Istodobna duboka venska tromboza i plućna embolija udružena s hipertireozom: prikaz slučaja

Numerous disorders of coagulation and fibrinolysis have been reported in patients with thyroid diseases, especially with hyperthyroidism. Most articles are focused on deep vein thrombosis risk, however, few of them describe association between hyperthyroidism and pulmonary embolism. We report a case of a 43-year-old woman with long-term uncontrolled hyperthyroidism complicated by venous thromboembolism. The potential mechanisms could be endothelial dysfunction, decreased fibrinolytic activity, and increased levels of coagulation factors. Thyroid evaluation should be recommended in patients with unprovoked venous thromboembolic events.Različiti poremećaji koagulacije ponekad se povezuju s bolestima štitnjače, najčešće hipertireozom. Većina dosadašnjih radova je usredotočena na rizik duboke venske tromboze kod takvih bolesnika, dok je u vrlo malom broju radova opisana povezanost hipertireoze i plućne embolije. Prikazuje se slučaj 43-godišnje bolesnice s dugogodišnjom nekontroliranom hipertireozom i posljedičnim akutnim venskim tromboembolizmom. Vjerojatni patofiziološki mehanizam uključuje oštećenje endotela, smanjenje fibrinolitičke aktivnosti i povećanu razinu faktora koagulacije. Klinička i laboratorijska evaluacija štitnjače preporučljiva je u bolesnika s neprovociranim tromboembolijskim događajem

Castlemanova bolest koja se prezentirala kao tumorska parakardijalna tvorba

Castleman’s disease (in the literature also known as angiofollicular hyperplasia) is a rare benign lymphoproliferative disease. Clinically, it can manifest as unicentric or multicentric disease. Unicentric disease is most often diagnosed by accident or by symptomatology resulting from compression upon the adjoining anatomical structures. Considering its lymphatic origin, tumor mass can theoretically occur in any body region. We present a case of paracardiac localization of unicentric Castleman’s disease in a previously healthy 24-year-old woman. In such clinical cases, the specific localization of the tumor and its radiological properties can pose a differential diagnostic dilemma. Correct diagnosis is only possible after complete surgical excision and histopathologic analysis, which is the optimal therapeutic approach in this disease.Castlemanova bolest (u literaturi još poznata kao angiofolikularna hiperplazija) je rijetka limfoproliferativna bolest dobroćudnog tijeka. Klinički se manifesira kao lokalizirana i multicentrična. Dijagnoza lokalizirane bolesti se najčešće postavlja slučajno nakon obrade simptomatologije uzrokovane kompresijom tvorbe na okolne anatomske strukture. S obzirom na njeno limfatičko podrijetlo tumorska masa se može pojaviti u bilo kojem dijelu tijela. Prikazujemo slučaj parakardijalno lokalizirane Castlemanove bolesti kod prethodno zdrave 24-godišnje žene. U ovakvom slučaju, zbog specifične lokalizacije i radioloških obilježja tvorba može predstavljati diferencijalno dijagnostičku dilemu. U tom slučaju točna dijagnoza je moguća tek nakon potpune kirurške ekscizije i patohistološke analize, što u slučaju ove bolesti ujedno predstavlja optimalan terapijski pristup

Gender Differences in In-hospital Mortality and Angiographic Findings of Patients with Acute ST-segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI)

There are conflicting reports in the literature regarding the role of sex on the in-hospital mortality of patients with acute myocardial infarction. The objective of this study is to determine whether there are gender differences in in-hospital mortality and angiographic findings of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We conducted a prospective study of all patients admitted to University Hospital Center Split, Croatia with STEMI from 2004 to 2008 who underwent PCI. From March 2004 throughout September 2008, 488 patients with STEMI underwent PCI (364 men, 74.6%; 124 women, 25.4%). Compared with men, women were significantly older (mean age, 67.3 vs. 60.3 years; p<0.001). Men had a significantly higher proportion of circumflex artery occlusion (19.5% vs. 10.5%, p=0.022). A higher proportion of men had a multivessel disease than women (56.8% vs. 41.9%; p=0.004). In-hospital mortality was significantly higher among women (11.3% vs. 4.6%; p=0.002) but after adjustment for the baseline difference in age, the female sex was not an independent predictor of in-hospital mortality (adjusted OR 1.15; 95% CI 0.82–1.84). In men, occlusions of left anterior descending artery showed higher mortality rate than occlusions of other coronary arteries (LM 0%, LAD 7.3%, Cx 2.8%, RCA 0.7%, p=0.03). According to our results female gender is not an independent predictor of in-hospital mortality after percutaneous coronary intervention. In men, occlusions of left anterior descending arteries are associated with higher mortality rate comparing to occlusions of other coronary arteries

Roman Military Medicine and Croatian Archaeological Perspectives

This article offers a general examination of the sources responsible for understanding Roman military medicine, starting with literal and epigraphical sources all the way to archaeological remains consisting of hospitals, the infrastructure of military garrisons and small medical tools. Given that not one of the literary sources does not directly mention the medical personnel within the various military units, epigraphical discoveries widely represent the main source of our knowledge on the subject. On the other hand, the archaeological exploration of military garrisons offers proof of the medical care of Roman soldiers. If at first it appears that Roman military medicine is perfectly obvious and clear, actually this is not the case as many questions remain to be answered and debated. In all this, Croatia has its own archaeological perspective, where notably, one site stands out, which could hold a key role according to the layout of buildings within the garrison including its hospital

PRIMARY PERCUTANEOUS CORONARY INTERVENTION (PPCI) IN HOSPITAL WITHOUT REGIONAL CARDIAC SURGERY SUPPORT, DATA FROM SPLIT REGION

Svrha rada: Cilj je istraživanja istražiti izvedivost programa PCI u bolnici bez kardiokirurške potpore, i usporediti naše rezultate sa smjernicama i skupinom konzervativno liječenih bolesnika u razdoblju prije uvođenja primarne perkutane koronarne intervencije (pPCI). Metode: Podatci o svim bolesnicima s akutnim infarktom miokarda sa ST elevacijom (STEMI) liječenim pPCI prospektivno su bilježeni. Rezultati: Od početka programa pPCI od siječnja 2005. do listopada 2007. godine kada je u našoj ustanovi započeo s radom Odjel kardiokirurgije liječeno je 366 bolesnika. Unutarbolnička smrtnost iznosila je 6,3%, u usporedbi s 15% (87/583) u skupini konzervativno liječenih bolesnika u trogodišnjem razdoblju prije uvođenja pPCI. Prosječno vrijeme od početka boli do postavljanja balona iznosilo je 315 minuta, vrijeme od boli do prvoga medicinskog kontakta 102 minute, vrijeme od prvoga medicinskog kontakta do vrata bolnice 94 minute, vrijeme od vrata bolnice do laboratorija 84 minute, vrijeme od laboratorija do otvaranja krvne žile 45 minuta, a vrijeme od vrata do postavljanja balona 129 minuta. Zaključak: Analiza rezultata pokazuje da je uvođenje programa primarne PCI u bolnici bez kardiokirurške potpore u regiji sigurno i da pruža značajnu redukciju mortaliteta u bolesnika sa STEMI. U organizaciji službe za zbrinjavanje akutnog infarkta miokarda treba naglasiti agresivno rješavanje vremenskog zastoja u primjeni pPCI unutar bolnice.Objectives: The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our »real-world« results to current guidelines and historical controls. Methods: Data of all STEMI patients treated by PCI were prospectively recorded. Results: From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. Conclusions: Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital time delays should be managed aggressively

Importance of Circulating Platelet Aggregates and Haemodynamic Changes in Ophthalmic Artery and Progression of Visual Field Loss at Pseudoexfoliation Glaucoma

The aim of this work is to examine the role of circulating platelet aggregates (CPA) at pseudoexfoliation glaucoma (PXG), haemodynamic changes in the ophthalmic artery by ultrasonic color Doppler, searching for visual field progression. Vascular component at PXG and its role in VF progression dynamics has not been sufficiently explained, as well as CPA influence to ischaemic events related to optic nerve damage and VF progression. The examination included 80 patients, where of 35 (44%) men average age 68.3±7.0 and 45 (56%) women average age 65.7±7.0 (t=1.66; p=0.101). Forthy of them suffered from primary open angle glaucoma (POAG) as a control group (healthy), and 40 from pseudoexfoliative glaucoma (PXG) as an experimental group. All the examinees underwent complete ophthalmological examination: visual acuity, ocular fundus, intraocular pressure measured, anterior eye segment biomicroscopy with gonioscopy performed. Also VF examination was performed three times at 6 months intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method and ultrasonic measurement of blood perfusion in the carotid tree, particularly concerning ophthalmic artery by means of color Doppler. Obtained decreased values of CPA proportion resulted in hypercoagulability of blood in PXG group. At PXG were also found increased blood flow resistivity indexes in ophthalmic artery (RI AO) and internal carotid artery (RI ACI), resulting with ischemia and hypoxia and finally progression of the visual filed damage. In conclusion, our study shows that examining CPA and ultrasonic monitoring of vascular parameters in ophthalmic artery with color Doppler may be the way of better understanding the vascular role in PXG prognosis

Specific and Gender Differences between Hospitalized and out of Hospital Mortality due to Myocardial Infarction

In this paper, the authors evaluate gender related differences of myocardial infarction mortality before and after hospital admittance. Myocardial infarction mortality in the Clinical Hospital Split in the seven years period between 2000 and 2006, have been analyzed together with out of hospital sudden death patients with acute myocardial infarction established during autopsy. During the seven year period between 2000 and 2006, 3434 patients were treated for myocardial infarction in the Split Clinical Hospital, 2336 (68%) males and 1098 (32%) females with a 12% total mortality (427 patients). The annual number of hospitalized persons has been increasing during that period (474 in yr. 2000 vs. 547 in yr. 2006), while mortality decreased from 15% in 2000 to 9.6% in 2006. Female patients had significantly higher hospital mortality than male patients, (228 or 21% vs. 202 or 9%, p<0.05). Women also had significantly higher total AMI mortality (23.7% vs. 15,7%, p<0.05). Anterior myocardial infarction with ST elevation in precordial leads had significantly higher mortality (19%) compared to patients with lateral (11%), inferior (10%) myocardial infarction with ST elevation and also NSTEMI (4%) mortality p<0.05. Female patients more frequently die in hospital, 84% (230) than out of hospital 16% (43). From the total number of AMI deaths (388) in male patients, 56% (217) were in hospital and 44% (171) out of hospital (p<0.001). Men had significantly higher prehospital mortality rate than women (81% vs. 19%, p<0.05). Men also more frequently died from ventricular fibrillation (22% vs. 10%, p<0.05), while women died more frequently of heart failure, cardiogenic shock, and myocardial rupture (33% vs. 15% p<0.05). Regarding the total number of deaths from myocardial infarction men had significantly higher prehospital mortality compared to women (178 or 7.3% vs. 43 or 3.7%, p<0.05). Anterior myocardial infarction had a significantly higher rate in patients dying pre-hospital (58%), in contrast to inferior (36%) and lateral myocardial infarction with ST elevation (6%) p<0,05.We have concluded that male patients die more frequently within the first few hours of AMI mostly due to malignant arrhythmias, while female patients died in sub acute stage due to heart failure while being hospitalized. Nevertheless total mortality of AMI remains significantly higher in women

PROGNOSTIC VALUE OF OPHTHALMIC ARTERY COLOR DOPPLER SONOGRAPHY FOR PROGRESSION TO GLAUCOMA IN VITILIGO PATIENTS

Cilj rada bio je ispitati prognostičku vrijednost, tj. ulogu hemodinamske promjene u arteriji oftalmici (AO) ultrazvučnim obojenim doplerom (CDI) kod bolesnika s vitiligom za nastanak primarnog glaukoma otvorenog kuta (PGOK), te skrenuti pažnju kliničarima dermatolozima i oftalmolozima na važnost ispitivanja i vaskularne komponente u rutinskoj obradi bolesnika zbog moguće povezanosti vitiliga i očnih promjena suspektnih za PGOK. Naše kliničko zapažanje i istraživanje da se kod bolesnika koji se liječe od vitiliga relativno često dijagnosticira ili uoči već ranije dijagnosticirani PGOK potaknulo nas je i na ispitivanje vaskularne komponente kao eventualne moguće poveznice vitiliga i PGOK. Vaskularna komponenta kod PGOK i njezina uloga u dinamici nastanka bolesti nije dovoljno razjašnjena i još je kontraverzna, a posljedična ishemijska događanja vezana su primarno za oštećenje vidnog živca (NO). U našem kontinuiranom dvogodišnjem istraživanju od ožujka 2008. do ožujka 2010. godine u specijalističkoj dermatovenerološkoj ambulanti Klinike za kožne i spolne bolesti pregledano je 42 bolesnika s vitiligom. Nakon kliničkog pregleda i uz pomoć Woodove lampe, zbog sumnje na glaukom upućeni su u ambulantu za glaukom Klinike za očne bolesti zbog detekcije ili kontrole primarnog glaukoma otvorenog kuta (PGOK). Svim se bolesnicima učinilo ultrazvuk arterije oftalmike oba oka na Klinici za unutarnje bolesti KBC-a Split u svrhu ispitivanja hemodinamike. Svim ispitanicima učini se kompletan oftalmološki pregled: vidna oštrina, pregled fundusa oka, mjerenje očnog tlaka, biomikroskopija prednjeg segmenta oka s gonioskopijom i vidno polje (VP). Naša studija pokazuje da se ultrazvučnim ispitivanjem i praćenjem vaskularnih parametara u arteriji oftalmici obojenim doplerom može bolje spoznati vaskularna uloga u diferencijalnoj dijagnozi i isključiti je kao poveznicu ili potencijalnog čimbenika rizika povezanog s vitiligom i PGOK. Dakle, bolesnici koji se liječe od vitiliga bez obzira na dob, spol, zahvaćenost, lokalizaciju i trajanje bolesti trebali bi se prema našem mišljenju redovito podvrgavati kompletnom oftalmološkom pregledu s posebnim osvrtom na dijagnosticiranje POAG. S obzirom na relativno mali uzorak i razdoblje ispitivanja može se već sada gotovo argumentirano potvrditi da ta povezanost nije slučajna. Buduća istraživanja na većem broju bolesnika s vitiligom i PGOK trebalo bi dati definitivan odgovor o povezanosti tih dviju bolesti i polučiti definitivni zaključak uz ispitivanje i drugih hematoloških faktora vezano za hiperkoagubilnost krvi kako bi se mogla bolje spoznati uloga vaskularne komponente.The aim of this study was to assess the prognostic value, i.e. the role of hemodynamic changes in the ophthalmic artery determined by color Doppler imaging in patients with vitiligo in relation to the occurrence of primary open-angle glaucoma (POAG), and to call attention to the importance of examination of the vascular component in routine examinations of patients by clinical dermatologists and ophthalmologists, due to the possible correlation of vitiligo and ophthalmologic changes indicating POAG. Clinical observations and research have shown that patients treated for vitiligo are often diagnosed with POAG or have confirmed diagnosis in their medical history. These findings motivated the research of the vascular component as a possible correlation between vitiligo and POAG. The vascular component of POAG and its role in the dynamics of glaucoma progression has not been fully explained and is still somewhat controversial, and the resulting ischemic disorders are primarily related to optical nerve damage. During the course of a continuous two-year research started in March 2008 and completed in March 2010, a total of 42 patients with vitiligo were examined in the specialist dermatovenereology unit of the Department of Skin Diseases and Sexually Transmitted Diseases. Following clinical examination and Wood’s lamp examination, patients with suspected glaucoma were referred to the glaucoma unit of the Department of Ophthalmology to detect or check the progression of POAG. At the Department of Internal Medicine, Split University Hospital Center, color Doppler imaging of ophthalmic artery was performed in all patients on both eyes to examine its hemodynamics. All study participants underwent complete ophthalmologic examination: visual acuity, fundus of the eye, eye pressure measurement, anterior eye segment biomicroscopy with gonioscopy and visual field. In conclusion, our study showed color Doppler imaging and investigation of vascular parameters in ophthalmic artery to provide an insight into the vascular function in differential analysis and can be determined as a correlation or potential risk factor related to vitiligo and POAG. For this reason, we suggest that patients treated for vitiligo, irrespective of their age, sex, affected area, localization and duration of the disease, should regularly undergo complete ophthalmologic examination with special emphasis on POAG diagnosis. Considering the relatively limited sample and trial period, we can already substantiate and confirm that the correlation is not random. Future research in a larger number of vitiligo and POAG patients should provide definitive answer concerning correlation between the two diseases and lead to final conclusion, along with investigation of other hematologic factors related to blood hypercoagulability in order to reach better understanding of the vascular component function