilj rada bio je analizirati učestalost HSV-1, HSV-2, VZV, CMV i EBV u bolesnika koji se liječe hemodijalizom. Tijekom trogodišnjeg razdoblja (2013.-2015.) ispitano je ukupno 152 uzastopno pristiglih uzoraka seruma bolesnika na hemodijalizi te 150 uzoraka seruma zdravih osoba (kontrolna skupina) na prisutnost herpes virusnih IgM/IgG protutijela. Serološko testiranje učinjeno je pomoću komercijalnog dijagnostičkog imunoenzimnog testa (ELISA) ili imunoenzimnog testa s fluorescentnom detekcijom (ELFA). Bolesnici na hemodijalizi bili su značajno češće CMV IgG seropozitivni u odnosu na kontrolnu skupinu (88,2% prema 78,7%, p=0,011). Nadalje, seroprevalencija HSV-1 i VZV također je bila viša u bolesnika na hemodijalizi, no statistička značajnost nije dostignuta (85,5% prema 80,0%, p=0,054; 99,3% prema 96,0%, p=0,051). Učestalost HSV-2 i EBV protutijela nije se razlikovala između skupina (12,5% prema 12,7%, p=0,137, odnosno 98,0% prema 95,3%, p=0,113). IgG seroprevalencija nije se razlikovala u odnosu na spol i mjesto prebivališta. Rezultati logističke regresije pokazali su da je starija životna dob značajan čimbenik rizika za CMV i EBV seropozitivnost (porastom dobi za jednu godinu CMV OR=1,055; 95%CI=1,030-1,080; EBV OR=1,075, 95%CI=1,023-1,130)

Perforated Ascending Colon Cancer Presenting as Colocutaneous Fistula with Abscess to the Anterior Abdominal Wall at the Site of a Cholecystectomy Scar Treated with Biologic Mesh

Ascending colon cancer as a colocutaneous fistula to the abdominal wall at the site of a previous postoperative scar is extremely rare. A 69 year old male presented with five day history of pain and foul smelling discharge from right subcostal scar from elective cholecystectomy performed 8 years ago. Last three days, he had fever up to 39°C, with mild pain in right upper abdominal quadrant without vomiting, diarrhea, bloody stools or weight loss. Computed tomography, with peroral contrast, revealed extralumination into abdominal wall with several fistulas reaching the skin. Emergency median laparotomy found infiltrating tumor of ascending colon into abdominal wall. A right hemicolectomy and complete thickness abdominal wall excision (7´10 cm) was performed. The abdominal wall defect was too extensive for primary closure and two 20 x 20 cm moist gauzes were placed to cover the defect and were fixed with stitches to the skin. On second postoperative day, due to contamination, porcine dermal collagen implant was placed intraperitoneally. Such emergency presentations and therapeutic options are discussed

Combined Vacuum-Assisted Closure Treatment with Laparoscopic Mobilization of an Omental Flap and Meshed Skin Grafts for Reconstruction of Infected Sternotomy Wounds: Two Cases

In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thicknes skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds

Giant Basal Cell Carcinoma of the Back: A Case Report and Review of the Literature

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and the most common human malignancy in general. Out of all basal cell carcinomas, giant basal cell carcinoma represents less than 1%. Only 10% of all basal cell carcinomas are located on the trunk and majority is located on the head and neck. We describe a patient with a exophytic giant basal cell carcinoma of the back size 8.5 x 8 x 6 cm, infiltrating skin 1.5 cm. Two years after the lesion has occurred, diagnosis was made by pathohistological analysis. The patent was treated surgically, by excision. Review of the literature that refers to giant basal cell carcinoma was carried out

Analysis use of antimicrobial drugs and microbiology findings as a method for hospital infection prevalence in a clinical hospital

U ovom istraživanju korištena je standardizirana metodologija Studije prevalencije infekcija u određenom vremenu (Point prevalence survey - PPS), koji je osmišljen od ECDC-a (European Center for Disease prevention and Control) s ciljem procjene infekcije povezane sa zdravstvenom skrbi (Healthcare-associated infections - HAI) i uporabu antimikrobnih lijekova. U razdoblju od 1.srpnja do 13 srpnja 2010.godine provedeno je istraživanje koristeći pilot projekt PPS u Kliničkom bolničkom centru Zagreb. Upotrijebljen je standardizirani upitnik temeljen podacima dobivenih iz povijesti bolesti (patient-based). Obuhvaćeno je 1590 bolesnika, a definiciju HAI zadovoljilo je 10,82% bolesnika. Najveća prevalencija HAI je zabilježena u Jedinicama intenzivnog liječenja s 42,88%. Najčešća HAI je bila infekcija mokraćnog sustava s 33,72%. Najčešće izolirani mikroorganizmi bili su E.coli i Pseudomonas aeruginosa. Primjena antimikrobne terapije u određivanju prevalencije HAI ima dobru osjetljivost (83,14%) i slabu specifičnost (29,8%). Primjena mikrobioloških nalaza u određivanju prevalencije HAI ima slabu osjetljivost (59,2%) i slabu specifičnost (48,75%). Potrebno je naglasiti da su uzorci za mikrobiološku pretragu uzeti u 75% slučajeva, a bili su pozitivni u samo 59,2%. Primjena antimikrobne terapije i mikrobioloških nalaza u određivanju prevalencije HAI ima dobru osjetljivost (72,06%) i slabu specifičnost (33,67%), ali kombinacija ovih dviju metoda značajno doprinosi metodologiji otkrivanja prevalencije bolničkih infekcija uz uštedu vremena zdravstvenih djelatnika.A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAI) and antimicrobial use, developed by the European Centre for Disease Prevention and Control (ECDC) was used in this analysis. Variables were collected at the University Hospital Centre Zagreb Croatia from 1 July to 13 July 2010. A patient-based protocol was used. Out of 1590 surveyed patients, 10,82% had HAI. The highest prevalence of HAI was observed in intensive care units with 42,88%. Urinary tract infection represented the most common type of HAI and presented 33,72% of all HAI. The most commonly isolated microorganisms were Escherichia coli and Pseudomonas aeruginosa. Application of antimicrobial use in determining the prevalence of HAI is highly sensitive (83,14%) and low specificity (29,8%) method. Application of microbiological findings in determining the prevalence of HAI is low sensitive (59,2%) and low specificity (48,75%), however we must emphasize that the swabs were taken in 75% of cases and were positive in only 59.2%. Application of antimicrobial use and microbiological findings in determining the prevalence of HAI are well sensitive (72,06%) and low specificity (33,67%) methods, but combination of these two methods, significantly contributes the methodology in determining the prevalence of hospital infections and saves time of healthcare workers

Analysis use of antimicrobial drugs and microbiology findings as a method for hospital infection prevalence in a clinical hospital

U ovom istraživanju korištena je standardizirana metodologija Studije prevalencije infekcija u određenom vremenu (Point prevalence survey - PPS), koji je osmišljen od ECDC-a (European Center for Disease prevention and Control) s ciljem procjene infekcije povezane sa zdravstvenom skrbi (Healthcare-associated infections - HAI) i uporabu antimikrobnih lijekova. U razdoblju od 1.srpnja do 13 srpnja 2010.godine provedeno je istraživanje koristeći pilot projekt PPS u Kliničkom bolničkom centru Zagreb. Upotrijebljen je standardizirani upitnik temeljen podacima dobivenih iz povijesti bolesti (patient-based). Obuhvaćeno je 1590 bolesnika, a definiciju HAI zadovoljilo je 10,82% bolesnika. Najveća prevalencija HAI je zabilježena u Jedinicama intenzivnog liječenja s 42,88%. Najčešća HAI je bila infekcija mokraćnog sustava s 33,72%. Najčešće izolirani mikroorganizmi bili su E.coli i Pseudomonas aeruginosa. Primjena antimikrobne terapije u određivanju prevalencije HAI ima dobru osjetljivost (83,14%) i slabu specifičnost (29,8%). Primjena mikrobioloških nalaza u određivanju prevalencije HAI ima slabu osjetljivost (59,2%) i slabu specifičnost (48,75%). Potrebno je naglasiti da su uzorci za mikrobiološku pretragu uzeti u 75% slučajeva, a bili su pozitivni u samo 59,2%. Primjena antimikrobne terapije i mikrobioloških nalaza u određivanju prevalencije HAI ima dobru osjetljivost (72,06%) i slabu specifičnost (33,67%), ali kombinacija ovih dviju metoda značajno doprinosi metodologiji otkrivanja prevalencije bolničkih infekcija uz uštedu vremena zdravstvenih djelatnika.A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAI) and antimicrobial use, developed by the European Centre for Disease Prevention and Control (ECDC) was used in this analysis. Variables were collected at the University Hospital Centre Zagreb Croatia from 1 July to 13 July 2010. A patient-based protocol was used. Out of 1590 surveyed patients, 10,82% had HAI. The highest prevalence of HAI was observed in intensive care units with 42,88%. Urinary tract infection represented the most common type of HAI and presented 33,72% of all HAI. The most commonly isolated microorganisms were Escherichia coli and Pseudomonas aeruginosa. Application of antimicrobial use in determining the prevalence of HAI is highly sensitive (83,14%) and low specificity (29,8%) method. Application of microbiological findings in determining the prevalence of HAI is low sensitive (59,2%) and low specificity (48,75%), however we must emphasize that the swabs were taken in 75% of cases and were positive in only 59.2%. Application of antimicrobial use and microbiological findings in determining the prevalence of HAI are well sensitive (72,06%) and low specificity (33,67%) methods, but combination of these two methods, significantly contributes the methodology in determining the prevalence of hospital infections and saves time of healthcare workers

Analysis use of antimicrobial drugs and microbiology findings as a method for hospital infection prevalence in a clinical hospital

U ovom istraživanju korištena je standardizirana metodologija Studije prevalencije infekcija u određenom vremenu (Point prevalence survey - PPS), koji je osmišljen od ECDC-a (European Center for Disease prevention and Control) s ciljem procjene infekcije povezane sa zdravstvenom skrbi (Healthcare-associated infections - HAI) i uporabu antimikrobnih lijekova. U razdoblju od 1.srpnja do 13 srpnja 2010.godine provedeno je istraživanje koristeći pilot projekt PPS u Kliničkom bolničkom centru Zagreb. Upotrijebljen je standardizirani upitnik temeljen podacima dobivenih iz povijesti bolesti (patient-based). Obuhvaćeno je 1590 bolesnika, a definiciju HAI zadovoljilo je 10,82% bolesnika. Najveća prevalencija HAI je zabilježena u Jedinicama intenzivnog liječenja s 42,88%. Najčešća HAI je bila infekcija mokraćnog sustava s 33,72%. Najčešće izolirani mikroorganizmi bili su E.coli i Pseudomonas aeruginosa. Primjena antimikrobne terapije u određivanju prevalencije HAI ima dobru osjetljivost (83,14%) i slabu specifičnost (29,8%). Primjena mikrobioloških nalaza u određivanju prevalencije HAI ima slabu osjetljivost (59,2%) i slabu specifičnost (48,75%). Potrebno je naglasiti da su uzorci za mikrobiološku pretragu uzeti u 75% slučajeva, a bili su pozitivni u samo 59,2%. Primjena antimikrobne terapije i mikrobioloških nalaza u određivanju prevalencije HAI ima dobru osjetljivost (72,06%) i slabu specifičnost (33,67%), ali kombinacija ovih dviju metoda značajno doprinosi metodologiji otkrivanja prevalencije bolničkih infekcija uz uštedu vremena zdravstvenih djelatnika.A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAI) and antimicrobial use, developed by the European Centre for Disease Prevention and Control (ECDC) was used in this analysis. Variables were collected at the University Hospital Centre Zagreb Croatia from 1 July to 13 July 2010. A patient-based protocol was used. Out of 1590 surveyed patients, 10,82% had HAI. The highest prevalence of HAI was observed in intensive care units with 42,88%. Urinary tract infection represented the most common type of HAI and presented 33,72% of all HAI. The most commonly isolated microorganisms were Escherichia coli and Pseudomonas aeruginosa. Application of antimicrobial use in determining the prevalence of HAI is highly sensitive (83,14%) and low specificity (29,8%) method. Application of microbiological findings in determining the prevalence of HAI is low sensitive (59,2%) and low specificity (48,75%), however we must emphasize that the swabs were taken in 75% of cases and were positive in only 59.2%. Application of antimicrobial use and microbiological findings in determining the prevalence of HAI are well sensitive (72,06%) and low specificity (33,67%) methods, but combination of these two methods, significantly contributes the methodology in determining the prevalence of hospital infections and saves time of healthcare workers

Analiza uporabe antimikrobnih lijekova i mikrobioloških nalaza kao metoda praćenja prevalencije bolničkih infekcija u kliničkoj bolnici [Analysis use of antimicrobial drugs and microbiology findings as a method for hospital infection prevalence in a clinical hospital]

A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAI) and antimicrobial use, developed by the European Centre for Disease Prevention and Control (ECDC) was used in this analysis. Variables were collected at the University Hospital Centre Zagreb Croatia from 1 July to 13 July 2010. A patient-based protocol was used. Out of 1590 surveyed patients, 10,82% had HAI. The highest prevalence of HAI was observed in intensive care units with 42,88%. Urinary tract infection represented the most common type of HAI and presented 33,72% of all HAI. The most commonly isolated microorganisms were Escherichia coli and Pseudomonas aeruginosa. Application of antimicrobial use in determining the prevalence of HAI is highly sensitive (83,14%) and low specificity (29,8%) method. Application of microbiological findings in determining the prevalence of HAI is low sensitive (59,2%) and low specificity (48,75%), however we must emphasize that the swabs were taken in 75% of cases and were positive in only 59.2%. Application of antimicrobial use and microbiological findings in determining the prevalence of HAI are well sensitive (72,06%) and low specificity (33,67%) methods, but combination of these two methods, significantly contributes the methodology in determining the prevalence of hospital infections and saves time of healthcare workers

Giant basal cell carcinoma of the back: a case report and review of the literature [Veliki bazocelularni karcinom na leđima: prikaz slučaja i pregled literature]

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and the most common human malignancy in general. Out of all basal cell carcinomas, giant basal cell carcinoma represents less than 1%. Only 10% of all basal cell carcinomas are located on the trunk and majority is located on the head and neck. We describe a patient with a exophytic giant basal cell carcinoma of the back size 8.5 x 8 x 6 cm, infiltrating skin 1.5 cm. Two years after the lesion has occurred, diagnosis was made by pathohistological analysis. The patent was treated surgically, by excision. Review of the literature that refers to giant basal cell carcinoma was carried out