Učinak pojedinih sastavnica krvnog tlaka na oblike hipertrofije lijeve klijetke

According to present findings, the impact of particular arterial pressure components on the occurrence of left ventricular hypertrophy (LVH) differs. We sought to determine which individual component of arterial pressure has the greatest impact on the LVH geometric pattern/degree. The study included 192 patients (87 men), aged 43-80 (median 68) years with hypertension and LVH. Patients were classified into three groups according to type of hypertrophy (concentric, eccentric and asymmetric) and into three subgroups according to the degree of hypertrophy (mild, moderate and severe). All patients had their blood pressure measured, and they underwent electrocardiography and echocardiography. Antihypertensive drugs and the duration of previous treatments were taken into consideration. Pulse pressure was significantly higher in patients with concentric LVH than in those with eccentric and asymmetric LVH (p=0.029), the values of which did not differ statistically. It rose with LVH degree (not significantly, p=0.217). There were no significant differences in systolic pressure among study groups (p=0.177). We concluded that pulse pressure had the greatest impact on the left ventricular geometry, particularly of the concentric type.Prema sadašnjim spoznajama utjecaj pojedinih sastavnica arterijskog tlaka na pojavu hipertrofije lijeve klijetke (HLK) je različit. Željeli smo ispitati koja pojedina sastavnica arterijskog tlaka ima najveći učinak na geometrijski tip/stupanj HLK. U istraživanje je bilo uključeno 192 bolesnika (87 muškaraca) u dobi od 43-80 godina (prosječne starosti 68 godina) s hipertenzijom i HLK. Bolesnike smo podijelili u tri skupine prema tipu hipertrofije (koncentrična, ekscentrična i asimetrična) i tri podskupine prema stupnju hipertrofije (blaga, umjerena i teška). Svakom boesniku je mjeren krvni tlak, učinjena je elektrokardiografija i ehokardiografija. U obzir je uzeta antihipertenzivna terapija i trajanje prethodnog liječenja. Tlak pulsa je bio značajno viši u bolesnika s koncentričnom HLK nego u onih s ekscentričnom i asimetričnom HLK (p=0,029), no bez statistički značajne razlike među ovim vrijednostima. Tlak pulsa je rastao sa stupnjem HLK (ne značajno, p=0,217). Sistolički tlak se nije značajno razlikovao među ispitivanim skupinama (p=0,177). Zaključili smo da je tlak pulsa imao najveći učinak na geometriju lijeve klijetke, osobito na koncentrični tip

Akutna torzija žučnoga mjehura s gangrenom i kolelitijazom – rijedak slučaj

We report a case of a 75-year-old female with acute torsion of the gallbladder with gangrene and cholelithiasis. On admission, the patient underwent physical examination, laboratory blood analysis, abdominal ultrasound and plain abdominal x-ray. Due to the signs of acute abdomen and poor general condition of the patient, urgent surgical procedure was indicated. Intraoperatively, the gallbladder was found to be greatly enlarged, gangrenous and greatly distended with 360° clockwise torsion around its mesentery. Cholecystectomy was performed. Gallbladder torsion is a rare surgical emergency which physicians should bear in mind when encountering patients with symptoms of acute cholecystitis. The only treatment for this condition is urgent cholecystectomy with prior detorsion. The mortality rate in patients not undergoing surgery is 100%.Prikazujemo slučaj 75-godišnje bolesnice s akutnom torzijom žučnoga mjehura s gangrenom i kolelitijazom. Nakon prijma učinjen je fizikalni pregled, laboratorijska analiza krvi, ultrazvuk abdomena i RTG snimka abdomena. Zbog znakova akutnog abdomena i općenito lošeg stanja bolesnice indiciran je hitni operativni zahvat. Intraoperacijski je nađen veoma povećan, gangrenozan i distendiran žučni mjehur s torzijom oko svog mezenterija od 360 stupnjeva u smjeru kazaljke na satu te je učinjena kolecistektomija. Torzija žučnoga mjehura je rijetko kirurško hitno stanje koje liječnik mora imati na umu kod bolesnika sa simptomima akutnog kolecistitisa. Jedina terapija ovakvog stanja je hitna kolecistektomija s detorzijom. Smrtnost u bolesnika koji se ne podvrgnu operativnom zahvatu je 100%

OUR RESULTS IN LAPAROSCOPIC-ASSISTED PLACEMENT OF PERITONEAL DIALYSIS CATHETERS: TEN-YEAR EXPERIENCE

Prikazujemo analizu naših rezultata i komplikacija pri postavljanju Tenckhoffova katetera za peritonejsku dijalizu laparoskopskom metodom i usporedbu s objavljenima u literaturi. Retrospektivna analiza uključila je 50 bolesnika koji su podvrgnuti postavljanju katetera za peritonejsku dijalizu laparoskopskom tehnikom u Klinici za kirurgiju Kliničkog bolničkog centra Rijeka od siječnja 2000. do studenog 2010. godine. Analizirani su uspješnost rezultata, rane i kasne postoperacijske komplikacije, konverzija u otvoren pristup te stopa reoperacije. Ranim komplikacijama su smatrane one nastale u prvih 4 tjedna od operacije. Komplikacije su se javile u 23 bolesnika (29 komplikacija). Ranih komplikacija bilo je 18, od toga 2 akutna peritonitisa, 2 ileusa, 4 krvarenja, 4 infekcije izlaznog mjesta katetera, 3 propuštanja dijalizata oko peritonejskog katetera, 2 malpozicije katetera te 1 genitalni edem. Kasnih komplikacija je bilo 11, od toga 5 akutnih peritonitisa, 1 recidivni peritonitis, 1 krvarenje, 1 infekcija izlaznog mjesta katetera, 1 malpozicija katetera, 1 propuštanje dijalizata oko peritonejskog katetera i 1 hernija u području implantacije peritonejskog katetera. Nije bilo smrtnih ishoda nakon operacije niti je bilo komplikacija koje su onemogućile provođenje peritonejske dijalize. Zaključujemo da se u liječenju bolesnika s terminalnim renalnim zatajivanjem laparoskopska tehnika pokazala prikladnom i sigurnom metodom postavljanja peritonejskog katetera.The aim was to analyze our results and complications in laparoscopic-assisted placement of the Tenckhoff catheter for peritoneal dialysis in comparison with results reported in the literature. Fifty patients were included in this retrospective analysis. From January 2000 to November 2010, they underwent laparoscopic-assisted placement of catheter for peritoneal dialysis at the University Department of Surgery, Rijeka University Hospital Center. The results of this approach, early and late postoperative complications, conversions to open technique, and reoperation rate were analyzed. The complications that occurred within the fi rst 4 weeks were considered as early complications. In 23 patients, 29 complications were recorded. There were 18 early complications, of which 2 acute peritonitis, 2 ileus, 4 bleeding, 4 catheter infection, 3 fl uid leakage, 2 catheter malpositioning and 1 genital edema. There were 11 late complications, of which 5 acute peritonitis, 1 recurrent peritonitis, 1 bleeding, 1 catheter infection, 1 catheter malpositioning, 1 fl uid leakage and 1 port site hernia. There were no deaths after surgery or any complications disabling the implementation of peritoneal dialysis. In patients with end-stage renal disease, laparoscopic-assisted placement of catheter for peritoneal dialysis is a safe and appropriate method of treatment

OUR RESULTS IN LAPAROSCOPIC-ASSISTED PLACEMENT OF PERITONEAL DIALYSIS CATHETERS: TEN-YEAR EXPERIENCE

Prikazujemo analizu naših rezultata i komplikacija pri postavljanju Tenckhoffova katetera za peritonejsku dijalizu laparoskopskom metodom i usporedbu s objavljenima u literaturi. Retrospektivna analiza uključila je 50 bolesnika koji su podvrgnuti postavljanju katetera za peritonejsku dijalizu laparoskopskom tehnikom u Klinici za kirurgiju Kliničkog bolničkog centra Rijeka od siječnja 2000. do studenog 2010. godine. Analizirani su uspješnost rezultata, rane i kasne postoperacijske komplikacije, konverzija u otvoren pristup te stopa reoperacije. Ranim komplikacijama su smatrane one nastale u prvih 4 tjedna od operacije. Komplikacije su se javile u 23 bolesnika (29 komplikacija). Ranih komplikacija bilo je 18, od toga 2 akutna peritonitisa, 2 ileusa, 4 krvarenja, 4 infekcije izlaznog mjesta katetera, 3 propuštanja dijalizata oko peritonejskog katetera, 2 malpozicije katetera te 1 genitalni edem. Kasnih komplikacija je bilo 11, od toga 5 akutnih peritonitisa, 1 recidivni peritonitis, 1 krvarenje, 1 infekcija izlaznog mjesta katetera, 1 malpozicija katetera, 1 propuštanje dijalizata oko peritonejskog katetera i 1 hernija u području implantacije peritonejskog katetera. Nije bilo smrtnih ishoda nakon operacije niti je bilo komplikacija koje su onemogućile provođenje peritonejske dijalize. Zaključujemo da se u liječenju bolesnika s terminalnim renalnim zatajivanjem laparoskopska tehnika pokazala prikladnom i sigurnom metodom postavljanja peritonejskog katetera.The aim was to analyze our results and complications in laparoscopic-assisted placement of the Tenckhoff catheter for peritoneal dialysis in comparison with results reported in the literature. Fifty patients were included in this retrospective analysis. From January 2000 to November 2010, they underwent laparoscopic-assisted placement of catheter for peritoneal dialysis at the University Department of Surgery, Rijeka University Hospital Center. The results of this approach, early and late postoperative complications, conversions to open technique, and reoperation rate were analyzed. The complications that occurred within the fi rst 4 weeks were considered as early complications. In 23 patients, 29 complications were recorded. There were 18 early complications, of which 2 acute peritonitis, 2 ileus, 4 bleeding, 4 catheter infection, 3 fl uid leakage, 2 catheter malpositioning and 1 genital edema. There were 11 late complications, of which 5 acute peritonitis, 1 recurrent peritonitis, 1 bleeding, 1 catheter infection, 1 catheter malpositioning, 1 fl uid leakage and 1 port site hernia. There were no deaths after surgery or any complications disabling the implementation of peritoneal dialysis. In patients with end-stage renal disease, laparoscopic-assisted placement of catheter for peritoneal dialysis is a safe and appropriate method of treatment

Impact of Blood Pressure Components on Left Ventricular Hypertrophy Remodeling

According to present findings, the impact of particular arterial pressure components on the occurrence of left ventricular hypertrophy (LVH) differs. We sought to determine which individual component of arterial pressure has the greatest impact on the LVH geometric pattern/degree. The study included 192 patients (87 men), aged 43-80 (median 68) years with hypertension and LVH. Patients were classified into three groups according to type of hypertrophy (concentric, eccentric and asymmetric) and into three subgroups according to the degree of hypertrophy (mild, moderate and severe). All patients had their blood pressure measured, and they underwent electrocardiography and echocardiography. Antihypertensive drugs and the duration of previous treatments were taken into consideration. Pulse pressure was significantly higher in patients with concentric LVH than in those with eccentric and asymmetric LVH (p=0.029), the values of which did not differ statistically. It rose with LVH degree (not significantly, p=0.217). There were no significant differences in systolic pressure among study groups (p=0.177). We concluded that pulse pressure had the greatest impact on the left ventricular geometry, particularly of the concentric type

The role of calpain in cardiac cell death

Cilj istraživanja: Cilj doktorskog rada bio je analizirani izražaj kalpaina 2, kalpaina 10 i stupnja apoptoze stanica srca (miocita i nemiocita) uključenih u mehanizme stanične smrti te ih usporediti između skupine preminulih osoba od iznenadne srčane smrti (engl. sudden cardiac death, SCD) s i bez šećerne bolesti uzrokovane ranom srčanom ishemijom (engl. early myocardial ischemia, EMI) i akutnim infarktom miokarda (engl. acute myocardial infarction, AMI) i kontrolne skupine. Također cilj je bio utvrditi postojanje povezanosti između ispitivanih parametara kao i izražaj kalpaina i apoptotičke aktivnosti stanica srca s obzirom na spol. Ispitanici i metode: Ispitanici su bili podijeljeni u tri skupine: u prvoj skupini je bio 101 ispitanik koji je preminuo od SCD-a uzrokovanog EMI i AMI-em kojem je tijekom sudskomedicinske obdukcije uzet uzorak tkiva iz zone ishemije/infarkta i suprotne stijenke miokarda lijeve klijetke. U drugoj skupini je bilo 54 ispitanika koji su preminuli od SCD-a uzrokovanog EMI i AMI-em, a bolovali su od šećerne bolesti tip II. U kontrolnoj skupini je bilo 50 ispitanika koji su preminuli od nagle moždane smrti uslijed prostrijelne rane glave i kojima je tijekom sudsko-medicinske obdukcije uzet uzorak tkiva iz prednje i stražnje stijenke miokarda lijeve klijetke. lzražaj kalpaina 2 i kalpaina 10 u stanicama srca analiziran je imunohistokemijskom metodom dok je stupanj apoptoze analiziran TUNEL-metodom. Rezultati: Kalpain 2 miocita pokazuje veći izražaj u zoni rane ishemije (te još veći u zoni infarkta) u odnosu na suprotnu stijenku i kontrolnu grupu (P<0.0001) dok je kalpain 10 miocita većeg izražaja u suprotnoj stijenci i kontrolnoj grupi (P<0.0001) uz negativnu korelaciju sa stupnjem apoptoze (P=0.002). Apoptotička aktivnost miocita pozitivno korelira s dobi ispitanika u području rane ishemije/infarkta i na suprotnoj stijenci miokarda (P=0.0004) te prati izražaj kalpaina 2 u miocita (P=0.048). Kalpain 2 pozitivni miociti iz područja rane ishemije/infarkta miokarda 106.72 puta povećavaju rizik nastanka apoptoze dok ga kalpain 10 pozitivni miociti smanjuju za 88%. Rizik događaja AMI u ispitanika s visokim stupnjem apoptotičke aktivnosti u miocitima veći je za 2.15 puta. Također endotelne, glatkomišićne stanice i leukociti pokazuju veći izražaj kalpaina 2 u zoni rane ishemije/infarkta u odnosu na suprotnu stijenku (P<0.0001; P=0.0078; P=0.0001) i kontrolnu grupu (P<0.0001; P=0.011; P<0.0001), dok je izražaj kalpaina 10 pokazivao obrnuti obrazac samo u endotelnim stanicama (P=0.0005). Miociti, endotelne i glatkomišićne stanice pokazuju manji izražaj kalpaina 2 u zoni infarkta skupine 2 u usporedbi sa zonom infarkta skupine 1. Miociti, endotelne stanice i leukociti pokazuju veći izražaj kalpaina 10 u zoni rane ishemije skupine 2 u odnosu na zonu rane ishemije skupine 1 (P=0.046; P=0.049; P=0.017). Jedino miociti u zoni infarkta skupine 2 pokazuju veći izražaj kalpaina 10 u odnosu na zonu infarkta skupine 1 (P=0.001). Zaključak: Utjecaj ishemije kao i njezine dužine se odražava na intenzitet aktivacije kalpaina 2 miocita što dovodi do povećanja apoptoze miocita te je isti mehanizam zamijećen i kod nekih nemiocita srca. Kalpain 10 u miocitima iz područja ishemije/infarkta miokarda djeluje „protektivno“ i štiti miocite od apoptoze. Medikamentozno regulirana šećerna bolest pokazuje drugačiju aktivaciju kalpaina te je generalno povezana s većom razinom kalpaina 10 u miocitima i nemiocitima. Ne postoje spolne razlike u izražaju kalpaina i apoptotičke aktivnosti miocita. Izražaj kalpaina 2 može služiti kao forenzični marker za SCD uzrokovanu EMI-emObjectives: The aim of the doctoral dissertation was to analyze the expression of calpain 2, calpain 10 and the degree of apoptosis of the heart cells that express it and to compare them between the examined groups of people who died of sudden cardiac death (SCD) caused by early myocardial ischemia (EMI)/acute myocardial infarction (AMI) and control groups. Also determine the existence of a correlation between the examined parameters as well as the expression of calpain and apoptotic activity of heart cells with respect to sex. Patients and Methods: Respondents were divided into three groups. Group 1 consisted of 101 persons who died of SCD caused by EMI and AMI in the period from January 2013 to August 2019. The tissue samples were taken from the zone of ischemia/infarction and the opposite wall during a forensic autopsy at Department of Forensic Medicine and Criminalistics, Faculty of Medicine, University of Rijeka. Group 2 consisted of 54 persons who died of SCD caused by EMI and AMI and suffered from type II diabetes. The control group included myocardial samples obtained from 50 persons who died of instant death by head gunshot. The expression of calpain 2 and calpain 10 in the studied heart cells was analyzed immunohistochemically, while the degree of apoptosis was determined by the TUNEL method. Statistical data processing was performed using the computer program MedCalcStatistical Software version 20.011. Results: Calpain 2 in myocytes show greater expression in the zone of EMI (and even greater in AMI zone) compared to the opposite wall and control group (P <0.0001). Calpain 10 in myocytes are more pronounced in the opposite wall and control group (P <0.0001) with negative correlation with the degree of apoposis (P = 0.002). Apoptotic activity of myocytes positively correlates with the age of persons in the area of EMI/AMI, also on the opposite wall of the myocardium (P = 0.0004) and correlates the expression of calpain 2 in myocytes (P = 0.048). Calpain 2 positive myocytes from the area of EMI/AMI increase the risk of apoptosis 106.72-fold while calpain 10 positive myocytes reduce it by 88%. The risk of AMI in persons with a high degree of apoptotic activity in myocytes is 2.15-fold higher. Also endothelial, smooth muscle cells and leukocytes show a higher expression of calpain 2 in the zone of EMI/AMI compared to the opposite wall (P <0.0001; P = 0.0078; P = 0.0001) and the control group (P <0.0001; P=0.011; P=<0.0001), while the expression of calpain 10 showed the reverse pattern only in endothelial cells (P=0.0005). Myocytes, endothelial and smooth muscle cells show lower expression of calpain 2 in the group 2 AMI zone compared to group 1 AMI zone. Myocytes, endothelial cells and leukocytes show higher expression of calpain 10 in the group 2 EMI zone compared to the group 1 EMI zone (P =0.046; P=0.049; P=0.017). Only myocytes in the group 2 AMI zone show a higher expression of calpain 10 compared to the group 1 AMI zone (P=0.001). Conclusion: The influence of ischemia as well as its length is reflected in the intensity of activation of calpain 2 myocytes. Calpain 10 in myocytes from the EMI/AMI area acts "protectively" and protects myocytes from apoptosis. Hypoglycemic drugs regulated diabetes is associated with higher levels of calpain 10 in myocytes and nonmyocytes. There are no sex differences in myocytes calpain expression and apoptotic activity. The expression of calpain 2 in cardiomyocytes is a specific and sensitive diagnostic marker for SCD caused by EMI

The role of calpain in cardiac cell death

Cilj istraživanja: Cilj doktorskog rada bio je analizirani izražaj kalpaina 2, kalpaina 10 i stupnja apoptoze stanica srca (miocita i nemiocita) uključenih u mehanizme stanične smrti te ih usporediti između skupine preminulih osoba od iznenadne srčane smrti (engl. sudden cardiac death, SCD) s i bez šećerne bolesti uzrokovane ranom srčanom ishemijom (engl. early myocardial ischemia, EMI) i akutnim infarktom miokarda (engl. acute myocardial infarction, AMI) i kontrolne skupine. Također cilj je bio utvrditi postojanje povezanosti između ispitivanih parametara kao i izražaj kalpaina i apoptotičke aktivnosti stanica srca s obzirom na spol. Ispitanici i metode: Ispitanici su bili podijeljeni u tri skupine: u prvoj skupini je bio 101 ispitanik koji je preminuo od SCD-a uzrokovanog EMI i AMI-em kojem je tijekom sudskomedicinske obdukcije uzet uzorak tkiva iz zone ishemije/infarkta i suprotne stijenke miokarda lijeve klijetke. U drugoj skupini je bilo 54 ispitanika koji su preminuli od SCD-a uzrokovanog EMI i AMI-em, a bolovali su od šećerne bolesti tip II. U kontrolnoj skupini je bilo 50 ispitanika koji su preminuli od nagle moždane smrti uslijed prostrijelne rane glave i kojima je tijekom sudsko-medicinske obdukcije uzet uzorak tkiva iz prednje i stražnje stijenke miokarda lijeve klijetke. lzražaj kalpaina 2 i kalpaina 10 u stanicama srca analiziran je imunohistokemijskom metodom dok je stupanj apoptoze analiziran TUNEL-metodom. Rezultati: Kalpain 2 miocita pokazuje veći izražaj u zoni rane ishemije (te još veći u zoni infarkta) u odnosu na suprotnu stijenku i kontrolnu grupu (P<0.0001) dok je kalpain 10 miocita većeg izražaja u suprotnoj stijenci i kontrolnoj grupi (P<0.0001) uz negativnu korelaciju sa stupnjem apoptoze (P=0.002). Apoptotička aktivnost miocita pozitivno korelira s dobi ispitanika u području rane ishemije/infarkta i na suprotnoj stijenci miokarda (P=0.0004) te prati izražaj kalpaina 2 u miocita (P=0.048). Kalpain 2 pozitivni miociti iz područja rane ishemije/infarkta miokarda 106.72 puta povećavaju rizik nastanka apoptoze dok ga kalpain 10 pozitivni miociti smanjuju za 88%. Rizik događaja AMI u ispitanika s visokim stupnjem apoptotičke aktivnosti u miocitima veći je za 2.15 puta. Također endotelne, glatkomišićne stanice i leukociti pokazuju veći izražaj kalpaina 2 u zoni rane ishemije/infarkta u odnosu na suprotnu stijenku (P<0.0001; P=0.0078; P=0.0001) i kontrolnu grupu (P<0.0001; P=0.011; P<0.0001), dok je izražaj kalpaina 10 pokazivao obrnuti obrazac samo u endotelnim stanicama (P=0.0005). Miociti, endotelne i glatkomišićne stanice pokazuju manji izražaj kalpaina 2 u zoni infarkta skupine 2 u usporedbi sa zonom infarkta skupine 1. Miociti, endotelne stanice i leukociti pokazuju veći izražaj kalpaina 10 u zoni rane ishemije skupine 2 u odnosu na zonu rane ishemije skupine 1 (P=0.046; P=0.049; P=0.017). Jedino miociti u zoni infarkta skupine 2 pokazuju veći izražaj kalpaina 10 u odnosu na zonu infarkta skupine 1 (P=0.001). Zaključak: Utjecaj ishemije kao i njezine dužine se odražava na intenzitet aktivacije kalpaina 2 miocita što dovodi do povećanja apoptoze miocita te je isti mehanizam zamijećen i kod nekih nemiocita srca. Kalpain 10 u miocitima iz područja ishemije/infarkta miokarda djeluje „protektivno“ i štiti miocite od apoptoze. Medikamentozno regulirana šećerna bolest pokazuje drugačiju aktivaciju kalpaina te je generalno povezana s većom razinom kalpaina 10 u miocitima i nemiocitima. Ne postoje spolne razlike u izražaju kalpaina i apoptotičke aktivnosti miocita. Izražaj kalpaina 2 može služiti kao forenzični marker za SCD uzrokovanu EMI-emObjectives: The aim of the doctoral dissertation was to analyze the expression of calpain 2, calpain 10 and the degree of apoptosis of the heart cells that express it and to compare them between the examined groups of people who died of sudden cardiac death (SCD) caused by early myocardial ischemia (EMI)/acute myocardial infarction (AMI) and control groups. Also determine the existence of a correlation between the examined parameters as well as the expression of calpain and apoptotic activity of heart cells with respect to sex. Patients and Methods: Respondents were divided into three groups. Group 1 consisted of 101 persons who died of SCD caused by EMI and AMI in the period from January 2013 to August 2019. The tissue samples were taken from the zone of ischemia/infarction and the opposite wall during a forensic autopsy at Department of Forensic Medicine and Criminalistics, Faculty of Medicine, University of Rijeka. Group 2 consisted of 54 persons who died of SCD caused by EMI and AMI and suffered from type II diabetes. The control group included myocardial samples obtained from 50 persons who died of instant death by head gunshot. The expression of calpain 2 and calpain 10 in the studied heart cells was analyzed immunohistochemically, while the degree of apoptosis was determined by the TUNEL method. Statistical data processing was performed using the computer program MedCalcStatistical Software version 20.011. Results: Calpain 2 in myocytes show greater expression in the zone of EMI (and even greater in AMI zone) compared to the opposite wall and control group (P <0.0001). Calpain 10 in myocytes are more pronounced in the opposite wall and control group (P <0.0001) with negative correlation with the degree of apoposis (P = 0.002). Apoptotic activity of myocytes positively correlates with the age of persons in the area of EMI/AMI, also on the opposite wall of the myocardium (P = 0.0004) and correlates the expression of calpain 2 in myocytes (P = 0.048). Calpain 2 positive myocytes from the area of EMI/AMI increase the risk of apoptosis 106.72-fold while calpain 10 positive myocytes reduce it by 88%. The risk of AMI in persons with a high degree of apoptotic activity in myocytes is 2.15-fold higher. Also endothelial, smooth muscle cells and leukocytes show a higher expression of calpain 2 in the zone of EMI/AMI compared to the opposite wall (P <0.0001; P = 0.0078; P = 0.0001) and the control group (P <0.0001; P=0.011; P=<0.0001), while the expression of calpain 10 showed the reverse pattern only in endothelial cells (P=0.0005). Myocytes, endothelial and smooth muscle cells show lower expression of calpain 2 in the group 2 AMI zone compared to group 1 AMI zone. Myocytes, endothelial cells and leukocytes show higher expression of calpain 10 in the group 2 EMI zone compared to the group 1 EMI zone (P =0.046; P=0.049; P=0.017). Only myocytes in the group 2 AMI zone show a higher expression of calpain 10 compared to the group 1 AMI zone (P=0.001). Conclusion: The influence of ischemia as well as its length is reflected in the intensity of activation of calpain 2 myocytes. Calpain 10 in myocytes from the EMI/AMI area acts "protectively" and protects myocytes from apoptosis. Hypoglycemic drugs regulated diabetes is associated with higher levels of calpain 10 in myocytes and nonmyocytes. There are no sex differences in myocytes calpain expression and apoptotic activity. The expression of calpain 2 in cardiomyocytes is a specific and sensitive diagnostic marker for SCD caused by EMI

The role of calpain in cardiac cell death

Cilj istraživanja: Cilj doktorskog rada bio je analizirani izražaj kalpaina 2, kalpaina 10 i stupnja apoptoze stanica srca (miocita i nemiocita) uključenih u mehanizme stanične smrti te ih usporediti između skupine preminulih osoba od iznenadne srčane smrti (engl. sudden cardiac death, SCD) s i bez šećerne bolesti uzrokovane ranom srčanom ishemijom (engl. early myocardial ischemia, EMI) i akutnim infarktom miokarda (engl. acute myocardial infarction, AMI) i kontrolne skupine. Također cilj je bio utvrditi postojanje povezanosti između ispitivanih parametara kao i izražaj kalpaina i apoptotičke aktivnosti stanica srca s obzirom na spol. Ispitanici i metode: Ispitanici su bili podijeljeni u tri skupine: u prvoj skupini je bio 101 ispitanik koji je preminuo od SCD-a uzrokovanog EMI i AMI-em kojem je tijekom sudskomedicinske obdukcije uzet uzorak tkiva iz zone ishemije/infarkta i suprotne stijenke miokarda lijeve klijetke. U drugoj skupini je bilo 54 ispitanika koji su preminuli od SCD-a uzrokovanog EMI i AMI-em, a bolovali su od šećerne bolesti tip II. U kontrolnoj skupini je bilo 50 ispitanika koji su preminuli od nagle moždane smrti uslijed prostrijelne rane glave i kojima je tijekom sudsko-medicinske obdukcije uzet uzorak tkiva iz prednje i stražnje stijenke miokarda lijeve klijetke. lzražaj kalpaina 2 i kalpaina 10 u stanicama srca analiziran je imunohistokemijskom metodom dok je stupanj apoptoze analiziran TUNEL-metodom. Rezultati: Kalpain 2 miocita pokazuje veći izražaj u zoni rane ishemije (te još veći u zoni infarkta) u odnosu na suprotnu stijenku i kontrolnu grupu (P<0.0001) dok je kalpain 10 miocita većeg izražaja u suprotnoj stijenci i kontrolnoj grupi (P<0.0001) uz negativnu korelaciju sa stupnjem apoptoze (P=0.002). Apoptotička aktivnost miocita pozitivno korelira s dobi ispitanika u području rane ishemije/infarkta i na suprotnoj stijenci miokarda (P=0.0004) te prati izražaj kalpaina 2 u miocita (P=0.048). Kalpain 2 pozitivni miociti iz područja rane ishemije/infarkta miokarda 106.72 puta povećavaju rizik nastanka apoptoze dok ga kalpain 10 pozitivni miociti smanjuju za 88%. Rizik događaja AMI u ispitanika s visokim stupnjem apoptotičke aktivnosti u miocitima veći je za 2.15 puta. Također endotelne, glatkomišićne stanice i leukociti pokazuju veći izražaj kalpaina 2 u zoni rane ishemije/infarkta u odnosu na suprotnu stijenku (P<0.0001; P=0.0078; P=0.0001) i kontrolnu grupu (P<0.0001; P=0.011; P<0.0001), dok je izražaj kalpaina 10 pokazivao obrnuti obrazac samo u endotelnim stanicama (P=0.0005). Miociti, endotelne i glatkomišićne stanice pokazuju manji izražaj kalpaina 2 u zoni infarkta skupine 2 u usporedbi sa zonom infarkta skupine 1. Miociti, endotelne stanice i leukociti pokazuju veći izražaj kalpaina 10 u zoni rane ishemije skupine 2 u odnosu na zonu rane ishemije skupine 1 (P=0.046; P=0.049; P=0.017). Jedino miociti u zoni infarkta skupine 2 pokazuju veći izražaj kalpaina 10 u odnosu na zonu infarkta skupine 1 (P=0.001). Zaključak: Utjecaj ishemije kao i njezine dužine se odražava na intenzitet aktivacije kalpaina 2 miocita što dovodi do povećanja apoptoze miocita te je isti mehanizam zamijećen i kod nekih nemiocita srca. Kalpain 10 u miocitima iz područja ishemije/infarkta miokarda djeluje „protektivno“ i štiti miocite od apoptoze. Medikamentozno regulirana šećerna bolest pokazuje drugačiju aktivaciju kalpaina te je generalno povezana s većom razinom kalpaina 10 u miocitima i nemiocitima. Ne postoje spolne razlike u izražaju kalpaina i apoptotičke aktivnosti miocita. Izražaj kalpaina 2 može služiti kao forenzični marker za SCD uzrokovanu EMI-emObjectives: The aim of the doctoral dissertation was to analyze the expression of calpain 2, calpain 10 and the degree of apoptosis of the heart cells that express it and to compare them between the examined groups of people who died of sudden cardiac death (SCD) caused by early myocardial ischemia (EMI)/acute myocardial infarction (AMI) and control groups. Also determine the existence of a correlation between the examined parameters as well as the expression of calpain and apoptotic activity of heart cells with respect to sex. Patients and Methods: Respondents were divided into three groups. Group 1 consisted of 101 persons who died of SCD caused by EMI and AMI in the period from January 2013 to August 2019. The tissue samples were taken from the zone of ischemia/infarction and the opposite wall during a forensic autopsy at Department of Forensic Medicine and Criminalistics, Faculty of Medicine, University of Rijeka. Group 2 consisted of 54 persons who died of SCD caused by EMI and AMI and suffered from type II diabetes. The control group included myocardial samples obtained from 50 persons who died of instant death by head gunshot. The expression of calpain 2 and calpain 10 in the studied heart cells was analyzed immunohistochemically, while the degree of apoptosis was determined by the TUNEL method. Statistical data processing was performed using the computer program MedCalcStatistical Software version 20.011. Results: Calpain 2 in myocytes show greater expression in the zone of EMI (and even greater in AMI zone) compared to the opposite wall and control group (P <0.0001). Calpain 10 in myocytes are more pronounced in the opposite wall and control group (P <0.0001) with negative correlation with the degree of apoposis (P = 0.002). Apoptotic activity of myocytes positively correlates with the age of persons in the area of EMI/AMI, also on the opposite wall of the myocardium (P = 0.0004) and correlates the expression of calpain 2 in myocytes (P = 0.048). Calpain 2 positive myocytes from the area of EMI/AMI increase the risk of apoptosis 106.72-fold while calpain 10 positive myocytes reduce it by 88%. The risk of AMI in persons with a high degree of apoptotic activity in myocytes is 2.15-fold higher. Also endothelial, smooth muscle cells and leukocytes show a higher expression of calpain 2 in the zone of EMI/AMI compared to the opposite wall (P <0.0001; P = 0.0078; P = 0.0001) and the control group (P <0.0001; P=0.011; P=<0.0001), while the expression of calpain 10 showed the reverse pattern only in endothelial cells (P=0.0005). Myocytes, endothelial and smooth muscle cells show lower expression of calpain 2 in the group 2 AMI zone compared to group 1 AMI zone. Myocytes, endothelial cells and leukocytes show higher expression of calpain 10 in the group 2 EMI zone compared to the group 1 EMI zone (P =0.046; P=0.049; P=0.017). Only myocytes in the group 2 AMI zone show a higher expression of calpain 10 compared to the group 1 AMI zone (P=0.001). Conclusion: The influence of ischemia as well as its length is reflected in the intensity of activation of calpain 2 myocytes. Calpain 10 in myocytes from the EMI/AMI area acts "protectively" and protects myocytes from apoptosis. Hypoglycemic drugs regulated diabetes is associated with higher levels of calpain 10 in myocytes and nonmyocytes. There are no sex differences in myocytes calpain expression and apoptotic activity. The expression of calpain 2 in cardiomyocytes is a specific and sensitive diagnostic marker for SCD caused by EMI

Acute gallbladder torsion with gangrene and cholelithiasis – a rare condition

We report a case of a 75-year-old female with acute torsion of the gallbladder with gangrene and cholelithiasis. On admission, the patient underwent physical examination, laboratory blood analysis, abdominal ultrasound and plain abdominal x-ray. Due to the signs of acute abdomen and poor general condition of the patient, urgent surgical procedure was indicated. Intraoperatively, the gallbladder was found to be greatly enlarged, gangrenous and greatly distended with 360° clockwise torsion around its mesentery. Cholecystectomy was performed. Gallbladder torsion is a rare surgical emergency which physicians should bear in mind when encountering patients with symptoms of acute cholecystitis. The only treatment for this condition is urgent cholecystectomy with prior detorsion. The mortality rate in patients not undergoing surgery is 100%

Acute gallbladder torsion with gangrene and cholelithiasis – a rare condition

We report a case of a 75-year-old female with acute torsion of the gallbladder with gangrene and cholelithiasis. On admission, the patient underwent physical examination, laboratory blood analysis, abdominal ultrasound and plain abdominal x-ray. Due to the signs of acute abdomen and poor general condition of the patient, urgent surgical procedure was indicated. Intraoperatively, the gallbladder was found to be greatly enlarged, gangrenous and greatly distended with 360° clockwise torsion around its mesentery. Cholecystectomy was performed. Gallbladder torsion is a rare surgical emergency which physicians should bear in mind when encountering patients with symptoms of acute cholecystitis. The only treatment for this condition is urgent cholecystectomy with prior detorsion. The mortality rate in patients not undergoing surgery is 100%