NEKARDIOGENI EDEM PLUĆA NAKON CARSKOG REZA

Acute dyspnea during and after pregnancy should bring a number of important conditions to the mind of a physician. Pulmonary embolism, amniotic fl uid embolism, pneumonia, aspiration and pulmonary edema must be considered. Although pulmonary edema is a very rare condition, the most common contributing factors include the administration of tocolytic agents, underlying cardiac disease, iatrogenic fluid overload and preeclampsia. We report on a case of noncardiogenic pulmonary edema in a 36-year-old woman a few hours after cesarean section. The acute event was probably due to iatrogenic fl uid overload combined with hemodynamic effects of oxytocin in interaction with hemodynamic changes at the end of pregnancy. The patient was successfully treated with diuretics and oxygen therapy, and after a few hours her chest radiograph and respiratory status were normal.Pojava akutne dispneje za vrijeme i nakon trudnoće treba pobuditi sumnju na nekoliko važnih diferencijalnih dijagnoza kao što su plućna tromboembolija, embolija amnionskom tekućinom, pneumonija, aspiracija i plućni edem. Plućni edem se javlja rijetko i obično je precipitiran tokolizom, već postojećom bolesti srca, volumnim preopterećenjem ili preeklampsijom. Opisujemo slučaj 36-godišnje bolesnice s nekardiogenim edemom pluća koji se manifestirao nekoliko sati nakon carskog reza kao rezultat volumnog opterećenja te istodobnog antidiuretskog djelovanja oksitocina i hemodinamskih promjena pred kraj trudnoće. Bolesnica je uspješno liječena diureticima i oksigenoterapijom. Nekoliko sati kasnije kontrolna slika srca i pluća i respiracijski status bili su normalni, a bolesnica nedugo zatim otpuštena iz bolnice

Hepatitis B – still the commonest sexually transmitted hepatitis in Croatia

Hepatitis B predstavlja značajan javnozdravstveni problem. Trećina svjetske populacije ima serološke znakove aktualne ili preboljele infekcije, a 350 milijuna ljudi je kronično inficirano. Jetrena bolest uzrokovana hepatitis B virusom uzrokuje godišnje preko milijun smrtnih ishoda kao posljedica dekompenzirane ciroze jetre i hepatocelularnog karcinoma. Predominantni načini prijenosa ovise o geografskom području i higijenskim uvjetima. U zemljama poput Hrvatske, hepatitis B se najčešće prenosi seksualnim putem i korštenjem nečistih igala kod intravenskih ovisnika o drogama. Rizik kroniciteta ovisi o dobi u času infekcije, odnosno o imunološkoj zrelosti zaražene osobe. Liječenje hepatitisa B ima za cilj eradikaciju virusa u ranoj fazi bolesti te trajnu supresiju HBV replikacije kod kronične bolesti, prevenirajući time razvoj ciroze i hepatocelularnog karcinoma. Lijekovi za hepatitis B odobreni u Europi su konvencionalni i pegilirani interferon-α, lamivudin, telbivudin, entekavir, adefovir i tenofovir. Uobičajene indikacije za terapiju su serumski HBV DNA >2000 IU/mL (>10 000 kopija/mL), povišen serumski ALT (2×) te umjerena do teška nekroinflamatorna aktivnost i/ili fibroza. Najvažnije je, međutim, provoditi profilaktičke mjere u osoba s rizikom akviriranja infekcije.Hepatitis B is a global public health problem. Approximately one third of the world population has serological evidence of past or present infection with hepatitis B virus (HBV), with more than 350 million people chronically infected, of whom roughly one million die annually from HBV-related liver disease (liver cirrhosis, hepatocellular cancer). The predominant mode of transmission of HBV varies in different areas of the world. In countries like Croatia, unprotected sexual intercourse and intravenous drug use in adults are major routes of transmission. Risk of chronicity depends on the age at infection and resultant immune maturity. Chronic carriers of HBV are at increased risk of developing liver cirrhosis and hepatocellular carcinoma (HCC). The goals of therapy for hepatitis B are eradication of virus in the early stage of disease and continuous suppression of viral replication in chronic disease, thus preventing the progression of cirrhosis and HCC. Drugs approved for the treatment of HBV infection in Europe are conventional interferon alpha, pegylated interferon alpha, lamivudine, telbivudine, entecavir, adefovir and tenofovir. The usual indications for treatment are serum HBV DNA>2000 IU/mL (>10 000 copies/mL), elevated aminotransferase levels and moderate to severe necroinflammatory activity and/or fibrosis. Preventive measures are most important in persons at risk of aquiring infection

Current Therapeutic Strategy in Inflammatory Bowel Diseases: The Importance of Mucosal Healing

Upalne bolesti crijeva, osobito Crohnova bolest, karakterizirane su intermitentnim tijekom bolesti, gdje svaki relaps bolesti dovodi do dodatnog oštećenja crijeva s rezultirajućim komplikacijama i potrebom za čestim hospitalizacijama i kirurškim zahvatima. Stoga se današnja terapija bazira na akceleriranom “step-up” pristupu gdje se što ranije nastoje uključiti najdjelotvorniji lijekovi kako bi rano zaustavili destruktivni upalni proces i prevenirali komplikacije. Ključni uvjet za postizanje duge stabilne remisije jest mukozno cijeljenje koje se definira kao endoskopska remisija, odnosno odsutnost mukoznih ulceracija. Mukozno cijeljenje samo je inicijalni, ali bitan događaj u supresiji upale u dubljim slojevima stijenke crijeva. U radu se opisuju mehanizmi procesa mukoznog cijeljenja te djelotvornost danas dostupnih lijekova u postizanju mukoznog cijeljenja. Ostaju mnoga otvorena pitanja poput izbora trenutka prekida biološke terapije te razvoja lijekova s alternativnim mehanizmima djelovanja važnih za bolesnike koji ne reagiraju na anti-TNF-terapiju.Inflammatory bowel diseases, particularly Crohn’s disease, are characterized by intermittent clinical course, where each relapse leads to additional bowel injuries with resultant complications and the need for frequent hospitalisations and surgeries. Our current therapeutic strategy is therefore to apply an accelerated step-up approach. This approach consist in an obligatory early introduction of most efficient drugs in order to achieve early control of destructive inflammatory processes and thereby prevent their complications. A key to the achievement of a long and stable remission is mucosal healing, which is defined as endoscopic remission with absence of mucosal ulcerations. Although mucosal healing is only the initial event, it is critical in the suppression of inflammation in deeper layers of the bowel wall. This paper describes the mechanisms of mucosal healing and evaluates the ability of presently available drugs to induce mucosal healing. Many questions remain open like timing of discontinuation of biological therapy and development of new drugs with alternative mechanisms of action, so important for patients who are primary non-responders to anti-TNF therapy

Hepatitis B – still the commonest sexually transmitted hepatitis in Croatia

Hepatitis B predstavlja značajan javnozdravstveni problem. Trećina svjetske populacije ima serološke znakove aktualne ili preboljele infekcije, a 350 milijuna ljudi je kronično inficirano. Jetrena bolest uzrokovana hepatitis B virusom uzrokuje godišnje preko milijun smrtnih ishoda kao posljedica dekompenzirane ciroze jetre i hepatocelularnog karcinoma. Predominantni načini prijenosa ovise o geografskom području i higijenskim uvjetima. U zemljama poput Hrvatske, hepatitis B se najčešće prenosi seksualnim putem i korštenjem nečistih igala kod intravenskih ovisnika o drogama. Rizik kroniciteta ovisi o dobi u času infekcije, odnosno o imunološkoj zrelosti zaražene osobe. Liječenje hepatitisa B ima za cilj eradikaciju virusa u ranoj fazi bolesti te trajnu supresiju HBV replikacije kod kronične bolesti, prevenirajući time razvoj ciroze i hepatocelularnog karcinoma. Lijekovi za hepatitis B odobreni u Europi su konvencionalni i pegilirani interferon-α, lamivudin, telbivudin, entekavir, adefovir i tenofovir. Uobičajene indikacije za terapiju su serumski HBV DNA >2000 IU/mL (>10 000 kopija/mL), povišen serumski ALT (2×) te umjerena do teška nekroinflamatorna aktivnost i/ili fibroza. Najvažnije je, međutim, provoditi profilaktičke mjere u osoba s rizikom akviriranja infekcije.Hepatitis B is a global public health problem. Approximately one third of the world population has serological evidence of past or present infection with hepatitis B virus (HBV), with more than 350 million people chronically infected, of whom roughly one million die annually from HBV-related liver disease (liver cirrhosis, hepatocellular cancer). The predominant mode of transmission of HBV varies in different areas of the world. In countries like Croatia, unprotected sexual intercourse and intravenous drug use in adults are major routes of transmission. Risk of chronicity depends on the age at infection and resultant immune maturity. Chronic carriers of HBV are at increased risk of developing liver cirrhosis and hepatocellular carcinoma (HCC). The goals of therapy for hepatitis B are eradication of virus in the early stage of disease and continuous suppression of viral replication in chronic disease, thus preventing the progression of cirrhosis and HCC. Drugs approved for the treatment of HBV infection in Europe are conventional interferon alpha, pegylated interferon alpha, lamivudine, telbivudine, entecavir, adefovir and tenofovir. The usual indications for treatment are serum HBV DNA>2000 IU/mL (>10 000 copies/mL), elevated aminotransferase levels and moderate to severe necroinflammatory activity and/or fibrosis. Preventive measures are most important in persons at risk of aquiring infection

Inflammatory bowel disease

Upalne bolesti crijeva su heterogena skupina upalnih bolesti karakterizirane kroničnom imunom aktivacijom i upalom gastrointestinalnog trakta praćene brojnim ekstraintestinalnim komplikacijama. Dvije najvažnije forme bolesti su Crohnova bolest i ulcerozni kolitis s brojnim fenotipovima. Patogeneza bolesti je još uvijek nejasna. Dijagnostički i terapijski pristup je vrlo kompleksan i zahtijeva dobro poznavanje tijeka i komplikacija bolesti i terapije. U ovom radu je prikazana sadašnja terapijska strategija s posebnim naglaskom na važnost procesa mukoznog cijeljenja te analiza saznanja o mjestu biološke terapije u liječenju IBD.Inflammatory bowel disease (IBD) is heterogenous group of inflammatory disorders characterized by chronic immune activation and inflammation of the gastrointestinal tract, associated with numerous extraintestinal manifestations. Two most important forms are Crohn’s disease and ulcerative colitis with several phenotypes. Etiopathogenesis of IBD is still unknown. Diagnostic and therapeutic approach of IBD is very complex and requires excellent knowledge of the clinical course and complications of the disease itself and therapy. The paper provides present therapeutic strategy with emphasis on the importance of mucosal healing and analysis of present knowledge of the role of biologics in the therapy of IBD

Inflammatory bowel disease

Upalne bolesti crijeva su heterogena skupina upalnih bolesti karakterizirane kroničnom imunom aktivacijom i upalom gastrointestinalnog trakta praćene brojnim ekstraintestinalnim komplikacijama. Dvije najvažnije forme bolesti su Crohnova bolest i ulcerozni kolitis s brojnim fenotipovima. Patogeneza bolesti je još uvijek nejasna. Dijagnostički i terapijski pristup je vrlo kompleksan i zahtijeva dobro poznavanje tijeka i komplikacija bolesti i terapije. U ovom radu je prikazana sadašnja terapijska strategija s posebnim naglaskom na važnost procesa mukoznog cijeljenja te analiza saznanja o mjestu biološke terapije u liječenju IBD.Inflammatory bowel disease (IBD) is heterogenous group of inflammatory disorders characterized by chronic immune activation and inflammation of the gastrointestinal tract, associated with numerous extraintestinal manifestations. Two most important forms are Crohn’s disease and ulcerative colitis with several phenotypes. Etiopathogenesis of IBD is still unknown. Diagnostic and therapeutic approach of IBD is very complex and requires excellent knowledge of the clinical course and complications of the disease itself and therapy. The paper provides present therapeutic strategy with emphasis on the importance of mucosal healing and analysis of present knowledge of the role of biologics in the therapy of IBD

Unilateral bupivacaine-fentanyl or bupivacaine-sufentanil spinal anaesthesia for arthroscopic knee surgery

Background and purpose: Unilateral spinal anaesthesia provides high cardiovascular stability and short ambulatory stay. Intrathecal coadministration od local anaesthetics and opioids has potent synergistic analgesic effect. We compared unilateral hyperbaric bupivacaine spinal anaesthesia with fentanyl or sufentanil in patients undergoing knee arthroscopy. Materials and methods: 40 ASA I-II adults received unilateral spinal anaesthesia with hyperbaric bupivacaine 4mg coadministered with either fentanyl 20μg (Group F,n=20) or sufentanil 2 μg (Group S, n=20). Sensory and motor block, hemodynamic data, side-effects and time to first analgesic were recorded. Results: Anaesthesia was successful in all 40 patients. Upper level of sensory block on operative leg was Th12 (Th12-Th8) in Group F and Th12 (Th11-Th9) in Group S, P=0.89. Complete motor block had 5 (25%) Group F and 3 (15%) Group S patients, P=0.69. uration of motor block was 78 ± 15 and 77 ± 13 min in Group F and Group S, respectively, P=0.89. Maximum decrease of baseline systolic arterial pressure was 16 ± 9 in Group F and 17 ± 7% in Group S, P=0.81 and of HR 16 ± 7 and 16 ±8%, P=0.90, respectively. Time to first analgesic was 285 ± 123 min in Group F and 355 ± 110 min in Group S, P=0.04. Pruritus had 7 (35%) Group F and 5 (25%) Group S patients, P=0.73. Conclusions: Unilateral hyperbaric bupivacaine spinal anaesthesia with fentanyl or sufentanil resulted in similar sensory and motor block and cardiovascular stability but bupivacaine-sufentanil combination provided prolonged first analgesic tim