Rupture of the common iliac artery aneurysm presenting with abdominal pain and fever

The common iliac artery aneurysms are rare and usually present in patients with abdominal aortic aneurysms. They are most commonly asymptomatic and the clinical symptoms are non-specific, including abdominal pain, genitourinary symptoms, back pain and sciatica. The rupture usually causes haemodynamic instability and carries a high mortality rate. We describe an elderly patient presenting with abdominal pain and fever who had a pulsating mass in the lower right quadrant of the abdomen, diagnosed via point-of-care ultrasound. The definite diagnosis was made with computed tomography and the patient was urgently transferred to the surgery department

Economic uncertainty and suicide mortality in post-pandemic England

This paper examines the relationship between different dimensions of economic uncertainty and suicide rates in England from 1985 to 2020, both in the short and long term. The study employs a non-linear autoregressive distributed lag framework for cointegration estimation. This approach allows testing for the existence of possible asymmetries in the response of suicide mortality to increased economic uncertainty. Uncertainty is gauged by different proxies that allow computing financial uncertainty and labour market uncertainty indicators. The analysis is replicated by gender and across regions, controlling for unemployment and economic growth. Overall, the analysis suggests that uncertainty intensified during the first year of the COVID-19 pandemic. This is in line with the stylized facts of economic uncertainty and its pronounced role in recessions. When replicating the experiment by gender, we find that women seem to be more sensitive to changes in uncertainty. Regarding the existence of asymmetries, we found that decreases in economic uncertainty have a greater impact on suicide mortality than increases

Rupture of the common iliac artery aneurysm presenting with abdominal pain and fever

The common iliac artery aneurysms are rare and usually present in patients with abdominal aortic aneurysms. They are most commonly asymptomatic and the clinical symptoms are non-specific, including abdominal pain, genitourinary symptoms, back pain and sciatica. The rupture usually causes haemodynamic instability and carries a high mortality rate. We describe an elderly patient presenting with abdominal pain and fever who had a pulsating mass in the lower right quadrant of the abdomen, diagnosed via point-of-care ultrasound. The definite diagnosis was made with computed tomography and the patient was urgently transferred to the surgery department

Splenic infarction as a rare cause of left upper abdominal quadrant pain in an elderly woman

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm resulting in increased red blood cell mass. It can lead to various symptoms caused by blood hyperviscosity and an elevated number of red blood cells. Both thrombosis and bleeding complications can occur in PV. Splenic infarction is a rare complication with an unknown incidence usually presenting with pain in the upper left quadrant of the abdomen. The treatment is usually conservative, but there are some complications requiring surgery. We describe an elderly female patient who presented to the emergency department with left costal margin pain which was caused by splenic infarction

Splenic infarction as a rare cause of left upper abdominal quadrant pain in an elderly woman

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm resulting in increased red blood cell mass. It can lead to various symptoms caused by blood hyperviscosity and an elevated number of red blood cells. Both thrombosis and bleeding complications can occur in PV. Splenic infarction is a rare complication with an unknown incidence usually presenting with pain in the upper left quadrant of the abdomen. The treatment is usually conservative, but there are some complications requiring surgery. We describe an elderly female patient who presented to the emergency department with left costal margin pain which was caused by splenic infarction

Recidiv atipičnog hemolitičko-uremijskog sindroma potaknut COVID-19 bolešću

Atypical hemolytic-uremic syndrome (aHUS) is a rare thrombotic microangiopathy (TMA) characterized by genetic or acquired deregulation of alternative complement pathway with the clinical triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). Within precipitating biological factors, several pathogens were identified. To date, only a few cases of aHUS relapses triggered by COVID-19 have been reported.Atipični hemolitičko-uremijski sindrom (aHUS) rijetka je trombotska mikroangiopatija (TMA) karakterizirana genetskom ili stečenom deregulacijom alternativnog puta aktivacije komplementa s kliničkim trijasom koji čine mikroangiopatska hemolitička anemija, trombocitopenija te akutna bubrežna ozljeda. Među precipitirajućim biološkim faktorima identificirano je nekoliko patogena. Do danas je zabilježeno tek nekoliko slučajeva recidiva, a HUS-a potaknutog COVID-19 bolešću

Dressler syndrome after myocardial infarction: a case report

Dressler syndrome is a rare type of secondary pericarditis that occurs after the injury of the heart by a myocardial infarction (MI), chest trauma, or heart surgery. The symptoms of Dressler syndrome usually present one to six weeks after the myocardial infarction with pleuritic chest pain, fever, dyspnoea, and ECG changes. It is estimated that only 0,1% of patients who have had acute myocardial infarction develop Dressler syndrome

Virchow’s node as the first manifestation of disseminated prostatic cancer

Prostate cancer is the second most common malignant tumour in men. It usually presents with lower urinary tract symptoms and spreads to the regional lymph nodes. Metastasis to Virchow’s node (left supraclavicular lymphadenopathy) is rare and often associated with other types of cancer, such as gastric, lung and breast cancer. We present the case of a patient with enlarged left supraclavicular nodes as the first manifestation of disseminated adenocarcinoma of the prostate

SPONTANA RUPTURA JETRE POVEZANA S PRIMJENOM HEPARINA NISKE MOLEKULARNE MASE

We present a rare case of a patient with spontaneous liver rupture, who was treated with anticoagulant therapy due to pulmonary embolism. The patient was diagnosed in the emergency department with deep vein thrombosis of his left leg and bilateral pulmonary embolism. He was admitted to the medical intensive care unit and low-molecular-weight heparin (enoxaparin) therapy was introduced. After the third dose, the patient started complaining of right shoulder and chest pain, and 3 hours later, when the patient was put in the sitting position, there was sharp drop of blood pressure, the patient lost consciousness, stopped breathing and pulse was impalpable. He was resuscitated for 4 minutes, after which he regained consciousness and complained of pain in the right shoulder, chest and right upper abdominal quadrant. Emergency abdominal ultrasonography showed free fl uid in the abdomen, and computed tomography showed liver hemorrhage and liver capsule rupture. The patient was transferred to the operating theater, where liver hemostasis and perihepatic packing were performed. This case report shows the extent of possible adverse effects of anticoagulant therapy, even in patients with short duration of therapy and with no prior blood clotting disorders. Prompt diagnosis and treatment of spontaneous liver rupture are crucial in favorable resolution of this complication.Prikazujemo slučaj bolesnika kod kojega je došlo do pojave spontane rupture jetre, a koji je bio liječen antikoagulacijskom terapijom zbog plućne embolije. Bolesniku je u hitnoj službi dijagnosticirana duboka venska tromboza lijeve noge te obostrana plućna embolija. Primljen je u Jedinicu intenzivne medicine te je započeto liječenje heparinom niske molekularne mase (enoksaparin). Nakon primljene treće doze bolesnik se počeo žaliti na bolove u desnom ramenu i prsnom košu te je 3 sata nakon toga, nakon postavljanja u sjedeći položaj, došlo do naglog pada tlaka, izgubio je svijest, prestao disati, a puls nije bio palpabilan. Nakon reanimiranja u trajanju od 4 minute došao je svijesti i žalio se na bolove u desnom ramenu, prsnom košu i gornjem desnom kvadrantu trbuha. Učinjenim ultrazvukom abdomena verifi cirana je slobodna tekućina u abdomenu, a kompjutoriziranom tomografi jom krvarenje iz jetre i ruptura jetrene čahure. Hitno je premješten u operacijsku dvoranu gdje je učinjena hemostaza i tamponada jetre. Prikaz ovoga bolesnika ukazuje na opseg mogućih neželjenih učinaka antikoagulacijske terapije, čak i kod bolesnika koji su kratkotrajno na antikoagulacijskoj terapiji i ne boluju od poremećaja zgrušavanja krvi. Pravodobno postavljanje dijagnoze spontane rupture jetre i primjena odgovarajuće terapije ključni su u poželjnom rješavanju navedene komplikacije