Idiopatski asinkroni obostrani segmentalni infarkt testisa - prikaz slučaja

We present an unusual case of sudden onset of pain in the left testis in a patient with a previous medical history of right orchiectomy due to hemorrhagic infarction. A partial orchiectomy was performed with complete removal of the lesion and reconstruction of the testicular parenchyma. Histopathological assessment confirmed segmental testicular infarction without the presence of malignancy. The patient subsequently received anticoagulant therapy.Prikazujemo neobičan slučaj iznenadne pojave boli u lijevom testisu kod bolesnika u kojeg je prethodno učinjena desnostrana orhidektomija zbog hemoragijskog infarkta. Izvršena je djelomična orhidektomija s potpunim uklanjanjem lezije i rekonstrukcijom parenhima testisa. Histopatološkom obradom potvrđen je segmentalni infarkt testisa bez prisutnosti zloćudne bolesti. U bolesnika je nakon toga primjenjena protuzgrušavajuća terapija

Produljeno aktivirano parcijalno tromboplastinsko vrijeme - prikaz slučaja

A case of a 75-year-old female referred to our hospital for hip replacement with preoperative laboratory test of prolonged activated partial thromboplastin time due to factor XII deficiency is described. Other coagulation parameters known to be associated with prolonged activated partial thromboplastin time like factor VIII, factor IX, factor XI, high-molecular-weight kininogen and prekallikrein were normal, and there was no evidence for the presence of unspecified circulating anticoagulants or heparin. There is a general consensus that factor XII deficiency usually does not result in hemorrhagic diathesis. Its relationship with overt venous thrombosis is still unclear. The patient and her family had no history of bleeding disorder or thromboembolic events. There was no excessive bleeding or thromboembolic incident during the surgery and postoperative recovery.Prikazan je slučaj 75-godišnje bolesnice upućene u našu bolnicu radi ugradnje umjetnog kuka s prijeoperacijskim nalazom produljenog aktiviranog parcijalnog tromboplastinskog vremena zbog nedostatka faktora XII. Drugi čimbenici koji mogu uzrokovati produljenje aktiviranog parcijalnog tromboplastinskog vremena kao faktor VIII, faktor IX, faktor XI, kininogen visoke molekularne mase i prekalikrein su bili uredni, a nije bilo znakova prisutnosti cirkulirajućih antikoagulansa niti heparina. Opći stav je da nedostatak faktora XII uglavnom ne uzrokuje krvarenje, dok je još nejasna povezanost s tromboembolijom. U bolesnice i njene obitelji nije bilo anamnestičkih podataka o poremećaju krvarenja niti tromboembolije. Za vrijeme kirurškog zahvata i u poslijeoperacijskom razdoblju nije bilo značajnog krvarenja niti tromboembolije

Stečeni inhibitor faktora V: Prikaz slučaja

A 19-year-old asymptomatic man who was admitted to our hospital for investigation of prolonged screening coagulation assays, prothrombin time and activated partial thromboplastin time is presented. Further evaluation revealed factor V deficiency and the presence of specific factor V inhibitors. The appearance of these inhibitors may be associated with administration of some antibiotics, topical bovine thrombin preparations containing bovine factor V during surgical or dental procedures, after blood transfusions and in patients with malignancy or autoimmune diseases. Factor V inhibitors may also develop spontaneously in patients without any clearly identifiable cause. Our patient had no personal or family history of bleeding tendency or thromboembolic event. There is a general consensus that asymptomatic patients should not be treated regardless of their inhibitor titer and residual factor V levels.Prikazan je slučaj 19-godišnjeg bolesnika bez simptoma, koji je upućen u našu bolnicu zbog ispitivanja uzroka produljenih probnih testova zgrušavanja, protrombinskog vremena i aktiviranog parcijalnog tromboplastinskog vremena. Daljnje istraživanje ukazalo je na nedostatak faktora V i prisutnost specifičnog inhibitora faktora V. Prisutnost ovih inhibitora može biti povezana s primjenom antibiotika, goveđeg trombina koji sadrži goveđi faktor V primijenjenih lokalno za vrijeme kirurških i zubnih zahvata, nakon transfuzije krvi i u bolesnika s malignim ili autoimunim bolestima. Inhibitori faktora V mogu također nastati spontano u bolesnika bez jasno otkrivenog uzroka. Naš bolesnik i njegova obitelj nisu imali anamnestičkih podataka o sklonosti krvarenju niti tromboemboliji. Opći je stav da bolesnike bez simptoma nije potrebno liječiti, bez obzira na titar inhibitora i preostalu razinu faktora V

Recombinant factor Vlla therapy in a patient on long term anticoagulant treatment with a bleeding and acute subdural hematoma

In this paper we report on the successful correction of a coagulopathy with activated recombinant factor seven (rFVIIa) therapy which enabled surgical removal of a life threatening subdural hematoma. The severe coagulopathy developed due to long term warfarin therapy, which followed heart valvular reconstruction and replacement. The coagulopathy failed to improve following fresh frozen plasma and vitamin K therapy. Activated recombinant factor VII therapy became the treatment of choice, which enabled the life saving surgical removal of the subdural hematoma

Plućna infekcija izazvana organizmom Nocardia asteroides: prikaz slučaja

Presentation is made of a 53-year-old woman with pulmonary infection caused by Nocardia asteroides. Tracheal aspirate was obtained and examined microbiologically. Direct smear of the tracheal aspirate stained with Gram stain revealed gram-positive branched filamentous hyphae and numerous leukocytes. Pure culture of colonies of a chalky white appearance grew on the blood agar after prolonged incubation. The Gram stained direct slide prepared from the culture showed gram-positive branching filaments. The microorganism was identified as Nocardia asteroides by standard methods.Prikazana je 53-godišnja bolesnica s plućnom infekcijom uzrokovanom mikroorganizmom Nocardia asteroides. Uzet joj je trahealni aspirat i pretražen je mikrobiološki. U direktnom mikroskopskom preparatu iz aspirata traheje bojenom po Gramu vidljive su gram pozitivne razgranate filamentne hife uz puno leukocita. Na krvnom agaru nakon duže inkubacije porasla je čista kultura kolonija bijelog, kredastog izgleda. Preparat iz kulture bojen po Gramu pokazao je gram pozitivne razgranate filamente. Primjenom standardnih metoda mikroorganizam je identificiran kao Nocardia asteroides

Evaluation of Periodontal Parameters in Patients with Early Stage Chronic Lymphocytic Leukemia

Svrha rada: Procjenjivao se parodontni status ispitanika s KLL-om u ranom stadiju i uspoređivao s parodontnim statusom zdravih ispitanika u kontrolnoj skupini te analizirala veza između parodontoloških i hematoloških parametara bolesnika s KLL-om. Materijali i metode: Pregledano je 60 ispitanika: 30 oboljelih od KLL-a – u stadiju Rai 0 (ispitna skupina) te 30 zdravih osoba iste životne dobi (kontrolna skupina). Kriteriji za isključivanje bili su: postojanje neke druge sistemske bolesti ili stanja (npr. dijabetes), već provedena parodontna terapija, liječenje antibioticima tijekom posljednja tri mjeseca i uzimanje lijekova. Socijalno-demografski podatci prikupljeni su upitnikom. Ispitanicima s najmanje osam zuba obavljen je kompletan parodontološki pregled i određeni su API, PBI, PPD, REC i CAL. Medicinski podatci oboljelih od KLL-a preuzeti su iz njihove medicinske dokumentacije, a hematološki parametri očitani su iz nalaza krvne pretrage. Rezultati: Skupine su se međusobno razlikovale s obzirom na dob, broj zuba i učestalost odlazaka stomatologu (p 0,05), nego samo za REC (F = 4,601; p 0,05). Zaključak: Rezultati ovog istraživanja pokazali su da su oboljeli od KLL-a imali lošiji parodontni status negoli zdravi ispitanici. Uzročno-posljedična veza između parodontoloških i hematoloških parametara nije dokazana.Objective: To assess periodontal conditions in patients with early stage CLL and to compare it with the periodontal status of age matched healthy controls and to analyze the relationship between periodontal and hematological parameters in CLL patients. Materials and Methods: 60 subjects were examined: 30 patients with CLL Rai 0 (test group) and 30 age-matching healthy individuals (control group). The exclusion criteria were: presence of other systemic disease or condition (e.g. diabetes), history of treatment for periodontitis, use of antibiotics during the last 3 months, use of medications. Socio-demographic data were obtained by means of a questionnaire. Participants with at least 8 teeth underwent a full mouth examination assessing API, PBI, PPD, REC and CAL. Medical data for CLL patients were collected from the patients’ records, while hematological data were obtained from the hemogram. Results: Difference between groups was statistically significant for age, number of teeth and frequency of dental checkups (p0.05), only for REC (F=4.601; p0.05). Conclusion: The results of this study showed that patients with CLL had worse periodontal status compared to healthy subjects. Causal relationship between periodontal and hematological parameters was not proved

Quality Management: Patients Reflections on Health Care at Outpatient Clinic of Internal Medicine Department

Middle and older age group relative share in the community permanently grows. Those are commonly burdened with several chronic health conditions or elevated incidence of acute ones and in more frequent need for consulting health services. In the era of modern technical medicine, it is important to increase quality of services particularly patients orientated. Department of Internal medicine developed questionnaire to assess reflections on medical care from the receiver of medical services point of view. Sample was formed from individuals that visited outpatient triage Unit (OTU) and voluntary enrolled, during period April 1 – August 31 2008 for any medical reason. Study population structure had similarly equally of both genders, socio-economical background, and was in age range 18–87. Questionnaire was developed by team of experienced personnel covering satisfaction on received medical care. There were 279 returned formulary in a sample of 6700 patients (4.18%). Patients visited OTU chiefly on behalf medical condition secondary to address of residency, followed by personal choice, on advice given by general practitioner, by emergency transportation services, or just due to earlier experiences. Regarding provided medical care extent, 4/5 of patients were examined in lesser than 2 hours, while total workup lasted mostly for 2–4, followed by over four. Over half of patients were moderate toward highly satisfied with provided medical information, personnel communication style and general reflection on all services while being in the Department premises. Astonishing proportion of patients (93%) was satisfied with positive personnel communication. Integration of patients’ self-perceived reports about medical services in organizing process is inevitable for augmenting content and at the same time valuable for developing overall quality of treatment. Communication excellence is of premier importance and unavoidable for giving additional positive effect to remain health status or to ease the healing process of individual and their families

Nasljedni nedostatak proteina s i opetovane tromboembolije

A case is presented of a 32-year-old female with hereditary protein S deficiency associated with pulmonary embolism and recurrent deep venous thrombosis of lower extremities. Other proteins known to be associated with familial thromboembolic disease, including antithrombin, plasminogen, fibrinogen, protein C, factor V Leiden and prothrombin G20210A, were normal. Her mother, grandmother and great-grandfather had a history of thromboembolic disease. This report illustrates the importance of protein S measurement in patients suspected of having inherited venous thrombotic disorders.Prikazan je slučaj 32-godišnje bolesnice s nasljednim nedostatkom proteina S povezanim s plućnom embolijom i opetovanom dubokom venskom trombozom donjih ekstremiteta. Ostali čimbenici nasljedne trombofilije, tj. antitrombin, plazminogen, fibrinogen, protein C, faktor V. Leiden i protrombin G20210A su bili uredni. Obiteljska anamneza majke, bake i pradjeda ukazivala je na opetovanu vensku trombozu i plućnu emboliju. Navodi se značenje određivanja proteina S u bolesnika sa sumnjom na nasljednu trombofiliju