Thrombosis of a biological pulmonary valve in a young patient on anticoagulant therapy with rivaroxaban: a case report

Background: Patients with repaired tetralogy Fallot often develop severe pulmonary regurgitation (PR) and need surgical or catheter valve replacement/implantation. Early valve failure is not expected and thrombosis of a biological valve in a mid-term period after surgery on pulmonary position is rare. ----- Case summary: We report a 33-year-old female patient, who presented with heart failure, 18 months after surgical implantation of a biological valve on pulmonary position for severe PR, after previous complete repair. The patient was on anticoagulant therapy with novel oral anticoagulants (NOACs) for paroxysmal atrial fibrillation. After revealing a big pulmonary valve (PV) thrombus as a cause of severe valve stenosis and right heart failure, patient was re-operated without complication. After surgery a long-term warfarin therapy was introduced. The patient had an uneventful 9-month follow-up. ----- Discussion: Thrombotic events after rivaroxaban therapy are rare in non-valvular disease and there is paucity of data for NOAC therapy related to valve thrombosis. In our case, severe heart failure 1 year and a half after PV replacement, in a patient taking anticoagulant therapy, was unexpected. The diagnosis of valve thrombosis was revealed by echocardiography, and confirmed by computed tomography. We did not find any sign of thrombophilia, or any mechanical reason for valve thrombosis

Tvorbe u ženskoj zdjelici – zamke u tumačenju snimaka dobivenih višeslojnom kompjutoriziranom tomografijom (MSCT) i magnetskom rezonancijom (MR)

Different conditions within the pelvis are presented with very few symptoms. Likewise, their imaging characteristics are usually non-specific, implying high chance of misinterpretation. The aim of this paper is to point to the misinterpretation possibilities in computed tomography (CT) and magnetic resonance (MR) studies of the pelvic lesions and to outline their differential diagnosis. CT (11), MR (seven) or both (four patients) were performed in 22 female patients (age 23-69) with suspicious pelvic masses. Relevant laboratory and medical history data were available for most of the patients. Twenty patients underwent subsequent surgery and pathological findings were available in 18 cases. After radiological examinations different diagnoses were proposed in respect to imaging findings and available clinical data: pelvic inflammatory disease (one), ovarian tumor (six), uterine tumor (eight), metastatic or recurrent tumor (four), lymphocele (one), and post-irradiation and post-chemotherapy changes (two) patients. Postoperative results of the pathological analysis differed from radiological diagnosis in three of 18 pathologically examined materials: one benign tumor was falsely characterized as possibly malignant by the radiologist, one surgically transposed ovary was described as tumor, and one case of post-irradiation changes was described as recurrent tumor. Aside from knowing imaging characteristics, it is of great importance for radiologists to be aware of clinical, laboratory, and surgical protocols information as well as to have insight in patients’ prior imaging material in order to be able to correctly interpret imaging findings of the pelvic lesions.Simptomi različitih stanja u zdjelici neznatni su pa su prema tome i njihove značajke na snimkama obično nespecifične, što podrazumijeva i veliku mogućnost pogrešnog tumačenja. Cilj ovoga rada jest upozoriti na mogućnosti pogrešnog tumačenja komjutorizirane tomografije (CT) i magnetske rezonancije (MR) lezija u zdjelici te u glavnim crtama prikazati i razmotriti diferencijalnu dijagnozu. CT (11), MR (sedam) ili oboje (četiri bolesnice) obavljeno je u 22 bolesnice (dob 23-69) sa sumnjivim tvorbama u zdjelici. Za većinu su bolesnica na raspolaganju bili njihovi prethodni relevantni laboratorijski i medicinski podaci. Dvadeset bolesnica bilo je podvrgnuto kirurškom zahvatu i za 18 bili su dostupni patološki nalazi. Nakon radiološkog pregleda predložene su različite dijagnoze s obzirom na snimke i raspoložive kliničke podatke: upalna bolest zdjelice (jedan), tumor jajnika (šest), tumor maternice (osam), metastatski tumor ili recidiv (četiri), limfokela (jedna), te postiradijacijske i postkemoetrapijske promjene (dvije bolesnice). Postoperativni nalazi patološke analize razlikovali su se od radiološke dijagnoze u tri od 18 pregledanih materijala: jedan dobroćudni tumor radiolog je pogrešno opisano kao vjerojatnom zloćudni, jedan kirurški transponirani jajnik opisan je kao tumor, a u jedne su bolesnice postiradijacijske promjene opisane kao recidiv tumora. Osim prepoznavanja značajaka na snimkama, za ispravno tumačenje snimaka lezija u zdjelici radiolozima su vrlo važni i podaci dobiveni kliničkim, laboratorijskim i kirurškim postupcima te uvid u prethodne snimke pacijenata

Should we use CT or MRI for detection and characterization of benign adrenal lesions?

OBJECTIVES: Computed tomography (CT) and magnetic resonance imaging (MRI) are the main imaging modalities used for analysis of adrenal lesions. We compared the ability of CT and MRI to detect and characterize benign adrenal lesions. ----- PATIENTS AND METHODS: Unenhanced abdominal CT and MRI were performed in 16 patients (age range 39-77), and reviewed by a radiologist with 6years of experience in abdominal imaging. The presence, number, size and structure of each mass were analyzed and compared between the two modalities. ----- RESULTS: There were 18 adrenal masses in 11 patients, four patients had adrenal hyperplasia (AH), whereas one patient had left-sided AH and right-sided adenoma. Ten masses were≥2cm in diameter, and were perfectly depicted using CT and all MRI techniques. There were nine masses with diameter10Hounsfield units could not be characterized using unenhanced CT, but three of them were characterized using MRI. ----- CONCLUSION: CT has higher sensitivity for detection of small adrenal tumours and adrenal hyperplasia than MRI. MRI is an important tool in characterization of adrenal masses that could not be characterized using unenhanced CT

Registar za psihoze Hrvatske (Croatian Psychoses Registry)

 Hrvatski zavod za javno zdravstvo je, uočivši javnozdravstveno značenje mentalnih/duševnih bolesti još 1961. godine utemeljio Registar za psihoze Hrvatske. Registar je započeo radom cenzusom svih bolesnika zatećenih 31. prosinca u psihijatrijskim bolnicama i odjelima u Hrvatskoj. Predstavlja specijalni zdravstveno statistički instrument za dugoročno poimenično praćenje bolesnika i ima značajke populacijskog registra.  Prate se podaci o osobama, s prebivalištem u Republici Hrvatskoj, koji boluju od shizofrenije a liječeni su   u psihijatrijskim bolnicama i odjelima. Izvor podataka je psihijatrijski obrazac koji se popunjava prilikom otpusta   osobe iz bolnice (redovita prijava i dnevna bolnica) i na dan cenzusa 31. prosinca svake godine.    Za svaku pojedinu osobu može se pratiti tijek bolničkog liječenja prema ustanovi, trajanju hospitalizacije, osnovnoj i drugoj psihijatrijskoj dijagnozi, te somatskoj dijagnozi, uzroku smrti u slučaju smrti u bolnici ili izvršenog samoubojstva.  Skupno se podaci analiziraju na razini osobe i slučaja po odabranim obilježjima (dob, spol, županija rođenja/boravka, ustanova liječenja) u okviru pojedinih podskupina tzv. kontingenata.  Uvođenje X revizije Međunarodne klasifikacije bolesti SZO   dovelo je do promjene u razvrstavanju pojedinih dijagnostičkih potskupina. Zbog kontinuiteta praćenja bolesnika u Registar se od 1995. godine uz osobe imaju dijagnozu shizofrenije (šifra F20) registriraju i osobe koje imaju dijagnozu shizoafektivnog poremećaja (prije shizoafektivna shizofrenija) (šifra F25)

Epidemiološki prikaz duševnih bolesti i poremećaja (Epidemiology of Mental Diseases)

Duševno zdravlje nedjeljivi je sastavni dio općeg zdravlja. Narušeno duševno zdravlje prijetnja je zdravlju pojedinca i zajednice. Na razini pojedinca  izaziva  veliku  subjektivnu  patnju,  smanjujekvalitetu  života  i  povećava  morbiditet  i  mortalitet  od  tjelesnih  bolesti,  a    na razini zajednice ugrožava društvene i gospodarske odnose.Na temelju istraživanja  Globalnog  opterećenja  bolestima, koje su objavile  Svjetskazdravstvena  organizacija  i  Svjetska  banka, ako se kao pokazatelj opterećenja bolešću analizira samo komponentu godina života s dizabilitetom (years lived with disability – YLDs) među 10 najčešćih uzroka dizabiliteta    u svijetu 2000. godine četiri su iz skupine duševnih poremećaja (Tablica 1). To su unipolarni depresivni poremećaj, alkoholizam, shizofrenija i bipolarni afektivni poremećaj. Na ljestvici za sve dobi ukupno unipolarni depresivni poremećaj zauzima prvo mjesto s udjelom od 11,9%.  Alkoholizam se nalazi na petom mjestu s udjelom od 3,1%, shizofrenija na sedmom mjestu (2,8%), a bipolarni afektivni poremećaj na devetom mjestu (2,5%).U dobnoj skupini 15-44 godine ove četiri dijagnostičke skupine uzrokuju gotovo trećinu godina života s dizabilitetom. Unipolarni depresivni poremećaj nalazi se također na prvom mjestu, ali s udjelom od 16,4%. Alkoholizam se nalazi na drugom mjestu s udjelom od 5,5%, a shizofrenija na trećem mjestu s udjelom od 4,9%, dok se bipolarni afektivni poremećaj nalazi se na petom mjestu s udjelom od 4,7%

Pectus excavatum – cosmetic problem or something more?

Introduction: Pectus excavatum, a deformity of the sternum and ribs caused by an unbalanced costochondral hypertrophy, is a congenital abnormality with a prevalence of 1/1000 and it is commonly considered to be an incidental finding without clinical significance. In more advanced cases there may be a considerable compression and relocation of thoracic organs which can lead to serious cardiac or respiratory symptoms.1-3 Case report: 19-year-old male patient was admitted for two-month history of palpitations, shortness of breath and continuous chest pain. Physical exam showed significant pectus excavatum and thoracic lordosis with otherwise normal findings. Resting 12-lead ECG and laboratory tests were normal, including cardiac troponin T levels. 24-hour ECG revealed premature ventricular beats with a paroxysm of non-sustained ventricular tachycardia. Echocardiography (Figure 1) showed normal biventricular size and function and raised suspicion of a large tumor mass compressing the left atrium (LA). No obvious signs of flow obstruction in LA using color and spectral Doppler were noticed. Mitral valve showed billowing of the anterior leaflet with otherwise normal valve function. The next diagnostic step was thoracic CT scan (Figure 2) which revealed extremely thin sagittal thoracic diameter with vertebrae compressing posterior wall of the LA and no signs of a tumor mass. Exercise stress test showed normal functional capacity with no signs of ischemia or arrhythmias in ECG. Patient was started on minimal dose of bisoprolol and follow up 24-hour ECG showed no ventricular arrhythmias. Since CT scan is the gold standard for determining the severity of the pectus excavatum defect, pectus severity index (PSI) was calculated and in our patient the value was 4.8. A normal chest has an average PSI of 2.5 and patients with a PSI of >3.25 are considered candidates for surgery. Patient was scheduled for additional respiratory function tests and will be referred to thoracic surgeon. Conclusion: Severe cases of pectus excavatum can have significant impact on cardiorespiratory function and in those patients, surgery should be considered. On echocardiography, LA compression by vertebrae can even mimic a tumor mass but thoracic CT scan is a gold standard for diagnostic and severity assessment of this condition

Registar izvršenih samoubojstava Hrvatske (Croatian Committed Suicides Registry)

Registar izvršenih samoubojstava Hrvatske osnovan je 1986. godine u Hrvatskom zavodu za javno zdravstvo. U njemu se registriraju podaci o osobama, s prebivalištem u Republici Hrvatskoj, koje su izvršile samoubojstvo.   Izvor podataka je potvrda o smrti i statistički izvještaj o smrti. Skupno se podaci analiziraju po dobi, spolu županiji rođenja/ boravka, metodi izvršenja, danu/mjesecu izvršenja te ev. psihijatrijskoj dijagnozi