Oportunističke mikoze središnjega živčanog sustava – prikaz dvaju bolesnika

This article presents two cases of opportunistic mycoses (OMs) of the central nervous system (CNS) caused by Cryptococcus neoformans and Aspergillus nidulans, respectively. The patients were hospitalised in local hospitals between 2009 and 2011 because of unspecific symptoms (fever, headache, and/or weight lost). Duration of symptoms varied from 4 days to over 2 weeks. The patients were treated with antibiotics and symptomatically. OM was not suspected in any of them. The patients became critically ill with symptoms of CNS involvement and were transferred to the Intensive Care Unit (ICU) of the University Hospital for Infectious diseases (UHID) in Zagreb. None of the patients belonged to the high-risk population for developing OMs. They were not HIV-infected, had no transplantation of bone marrow or solid organ, and were not on severe immunosuppressive chemotherapy. Fungi were isolated from cerebrospinal fluid (CSF) samples and, in one patient, from aspirate of cerebral abscess. Isolation and mycological identifi cation of all fungal isolates and in vitro antifungal susceptibility testing of these isolates were done at the Reference Centre for Mycological Diagnostics of Systemic and Disseminated Infections (RCMDSDI) in Zagreb. The patient with cryptococcal meningitis was treated with amphotericin B and fl uconazole and the patient with cerebral aspergilloma with voriconazole.Ovaj rad prikazuje dva slučaja oportunističkih mikoza (OM-a) središnjega živčanoga sustava uzrokovanih vrstama Cryptococcus neoformans i Aspergillus nidulans. Bolesnici su bili hospitalizirani u lokalnim bolnicama od 2009. do 2011. godine zbog nespecifi čnih simptoma (febrilitet, glavobolja i/ili gubitak tjelesne težine). Trajanje simptoma variralo je od 4 dana do više od 2 mjeseca. Bolesnici su bili liječeni antibioticima i simptomatski. Ni u jednog bolesnika nije postojala sumnja na OM. Kod oba bolesnika razvile su se teške kliničke slike infekcije sa simptomima zahvaćanja središnjega živčanog sustava i stoga su bili primljeni u Jedinicu intenzivnog liječenja Klinike za infektivne bolesti “Dr. F. Mihaljević” u Zagrebu. Nijedan bolesnik nije pripadao skupini bolesnika s najvećim rizikom od razvoja oportunističkih mikoza. Nisu bili infi cirani HIV-om, niti su bili liječeni transplantacijom koštane srži ili solidnog organa, kao ni jakim imunosupresivnim lijekovima. Gljivični izolati izdvojeni su iz uzoraka likvora u jednog bolesnika, a u drugog bolesnika iz uzorka aspirata moždanog apscesa. Izolacija i mikološka identifi kacija svih gljivičnih izolata i in vitro ispitivanje osjetljivosti gljivičnih izolata na antifungalne lijekove bili su provedeni u Referentnom centru za mikološku dijagnostiku sustavnih i diseminiranih infekcija (RCMDSDI) u Zagrebu. Amfotericin B i flukonazol davani su za liječenje kriptokoknog meningitisa, a vorikonazol za liječenje aspergiloma mozga

Biotypes of Candida albicans isolated from clinical material of hospitalized patients

Metodom biotipizacije po Oddsu i Abbottu tipizirano je 910 izolata vrste Candida albicans iz uzoraka materijala različitih organskih sustava 360 hospitaliziranih bolesnika. Tipizacijom je dobiveno 79 biotipova, a 14 najučestalijih (355, 305, 345, 155, 357, 105, 315, 144, 157, 115, 057, 257, 300 i 244) činilo je 89,3 % svih biotipova ove vrste. Najučestaliji biotip bio je 355 i činio je 20,9 % svih biotipova vrste C. albicans iz svih uzoraka. Ovaj biotip bio je zastupljen s 36,2 % u izolatima iz kardiovaskularnog sustava, s 21,4 % u izolatima iz dišnog sustava, s 20,1 % u izolatima iz probavnog sustava, s 19,5 % u izolatima iz obrisaka kože, s 19,4 % u izolatima iz središnjeg živčanog sustava i sa 17,1 % u izolatima iz spolnomokraćnog sustava. Ova metoda biotipizacije pogodna je za epidemiološka istraživanja zastupljenosti biotipova vrste C. albicans, jer omogućava ispitivanje velikog broja izolata, a ne iziskuje velike materijalne troškove i skupu opremu.Using the Odds and Abbott method, 910 isolates of Candida albicans were typed. They were isolated from samples of different systems in 360 hospitalized patients. Typing revealed 79 biotypes where 14 (355, 305, 345, 155, 357, 105, 315, 144, 157, 115, 057, 257, 300 i 244) of them were the most common, accounted for 89.3 % of all biotypes. The most common biotype, 355, made up 20.9 % of all biotypes of this species isolated from all samples. It was present in 36.2 % of isolates from the cardiovascular system, 21.4 % of isolates from the respiratory system, 20.1 % of isolates from the gastrointestinal system, 19.5 % of isolates from the skin, 19.4 % of isolates from the central nervous system, and in 17.1 % of isolates from the urogenital system. This method is suitable for epidemiological research of the presence of C. albicans biotypes because it enables the testing of a large number of isolates with very low cost and reasonably simple equipment

INFECTIONS CAUSED BY FREE LIVING AMOEBAS - ETIOLOGY, CLINICAL SYMPTOMS, DIAGNOSTIC, THERAPY AND PREVENTION

SAŽETAK Slobodnoživuće amebe iz rodova Naegleria, Acanthamoeba, Balamuthia i Sappinia, široj su medicinskoj struci nepoznate, ili slabo poznate. Te amebe mogu biti uzročnici životno ugrožavajućih bolesti koje nepravodobno prepoznate i neodgovarajuće liječene, gotovo redovito završavaju ili s teškim posljedicama, ili smrću. U radu je u kratkim crtama prikazana morfologija i epidemiologija slobodnoživućih ameba, kliničke osobitosti, te mogućnosti dijagnostike, liječenja i prevencije infekcija uzrokovanih tim amebama.SUMMARY Free-living amoebas, members of the genera Naegleria, Acanthamoea, Balamuthia and Sappinia are generally unknown or little known in the medical profession. They can cause life-treathening diseases. If not recognized early enough or inapropriately treated they can cause death or serious consequences. In this paper we presented morphology, epidemiology, clinical characteristics, diagnosis, therapy and prevention of these infections

KORIŠTENJE PALEORADIOLOŠKE I MIKROBIOLOŠKE ANALIZE ANTIČKOGA KULTURNOG MATERIJALA: MSCT, MAMOGRAFIJA I MIKROBIOLOŠKA ANALIZA KAPULJAČE S LIKOM SV. MARTINA I PROSJAKA (TROGIR, HRVATSKA)

Paleoradiology is the study of biological and other materials from archeological settings through the use of various medical imaging techniques. Although it is most often used in the scientific study of ancient human remains, it can also be used to study metals, ceramics, paper, and clothes. The aim of this study was to test two paleoimaging techniques (MSCT and mammography) in the analysis of an important Croatian liturgical vestment: the hood of a bishop’s cope from St. Lawrence’s Treasury in Trogir depicting St. Martin and a beggar. To ensure a safe environment for scientists participating in the analysis, a preliminary microbiological analysis was performed, which contributed to the database of microbiological flora found on Croatian archeological remains and relics studied to date. Due to a great amount of metal filaments, the paleoradiological analysis did not produce satisfactory results. However, a digitally enhanced image clearly showed fine metal embroidery of the hood that was not so easily perceived by naked eye. This article argues in favor of expanding paleoradiological studies on materials other than human remains and also of publishing unsatisfactory results, as important lessons for future development of techniques and methods to analyze ancient remains and seek answers about human historical and cultural heritage.Paleoradiologija je znanstvena disciplina koja se u analizi arheološki značajnih bioloških i drugih materijala služi različitim medicinskim slikovnim metodama. Iako se danas najčešće primjenjuje u istraživanju ljudskih ostataka, paleoradiologija se može koristiti i u analizi metala, keramike, papira i odjeće. Cilj je ovoga rada prikazati rezultate paleoradiološke (MSCT i mamografske) analize značajnoga hrvatskog obrednog crkvenog ruha: kapuljače biskupskog plašta s likom sv. Martina i prosjaka iz Trogirske riznice. Da bi se istraživačima osigurali sigurni uvjeti rada, izvedeno je mikrobiološko testiranje plašta, kojim su se nadopunili dosadašnji podaci o mikrobiološkoj flori hrvatskih arheoloških ostataka i relikvija. Zbog velikog broja metalnih niti prisutnih u kukuljici, paleoradiološka analiza nije dala zadovoljavajuće rezultate. Ipak, digitalno poboljšanje slike omogućilo je bolje uočavanje samog stila figuralnoga metalnog veza kapuljače, koji je teže uočiti golim okom. Naposljetku, studija obrazlaže značenje paleoradiologije u proučavanju nehumanoga arheološkog materijala kao i objavljivanje rezultata koji nisu posve zadovoljavajući, a bitni su za daljnji razvoj i poboljšavanje tehnika koje se koriste u istraživanju i arheološkog materijala i ljudske povijesti

Microbiological Analysis of the Mummy of St. Marcian

The paper provides the results of the microbiological analysis of samples taken from the mummified remains of St. Marcian. Microorganisms found belong to bacteria and fungi of the genera Aspergillus, Bacillus, Penicillium, Sarcina, and Shewanella which are all a part of the common air, soil, and human microbial flora and therefore present no health hazard

Haemorrhage from the parenchymatous organs of the abdomen

U svakodnevnoj kirurškoj praksi krvarenja iz parenhimatoznih organa abdomena svode se uglavnom na krvarenja iz jetre i slezene. Krvarenja nakon povrede pankereasa obično nisu jačeg intenziteta, dok krvarenja koja prate akutni hemoragični pankreatitis znaju biti vrlo jaka. Krvarenja iz uterusa i jajnika spadaju u domenu ginekologije, a krvarenja iz bubrega u domenu urologa. Kirurg se s njima susreća najčešće u politraumatiziranih bolesnika. Krvarenja iz jetre i slezene su većinom izdašna i mogu ugrožavati život bolesnika. Zbog toga preoperativna dijagnostika treba biti što brža i efikasnija kako bi se na vrijeme mogla provesti odgovarajuća kirurška terapija. Uzroci krvarenja iz ovih parenhimatoznih organa su pretežno povrede, bilo akcidentalne, bilo jatrogene. Krvarenja koja izazivaju patološki procesi, relativno su rijetka. Kod otvorenih povreda abdomena češće je oštećena jetra nego slezena, dok je to kod zatvorenih povreda obratno. Nagli porast prometnih nesreća paralelno prati i porast povreda parenhimatoznih organa abdomena, i to uglavnom u sklopu politraume. Prognoza ovih povreda ovisna je o opsežnosti dominantne povrede, jačini krvarenja i o faktoru vremena. U dijagnostičkom postupku otvorene povrede ne predstavljaju veće probleme, jer je u njih, osim u izuzetnim slučajevima, indicirana eksplorativna laparotomija. Najveći problem predstavljaju povrede abdomena i donjeg dijela toraksa, praćene hipovolemičkim šokom. Takva stanja zahtijevaju hitno zbrinjavanje u najbližoj zdravstvenoj ustanovi, bez obzira kako je ona opremljena. Radi toga u dijagnostičkom postupku posebno ističemo vrijednost punkcije i lavaže abdomena, koje se mogu izvesti u svakoj zdravstvenoj ustanovi. Shvaćanje da se u slučaju povrede jetre treba očuvati što više njenog tkiva, dok se slezena može odstraniti bez štetnih posljedica, mora se korigirati. Jetreno tkivo treba očuvati, ali pod uvjetom da mu je vitalitet održan, jer naknadna kirurška intervencija je znatno teža i opasnija. Splenektomija dovodi do niza štetnih posljedica, prvenstveno u djece. To se uglavnom odnosi na smanjenje imune obrane organizma i sklonost za infekciju koju prati visoki mortalitet. Radi toga, ako se slezena ne može očuvati poštednim kirurškim zahvatom, treba je poku­šati reimplantirati. To je opravdano uz uvjet da istovremeno nema kontaminacije sa znakovima peritonitisa. U prilog ovakvom stavu govore statistički podaci i iskustva stečena u Kirurškoj klinici KB »Dr Mladen Stojanović« u Zagrebu i Djelatnosti opće kirurgije u Medicinskom centru Bjelovar.In everyday surgical practice, bleedings from parenchymatous organs of the abdomen are mostly reduced to bleedings from the liver and spleen. Bleeding after the injury of pancreas is usually not very strong, whereas the bleeding connected with haemorrhagic pancreatitis can be very strong. Bleeding from the uterus and ovaries belongs to the sphere of gynecological practice and the bleeding from kidneys to the sphere of urology. A surgeon can meet them in polytraumatic patients. Bleedings from the liver and spleen are mostly strong and can endanger the patient’s life. Because of that, preoperative diagnostics should be very fast and efficient, to enable a suitable surgical therapy to be applied on time. The causes of bleeding from parenchymatous organs are mostly the injuries in an accident or jatrogenic management. Bleeding caused by pathologic processes is rather rare. In the open injuries of the abdomen liver is damaged more often than spleen, whereas in closed injuries the opposite is true. Rapid increase in traffic accidents causes the corresponding increase in injuries of the parenchymatous organs of the abdomen, which are mostly a part of polytrauma. The prognosis of these injuries depends on the extent of the main injury, the amount of bleeding and the factor of time. In the diagnostic procedure open injuries do not cause many problems, because here, with few exceptions, explorative laparatomy is indicated. The greatest problem are the injuries of the abdomen and the lower part of the thorax connected with hypovolemic shock. These states demand an urgent treatment in the nearest medical institution, regardless of its equipment. Because of that, in the diagnostic procedure the value of punction and lavage of the abdomen is emphasized, for it can be done in any medical institution. The opinion must be corrected that in case of liver injury ist tissue should be kept, while the spleen can be removed without dangerous consequences. The liver tissue should be kept, but only if its vitality is preserved, because the later surgical treatment is more difficult and dangerous. Splenectomy has a number of serious consequences, especially in children. It chiefly refers to the lack of immunity of the human body and resistlessness to infections, leading to high mortality rate. Therefore, if the spleen cannot be preserved by surgical operations, it must be reimplanted. This is justified only if there is no bacterial contamination with the signs of peritonitis. In favour of such a statement speak both the statistics and the experience from our Departments of General Surgery

THE USE OF PALEO-IMAGING AND MICROBIOLOGICAL TESTING IN THE ANALYSIS OF ANTIQUE CULTURAL MATERIAL: MULTISLICE COMPUTER TOMOGRAPHY, MAMMOGRAPHY, AND MICROBIAL ANALYSIS OF THE TROGIR CATHEDRAL COPE HOOD DEPICTING ST. MARTIN AND A BEGGAR

Paleoradiologija je znanstvena disciplina koja se u analizi arheološki značajnih bioloških i drugih materijala služi različitim medicinskim slikovnim metodama. Iako se danas najčešće primjenjuje u istraživanju ljudskih ostataka, paleoradiologija se može koristiti i u analizi metala, keramike, papira i odjeće. Cilj je ovoga rada prikazati rezultate paleoradiološke (MSCT i mamografske) analize značajnoga hrvatskog obrednog crkvenog ruha: kapuljače biskupskog plašta s likom sv. Martina i prosjaka iz Trogirske riznice. Da bi se istraživačima osigurali sigurni uvjeti rada, izvedeno je mikrobiološko testiranje plašta, kojim su se nadopunili dosadašnji podaci o mikrobiološkoj flori hrvatskih arheoloških ostataka i relikvija. Zbog velikog broja metalnih niti prisutnih u kukuljici, paleoradiološka analiza nije dala zadovoljavajuće rezultate. Ipak, digitalno poboljšanje slike omogućilo je bolje uočavanje samog stila figuralnoga metalnog veza kapuljače, koji je teže uočiti golim okom. Naposljetku, studija obrazlaže značenje paleoradiologije u proučavanju nehumanoga arheološkog materijala kao i objavljivanje rezultata koji nisu posve zadovoljavajući, a bitni su za daljnji razvoj i poboljšavanje tehnika koje se koriste u istraživanju i arheološkog materijala i ljudske povijesti.Paleoradiology is the study of biological and other materials from archeological settings through the use of various medical imaging techniques. Although it is most often used in the scientific study of ancient human remains, it can also be used to study metals, ceramics, paper, and clothes. The aim of this study was to test two paleoimaging techniques (MSCT and mammography) in the analysis of an important Croatian liturgical vestment: the hood of a bishop’s cope from St. Lawrence’s Treasury in Trogir depicting St. Martin and a beggar. To ensure a safe environment for scientists participating in the analysis, a preliminary microbiological analysis was performed, which contributed to the database of microbiological flora found on Croatian archeological remains and relics studied to date. Due to a great amount of metal filaments, the paleoradiological analysis did not produce satisfactory results. However, a digitally enhanced image clearly showed fine metal embroidery of the hood that was not so easily perceived by naked eye. This article argues in favor of expanding paleoradiological studies on materials other than human remains and also of publishing unsatisfactory results, as important lessons for future development of techniques and methods to analyze ancient remains and seek answers about human historical and cultural heritage