Rana paraliza hemidijafragme uz kasniji razvoj poliradikulomijelitisa kao komplikacije leptospiroze – izvješće o studiji slučaja

We describe a patient with acute encephalomyeloradiculitis during leptospirosis. Unilateral diaphragmatic paralysis, noted on the 7th day of illness, appeared as the first neurological deficit. The patient was treated with amoxicillin/clavulanic acid for seven days, from the 7th day of illness. The symptoms of polyradiculitis appeared in the second phase of the illness, and progressed during high dose dexamethasone therapy. The patient recovered completely.Opisujemo bolesnika s akutnim encefalomijeloradikulitisom tijekom leptospiroze. Kao prvi neurološki deficit je 7. dana bolesti zabilježena unilateralna paraliza ošita. Bolesnik je od 7. dana bolesti liječen amoksicilin/klavulonskom kiselinom kroz 7 dana. Simptomi poliradikulitisa su se pojavili u drugoj fazi bolesti te su progredirali unatoč započetom liječenju visokim dozama deksametazona. Bolesnik se u konačnici potpuno oporavio

Rana paraliza hemidijafragme uz kasniji razvoj poliradikulomijelitisa kao komplikacije leptospiroze – izvješće o studiji slučaja

We describe a patient with acute encephalomyeloradiculitis during leptospirosis. Unilateral diaphragmatic paralysis, noted on the 7th day of illness, appeared as the first neurological deficit. The patient was treated with amoxicillin/clavulanic acid for seven days, from the 7th day of illness. The symptoms of polyradiculitis appeared in the second phase of the illness, and progressed during high dose dexamethasone therapy. The patient recovered completely.Opisujemo bolesnika s akutnim encefalomijeloradikulitisom tijekom leptospiroze. Kao prvi neurološki deficit je 7. dana bolesti zabilježena unilateralna paraliza ošita. Bolesnik je od 7. dana bolesti liječen amoksicilin/klavulonskom kiselinom kroz 7 dana. Simptomi poliradikulitisa su se pojavili u drugoj fazi bolesti te su progredirali unatoč započetom liječenju visokim dozama deksametazona. Bolesnik se u konačnici potpuno oporavio

Sweet’s syndrome – report of a patient with a variety of extraintestinal manifestations of ulcerative colitis

Sweetov sindrom je rijedak kožni poremećaj kojeg karakterizira izbijanje bolno osjetljivih crvenkastih plakova po koži, što je često praćeno febrilitetom, neutrofilijom u perifernoj krvi te nalazom pretežno perivaskularno smještenih nakupina neutrofila u histološkom preparatu bioptata kože. Bolest je u 50% slučajeva povezana s drugim bolestima i stanjima kao što su maligne bolesti, bakterijske i virusne infekcije, autoimune bolesti i kolagenoze, upalne bolesti crijeva, upotreba nekih lijekova, itd. Ulcerozni kolitis je idiopatska, imunološki uvjetovana upalna bolest crijeva koja je u malog broja bolesnika praćena i vancrijevnim manifestacijama bolesti, koje se najčešće razvijaju na koštano-zglobnom sustavu, koži i sluznicama. U ovom radu prikazujemo 39-godišnju bolesnicu s ulceroznim kolitisom u koje su se šest mjeseci nakon pojave kolitičkih tegoba razvili Sweetov sindrom, reaktivni poliartritis i poliserozitis. Kombiniranim protuupalnim liječenjem metil-prednizolonom i mesalazinom u terapijskim dozama postignuta je remisija ulceroznog kolitisa i povlačenje svih simptoma vancrijevnih manifestacija bolesti, no tri mjeseca kasnije je u bolesnice došlo do relapsa reaktivnog poliartritisa, koji je uspješno suzbijen primjenom ibuprofena. Kod sumnje na Sweetov sindrom potrebno je učiniti histološki pregled kožnih promjena te ukoliko se uz karakterističan histološki nalaz i prisutne ostale kliničke i laboratorijske kriterije postavi dijagnoza Sweetovog sindroma, potrebno je tragati za predležećim bolestima. Kao zlatni standard preporučeno liječenje sistemskom primjenom kortikosteroida se pokazalo učinkovitim u liječenju naše bolesnice.Sweet’s syndrome is a rare dermatological disorder characterized by eruption of painful reddish plaques on the skin, accompanied by fever, neutrophilia in peripheral blood and finding of perivascular neutrophilic infiltrates in the skin biopsy sample. The syndrome is in 50% of cases associated with other diseases and conditions such as malignancies, bacterial and viral infections, autoimmune and connective tissue diseases, inflammatory bowel diseases, use of certain drugs, etc. Ulcerative colitis is idiopathic, immunologically mediated inflammatory bowel disease which is in a small proportion of patients associated with extraintestinal manifestations of disease, characteristically developed on the joints, skin and mucous membranes. We present a case of a 39-year-old woman with ulcerative colitis in whom the six month period of colitis symptoms was followed by the development of Sweet’s syndrome, reactive polyarthritis and polyserositis. Using the combined anti-inflammatory treatment with methylprednisolone and mesalazine in therapeutical doses the remission of ulcerative colitis and regression of all extraintestinal manifestations was achieved, but three months later a relapse of reactive polyarthritis developed that was successfully treated with ibuprofen. When Sweet’s syndrome is suspected, the histological examination of the skin lesions should be performed, and if a characteristic histological finding is accompanied by other clinical and laboratory criteria and the diagnosis of Sweet’s syndrome is established, the search for underlying diseases should be done. The systemic treatment with corticosteroids, recommended as the golden standard, proved effective in the treatment of our patient

Sweet’s syndrome – report of a patient with a variety of extraintestinal manifestations of ulcerative colitis

Sweetov sindrom je rijedak kožni poremećaj kojeg karakterizira izbijanje bolno osjetljivih crvenkastih plakova po koži, što je često praćeno febrilitetom, neutrofilijom u perifernoj krvi te nalazom pretežno perivaskularno smještenih nakupina neutrofila u histološkom preparatu bioptata kože. Bolest je u 50% slučajeva povezana s drugim bolestima i stanjima kao što su maligne bolesti, bakterijske i virusne infekcije, autoimune bolesti i kolagenoze, upalne bolesti crijeva, upotreba nekih lijekova, itd. Ulcerozni kolitis je idiopatska, imunološki uvjetovana upalna bolest crijeva koja je u malog broja bolesnika praćena i vancrijevnim manifestacijama bolesti, koje se najčešće razvijaju na koštano-zglobnom sustavu, koži i sluznicama. U ovom radu prikazujemo 39-godišnju bolesnicu s ulceroznim kolitisom u koje su se šest mjeseci nakon pojave kolitičkih tegoba razvili Sweetov sindrom, reaktivni poliartritis i poliserozitis. Kombiniranim protuupalnim liječenjem metil-prednizolonom i mesalazinom u terapijskim dozama postignuta je remisija ulceroznog kolitisa i povlačenje svih simptoma vancrijevnih manifestacija bolesti, no tri mjeseca kasnije je u bolesnice došlo do relapsa reaktivnog poliartritisa, koji je uspješno suzbijen primjenom ibuprofena. Kod sumnje na Sweetov sindrom potrebno je učiniti histološki pregled kožnih promjena te ukoliko se uz karakterističan histološki nalaz i prisutne ostale kliničke i laboratorijske kriterije postavi dijagnoza Sweetovog sindroma, potrebno je tragati za predležećim bolestima. Kao zlatni standard preporučeno liječenje sistemskom primjenom kortikosteroida se pokazalo učinkovitim u liječenju naše bolesnice.Sweet’s syndrome is a rare dermatological disorder characterized by eruption of painful reddish plaques on the skin, accompanied by fever, neutrophilia in peripheral blood and finding of perivascular neutrophilic infiltrates in the skin biopsy sample. The syndrome is in 50% of cases associated with other diseases and conditions such as malignancies, bacterial and viral infections, autoimmune and connective tissue diseases, inflammatory bowel diseases, use of certain drugs, etc. Ulcerative colitis is idiopathic, immunologically mediated inflammatory bowel disease which is in a small proportion of patients associated with extraintestinal manifestations of disease, characteristically developed on the joints, skin and mucous membranes. We present a case of a 39-year-old woman with ulcerative colitis in whom the six month period of colitis symptoms was followed by the development of Sweet’s syndrome, reactive polyarthritis and polyserositis. Using the combined anti-inflammatory treatment with methylprednisolone and mesalazine in therapeutical doses the remission of ulcerative colitis and regression of all extraintestinal manifestations was achieved, but three months later a relapse of reactive polyarthritis developed that was successfully treated with ibuprofen. When Sweet’s syndrome is suspected, the histological examination of the skin lesions should be performed, and if a characteristic histological finding is accompanied by other clinical and laboratory criteria and the diagnosis of Sweet’s syndrome is established, the search for underlying diseases should be done. The systemic treatment with corticosteroids, recommended as the golden standard, proved effective in the treatment of our patient

Endonasal Endoscopic Hydatid Cyst Removal Located in the Pterygopalatine Fossa

Introduction: Hydatid cyst (Echinococcosis) is a zoonosis, most commonly caused by the larval stage of Echinococcus granulosus. The disease has a worldwide geographic distribution and the Mediterranean region is an important endemic area. Definitive hosts are carnivores (e.g. dogs, foxes, cats), and humans are accidental hosts. The infection occurs by ingesting food contaminated with Echinoccocus eggs. Hydatid cysts are most commonly seen in the liver and lungs. Head and neck involvment is rare. To our knowledge, this is the sixth reported case of pterygopalatine fossa involvement in literature. Case report: A 45-years old female patient presented with a hydatid cyst in the right pterygopalatine fossa, which was accidentally discovered on MRI of the head performed for follow up due to previous hydatid cyst management in the parietooccipital brain lobe. We managed the cyst with endoscopic endonasal approach. Discussion: In this report, we present a case of hydatid cyst of the right pterygopalatine fossa and right middle nose meatus which was treated with endoscopic endonasal approach. Conclusion: The hydatid cyst of pterygopalatine fossa is extremely rare. A multidisciplinary approach is mandatory in the management of hydatid cysts. Endoscopic endonasal management has low morbidity and the technique may vary due to surgeon skills, localization of the cyst and available instruments

Subcutaneous dirofilariosis — a case report

Humana dirofilarioza je u Hrvatskoj rijetka. Prikazali smo dva slučaja, koja su se manifestirala bezbolnim supkutanim čvorićima u trajanju od nekoliko mjeseci. Prvi bolesnik je 44-godišnja kućanica iz ruralne sredine. Drugi je bolesnik 66-godišnji muškarac iz Zagreba, koji nema životinja i nije izbivao izvan Hrvatske. U oba slučaja su potkožni čvorići kirurški ekscidirani i histološki obrađeni nakon čega su bolesnici bili izliječeni. Ističemo značaj dirofilarioze u diferencijalnoj dijagnozi potkožnih čvorića.Human dirofilariosis is very rare in Croatia. We present two cases that manifested in painless subcutaneous nodules lasting for several months. The first patient was a 44-year-old housewife from rural environment. The second patient was a 66-year-old male from Zagreb that kept no domestic animals, and did not reside outside Croatia. In both cases subcutaneous nodules were surgically removed and histological analysis was performed, after which both patients were cured. The authors stress the importance of dirofilariosis in differential diagnostics of subcutaneous nodules

Intensive care unit acquired bloodstream infections – impact of the patient`s age

Uvod: Infekcije nastale tijekom liječenja u jedinici intenzivne medicine (JIM) predstavljaju rastući problem suvremene medicine i malo se zna o odnosu starije životne dobi i u JIM nastalih infekcija. ----- Cilj: Utvrditi odnos starije životne dobi i rizika nastanaka bolničkih infekcija krvotoka (BIK) u JIM, utvrditi njihov ishod i epidemiologiju. ----- Ustroj: Retrospektivno kohortno istraživanje. ----- Ustanova: JIM Klinike za infektivne bolesti, Zagreb. ----- Bolesnici: Mehanički ventilirani infektološki bolesnici oba spola ≥18 g, liječeni u JIM ≥48h od 1994-2008. ----- Metode: Uni i bivarijantne analize, multivarijantna analiza, izračunavanje „propensity“ skorova. -----Rezultati: Od 1093 bolesnika 46.6% je bilo ≥65 g, a 23.4% je imalo BIK. Dob bolesnika nije bila povezana s vjerojatnošću nastanka BIK (OR:0.992, 95%CI: 0.712- 1.381). Iako su bili značajno duže liječeni u JIM, utvrđena je tendencija boljeg preživljavanja i 28-dnevnog preživljavanja u bolesnika ≥65 g. s BIK (p=0.0686 i p=0.047). Etiologija 353 BIK je bila podjednaka u promatranim dobnim skupinama (p=0.4940); nefermentirajuće gram-negativne bakterije: 32.0% (MDR 4.5%), enterobakterije: 24.1% (ESBL+CEF3 R 14.2%), gram-pozitivne bakterije: 18.1% (MRSA 9.3%, enterokoki rezistentni na ampicilin 1.1%), polimikrobne: 17.6%, kandida: 7.1%, ostalo: 1.1%. ----- Zaključak: Starija životna dob nije bila povezana s vjerojatnošću nastanka BIK. Bolesnici ≥65 g. s BIK su bili značajno duže liječeni u JIM, ali su imali bolje ukupno i 28-dnevno preživljavanje. Nije utvrđena razlika u etiologiji niti u antimikrobnoj osjetljivosti uzročnika BIK između promatranih dobnih skupina.Introduction: The intensive care units (ICU) aquired infections are the rising problem of the modern medicine and the little is known about the relationship between older age and ICU acquired infections. ----- Objective: To assess the relationship between the older age and risk for acquisition of ICU aquired bloodstream infections (BSI), determine their outcome and epidemiology. ----- Design: Retrospective cohort study. ----- Setting: ICU of the University Hospital for Infectious Diseases, Zagreb. ----- Patients: Mechanically ventilated infectious disease patients of both sexes ≥18 yrs, treated in ICU ≥48h from 1994-2008. ----- Methods: Uni-, bi- and multi-variate analysis, „propensity score“ calculation. ----- Results: Of 1093 patients 46.6% were ≥65 yrs. and 23.4% had BSI. The corelation between age and BSI aquisition was not found (OR:0.992, 95%CI: 0.712-1.381). Although showing significantly longer ICU stay, tendency of better survival and 28- days survival was found among patients ≥65 yrs. with BSI (p=0.0686, p=0.047). Etiology of 353 episodes of BSI was similar in both age-groups (p=0.4940); nonfermenting gram-negative bacteria: 32.0% (MDR 4.5%), enterobacteria: 24.1% (ESBL+CEF3 R 14.2%), gram-positive bacteria 18.1% (MRSA 9.3%, ARE 1.1%), polymicrobial: 17.6%, Candida sp: 7.1%, other: 1.1%. ----- Conclusions: No correlation between older age and BSI acquisition was found. Analyses showed significantly longer ICU stay, but better overall and 28-day survival among patients ≥65 yrs. with BSI. No differencies were found in etiology and resistance pattern of BSI episodes between observed age-groups

Intensive care unit acquired bloodstream infections – impact of the patient`s age

Uvod: Infekcije nastale tijekom liječenja u jedinici intenzivne medicine (JIM) predstavljaju rastući problem suvremene medicine i malo se zna o odnosu starije životne dobi i u JIM nastalih infekcija. ----- Cilj: Utvrditi odnos starije životne dobi i rizika nastanaka bolničkih infekcija krvotoka (BIK) u JIM, utvrditi njihov ishod i epidemiologiju. ----- Ustroj: Retrospektivno kohortno istraživanje. ----- Ustanova: JIM Klinike za infektivne bolesti, Zagreb. ----- Bolesnici: Mehanički ventilirani infektološki bolesnici oba spola ≥18 g, liječeni u JIM ≥48h od 1994-2008. ----- Metode: Uni i bivarijantne analize, multivarijantna analiza, izračunavanje „propensity“ skorova. -----Rezultati: Od 1093 bolesnika 46.6% je bilo ≥65 g, a 23.4% je imalo BIK. Dob bolesnika nije bila povezana s vjerojatnošću nastanka BIK (OR:0.992, 95%CI: 0.712- 1.381). Iako su bili značajno duže liječeni u JIM, utvrđena je tendencija boljeg preživljavanja i 28-dnevnog preživljavanja u bolesnika ≥65 g. s BIK (p=0.0686 i p=0.047). Etiologija 353 BIK je bila podjednaka u promatranim dobnim skupinama (p=0.4940); nefermentirajuće gram-negativne bakterije: 32.0% (MDR 4.5%), enterobakterije: 24.1% (ESBL+CEF3 R 14.2%), gram-pozitivne bakterije: 18.1% (MRSA 9.3%, enterokoki rezistentni na ampicilin 1.1%), polimikrobne: 17.6%, kandida: 7.1%, ostalo: 1.1%. ----- Zaključak: Starija životna dob nije bila povezana s vjerojatnošću nastanka BIK. Bolesnici ≥65 g. s BIK su bili značajno duže liječeni u JIM, ali su imali bolje ukupno i 28-dnevno preživljavanje. Nije utvrđena razlika u etiologiji niti u antimikrobnoj osjetljivosti uzročnika BIK između promatranih dobnih skupina.Introduction: The intensive care units (ICU) aquired infections are the rising problem of the modern medicine and the little is known about the relationship between older age and ICU acquired infections. ----- Objective: To assess the relationship between the older age and risk for acquisition of ICU aquired bloodstream infections (BSI), determine their outcome and epidemiology. ----- Design: Retrospective cohort study. ----- Setting: ICU of the University Hospital for Infectious Diseases, Zagreb. ----- Patients: Mechanically ventilated infectious disease patients of both sexes ≥18 yrs, treated in ICU ≥48h from 1994-2008. ----- Methods: Uni-, bi- and multi-variate analysis, „propensity score“ calculation. ----- Results: Of 1093 patients 46.6% were ≥65 yrs. and 23.4% had BSI. The corelation between age and BSI aquisition was not found (OR:0.992, 95%CI: 0.712-1.381). Although showing significantly longer ICU stay, tendency of better survival and 28- days survival was found among patients ≥65 yrs. with BSI (p=0.0686, p=0.047). Etiology of 353 episodes of BSI was similar in both age-groups (p=0.4940); nonfermenting gram-negative bacteria: 32.0% (MDR 4.5%), enterobacteria: 24.1% (ESBL+CEF3 R 14.2%), gram-positive bacteria 18.1% (MRSA 9.3%, ARE 1.1%), polymicrobial: 17.6%, Candida sp: 7.1%, other: 1.1%. ----- Conclusions: No correlation between older age and BSI acquisition was found. Analyses showed significantly longer ICU stay, but better overall and 28-day survival among patients ≥65 yrs. with BSI. No differencies were found in etiology and resistance pattern of BSI episodes between observed age-groups

Bolničke infekcije krvotoka u mehanički ventiliranih infektoloških bolesnika starije životne dobi [Intensive care unit acquired bloodstream infections – impact of the patient`s age]

Introduction: The intensive care units (ICU) aquired infections are the rising problem of the modern medicine and the little is known about the relationship between older age and ICU acquired infections. ----- Objective: To assess the relationship between the older age and risk for acquisition of ICU aquired bloodstream infections (BSI), determine their outcome and epidemiology. ----- Design: Retrospective cohort study. ----- Setting: ICU of the University Hospital for Infectious Diseases, Zagreb. ----- Patients: Mechanically ventilated infectious disease patients of both sexes ≥18 yrs, treated in ICU ≥48h from 1994-2008. ----- Methods: Uni-, bi- and multi-variate analysis, „propensity score“ calculation. ----- Results: Of 1093 patients 46.6% were ≥65 yrs. and 23.4% had BSI. The corelation between age and BSI aquisition was not found (OR:0.992, 95%CI: 0.712-1.381). Although showing significantly longer ICU stay, tendency of better survival and 28- days survival was found among patients ≥65 yrs. with BSI (p=0.0686, p=0.047). Etiology of 353 episodes of BSI was similar in both age-groups (p=0.4940); nonfermenting gram-negative bacteria: 32.0% (MDR 4.5%), enterobacteria: 24.1% (ESBL+CEF3 R 14.2%), gram-positive bacteria 18.1% (MRSA 9.3%, ARE 1.1%), polymicrobial: 17.6%, Candida sp: 7.1%, other: 1.1%. ----- Conclusions: No correlation between older age and BSI acquisition was found. Analyses showed significantly longer ICU stay, but better overall and 28-day survival among patients ≥65 yrs. with BSI. No differencies were found in etiology and resistance pattern of BSI episodes between observed age-groups

Intensive care unit acquired bloodstream infections – impact of the patient`s age

Uvod: Infekcije nastale tijekom liječenja u jedinici intenzivne medicine (JIM) predstavljaju rastući problem suvremene medicine i malo se zna o odnosu starije životne dobi i u JIM nastalih infekcija. ----- Cilj: Utvrditi odnos starije životne dobi i rizika nastanaka bolničkih infekcija krvotoka (BIK) u JIM, utvrditi njihov ishod i epidemiologiju. ----- Ustroj: Retrospektivno kohortno istraživanje. ----- Ustanova: JIM Klinike za infektivne bolesti, Zagreb. ----- Bolesnici: Mehanički ventilirani infektološki bolesnici oba spola ≥18 g, liječeni u JIM ≥48h od 1994-2008. ----- Metode: Uni i bivarijantne analize, multivarijantna analiza, izračunavanje „propensity“ skorova. -----Rezultati: Od 1093 bolesnika 46.6% je bilo ≥65 g, a 23.4% je imalo BIK. Dob bolesnika nije bila povezana s vjerojatnošću nastanka BIK (OR:0.992, 95%CI: 0.712- 1.381). Iako su bili značajno duže liječeni u JIM, utvrđena je tendencija boljeg preživljavanja i 28-dnevnog preživljavanja u bolesnika ≥65 g. s BIK (p=0.0686 i p=0.047). Etiologija 353 BIK je bila podjednaka u promatranim dobnim skupinama (p=0.4940); nefermentirajuće gram-negativne bakterije: 32.0% (MDR 4.5%), enterobakterije: 24.1% (ESBL+CEF3 R 14.2%), gram-pozitivne bakterije: 18.1% (MRSA 9.3%, enterokoki rezistentni na ampicilin 1.1%), polimikrobne: 17.6%, kandida: 7.1%, ostalo: 1.1%. ----- Zaključak: Starija životna dob nije bila povezana s vjerojatnošću nastanka BIK. Bolesnici ≥65 g. s BIK su bili značajno duže liječeni u JIM, ali su imali bolje ukupno i 28-dnevno preživljavanje. Nije utvrđena razlika u etiologiji niti u antimikrobnoj osjetljivosti uzročnika BIK između promatranih dobnih skupina.Introduction: The intensive care units (ICU) aquired infections are the rising problem of the modern medicine and the little is known about the relationship between older age and ICU acquired infections. ----- Objective: To assess the relationship between the older age and risk for acquisition of ICU aquired bloodstream infections (BSI), determine their outcome and epidemiology. ----- Design: Retrospective cohort study. ----- Setting: ICU of the University Hospital for Infectious Diseases, Zagreb. ----- Patients: Mechanically ventilated infectious disease patients of both sexes ≥18 yrs, treated in ICU ≥48h from 1994-2008. ----- Methods: Uni-, bi- and multi-variate analysis, „propensity score“ calculation. ----- Results: Of 1093 patients 46.6% were ≥65 yrs. and 23.4% had BSI. The corelation between age and BSI aquisition was not found (OR:0.992, 95%CI: 0.712-1.381). Although showing significantly longer ICU stay, tendency of better survival and 28- days survival was found among patients ≥65 yrs. with BSI (p=0.0686, p=0.047). Etiology of 353 episodes of BSI was similar in both age-groups (p=0.4940); nonfermenting gram-negative bacteria: 32.0% (MDR 4.5%), enterobacteria: 24.1% (ESBL+CEF3 R 14.2%), gram-positive bacteria 18.1% (MRSA 9.3%, ARE 1.1%), polymicrobial: 17.6%, Candida sp: 7.1%, other: 1.1%. ----- Conclusions: No correlation between older age and BSI acquisition was found. Analyses showed significantly longer ICU stay, but better overall and 28-day survival among patients ≥65 yrs. with BSI. No differencies were found in etiology and resistance pattern of BSI episodes between observed age-groups