Successful Use of Silver Impregnated Hydrofiber Dressing in the Treatment of Kerion Celsi Caused by Microsporum gypseum

A method of treatment of tinea capitis is presented in the case of a 10-year-old boy who was referred to the pediatric surgical unit for the treatment of a skin lesion on the scalp which had persisted for more than two months. The initial dermatological examination led to the clinical diagnosis of inflammation of the scalp, while mycological analysis revealed an uncommon dermatophyte agent, Microsporum gypseum, in the culture. The lesion was subsequently treated with local and oral antifungal agents, but the antifungal therapy was discontinued due to developed liver dysfunction and replaced with treatment using a silver impregnated hydrofiber dressing. During one month of follow-up, the patient\u27s scalp lesion cleared completely. The treatment of tinea capitis is discussed.</p

Infekcija parazitom dirofilaria repens u desetogodišnjeg dječaka u Istri: prikaz slučaja

Dirofilariasis is a zoonotic infection caused by worms belonging to the genus Dirofilaria. The disease is transmitted by mosquitoes and the hosts are usually dogs. Infections in humans are rare and they usually manifest as a subcutaneous nodule or a conjunctival form. We present a 10-year-old boy with a subcutaneous nodule on his left forearm, who was admitted to the hospital. On examination, the only significant findings were high levels of eosinophils. The pediatrician suspected dirofilariasis and the boy was referred to pediatric surgery. The whole lesion was surgically removed and histopathologic examination confirmed parasitic infection by Dirofilaria repens. Although human dirofilariasis is a rare disease, the number of reported cases has recently increased worldwide. The disease mainly occurs in southern European countries, but has also been described in eastern Europe, Central Asia and Sri Lanka. Croatia is one of the endemic areas for dirofilariasis, especially in the region of the Istria Peninsula. The case presented highlights the requirement for further monitoring of endemic areas in order to establish effective preventive measures.Dirofilarijaza je zoonoza uzrokovana crvima koji pripadaju rodu Dirofilaria. Bolest prenose komarci, a uobičajeni domaćini su psi. Infekcije ljudi su rijetke i najčešće se očituju kao potkožni čvor ili kao konjunktivan oblik. Prikazuje se slučaj 10-godišnjeg dječaka koji je zaprimljen u bolnicu sa subkutanim čvorom na lijevoj podlaktici. Jedini značajniji nalaz su bile povišene vrijednosti eozinofila u krvi. Pedijatar je posumnjao na dirofilarijazu i dječak je upućen na dječju kirurgiju. Lezija je kirurški u cijelosti odstranjena i patohistološki je potvrđena parazitna infekcija, Dirofilaria repens. Unatoč tome što je ljudska dirofilarijaza rijetka bolest, broj zabilježenih slučajeva je u porastu u cijelom svijetu. Bolest se uglavnom javlja u zemljama južne Europe, ali je opisana i u istočnoj Europi, Centralnoj Aziji i Šri Lanki. Hrvatska je također jedno od endemskih područja za dirofilarijazu, osobito dijelovi Istarskog poluotoka. Prikazanim slučajem želi se istaknuti važnost praćenja endemskih područja kako bi se eventualno potaknulo uvođenje preventivnih mjera

THE INCIDENCE OF PERIPARTAL HYSTERECTOMY IN FIVE CROATIAN HOSPITALS DURING SIXTEEN-YEAR PERIOD

Uvod: Peripartalna histerektomija (PPH) najdramatičniji je kirurški zahvat u modernoj opstetriciji i obično se obavlja kada se konzervativnim mjerama nije uspjela postići kontrola krvarenja. Navodi se trend porasta učestalosti u razvijenim zemljama. Cilj rada: Odrediti učestalost PPH u pet hrvatskih bolnica tijekom dvaju osmogodišnjih razdoblja u odnosu prema načinu dovršenja porođaja. Metode: Retrospektivnom analizom prikupljeni su podaci iz pismohrana pet hrvatskih bolnica. U istraživanje su uključeni svi porođaji podijeljeni u dva osmogodišnja razdoblja, od 1998. do 2013. Rezultati: Od ukupno 153.302 porođaja tijekom obaju promatranih razdoblja u 70 (0,46‰) slučajeva učinjen je hitni PPH. PPH nakon vaginalnog porođaja u prvom razdoblju iznosio je 0,21‰, a u drugom razdoblju 0,16‰. Učestalost PPH nakon carskog reza u prvom razdoblju iznosio je 1,91‰, a u drugom razdoblju 2,04‰. Rasprava i zaključak: Nema porasta pojavnosti PPH usporedbom dvaju osmogodišnjih razdoblja premda postoji statistički značajan porast učestalosti carskog reza (s 14,2% na 16,0%). Carski je rez čimbenik rizika za PPHIntroduction: Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence among developed countries. Aim: To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of delivery. Methods: Patients data were collected retrospectively from the medical records of the five Croatian hospitals. We analyzed data from 1998 to 2013, and divided them in two eight-year periods. Results: In 70 cases out of 153,302 deliveries urgent PPH was performed. PPH after vaginal deliveries was found in 0.21‰ and 0.16‰ and PPH after caesarean section was 1.91‰ and 2.04‰ in the first and second period, respectively. Discussion and conclusion: There is no increase of PPH rate in the two analyzed periods, although there is a statistically significant increase of caesarean section rate. Caesarean section presents higher risk for PPH

THE INCIDENCE OF PERIPARTAL HYSTERECTOMY IN FIVE CROATIAN HOSPITALS DURING SIXTEEN-YEAR PERIOD

Uvod: Peripartalna histerektomija (PPH) najdramatičniji je kirurški zahvat u modernoj opstetriciji i obično se obavlja kada se konzervativnim mjerama nije uspjela postići kontrola krvarenja. Navodi se trend porasta učestalosti u razvijenim zemljama. Cilj rada: Odrediti učestalost PPH u pet hrvatskih bolnica tijekom dvaju osmogodišnjih razdoblja u odnosu prema načinu dovršenja porođaja. Metode: Retrospektivnom analizom prikupljeni su podaci iz pismohrana pet hrvatskih bolnica. U istraživanje su uključeni svi porođaji podijeljeni u dva osmogodišnja razdoblja, od 1998. do 2013. Rezultati: Od ukupno 153.302 porođaja tijekom obaju promatranih razdoblja u 70 (0,46‰) slučajeva učinjen je hitni PPH. PPH nakon vaginalnog porođaja u prvom razdoblju iznosio je 0,21‰, a u drugom razdoblju 0,16‰. Učestalost PPH nakon carskog reza u prvom razdoblju iznosio je 1,91‰, a u drugom razdoblju 2,04‰. Rasprava i zaključak: Nema porasta pojavnosti PPH usporedbom dvaju osmogodišnjih razdoblja premda postoji statistički značajan porast učestalosti carskog reza (s 14,2% na 16,0%). Carski je rez čimbenik rizika za PPHIntroduction: Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence among developed countries. Aim: To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of delivery. Methods: Patients data were collected retrospectively from the medical records of the five Croatian hospitals. We analyzed data from 1998 to 2013, and divided them in two eight-year periods. Results: In 70 cases out of 153,302 deliveries urgent PPH was performed. PPH after vaginal deliveries was found in 0.21‰ and 0.16‰ and PPH after caesarean section was 1.91‰ and 2.04‰ in the first and second period, respectively. Discussion and conclusion: There is no increase of PPH rate in the two analyzed periods, although there is a statistically significant increase of caesarean section rate. Caesarean section presents higher risk for PPH

EXPRESSION OF INTERLEUKIN-15 AND GRANULYSIN AT THE MATERNAL-EMBRYONAL INTERFACE OF MISSED ABORTION AND ANEMBRYONIC PREGNANCY

Cilj istraživanja ovog doktorskog rada je ispitati izražaj citotoksične molekule granulizina na razini bjelančevine i glasničke ribonukleinske kiseline (gRNK) na spoju majčinih i embrijskih tkiva u anembrijskoj trudnoći i zadržanom pobačaju te rezultate usporediti s decidualnim tkivom elektivno prekinute normalne trudnoće prvog tromjesečja. Materijali i metode: Uzorke bazalne decidue normalne i anembrijske trudnoće, te zadržanog pobačaja dobivali smo s Klinike za ginekologiju i porodništvo, KBC Rijeka. Od imunoloških metoda koristili smo imunohistologijsko obilježavanje antigena u decidualnom tkivu uklopljenom u parafin (citokeratin, granulizin, IL-15, Apaf-1, NF-B, CD56) uz kompjutersko kvantificiranje broja obilježenih stanica/mm2 tkiva i semikvantitativnu analizu jačine obilježavanja (H score). Višestrukom imunofluorescencijom obilježavali smo citokeratin i CD56, IL-15, granulizin, Apaf-1 ili NF-B u decidualnom tkivu uz očitavanje na fluorescentnom mikroskopu i obilježavali smo CD3/CD56 i NKp46, NKp44, CD94, NKG2A ili NKG2D u suspenziji DMS dobivenih enzimatskom razgradnjom protočnom citometrijom. Metodom lančane reakcije polimeraze u stvarnom vremenu (RT-qPCR) određivali smo izražaj gena za granulizin i perforin. Rezultati: Udio CD3ˉCD56⁺ stanica NK u suspenziji DMS, apsolutni broj CD56⁺ stanica i IL-15⁺ stanica/mm2 decidualnog tkiva bio je manji u zadržanom pobačaju Učestalost NKG2A, NKG2D i NKp46 biljega na CD3ˉCD56⁺ stanicama NK u suspenziji DMS iz zadržanog pobačaja je bila statistički značajno manja u odnosu na normalnu trudnoću. U anembrijskoj trudnoći udio stanica NK se nije mijenjao. Učestalost NKG2C, CD94 i NKP44 nije se značajnije mijenjala. Glasnička RNK za granulizin je četverostruko manja u DMS zadržanog pobačaja, a četverostruko veća u DMS anembrijske trudnoće, dok je gRNK za perforin povećana u objema. U normalnoj trudnoći dominiralo je citoplazmatsko obilježavanje granulizina, dok se u patološkim trudnoćama granulizin nalazio u jezgrama stanica. Apsolutni broj NF-B⁺ stanica/mm2 decidualnog tkiva je najveći u anembrijskoj trudnoći a najniža učestalost NF-B⁺ stanica je utvrđena u resicama trofoblasta zadržanog pobačaja. Zaključak: Slabije učinkovito ubijanje trofoblasta granulizinom može biti uključeno u sporije odbacivanje trofoblasta u anembrijskoj trudnoći i zadržanom pobačaju, zbog smanjene dopreme granulizina u jezgre trofoblasta u odnosu na normalnu trudnoću.The research objective of this doctoral thesis was to examine the expression of the cytotoxic molecule of granulysin at the level of protein and messenger ribonucleic acid (mRNA) at the interface of maternal and embryonic tissues in anembryonic pregnancy and missed abortion, and to compare the results with decidual tissue from an electively terminated normal first trimester pregnancy. Materials and methods: Basal decidua samples from a normal and an anembryonic pregnancy as well as a missed abortion were obtained from the Obstetrics and Gynecology Clinic of the Clinical Hospital Center Rijeka Of immunoassays, we used immunohistochemical staining of antigens in decidual tissue embedded in paraffin (cytokeratin, granulysin, IL-15, Apaf-1, NF-B, CD56) with computer quantification of the number of stained cells/mm2 of tissue and semiquantitative analysis of the intensity of staining (H score). We performed multiple immunofluorescence labelling of cytokeratin and CD56, IL-15, granulysin, Apaf-1 or in decidual tissue with fluorescent microscope reading, as well as the staining of CD3/CD56 and NKp46, NKp44, CD94, NKG2A or NKG2D in the suspension of DMCs obtained by enzymatic degradation using flow cytometry. Using the real-time polymerase chain reaction method (RT-qPCR), we determined the gene expression for granulysin and perforin. Results: The content of CD3-CD56⁺ NK cells in the DMC suspension, the absolute number of CD56⁺ cells and IL-15⁺ cells/mm2 of decidual tissue was lower in the missed abortion. The frequency of NKG2A, NKG2D and NKp46 markers on CD3ˉCD56⁺ NK cells in the DMC suspension from the missed abortion was statistically significantly lower than in the normal pregnancy. In anembryonic pregnancy proportion of NK cells did not change. The frequency of NKG2C, CD94 and NKP44 did not differ significantly. The messenger RNA for granulysin was four times lower in the DMC from the missed abortion, and four times higher in the DMC from the anembryonic pregnancy, while the mRNA for perforin was increased in both. In the normal pregnancy, cytoplasmic staining of granulysin was predominant, while, in the pathological pregnancies, granulysin was present in cell nuclei. The absolute number of NF-B⁺ cells/mm2 of decidual tissue was the highest in the anembryonic pregnancy. The lowest frequency of NF-B⁺ cells was determined in the trophoblast villi of the missed abortion. Conclusion: A less efficient killing of trophoblasts with granulysin may be involved in a slower rejection of trophoblasts in anembryonic pregnancy and missed abortion, because of a decreased supply of granulysin to trophoblast nuclei compared to normal pregnancy

EXPRESSION OF INTERLEUKIN-15 AND GRANULYSIN AT THE MATERNAL-EMBRYONAL INTERFACE OF MISSED ABORTION AND ANEMBRYONIC PREGNANCY

Cilj istraživanja ovog doktorskog rada je ispitati izražaj citotoksične molekule granulizina na razini bjelančevine i glasničke ribonukleinske kiseline (gRNK) na spoju majčinih i embrijskih tkiva u anembrijskoj trudnoći i zadržanom pobačaju te rezultate usporediti s decidualnim tkivom elektivno prekinute normalne trudnoće prvog tromjesečja. Materijali i metode: Uzorke bazalne decidue normalne i anembrijske trudnoće, te zadržanog pobačaja dobivali smo s Klinike za ginekologiju i porodništvo, KBC Rijeka. Od imunoloških metoda koristili smo imunohistologijsko obilježavanje antigena u decidualnom tkivu uklopljenom u parafin (citokeratin, granulizin, IL-15, Apaf-1, NF-B, CD56) uz kompjutersko kvantificiranje broja obilježenih stanica/mm2 tkiva i semikvantitativnu analizu jačine obilježavanja (H score). Višestrukom imunofluorescencijom obilježavali smo citokeratin i CD56, IL-15, granulizin, Apaf-1 ili NF-B u decidualnom tkivu uz očitavanje na fluorescentnom mikroskopu i obilježavali smo CD3/CD56 i NKp46, NKp44, CD94, NKG2A ili NKG2D u suspenziji DMS dobivenih enzimatskom razgradnjom protočnom citometrijom. Metodom lančane reakcije polimeraze u stvarnom vremenu (RT-qPCR) određivali smo izražaj gena za granulizin i perforin. Rezultati: Udio CD3ˉCD56⁺ stanica NK u suspenziji DMS, apsolutni broj CD56⁺ stanica i IL-15⁺ stanica/mm2 decidualnog tkiva bio je manji u zadržanom pobačaju Učestalost NKG2A, NKG2D i NKp46 biljega na CD3ˉCD56⁺ stanicama NK u suspenziji DMS iz zadržanog pobačaja je bila statistički značajno manja u odnosu na normalnu trudnoću. U anembrijskoj trudnoći udio stanica NK se nije mijenjao. Učestalost NKG2C, CD94 i NKP44 nije se značajnije mijenjala. Glasnička RNK za granulizin je četverostruko manja u DMS zadržanog pobačaja, a četverostruko veća u DMS anembrijske trudnoće, dok je gRNK za perforin povećana u objema. U normalnoj trudnoći dominiralo je citoplazmatsko obilježavanje granulizina, dok se u patološkim trudnoćama granulizin nalazio u jezgrama stanica. Apsolutni broj NF-B⁺ stanica/mm2 decidualnog tkiva je najveći u anembrijskoj trudnoći a najniža učestalost NF-B⁺ stanica je utvrđena u resicama trofoblasta zadržanog pobačaja. Zaključak: Slabije učinkovito ubijanje trofoblasta granulizinom može biti uključeno u sporije odbacivanje trofoblasta u anembrijskoj trudnoći i zadržanom pobačaju, zbog smanjene dopreme granulizina u jezgre trofoblasta u odnosu na normalnu trudnoću.The research objective of this doctoral thesis was to examine the expression of the cytotoxic molecule of granulysin at the level of protein and messenger ribonucleic acid (mRNA) at the interface of maternal and embryonic tissues in anembryonic pregnancy and missed abortion, and to compare the results with decidual tissue from an electively terminated normal first trimester pregnancy. Materials and methods: Basal decidua samples from a normal and an anembryonic pregnancy as well as a missed abortion were obtained from the Obstetrics and Gynecology Clinic of the Clinical Hospital Center Rijeka Of immunoassays, we used immunohistochemical staining of antigens in decidual tissue embedded in paraffin (cytokeratin, granulysin, IL-15, Apaf-1, NF-B, CD56) with computer quantification of the number of stained cells/mm2 of tissue and semiquantitative analysis of the intensity of staining (H score). We performed multiple immunofluorescence labelling of cytokeratin and CD56, IL-15, granulysin, Apaf-1 or in decidual tissue with fluorescent microscope reading, as well as the staining of CD3/CD56 and NKp46, NKp44, CD94, NKG2A or NKG2D in the suspension of DMCs obtained by enzymatic degradation using flow cytometry. Using the real-time polymerase chain reaction method (RT-qPCR), we determined the gene expression for granulysin and perforin. Results: The content of CD3-CD56⁺ NK cells in the DMC suspension, the absolute number of CD56⁺ cells and IL-15⁺ cells/mm2 of decidual tissue was lower in the missed abortion. The frequency of NKG2A, NKG2D and NKp46 markers on CD3ˉCD56⁺ NK cells in the DMC suspension from the missed abortion was statistically significantly lower than in the normal pregnancy. In anembryonic pregnancy proportion of NK cells did not change. The frequency of NKG2C, CD94 and NKP44 did not differ significantly. The messenger RNA for granulysin was four times lower in the DMC from the missed abortion, and four times higher in the DMC from the anembryonic pregnancy, while the mRNA for perforin was increased in both. In the normal pregnancy, cytoplasmic staining of granulysin was predominant, while, in the pathological pregnancies, granulysin was present in cell nuclei. The absolute number of NF-B⁺ cells/mm2 of decidual tissue was the highest in the anembryonic pregnancy. The lowest frequency of NF-B⁺ cells was determined in the trophoblast villi of the missed abortion. Conclusion: A less efficient killing of trophoblasts with granulysin may be involved in a slower rejection of trophoblasts in anembryonic pregnancy and missed abortion, because of a decreased supply of granulysin to trophoblast nuclei compared to normal pregnancy

Colocalization of Granulysin Protein Forms with Perforin and LAMP-1 in Decidual Lymphocytes During Early Pregnancy

PROBLEM: Granulysin (GNLY) occurs in two forms, which have molecular weights of 9 and 15 kDa. We analyzed the cytotoxic potential of decidual lymphocytes (DLs) and peripheral blood lymphocytes (PBLs) based on the forms of GNLY that colocalizes with perforin (PER) and LAMP-1 following activation. METHODS: The forms of GNLY were detected by using confocal microscopy. We investigated the colocalization with PER and LAMP-1 in freshly isolated and activated DLs and PBLs. RESULTS: Activation of DLs and PBLs by K- 562 cells increased the colocalization of 9 kDa GNLY with PER and LAMP- 1. K-562 cells transfected with HLA-C decreased 9 kDa GNLY colocalization with PER in DLs only. IL-15 in DLs decreased 9 kDa GNLY and LAMP-1 colocalization, but increased both 15 kDa GNLY and LAMP-1, and PER and LAMP-1 colocalization. CONCLUSION: Activated DLs and PBLs show greater cytotoxic potential based on increased colocalization of 9 kDa GNLY and PER. HLA-C and IL-15 affect DLs, indicating their role in maintaining the pregnancy tolerance

Colocalization of Granulysin Protein Forms with Perforin and LAMP-1 in Decidual Lymphocytes During Early Pregnancy

PROBLEM: Granulysin (GNLY) occurs in two forms, which have molecular weights of 9 and 15 kDa. We analyzed the cytotoxic potential of decidual lymphocytes (DLs) and peripheral blood lymphocytes (PBLs) based on the forms of GNLY that colocalizes with perforin (PER) and LAMP-1 following activation. METHODS: The forms of GNLY were detected by using confocal microscopy. We investigated the colocalization with PER and LAMP-1 in freshly isolated and activated DLs and PBLs. RESULTS: Activation of DLs and PBLs by K- 562 cells increased the colocalization of 9 kDa GNLY with PER and LAMP- 1. K-562 cells transfected with HLA-C decreased 9 kDa GNLY colocalization with PER in DLs only. IL-15 in DLs decreased 9 kDa GNLY and LAMP-1 colocalization, but increased both 15 kDa GNLY and LAMP-1, and PER and LAMP-1 colocalization. CONCLUSION: Activated DLs and PBLs show greater cytotoxic potential based on increased colocalization of 9 kDa GNLY and PER. HLA-C and IL-15 affect DLs, indicating their role in maintaining the pregnancy tolerance

Infekcija parazitom dirofilaria repens u desetogodišnjeg dječaka u Istri: prikaz slučaja

Dirofilariasis is a zoonotic infection caused by worms belonging to the genus Dirofilaria. The disease is transmitted by mosquitoes and the hosts are usually dogs. Infections in humans are rare and they usually manifest as a subcutaneous nodule or a conjunctival form. We present a 10-year-old boy with a subcutaneous nodule on his left forearm, who was admitted to the hospital. On examination, the only significant findings were high levels of eosinophils. The pediatrician suspected dirofilariasis and the boy was referred to pediatric surgery. The whole lesion was surgically removed and histopathologic examination confirmed parasitic infection by Dirofilaria repens. Although human dirofilariasis is a rare disease, the number of reported cases has recently increased worldwide. The disease mainly occurs in southern European countries, but has also been described in eastern Europe, Central Asia and Sri Lanka. Croatia is one of the endemic areas for dirofilariasis, especially in the region of the Istria Peninsula. The case presented highlights the requirement for further monitoring of endemic areas in order to establish effective preventive measures.Dirofilarijaza je zoonoza uzrokovana crvima koji pripadaju rodu Dirofilaria. Bolest prenose komarci, a uobičajeni domaćini su psi. Infekcije ljudi su rijetke i najčešće se očituju kao potkožni čvor ili kao konjunktivan oblik. Prikazuje se slučaj 10-godišnjeg dječaka koji je zaprimljen u bolnicu sa subkutanim čvorom na lijevoj podlaktici. Jedini značajniji nalaz su bile povišene vrijednosti eozinofila u krvi. Pedijatar je posumnjao na dirofilarijazu i dječak je upućen na dječju kirurgiju. Lezija je kirurški u cijelosti odstranjena i patohistološki je potvrđena parazitna infekcija, Dirofilaria repens. Unatoč tome što je ljudska dirofilarijaza rijetka bolest, broj zabilježenih slučajeva je u porastu u cijelom svijetu. Bolest se uglavnom javlja u zemljama južne Europe, ali je opisana i u istočnoj Europi, Centralnoj Aziji i Šri Lanki. Hrvatska je također jedno od endemskih područja za dirofilarijazu, osobito dijelovi Istarskog poluotoka. Prikazanim slučajem želi se istaknuti važnost praćenja endemskih područja kako bi se eventualno potaknulo uvođenje preventivnih mjera

Imperforate hymen presenting as vaginal cyst in a 16-month-old child – considerations for an early diagnosis

Imperforate hymen is a congenital anomaly of female external genitalia, which is mostly diagnosed in puberty, at the age of 9–13 years, or very rarely at a younger age. Clinical picture varies from abdominal pain and low back pain to acute urinary retention. We describe a case of a 16-month-old female infant where the imperforate hymen presented as a vaginal cyst. The cyst was first observed by the patient’s mother, although the child had been examined by a paediatrician on several occasions after birth. Complete workup performed for differential diagnosis, mostly to exclude other reproductive system anomalies, led to the final diagnosis of imperforate hymen. The aim of this report is to emphasise the necessity of thorough examination of genitalia in female newborns in order to avoid possible complications associated with this diagnosis later in life, as well as other, more severe differential diagnostic anomalies