Masivna tromboza abdominalne aorte s distalnom embolijom kao jedina klinička manifestacija COVID-19 infekcije

COVID-19 infection usually presents with respiratory symptoms and fever however several unusual initial presentations of this infection were reported in literature. We report a case of arterial thrombosis as a presenting features of this disease without any other COVID-19-related symptoms. This might lead to delayed COVID-19 diagnosis and isolation of suspected patient causing epidemiologic consequences and increased risk of transmission of the virus inside the hospital in time of pandemic unless timely recognized.Infekcija COVID-19 se obično manifestira respiratornim simptomima i vrućicom, no u literaturi je opisano nekoliko neuobi-čajenih početnih simptoma bolesti. Prikazujemo slučaj bolesnice s trombozom arterije kao jedinom kliničkom prezentacijom ove bolesti, bez drugih uobičajenih simptoma vezanih uz COVID-19. Ukoliko se pravovremeno ne prepozna, to može rezultirati odgo-đenim dijagnosticiranjem i izolacijom suspektnog bolesnika te uzrokovati epidemiološke posljedice i povećani rizik prijenosa virusa unutar bolnice u doba pandemije

Castlemanova bolest koja se prezentirala kao tumorska parakardijalna tvorba

Castleman’s disease (in the literature also known as angiofollicular hyperplasia) is a rare benign lymphoproliferative disease. Clinically, it can manifest as unicentric or multicentric disease. Unicentric disease is most often diagnosed by accident or by symptomatology resulting from compression upon the adjoining anatomical structures. Considering its lymphatic origin, tumor mass can theoretically occur in any body region. We present a case of paracardiac localization of unicentric Castleman’s disease in a previously healthy 24-year-old woman. In such clinical cases, the specific localization of the tumor and its radiological properties can pose a differential diagnostic dilemma. Correct diagnosis is only possible after complete surgical excision and histopathologic analysis, which is the optimal therapeutic approach in this disease.Castlemanova bolest (u literaturi još poznata kao angiofolikularna hiperplazija) je rijetka limfoproliferativna bolest dobroćudnog tijeka. Klinički se manifesira kao lokalizirana i multicentrična. Dijagnoza lokalizirane bolesti se najčešće postavlja slučajno nakon obrade simptomatologije uzrokovane kompresijom tvorbe na okolne anatomske strukture. S obzirom na njeno limfatičko podrijetlo tumorska masa se može pojaviti u bilo kojem dijelu tijela. Prikazujemo slučaj parakardijalno lokalizirane Castlemanove bolesti kod prethodno zdrave 24-godišnje žene. U ovakvom slučaju, zbog specifične lokalizacije i radioloških obilježja tvorba može predstavljati diferencijalno dijagnostičku dilemu. U tom slučaju točna dijagnoza je moguća tek nakon potpune kirurške ekscizije i patohistološke analize, što u slučaju ove bolesti ujedno predstavlja optimalan terapijski pristup

Naše iskustvo u endovaskularnom liječenju aneurizme abdominalne aorte talent stent-graftom

The aim of the study was to evaluate the safety and efficacy of endovascular treatment of abdominal aorta aneurysm (AAA) with Talent stent-graft (TSG). From October 1999 to February 2002, 18 patients (17 male and one female) aged 65-77, with AAA >5 cm in diameter, were treated by bifurcated Talent stent grafting. In all patients, postinterventional CT was performed 24 hours after stent grafting. The sutures were removed on the seventh to ninth day after the procedure, and the patients were released for home care. Regular spiral CT control evaluation was scheduled at 1, 3, 6, 9, 12 and 24 months after stent grafting. The mean follow up time was 11 months. Talent stent grafting procedure was initially successful in all patients. During regular controls, the TSGs were not occluded. In two (11%) patients, Talent stent grafting was preceded by preinterventional embolization. In five (27%) patients, control spiral CT after stent grafting showed a small endoleak. In these patients, systemic heparinization was interrupted and spiral CT was repeated after seven days. Repeat spiral CT after seven days showed absence of endoleak in four of five (80%) patients. A small endoleak in one patient disappeared spontaneously a month after TSG placement. The mean annual reduction in aneurysmal sac diameter was 7.3 (0 to 28) mm. TSG placement is a safe and efficient method of AAA treatment. In patients with accurately determined indication for the procedure, it is today considered a justified alternative to surgery.Cilj rada bio je procijeniti sigurnost i učinkovitost endovaskularnog liječenja aneurizme abdominalne aorte (AAA) talent stent-graftom (TSG). Od listopada 1999. do veljače 2002. godine 18 bolesnika (17 muškaraca i jedna žena) životne dobi između 65 i 77 godina s AAA promjera >5 cm liječeno je postavljanjem bifurkacijskog TSG. U svih bolesnika poslijeintervencijski CT rađen je 24 sata nakon intervencije. Sedmog do devetog poslije intervencijskog dana skinuti su šavi i bolesnici su otpušteni na kućnu njegu. Redoviti kontrolni pregledi provedeni se spiralnim CT-om, i to 1., 3., 6., 9., 12. i 24. mjeseca nakon postavljanja TSG. Srednje vrijeme praćenja iznosilo je 11 mjeseci. U svih bolesnika postignut je primarni uspjeh, a na kontrolnim pregledima TSG je bio prohodan. U dvoje (11%) bolesnika prije postavljanja TSG napravljene su prije intervencijske embolizacije. U petoro (27%) bolesnika na poslijeintervencijskom CT-u bilo je vidljivo manje endopropuštanje. U tih bolesnika ukinuta je sistemska heparinizacija i na spiralnom CT-u ponovljenom nakon sedam dana u četvoro od pet (80%) bolesnika endopropuštanja više nije bilo. U jednog je bolesnika manje endopropuštanje spontano prestalo mjesec dana nakon postavljanja TSG. Srednje smanjenje promjera aneurizmatske vreće iznosilo je 7,3 mm (0-28 mm) na godinu. Postavljanje TSG predstavlja sigurnu i učinkovitu metodu liječenja AAA. U bolesnika s pravilno postavljenom indikacijom danas se opravdano smatra alternativnom metodom kirurškom liječenju

Pain to Hospital Times After Myocardial Infarction in Patients from Dalmatian Mainland and Islands, Southern Croatia

Aim To analyze pre-hospital delay in patients with myocardial infarction from mainland and islands of Split-Dalmatian County, southern Croatia. Methods The study included all patients with myocardial infarction transported by ambulance to the University Hospital Split in 1999, 2003, and 2005. Pre-hospital delay was analyzed in the following intervals: pain-to-call, call-to-ambulance, ambulance-to-door, and door-to-coronary care unit interval. Patients were categorized according to the location from which they were transported: Split, mainland >15 km from Split, and islands. Results There were 1314 patients (62.9% men) transported and hospitalized for myocardial infarction. Total prehospital delay (pain-to-hospital) was significantly reduced from 1999 to 2005 (5.2 hours vs 4.3 hours, P = 0.011). Seventy- five patients (5.7%) were admitted to the coronary care unit within the recommended time-frame of less than 90 minutes, none of which was from the islands, while 248 patients (18.9%) were admitted more than 12 hours from the onset of pain. Conclusion Pre-hospital delay in patients with myocardial infarction in southern Croatia is still too long, especially in patients coming from outside of Split. Prognosis and survival of such patients may be improved by introducing changes to the health care system in remote areas, such as out-of-hospital thrombolysis, greater use of telemedicine, training of lay persons and paramedics in defibrillation, introduction of quality assessment mechanisms, and improved patient transport

Procjena testikularne cirkulacije i imunološke senzibilizacije nakon hernioplastike s ugradnjom neresorptivne mrežice

Cilj: Ispitati dolazi li nakon operacija preponske kile s ugradnjom neresorptivne mrežice do promjene testikularne cirkulacije s konsekutivnom imunološkom reakcijom stvaranja antitijela na spermije. Metode: U prospektivnu studiju uključena su 82 bolesnika koja su operirala preponsku kilu laparoskopskom ili otvorenom metodom. Testikularni protok mjeren je prije operacije, u ranom i kasnom poslije operacijskom razdoblju. Antitijela na spermije mjerena su prije operacije i u kasnom poslije operacijskom razdoblju. Rezultati: Razina antitijela na spermije raste nakon operacije preponske kile s mrežicom. Porast je značajan samo nakon operacije otvorenom metodom. Razina antitijela ostaje unutar normalnih vrijednosti u svih bolesnika osim u slučaju jednog bolesnika s komplikacijom. Intratestikularni indeks otpora raste u ranom poslije operacijskom razdoblju da bi se, u kasnom poslije operacijskom razdoblju vratio na prije operacijske vrijednosti. Zaključak: Operacija preponske kile uz uporabu mrežice nema dugotrajan učinak na testikularni protok. Samo u slučaju komplikacije, operacija preponske kile uz uporabu mrežice dovodi do imunološke senzibilizacije. Operacija preponske kile s ugradnjom neresorptivne mrežice ne dovodi do klinički bitne promjene testikularnog protoka i imunološke senzibilizacije

Procjena testikularne cirkulacije i imunološke senzibilizacije nakon hernioplastike s ugradnjom neresorptivne mrežice

Cilj: Ispitati dolazi li nakon operacija preponske kile s ugradnjom neresorptivne mrežice do promjene testikularne cirkulacije s konsekutivnom imunološkom reakcijom stvaranja antitijela na spermije. Metode: U prospektivnu studiju uključena su 82 bolesnika koja su operirala preponsku kilu laparoskopskom ili otvorenom metodom. Testikularni protok mjeren je prije operacije, u ranom i kasnom poslije operacijskom razdoblju. Antitijela na spermije mjerena su prije operacije i u kasnom poslije operacijskom razdoblju. Rezultati: Razina antitijela na spermije raste nakon operacije preponske kile s mrežicom. Porast je značajan samo nakon operacije otvorenom metodom. Razina antitijela ostaje unutar normalnih vrijednosti u svih bolesnika osim u slučaju jednog bolesnika s komplikacijom. Intratestikularni indeks otpora raste u ranom poslije operacijskom razdoblju da bi se, u kasnom poslije operacijskom razdoblju vratio na prije operacijske vrijednosti. Zaključak: Operacija preponske kile uz uporabu mrežice nema dugotrajan učinak na testikularni protok. Samo u slučaju komplikacije, operacija preponske kile uz uporabu mrežice dovodi do imunološke senzibilizacije. Operacija preponske kile s ugradnjom neresorptivne mrežice ne dovodi do klinički bitne promjene testikularnog protoka i imunološke senzibilizacije

Procjena testikularne cirkulacije i imunološke senzibilizacije nakon hernioplastike s ugradnjom neresorptivne mrežice

Cilj: Ispitati dolazi li nakon operacija preponske kile s ugradnjom neresorptivne mrežice do promjene testikularne cirkulacije s konsekutivnom imunološkom reakcijom stvaranja antitijela na spermije. Metode: U prospektivnu studiju uključena su 82 bolesnika koja su operirala preponsku kilu laparoskopskom ili otvorenom metodom. Testikularni protok mjeren je prije operacije, u ranom i kasnom poslije operacijskom razdoblju. Antitijela na spermije mjerena su prije operacije i u kasnom poslije operacijskom razdoblju. Rezultati: Razina antitijela na spermije raste nakon operacije preponske kile s mrežicom. Porast je značajan samo nakon operacije otvorenom metodom. Razina antitijela ostaje unutar normalnih vrijednosti u svih bolesnika osim u slučaju jednog bolesnika s komplikacijom. Intratestikularni indeks otpora raste u ranom poslije operacijskom razdoblju da bi se, u kasnom poslije operacijskom razdoblju vratio na prije operacijske vrijednosti. Zaključak: Operacija preponske kile uz uporabu mrežice nema dugotrajan učinak na testikularni protok. Samo u slučaju komplikacije, operacija preponske kile uz uporabu mrežice dovodi do imunološke senzibilizacije. Operacija preponske kile s ugradnjom neresorptivne mrežice ne dovodi do klinički bitne promjene testikularnog protoka i imunološke senzibilizacije

Embolisation of pulmonary arteriovenous malformations : case series

Purpose: Pulmonary arteriovenous malformations (PAVM) are the direct communications between the pulmonary arteries and veins. These malformations can cause serious complications, and most of these patients should be treated. Herein we present our experience in the treatment of 18 cases of PAVM, treated with endovascular embolisation. Material and methods: Eighteen patients with PAVMs underwent endovascular embolisation during a five-year period. Eight were male and 10 were female, with ages ranging from 16 to 65 years. Standard steel coils and vascular plug were used for embolisation. Results: Embolisation was successful in 17 of 18 patients. Coiling was used in 10 patients, vascular plug in five, and both materials in two patients. All symptomatic patients with successful embolisation lost all their symptoms after treatment. Control angiography after embolisation showed a closure of AV shunt without migration of embolic material in all patients. Post-embolisation syndrome developed in four patients and late onset of pleural pain in three patients. There was no connection between pleural reaction and type of PAVM and embolic material. Conclusions: Endovascular PAVM treatment is a minimally invasive, highly successful method with a low rate of only transitory complications

Impact of Late Hospital Admission on the Prognosis of Patients with Acute Myocardial Infarction

The objective of this study is to determine the time elapsed from the onset of pain in patients with AMI to their hospital admission (pain to door time) and fibrinolytic administration (door to needle time). The objective is also to determine whether there is a difference between the frequency of fibrinolytic administration to patients and the survival rate of patients with AMI with respect to the location they are transported from. This prospective clinical study included patients manifesting clear clinical, electrocardiographic and biochemical evidence of AMI, according to criteria of ECS (European Society of Cardiology), and who were admitted to the Coronary Care Unit of Split Clinical Hospital in the period from 1 January to 31 December 1999. On the basis of their residence, the patients were divided into three groups: 1. patients from Split and the surrounding area distant up to 15 km from the city; 2. patients from the surrounding area within 15 km from Split, 3. patients living on the islands of Central Dalmatia. 409 patients with AMI were admitted to hospital in the period in question. The first group consisted of 207, the second of 163, and the third of 39 subjects (254:39; p0.05). Similarly, the mortality rate prior to hospital discharge is high (18.8 %) and does not vary among the three studied groups (p>0.05). The results of this study are in opposition to the assumption that the mortality rate will be lower in patients living in Split and the immediate surroundings when compared to the mortality rate of patients living on the islands of Central Dalmatia (21.7% : 15.4%)

Impact of Late Hospital Admission on the Prognosis of Patients with Acute Myocardial Infarction

The objective of this study is to determine the time elapsed from the onset of pain in patients with AMI to their hospital admission (pain to door time) and fibrinolytic administration (door to needle time). The objective is also to determine whether there is a difference between the frequency of fibrinolytic administration to patients and the survival rate of patients with AMI with respect to the location they are transported from. This prospective clinical study included patients manifesting clear clinical, electrocardiographic and biochemical evidence of AMI, according to criteria of ECS (European Society of Cardiology), and who were admitted to the Coronary Care Unit of Split Clinical Hospital in the period from 1 January to 31 December 1999. On the basis of their residence, the patients were divided into three groups: 1. patients from Split and the surrounding area distant up to 15 km from the city; 2. patients from the surrounding area within 15 km from Split, 3. patients living on the islands of Central Dalmatia. 409 patients with AMI were admitted to hospital in the period in question. The first group consisted of 207, the second of 163, and the third of 39 subjects (254:39; p0.05). Similarly, the mortality rate prior to hospital discharge is high (18.8 %) and does not vary among the three studied groups (p>0.05). The results of this study are in opposition to the assumption that the mortality rate will be lower in patients living in Split and the immediate surroundings when compared to the mortality rate of patients living on the islands of Central Dalmatia (21.7% : 15.4%)