Warm autoimmune haemolytic anaemia complicated by simultaneous arterial and venous thromboses: a case report.

The novelty described in this case report is the simultaneous development of arterial and venous thrombosis in a previously healthy Caucasian 37-year-old male with newly diagnosed warm autoimmune haemolytic anaemia (WA-AIHA). Clinical presentation included sensorimotor dysphasia, right arm paresis, abdominal pain, and swelling of the left leg. Computed tomography angiography showed partial occlusion of the left middle cerebral artery and multiple infarcts of the kidneys and spleen, while Doppler ultrasound revealed thrombosis of the left popliteal vein. A therapeutic dose of low-molecular-weight-heparin was instituted together with rituximab, leading to the complete serological and haematological remission. The exact thrombotic risk factors in WA-AIHA are still not completely identified and no generally accepted guidelines on thromboprophylaxis exist. The severe onset of the WA-AIHA might point towards a close association between haemolysis itself and thrombosis, raising the question of the necessity of prophylactic anticoagulation.

Utility of procalcitonin in a medical intensive care unit in Croatia.

AIMS: To investigate the clinical benefit of routine procalcitonin (PCT) measurement in the medical intensive care unit (ICU) of a tertiary referral hospital. METHODS: Adult patients with suspected infections were included. White blood cells, C­reactive protein (CRP), and PCT were measured. RESULTS: In this study 129 patients of median age 64 years (interquartile range 39-89 years) were prospectively included. The Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 21 ± 14 and 7 ± 6, respectively. Intensive care unit (ICU) mortality was 22.5%. Immunocompromised patients constituted 39.5%. A significant correlation was observed between PCT and APACHE II (Spearman's rho 0.461, p < 0.01), PCT and SOFA (Spearman's rho 0.494, p < 0.01) and PCT and CRP (Spearman's rho 0.403, p < 0.01). Most patients (n = 83, 64.3%) received antibiotics before admission. No difference in PCT (1.56 ± 8 µg/L vs. 1.44 ± 13 µg/L, p = 0.6) was observed with respect to previous antibiotic therapy. Levels of PCT and CRP were significantly increased in patients with positive blood cultures, the infection caused by Gram-negative microorganism regardless of disease severity and pneumonia with complications. PCT did not differ among patients with positive vs negative urine culture (4.6 ± 16 µg/L vs. 1.76 ± 11.9 µg/L) or positive vs. negative endotracheal aspirate (1.93 ± 11.4 µg/L vs. 1.76 ± 1.11 µg/L). PCT-guided stewardship was applied in 36 patients (28%). CONCLUSION: Increased initial PCT levels might point to the development of more severe disease caused by Gram-negative bacteria, regardless of previous antibiotic treatment. The results pertain to immunocompetent and immunocompromised patients. Implementation of PCT-guided stewardship in those patients is possible and relies on experience as well as knowledge of reference change value for a marker within the specific setting.

Dynamics of optic canal and orbital cavity development revealed by microCT.

PURPOSE: Numerous studies have attempted to clarify the exact anatomy and variations of the optic canal with non-conclusive results due to its close proximity to many vulnerable structures. We sought to determine the dynamics of growth and development of these structures on fetal skulls, which will help us to better understand of gender and age-dependent variations, as well as fatal malformations. METHODS: Fifteen previously macerated fetal frontal and sphenoid bones were analyzed and the diameters of optic canal, and distance of orbit from frontomaxillary suture to frontozygomatic suture were measured using 3D reconstruction images obtained by micro-CT. RESULTS: Average diameter of the optic canal in 300 mm fetus was measured to be 1,546 ± 36 µm, in 400 mm fetus 2,470 ± 123 µm and in 500 mm fetus 3,757 ± 203 µm. This trend indicates a linear enlargement of optic canal during the fetal period. During the same time period, diameter of the orbit enlarges from 12,319 ± 559 µm in 300 mm fetus to 19,788 ± 736 µm in 500 mm fetus. Growth curve is significantly lower in comparison with the same curve in optic canal data. We also calculated the ratio of orbit diameter and optic canal diameter between those groups which decreased from a value of 7.9 ± 0.4 for 300 mm fetus to 5.3 ± 0.2 for 500 mm fetus. CONCLUSION: Dynamics of optic canal and orbital cavity development is different in early and late fetal period. Diameters of those structures are in better correlation with the fetal length.

[LOW SPECIFICITY OF PLATELET TO SPLEEN RATIO FOR NONINVASIVE PREDIC- TION AND CHARACTERIZATION OF ESOPHAGEAL VARICES IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS]. / OMJER BROJA TROMBOCITA I VELICINE SLEZENE IMA NISKU SPECIFICNOST U NEINVAZIVNOJ PREDIKCIJI I KARAKTERIZACIJI VARIKOZITETA JEDNJAKA KOD BOLESNIKA S ALKOHOLNOM CIROZOM JETRE.

Diagnosis of esophageal varices (EV) is based upon endoscopic examination, which is a rather unpleasant method that carries a certain risk of complications. For that reason, efforts have been made to develop noninvasive methods for characterization of EV. The aim of this study was to explore the value of platelet count to spleen size ratio (PSR) for noninvasive prediction and characterization of EV in patients with alcoholic liver cirrhosis (ALC). One hundred and seventeen patients (20 females and 97 males, mean age 60.7) with ALC were included in our research. All patients underwent endoscopic examination upon which the EV were classified as small (< 5 mm), large (> 5 mm), or absent. Spleen size (bipolar diameter in mm) was assessed by ultrasound. Platelet count to spleen diameter ratio was calculated and the values obtained were compared to the presence, size and risk of bleeding from EV as defined by endoscopy. No significant difference in PSR could be found between patients without and with EV (1.341 ± 0.725 vs. 1.053 ± 0.636, respectively; p = 0.06). The PSR was significantly different between the patients with small and large EV (1.103 ± 0.689 vs. 0.876 ± 0.314; p < 0.05) with a cut-off value of 1.141 (sensitivity 94.7%, specificity 38.2%, AUROC = 0.656; p = 0.042). The value of PSR below 1.182 pointed to patients at risk from variceal bleeding with 91.7% sensitivity and 38.5% specificity (AUROC = 0.625, p = 0.035). Based on our results, it is not possible to recommend the use of PSR as the exclusive noninvasive indicator for the presence, size and bleeding risk from EV due to its low specificity for these categories in patients with ALC.