Netraumatski obostrani subduralni hematom uzrokovan antiagregacijskom terapijom: Prikaz slučaja i pregled literature

A 64-year-old female receiving clopidogrel and aspirin antiaggregation therapy after percutaneous coronary intervention for non-STEMI myocardial infarction developed nontraumatic bilateral subdural hematoma with dizziness, vertigo and headache. Craniotomy had to be postponed because of reduced ADP platelet aggregability. Four days after clopidogrel withdrawal and transfusion of 12 platelet concentrate units, ADP aggregation transiently normalized and bilateral trepanation with hematoma evacuation was performed. The procedure was followed by excellent neurologic and clinical recovery; however, decreased platelet aggregability was recorded by postoperative day 12 despite strict clopidogrel and other platelet inhibitor withdrawal. Suspicion of Glanzmann thrombastenia was excluded by flow cytometry. Two weeks after neurosurgery, the right femoral vein thrombosis was detected by color doppler ultrasonography and therapy with fractionated heparin was initiated, followed by warfarin. The risk and incidence of hemorrhagic complications of antiaggregation and anticoagulation therapy are discussed. Caution is warranted on prescribing this potentially harmful therapy to older patients, generally burdened with other chronic comorbidities.U 64-godišnje bolesnice koja je zbog ne-STEMI srčanog infarkta dobivala aspirin i klopidogrel razvio se netraumatski obostrani subduralni hematom praćen smušenošću, vrtoglavicom i glavoboljom. Kod prijma je utvrđena smanjena agregacija trombocita u ADP testu pa je kraniotomija i dekompresija odgođena za 4 dana. Četiri dana nakon prestanka uzimanja klopidogrela i aspirina te uz transfuziju od 12 doza trombocita prolazno se normalizirala agregabilnost trombocita pa je učinjena obostrana trepanacija i uklonjeni su hematomi. Slijedio je odličan neurološki oporavak. Smanjena agregabilnost trombocita bila je prisutna do 12. poslijeoperacijskog dana. Sumnja na Glanzmannovu trombasteniju isključena je protočnom citometrijom. Četrnaestoga poslijeoperacijskog dana nastala je tromboza desne femoralne vene koja je liječena smanjenim dozama heparina i varfarina. Uz prikaz bolesnice analizira se rizik od krvarenja i tromboze u bolesnika koji uzimaju antitrombocitne lijekove. Preporuča se oprez u starijih bolesnika kod kojih su prisutne i druge teške bolesti, što povećava rizik od krvarenja

DETECTION OF TEXTURE-LESS OBJECTS BY LINE-BASED APPROACH

This paper proposes a method for tackling the problem of scalable object instance detection in the presence of clutter and occlusions. It gathers together advantages in respect of the state-of-the-art object detection approaches, being at the same time able to scale favorably with the number of models, computationally efficient and suited to texture-less objects as well. The proposed method has the following advantages: a) generality – it works for both texture-less and textured objects, b) scalability – it scales sub-linearly with the number of objects stored in the object database, and c) computational efficiency – it runs in near real-time. In contrast to the traditional affine-invariant detectors/descriptors which are local and not discriminative for texture-less objects, our method is based on line segments around which it computes semi-global descriptor by encoding gradient information in scale and rotation invariant manner. It relies on both texture and shape information and is, therefore, suited for both textured and texture-less objects. The descriptor is integrated into efficient object detection procedure which exploits the fact that the line segment determines scale, orientation and position of an object, by its two endpoints. This is used to construct several effective techniques for object hypotheses generation, scoring and multiple object reasoning; which are integrated in the proposed object detection procedure. Thanks to its ability to detect objects even if only one correct line match is found, our method allows detection of the objects under heavy clutter and occlusions. Extensive evaluation on several public benchmark datasets for texture-less and textured object detection, demonstrates its scalability and high effectiveness

DESIGN OF FIRST ORDER DIFFERENTIATOR WITH PARALLEL ALL-PASS STRUCTURE

In this paper a new method for design of the first order differentiator is presented. The proposed differentiator consists of two parallel branches, i.e. direct path and IIR all-pass filter. The described design method allows one to obtain solution with minimum mean relative error at the desired region by controlling the ratio of phase response extremes. A small relative magnitude error, as well as a low phase error, at low frequencies is condition for good time domain behaviour. The obtained differentiator can be realized by means of only two multipliers, hence being a good choice for real time applications. The proposed solution provides a lower magnitude error than several known differentiators with similar phase error

Recidivi venske tromboze unatoč “optimalne antikoagulantne terapije” antifosfolipidnog sindroma. Mogu li novi peroralni antikoagulansi riješiti problem ?

The aim was to determine the validity of the international normalized ratio (IN R) and prothrombin time (PT ) as a monitor for warfarin therapy in patients with lupus anticoagulants and recurrent thrombosis, and to investigate alternative approaches to monitoring warfarin therapy and new treatment options in these patients. A case is described of a 63-year-old female with antiphospholipid syndrome and recurrent venous thrombosis despite optimal adjusted warfarin therapy. In patients with lupus anticoagulants, the IN Rs obtained while receiving warfarin vary and often overestimate the extent of anticoagulation, while PT without receiving warfarin is often prolonged. In conclusion, lupus anticoagulants can influence PT and lead to IN R that does not accurately reflect the true level of anticoagulation. Optimizing of (warfarin) oral anticoagulation therapy could be achieved by individual monitoring of anticoagulation effect with a test that is insensitive to lupus anticoagulants (chromogenic factor X assay). Emerging oral anticoagulants, direct thrombin inhibitors and direct factor Xa inhibitors, such as dabigatran and rivaroxaban, with a predictable anticoagulant response and little potential for food or drug interactions, have been designed to be administered in fixed doses without coagulation monitoring and could be the treatment choice for these patients.Cilj je bio analizirati uzroke neuspjeha “optimalno doziranog” varfarina kod prevencije recidiva duboke venske tromboze u bolesnika s antifosfolipidnim sindromom. Opisuje se slučaj 63-godišnje bolesnice s antifosfolipidnim sindromom i recidivima venske tromboze tijekom uzimanja varfarina. Vrijednosti IN R bile su u terapijskim granicama. Analizirali su se patofiziološki mehanizmi nastanka tromboze i literaturni podaci. Rezultati su pokazali kako u bolesnika s pozitivnim lupus antikoagulans (LA) testom vrijednost PV -IN R ne daje pravu sliku protuzgrušavajućeg učinka varfarina. Aktivnost PV je zbog interferencije često lažno smanjena, iako u času mjerenja bolesnik ne uzima varfarin ili drugi antagonist vitamina K. Zaključak je kako prisutnost LA može interferencijom lažno smanjiti aktivnost u PV testu i rezultirati nalazom IN R koji ne odražava pravo stanje protuzgrušavajuće aktivnosti izazvane varfarinom. U tom bi slučaju umjesto PV testa trebalo mjeriti aktivnost faktora Xa kromogenom metodom koja je neosjetljiva na LA. Drugo moguće rješenje bi u bolesnika s antifosfolipidnim sindromom bila zamjena varfarina novim lijekovima, oralnim inhibitorima trombina i faktora X. Ovi lijekovi u fiksnoj dozi s predvidivim te o hrani i lijekovima uglavnom neovisnim protuzgrušavajućim učinkom imaju djelotvornost i nuspojave uglavnom slične varfarinu, ali ne trebaju kontrole IN R

REALIZATION OF DIGITAL FILTERS WITH COMPLEX COEFFICIENTS

A comprehensive analysis of realization of digital filters with complex coefficients obtained by decomposition of real digital filters, using complex and real allpass networks, is given in the paper. Realization of complex coefficient filters obtained directly in the z domain is also discussed in the paper. An analysis of hardware costs for different structures used for realization of complex coefficient filters is presented

A NEW METHOD FOR DESIGN OF SELECTIVE DIGITAL IIR FILTERS WITH ARBITRARY PHASE

In this paper the design of selective digital filters that consists of parallel connection of two all-pass sub-filters is presented. The phase of this filters has given arbitrary shape ϕ(ω) in both pass-band and stop-band. The proposed method allows the calculation of selective filters with elliptic-like magnitude characteristic. Equations given in the paper are general and suitable for design of filters with arbitrary phase. The efficiency of the method is demonstrated on design of filters with piecewise linear and quadratic phase

Uticaj Min-a-zela Plus na biohemijske, mikrobiološke i mikotoksikološke parametre silaža lucerke

Lucerne of the 5th cut in the budding phase was ensiled in the experiment as fresh and wilted (DM= 220 and 360 g/kg), with two degrees of compression (520 and 380 g/dm3) and with added Min-a-zel plus as 2 g/kg green mass. The experiment was performed as the statistical model 2K. Min-a-zel plus used as 2 g/kg green mass had no influence on biochemical, microbiological and mycotoxicological parameters of lucerne silage. Compared to the beginning material, silages had more diverse microflora and more mycotoxins. All silages had high pH values and fermentation of the acetic acid type. Some improvement was achieved with wilting of the ensiling material. The least quality (V class) was obtained with fresh lucerne, which was less compressed, while others were ranked as IV quality class. The obtained results fortify the need for further investigations in developing correct doses of Min-a-zel plus to be used in ensiling of lucerne and other materials.U eksperimentu je silirana lucerka V otkosa u fazi butonizacije kao sveža i provenula (SM = 220 i 360 g/kg), sa dva stepena sabijenosti (520 i 380 g/dm3) i sa dodatkom Min-a-zela Plus, 2 g/kg zelene mase. Ogled je postavljen po statističkom modelu 2K. Min-a-zel Plus korišćen u dozi od 2 g/kg zelene mase nije uticao na biohemijske, mikrobiološke i mikotoksikološke parametre silaža lucerke. U odnosu na početni materijal silaže su sadržale raznovrsniju mikrofloru i veću količinu mikotoksina. Sve silaže su se odlikovale visokim pH vrednostima i fermentacijom sirćetnokiselinskog tipa. Izvesno poboljšanje je postignuto provenjavanjem biljnog materijala. Najlošiji kvalitet (V klasa) imale su silaže od sveže lucerke sa manjim stepenom sabijenosti, dok su ostale ocenjene IV klasom kvaliteta. Utvrđeni rezultati ukazuju na neophodnost nastavljanja ispitivanja u cilju utvrđivanja optimalne doze Min-a-zela Plus za siliranje lucerke i drugih sirovina

Intraoperative volume restriction in esophageal cancer surgery: an exploratory randomized clinical trial

Aim To investigate whether the fluid volume administered during esophageal cancer surgery affects pulmonary gas exchange and tissue perfusion. Methods An exploratory single-center randomized clinical trial was performed. Patients with esophageal cancer who underwent Lewis-Tanner procedure between June 2011 and August 2012 at the Department of Thoracic surgery “Jordanovac”, Zagreb were analyzed. Patients were randomized (1:1) to receive a restrictive volume of intraoperative fluid (≤8 mL/kg/h) or a liberal volume (>8 mL/kg/h). Changes in oxygen partial pressure (Pao2), inspired oxygen fraction (FiO2), creatinine, and lactate were measured during and after surgery. Results Overall 16 patients were randomized and they all were analyzed (restrictive group n = 8, liberal group n = 8). The baseline value Pao2/FiO2 ratio (restrictive) was 345.01 ± 35.31 and the value six hours after extubation was 315.51 ± 32.91; the baseline Pao2/FiO2 ratio (liberal) was 330.11 ± 34.71 and the value six hours after extubation was 307.11 ± 30.31. The baseline creatinine value (restrictive) was 91.91 ± 12.67 and the value six hours after extubation was 100.88 ± 18.33; the baseline creatinine value (liberal) was 90.88 ± 14.99 and the value six hours after extubation was 93.51 ± 16.37. The baseline lactate value (restrictive) was 3.93 ± 1.33 and the value six hours after extubation was 2.69 ± 0.91. The baseline lactate value (liberal) was 3.26 ± 1.25 and the value six hours after extubation was 2.40 ± 1.08. The two groups showed no significant differences in Pao2/FiO2 ratio (P = 0.410), creatinine (P = 0.410), or lactate (P = 0.574). Conclusions Restriction of intraoperative applied volume does not significantly affect pulmonary exchange function or tissue perfusion in patients undergoing surgical treatment for esophageal cancer

Uticaj mineralnog adsorbenta 'Minazel' na smanjenje rezidua zearalenona i njegovih metabolita u mleku krava

The results of the use of mineral adsorbent - Minazel, preparation based on the natural zeolite, in the prevention of mycotoxicoses and avoidance of zearalenone and its metabolites transfer into cow´s milk were described in this paper. Using mineral adsorbent Minazel at the concentration of 0,5% of concentrate mixture the transfer of zearalenone from feeds to milk was prevented.U radu su prikazani rezultati korišćenja adsorbenta mikotoksina - Minazel preparata na bazi prirodnog zeolita, u prevenciji mikotoksikoza i sprečavanju prelaska (akumuliranja) zearalenona i njegovih metabolita u mleku krava. Mikotoksikološkim analizama mleka utvrđeno je da je prisustvo zearalenona u mleku (0,053; 0,019 i 0,004 mg/kg) opadalo sa povećanjem količine Minazela u koncentratu (0; 0,2; 0,5), što uz ostvareno povećanje proizvodnje mleka opravdava njegovo korišćenje