Mogu li faktori rizika biti bolji prediktori rane akutne mezenterijalne ishemije od laboratorijskih i slikovnih pretraga? Retrospektivna studija i algoritam za ranu intervenciju

Objectives The aim is to delineate relevant risk factors and construct an algorithm for earlier performance of selective mesenteric angiography, thus lowering mortality rates of acute mesenteric ischemia. Methods During a 5-year period 31 patients were examined. Thirteen risk factors were analysed and compared to standard diagnostic procedures. Results Only one patient did not have arterial hypertension. The second most common risk factor is atrial fibrillation with the incidence rate of 64.5%. The largest group of patients (38.7%) had two risk factors and there were 6.5% patients with six risk factors and 87.2% of all patients had two or more risk factors. In 67.7% of the patients we only performed emergency laparotomy due to inoperable state. Hospital mortality was 74.2%. Conclusions Combination of age over 70, hypertension and two or more risk factors associated with elevated D-dimers, in a patient with severe abdominal pain and minimal clinical findings with nonspecific laboratory findings and plain abdominal radiographs, could be an indication for early selective mesenteric angiography.Ciljevi Cilj je naznačiti relevantne faktore rizika i izraditi algoritam za ranije slučajeve selektivne mezenterijalne angiografije te na taj način smanjiti stopu smrtnosti akutne mezenterijalne ishemije. Metode Tijekom petogodišnjeg razdoblja pregledan je 31 pacijent. Analizirano je 13 faktora rizika koji su uspoređeni sa standardnim dijagnostičkim postupcima. Rezultati Samo jedan pacijent nije imao arterijsku hipertenziju. Drugi najčešći faktor rizika je atrijalna fibrilacija s učestalošću od 64,5%. Najveća skupina pacijenata (38,7%) imala je dva faktora rizika, 6,5% pacijenata imalo je šest faktora rizika, a 87,2% svih pacijenata imalo je dva ili više faktora rizika. U 67,7% pacijenata izveli smo samo hitnu laparotomiju zbog neoperabilnog stanja. Bolnička smrtnost bila je 74,2%. Zaključci Kombinacija dobi iznad 70, hipertenzije i dva ili više faktora rizika povezanih s povišenim D-dimerima, kod pacijenta sa znatnom abdominalnom boli i minimalnim kliničkim zaključcima s nespecifičnim laboratorijskim zaključcima i uobičajenim abdominalnim radiografima mogu biti indikacija za ranu selektivnu mezenterijalnu angiografiju

Molecular characteristics of MRSA strains and patient risk factors in vascular surgery

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major pathogens in hospitals, and since the 1990s it has been recognized as an important pathogen in community infections. (1) The aim of this study was to analyze MRSA strains from a vascular surgery ward over a five-year period, since the vascular ward is considered to be a high-risk site for different multi-resistant pathogens, among which MRSA is very important. The method used for the microbiological identification and susceptibility testing of strains was the Vitek2 system. For the detailed characterization of the MRSA strains, we used the following molecular methods: SCCmec typing, pulse-field gel electrophoresis (PFGE), spa typing and Panton-Valentine leukocidin (PVL) detection. During the 5-year period, 77 MRSA strains were isolated. Antimicrobial susceptibility: 100% of MRSA isolates were susceptible to oxazolidinones and glycopeptides, 55% were susceptible to gentamycin, and 98% were susceptible to tetracyclines. SCCmec typing: 43 of 77 (55.8%) strains were typed as SCCmec I. The number of isolates with SCCmec II was 28 (36.4%). Three isolates carried SCCmec III. After the PFGE analysis, the isolates were grouped into six similarity groups: A-F. The largest number of isolates (80.6%) belonged to one of two groups: A: 35 (46.8%) and D: 25 (33.8%). Conclusion: The analysis of MRSA strains in the vascular surgery ward revealed high homogeneity among the strains, the majority of which belonged to SCCmec type I. This type, together with the susceptibility profile and PFGE grouping, is considered to be typical of Hospital-Acquired (HA) MRSA

Tumori jetre u dječjoj dobi

Liver tumors count for approximately 2% of all childhood tumors and almost 70% of them are malignant. Most of them present as palpable abdominal mass. Correct diagnosis considering type, size and localization of the tumor is crucial for the right treatment strategy. Although surgical resection still remains the most important factor for survival, when combined with chemotherapy, the survival rates will raise. Liver transplantation is also considered in some cases of liver tumors. From 1991 to 2008 we treated 13 children with liver tumors. Our experience together with the review of recent literature is presented here.Tumori jetre čine ukupno 2% svih tumora dječje dobi, a preko dvije trećine su zloćudni. Većina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana liječenja nužno je postaviti točnu dijagnozu i odrediti stupanj bolesti. Iako je kirurška resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja značajno raste. U određenim slučajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate. Od 1991. godine do 2008. liječili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naše rezultate uz pregled recentne literature

Nationwide survey of Klebsiella pneumoniae strains producing CTX-M extended-spectrum b-lactamases in Croatia [Nacionalno istraživanje sojeva bakterije klebsiella pneumoniae koji proizvode CTX-M prošireni-spektar b-laktamaza u Hrvatskoj]

Extended-spectrum β-lactamases (ESBL) producing bacteria have been increasingly reported in both hospital and community patients. Production of ESBLs is the major mechanism of resistance to oxymino-cephalosporins and aztreonam in Gram-negative bacteria. Recently a new family of ESBLs with predominant activity against cefotaxime (CTX-M β-lactamases) has been reported. Over 80 CTX-M enzymes have been described so far, which can be grouped into five main subgroups according to amino acid sequence identity (CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9 and CTX-M-25). In some countries, CTX-M β-lactamases are the most prevalent types of ESBLs, for instance in Russia, Greece, Spain, Switzerland, Japan, Taiwan, China and Argentina. These enzymes have been identified in countries near Croatia such is Italy, Hungary and Austria. The aim of this study was to determine the prevalence and the types of CTX-M β lactamases produced by Klebsiella pneumoniae clinical isolates collected from October 2006 to January 2007 from both community- and hospital-based isolates were included (Figure 1.). 128 ESBL isolates were subjected to further analysis: screening with double disc diffusion test and confirmed by ESBL E test

Surveillance of surgical site infection after cholecystectomy using the hospital in Europe link for infection control through surveillance protocol

BACKGROUND: The third most common healthcare-associated infection is surgical site infection (SSI), accounting for 14%-16% of infections. These SSIs are associated with high morbidity, numerous deaths, and greater cost. ----- METHODS: A prospective study was conducted to assess the incidence of SSI in a single university hospital in Croatia. We used the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol for surveillance. The SSIs were classified using the standard definition of the National Nosocomial Infections Surveillance (NNIS) system. ----- RESULTS: The overall incidence of SSI was 1.44%. The incidence of infection in the open cholecystectomy group was 6.06%, whereas in the laparoscopic group, it was only 0.60%. The incidence density of in-hospital SSIs per 1,000 post-operative days was 5.76. Patients who underwent a laparoscopic cholecystectomy were significantly younger (53.65±14.65 vs. 64.42±14.17 years; p<0.001), spent roughly one-third as many days in the hospital (2.40±1.72 vs. 8.13±4.78; p<0.001), and had significantly shorter operations by nearly 26 min (60.34±28.34 vs. 85.80±37.17 min; p<0.001). Procedures that started as laparoscopic cholecystectomies and were converted to open procedures (n=28) were reviewed separately. The incidence of SSI in this group was 17.9%. The majority of converted procedures (71.4%) were elective, and the operating time was significantly longer than in other two groups (109.64±85.36 min). ----- CONCLUSION: The HELICS protocol has a good concept for the monitoring of SSI, but in the case of cholecystectomy, additional factors such as antibiotic appropriateness, gallbladder entry, empyema of the gallbladder, and obstructive jaundice must be considered

Nacionalno istraživanje sojeva bakterije klebsiella pneumoniae koji proizvode CTX-M prošireni-spektar b-laktamaza u Hrvatskoj

Extended-spectrum β-lactamases (ESBL) producing bacteria have been increasingly reported in both hospital and community patients. Production of ESBLs is the major mechanism of resistance to oxymino-cephalosporins and aztreonam in Gram-negative bacteria. Recently a new family of ESBLs with predominant activity against cefotaxime (CTX-M β-lactamases) has been reported. Over 80 CTX-M enzymes have been described so far, which can be grouped into five main subgroups according to amino acid sequence identity (CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9 and CTX-M-25). In some countries, CTX-M β-lactamases are the most prevalent types of ESBLs, for instance in Russia, Greece, Spain, Switzerland, Japan, Taiwan, China and Argentina. These enzymes have been identified in countries near Croatia such is Italy, Hungary and Austria. The aim of this study was to determine the prevalence and the types of CTX-M β lactamases produced by Klebsiella pneumoniae clinical isolates collected from October 2006 to January 2007 from both community- and hospital-based isolates were included (Figure 1.). 128 ESBL isolates were subjected to further analysis: screening with double disc diffusion test and confirmed by ESBL E test.Prošireni spektar beta-laktamaza (ESBL) kojr proizvode bakterije se povišeno pojavljuje kod bolničkih pacijenta I pacijenata u zajednici. Proizvodnja ESBL-a je glavni mehanizam otpornosti na oxymino-cefalosporine i aztreoname kod gram-negativnih bakterija1,2. Nedavno je zabilježena nova obitelj ESBL-a s dominantnim djelovanjem protiv cefotaksima (CTX-M beta-laktamaze). Više od 80 CTX-M enzima je do sada opisano, koji se mogu grupirati u pet glavnih podskupina prema istovjetnosti aminokiselinskog slijeda (CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9 i CTX-M-25)3. U nekim zemljama, CTX-M beta-laktamaze su najzastupljenije vrste ESBL-a, primjerice u Rusiji4, Grčkoj5, Španjolskoj6, Švicarskoj7 , Japanu8, Tajvanu9 , Kini10 i Argentini11. Ovi enzimi su identificirani u zemljama u blizini Hrvatske poput Italije12, Madžarske13 i Austrije14. Cilj ovog istraživanja bio je utvrditi učestalost i vrste CTX-M beta laktamaza koje proizvode klinički izolati bakterjie Klebsiella pneumoniae prikupljeni od listopada 2006. do siječnja 2007. godine od oba u zajednici i bolnica-based izolata su bili uključeni (slika 1.). 128 ESBL izolati bili podvrgnuti daljnjoj analizi: screening s dvostrukim disk difuzije testa i potvrđuje ESBL E test

Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings

AIM To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina. ----- METHODS Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE. ----- RESULTS Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was isolated in 11 in- and seven outpatients. MLST CC152 was the most prevalent MRSA. Seven (38.9%) Klebsiella spp. yielded amplicons with primers specific for SHV, TEM-1 and CTX-M group 1 β-lactamases. Eight K. pneumonia (44.4%) and 16 (64%) MRSA (including the in- and outpatient) strains were clonally related. ----- CONCLUSION The presence of MRSA and ESBL-producing organisms causing SSTIs in the community poses a substantial concern, due to the high morbidity and mortality associated with possible consequent hospital infections

Nacionalno istraživanje sojeva bakterije klebsiella pneumoniae koji proizvode CTX-M prošireni-spektar b-laktamaza u Hrvatskoj

Extended-spectrum β-lactamases (ESBL) producing bacteria have been increasingly reported in both hospital and community patients. Production of ESBLs is the major mechanism of resistance to oxymino-cephalosporins and aztreonam in Gram-negative bacteria. Recently a new family of ESBLs with predominant activity against cefotaxime (CTX-M β-lactamases) has been reported. Over 80 CTX-M enzymes have been described so far, which can be grouped into five main subgroups according to amino acid sequence identity (CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9 and CTX-M-25). In some countries, CTX-M β-lactamases are the most prevalent types of ESBLs, for instance in Russia, Greece, Spain, Switzerland, Japan, Taiwan, China and Argentina. These enzymes have been identified in countries near Croatia such is Italy, Hungary and Austria. The aim of this study was to determine the prevalence and the types of CTX-M β lactamases produced by Klebsiella pneumoniae clinical isolates collected from October 2006 to January 2007 from both community- and hospital-based isolates were included (Figure 1.). 128 ESBL isolates were subjected to further analysis: screening with double disc diffusion test and confirmed by ESBL E test.Prošireni spektar beta-laktamaza (ESBL) kojr proizvode bakterije se povišeno pojavljuje kod bolničkih pacijenta I pacijenata u zajednici. Proizvodnja ESBL-a je glavni mehanizam otpornosti na oxymino-cefalosporine i aztreoname kod gram-negativnih bakterija1,2. Nedavno je zabilježena nova obitelj ESBL-a s dominantnim djelovanjem protiv cefotaksima (CTX-M beta-laktamaze). Više od 80 CTX-M enzima je do sada opisano, koji se mogu grupirati u pet glavnih podskupina prema istovjetnosti aminokiselinskog slijeda (CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9 i CTX-M-25)3. U nekim zemljama, CTX-M beta-laktamaze su najzastupljenije vrste ESBL-a, primjerice u Rusiji4, Grčkoj5, Španjolskoj6, Švicarskoj7 , Japanu8, Tajvanu9 , Kini10 i Argentini11. Ovi enzimi su identificirani u zemljama u blizini Hrvatske poput Italije12, Madžarske13 i Austrije14. Cilj ovog istraživanja bio je utvrditi učestalost i vrste CTX-M beta laktamaza koje proizvode klinički izolati bakterjie Klebsiella pneumoniae prikupljeni od listopada 2006. do siječnja 2007. godine od oba u zajednici i bolnica-based izolata su bili uključeni (slika 1.). 128 ESBL izolati bili podvrgnuti daljnjoj analizi: screening s dvostrukim disk difuzije testa i potvrđuje ESBL E test

Tumori jetre u dječjoj dobi

Liver tumors count for approximately 2% of all childhood tumors and almost 70% of them are malignant. Most of them present as palpable abdominal mass. Correct diagnosis considering type, size and localization of the tumor is crucial for the right treatment strategy. Although surgical resection still remains the most important factor for survival, when combined with chemotherapy, the survival rates will raise. Liver transplantation is also considered in some cases of liver tumors. From 1991 to 2008 we treated 13 children with liver tumors. Our experience together with the review of recent literature is presented here.Tumori jetre čine ukupno 2% svih tumora dječje dobi, a preko dvije trećine su zloćudni. Većina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana liječenja nužno je postaviti točnu dijagnozu i odrediti stupanj bolesti. Iako je kirurška resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja značajno raste. U određenim slučajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate. Od 1991. godine do 2008. liječili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naše rezultate uz pregled recentne literature

Zbornik Drage Roksandića

U ovom se zborniku objavljuju tekstovi koje su prijatelji, suradnici i nekadašnji studenti&nbsp;profesora Drage Roksandića iz cijeloga svijeta napisali kako bi obilježili njegov&nbsp;sedamdeseti rođendan i odlazak u mirovinu s Odsjeka za povijest Filozofskog fakulteta&nbsp;Sveučilišta u Zagrebu.Tkogod da je susreo profesora Dragu Roksandića između 1990., kada je na Odsjeku&nbsp;za povijest izabran za docenta, i 2018. godine, kada je otišao u mirovinu, vjerojatno je&nbsp;primijetio njegov značajan utjecaj na studente svih razina, od preddiplomskih do doktorskih.&nbsp;Profesor je snažno inspirirao i utjecao na bliske suradnike svih generacija.Ovdje je riječ o pravom Festschriftu, „pisanoj proslavi“, koja prema dobrim običajima&nbsp;akademske zajednice izlazi u čast jednog njezina uvaženog člana. Prilozi u zborniku&nbsp;obuhvaćaju različite epohalne horizonte – neki detaljno istražuju pojedine segmente&nbsp;određenog perioda, neki se usmjeravaju na lokalne fenomene ili pristupaju istraživačkim&nbsp;problemima mikrohistorijski. Neki tekstovi obuhvaćaju razdoblja u duljem trajanju,&nbsp;obrađuju različite strukture ili nude određene globalnohistorijske odrednice. Mnogi su&nbsp;prilozi multidisciplinarni, interdisciplinarni ili transdisciplinarni, što je odraz činjenice da&nbsp;Drago Roksandić nikada nije smatrao da je povjesničarev zanat isključiv ili zatvoren, već&nbsp;je u svojim predavanjima i radovima uvijek otvarao komunikacijske prostore s drugim&nbsp;disciplinama. U nekim se tekstovima autori posebno bliski profesoru Roksandiću prisjećaju&nbsp;iskustava kolegijalne suradnje. Zajedničko je svim radovima to što su znak predanosti i&nbsp;iskrene počasti profesoru i kolegi koji svojim primjerom pokazuje što znači odanost struci,&nbsp;na koji način istraživati određene teme inovativno, polazeći iz različitih perspektiva, zatim&nbsp;kako postavljati prava problemska pitanja i kako očuvati istraživačku radost, energiju i žar,&nbsp;odnosno zbog čega povijesne kontroverze treba proučavati hrabro i trezveno, a prilaziti im&nbsp;dijaloški. Ovaj je zbornik, dakako, samo jedan mogući prikaz interesa, epoha, problema&nbsp;i pristupa kojima se do sada Drago Roksandić bavio. U svim je radovima moguće pronaći&nbsp;njegove utjecaje, a brojna je istraživanja, čiji su rezultati sada ovdje objavljeni, i on sâm&nbsp;potaknuo, mnogo prije negoli je započeo rad na ovom zborniku.U ovom se zborniku objavljuju tekstovi koje su prijatelji, suradnici i nekadašnji studenti&nbsp;profesora Drage Roksandića iz cijeloga svijeta napisali kako bi obilježili njegov&nbsp;sedamdeseti rođendan i odlazak u mirovinu s Odsjeka za povijest Filozofskog fakulteta&nbsp;Sveučilišta u Zagrebu.Tkogod da je susreo profesora Dragu Roksandića između 1990., kada je na Odsjeku&nbsp;za povijest izabran za docenta, i 2018. godine, kada je otišao u mirovinu, vjerojatno je&nbsp;primijetio njegov značajan utjecaj na studente svih razina, od preddiplomskih do doktorskih.&nbsp;Profesor je snažno inspirirao i utjecao na bliske suradnike svih generacija.Ovdje je riječ o pravom Festschriftu, „pisanoj proslavi“, koja prema dobrim običajima&nbsp;akademske zajednice izlazi u čast jednog njezina uvaženog člana. Prilozi u zborniku&nbsp;obuhvaćaju različite epohalne horizonte – neki detaljno istražuju pojedine segmente&nbsp;određenog perioda, neki se usmjeravaju na lokalne fenomene ili pristupaju istraživačkim&nbsp;problemima mikrohistorijski. Neki tekstovi obuhvaćaju razdoblja u duljem trajanju,&nbsp;obrađuju različite strukture ili nude određene globalnohistorijske odrednice. Mnogi su&nbsp;prilozi multidisciplinarni, interdisciplinarni ili transdisciplinarni, što je odraz činjenice da&nbsp;Drago Roksandić nikada nije smatrao da je povjesničarev zanat isključiv ili zatvoren, već&nbsp;je u svojim predavanjima i radovima uvijek otvarao komunikacijske prostore s drugim&nbsp;disciplinama. U nekim se tekstovima autori posebno bliski profesoru Roksandiću prisjećaju&nbsp;iskustava kolegijalne suradnje. Zajedničko je svim radovima to što su znak predanosti i&nbsp;iskrene počasti profesoru i kolegi koji svojim primjerom pokazuje što znači odanost struci,&nbsp;na koji način istraživati određene teme inovativno, polazeći iz različitih perspektiva, zatim&nbsp;kako postavljati prava problemska pitanja i kako očuvati istraživačku radost, energiju i žar,&nbsp;odnosno zbog čega povijesne kontroverze treba proučavati hrabro i trezveno, a prilaziti im&nbsp;dijaloški. Ovaj je zbornik, dakako, samo jedan mogući prikaz interesa, epoha, problema&nbsp;i pristupa kojima se do sada Drago Roksandić bavio. U svim je radovima moguće pronaći&nbsp;njegove utjecaje, a brojna je istraživanja, čiji su rezultati sada ovdje objavljeni, i on sâm&nbsp;potaknuo, mnogo prije negoli je započeo rad na ovom zborniku