Reducing pain and improving quality of life for patients suffering the acetabular fracture.

The rationale for this paper was to find out assessment tools and relevant factors that may reduce pain, and improve the quality of life and ability to perform activities of daily living in surgically and conservatively treated patients who sustained the acetabular fracture. One hundred and three patients with the acetabular injury were analysed during the 10-year retrospective case-control study. The case group consisted of 21 patients in whom the posterior acetabular wall was fractured and who were treated surgically. The control group comprised 82 patients with complex acetabular fracture in whom conservative treatment was applied. In order to assess post injury and postoperative quality of life different factors, such as the intensity and chronicity of pain, as well as the ability to resume activities of daily living, the patients were surveyed by anamnestic questionnaire to acquire the results. The quality of life was mostly better in patients from the case group who were operated on. At the follow-up, the features of pain were lower, management overall length shorter, and return to normal daily life activities faster in the surgically treated patients, compared to those who were not. In conclusion, based on our research we assume that surgery may notably decrease features of pain and improve the quality of life in patients with the acetabular injury.

Influence of surgery onto the appearance of the hip joint periarticular calcification in patients with the acetabular fracture.

The intention of this study was to investigate the influence of surgery onto the appearance of the hip joint periarticular calcification in different groups of patients who suffered the acetabular fracture. A series of 103 patients with the acetabular fracture was analysed in a retrospective case-control study during a seven-year period. The patients were divided into two groups. The case group was comprised of 21 patients who were operated on due to the posterior acetabular wall fracture, while the control group was formed from 82 patients who underwent conservative treatment and who suffered complex acetabular fracture. To obtain the results, the rate and grade of the hip joint post-injury periarticular calcification formation were observed and analysed. They were considerably lower in patients from the case group who were operated on, compared to patients from the control group where the hip joint arthrosis was more common. In conclusion, considering the results of this paper, the rate and grade of the hip joint osteodegenerative changes may be highly decreased by surgery in patients who sustained the acetabular fracture.

Fulminant meningococcal sepsis in a young child--a case report.

We are presenting a case of isolated fulminant meningococcal sepsis with two and a half year old child. Initial symptoms were obscure and common to many medical conditions, but also previously described as symptoms of meningococcal sepsis. Unrecognizing the seriousness of the condition child died at home, within few hours after examination and discharge from the hospital. Autopsy and microbiological findings unquestionably proved that the child died from septic shock caused by fulminant meningococcal sepsis.

The main biomechanical risk factors for the prevalence of the left hip joint traumatic and degenerative changes.

The aim of this paper is to examine characteristic biomechanical features leading to the acetabular fracture and hip joint arthrosis, and to explain the prevalence of the left side traumatic and degenerative pelvic pathology that is usually seen in diverse groups of patients. A total of 253 patients were analyzed in a retrospective case-control study during a six-year period. The patients were divided into the case group of 103 patients suffering traumatic acetabular fractures and into the control group of 150 patients with hip joint arthrosis, where operative aloarthroplasty was not yet performed. The data of the affected hip joint range of motions in the case and control group of patients were statistically analyzed correlating the difference in frequency of the left and right hip joint pathology. The left acetabulum was affected more commonly in both groups of patients, while arthrosis of the left hip joint was more commonly recorded in the control group. More frequent pathology of the left hip joint, found in both groups of patients, was probably due to weaker neuromuscular function of the left pelvic side, which was also more exposed to injury due to the greater input of forces to the left hip joint during a traffic accident.

Vascular thrombosis associated with antiphospholipide syndrome.

The aim of this study was to present our diagnostic and therapeutic experience with antiphospholipide syndrome (APS) and vascular thrombosis. Ninety-nine patients with positive antiphospholipide antibodies (aPL) and vascular thrombosis were included in the study: forty patients, according to clinical classification criteria, had primary antiphospholipide syndrome (PAPS), and fifty-nine patients had secondary antiphospholipide syndrome (SAPS). In PAPS group, 82.5% of the patients were LA-positive, 37.5% of the patients were IgG aCL-positive, 27.5% of the patients were IgM aCL-positive, and 15% of the patients were IgG antibeta2GPI-positive. In SAPS group, 61% of the patients were LA-positive, 50.8% of the patients were IgG aCL-positive, and 47.5% of the patients were IgM aCL-positive. Administered therapy was low molecular weight heparin (LMWH) throughout 7 days, followed by warfarin with prothrombin time maintained between 2.0 and 3.0 INR.

Anti-inflammatory effects of exercise training in the early period after myocardial infarction.

The aim of this investigation was to determine the effect of exercise training on the levels of plasma cytokines and acute phase reactants in the early post acute myocardial infarction (AMI) period. Sixty patients were enrolled into this three-week cardiac rehabilitation study. The mean time from AMI was 7.08 +/- 1.60 days, and the patient mean age was 60 +/- 10 years. Subjects were randomly assigned to one of the two groups: the control group treated with standard measures, and the group with additional regular moderate-intensity exercise training. Physical activity was based on the ergospirometry test results. Apart from clinical follow-up and routine laboratory analysis we determined the levels of plasma cytokines: tumor necrosis factor (TNF-alpha), soluble TNF-alpha receptor 1 (TNF-alphaSR1), interleukin (IL)-8, IL-10, and acute phase reactants: high sensitivity C-reactive protein (hsCRP) and fibrinogen. The obtained results confirmed the hypothesis that the early post AMI period is an inflammatory state the intensity of which gradually decreases with standard treatment during the first month after AMI, while including patients into early exercise training improves their inflammatory profile by decreasing the level of acute phase reactant and TNF-alphaSR1.

Giant cell arteritis: how to diagnose?--a case report.

We present a case of 77 years old male with suspected giant cell arteritis. With anamnesis, physical examination, immunological tests, Colour Doppler ultrasonography of superficial temporal artery and finally with patohistological analysis of temporal artery biopsy, we came to right diagnosis.

Helicobacter pylori infection and coronary artery disease.

The aim of this investigation was to determine the seroprevalence of H. pylori in patients with coronary artery disease (CAD). Patients with coronary artery disease (n = 90) and control group (n = 90) were enrolled into this randomized, multi-centre study. CAD risk factors analyzed included age, male gender, diabetes mellitus, systemic hypertension, cigarette smoking, hypercholesterolemia and socioeconomic status. The results of this study showed a higher seroprevalence of Helicobacter pylori infection in patients with CAD compared to controls (78.8% versus 58.3%, p < 0.05). However, Helicobacter pylori seropositivity was not associated with coronary artery risk factors (smoking, body mass index, diabetes mellitus, hypertension, total cholesterol and socioeconomic status) either in the whole study population or in the patients and control subjects analyzed separately (P > 0.05). Further study are needed to clarify the precise role of Helicobacter pylori infection on the development of coronary artery disease.

Empirical antibiotic therapy of sepsis in surgical intensive care unit.

Retrospective study was conducted in surgical intensive care unit (ICU) in Clinical Hospital Center Zagreb in 2005. The aim of study was to create guidelines for empirical antibiotic therapy of sepsis in ICU for unknown causative agent based on antimicrobial susceptibility of causative bacteria. Thirty-two patients with severe sepsis were included in study and from medical records their clinical and microbiological data were analyzed. Antimicrobial susceptibility of the strains isolated from the blood-culture was tested by disk diffusion method according to CLSI (Clinical Laboratory Standard Institution). We used APACHE II score to predict the severity of illness. Mann-Whitney test and chi2 test were used to test statistical significance difference between results. Acinetobacter baumannii and Pseudomonas aeruginosa were the predominant causative agent. Acinetobacter baumannii was displaying excellent susceptibility to ampicillin+sulbactam and carbapenems, whereas Pseudomonas aeruginosa was showed good susceptibility on ceftazidim and carbapenems. Methicillin-resistant Staphylococcus aureus (MRSA), third predominant causative agent exhibiting good susceptibility to vancomycin and linezolide. The recommended therapy is empirical antibiotic therapy and should cover all important pathogens.

Antibody profile of pregnant women with antiphospholipid syndrome and pregnancy outcome after treatment with low dose aspirin and low-weight-molecular heparin.

The aim of the research was to show our diagnostic and therapeutic experience with antiphospholipid syndrome (APS) in pregnant women. 36 pregnant women suspect on APS were included in the study: 32 with primary antiphospholipd syndrome (PAPS) and 4 with secondary antiphospholipid syndrome (SAPS). All pregnant women received low-molecular-weight-heparin (LMWH) and low dose aspirin (LDA) therapy. Control group represented 26 women with SAPS and previous bad reproductive anamnesis. Average pregnancy lasted 37.06 +/- 0.707 weeks. LMWH and LDA therapy was successful in 97.22%. Lupus anticoagulant (LA) was found to be more frequent in PAPS group (71.87%). Anticardiolipin antibodies (aCL) were found to be more frequent in SAPS (26.66%). For three patients (3.37%), PAPS was diagnosed due to a fact that they had positive antibeta2-glycoproteinl (antibeta-GP1). To make APS diagnosis, it is of great importance to search for all antiphospholipid antibodies. LMWH and low dose of acetylsalicylic acid should be the first choice therapy.

Erectile dysfunction after myocardial infarction--myth or a real problem?

Erectile dysfunction is a common problem whose relation to cardiovascular diseases has scientifically been proved, but it has not been studied sufficiently in patients recovering from myocardial infarction. The objective of this study was to establish the frequency of erectile dysfunction in patients recovering from myocardial infarction. We examined 89 patients (aged 30 to 75 years) included in the program of cardiac rehabilitation after myocardial infarction. The results were compared with 91 healthy examinees of the same age. Even 82% of the patients who recovered from myocardial infarction have problems with erectile dysfunction, compared to 42.9% of healthy examinees. The prevalence of erectile dysfunction increases with the age in both groups. In the group of patients recovering from myocardial infarction aged 30 do 39 years, the erectile dysfunction decreased after 6 months, while in other age subgroups and between controls, there were no significant changes in erectile dysfunction prevalence during the analysed time period. We concluded that erectile dysfunction is a significant problem in patients recovering from myocardial infarction. It should be recognized on time in order to provide a better life quality for the patient with a multidisciplinary approach.

Anti-citrullinated antibodies, radiological joint damages and their correlations with disease activity score (DAS28).

Determination of anti-citrullinated peptides (anti-CCP) specificity as a predictor of joint erosive changes, correlation between their serum level and radiological damages as well as disease activity score (DAS28). A trial has been conducted on a 211 patient sample fulfilling ACR criteria for rheumatoid arthritis (RA). There was assigned anti-CCP serum level, disease activity score by the formula for DAS28(3)-CRP and assessed radiological changes degree after Steinbrocker score. In 132 patient (62.559%) the serum anti-CCP concentration was positive for RA. Specificity of the test was 100% and sensitivity 65% (Z = 0.731, p = 0.465). There is a medium intensity correlation between variables representing anti-CCP and Steinbrocker score. Pearson's coefficient was 0.479 and Spearman's rank correlation coefficient was 0.614, i.e. statistically significant (p = 0.000). There is no statistically significant correlation between variables representing anti-CCP and DAS28(3)-CRP Anti-CCP are good RA predictor and their concentration correlate with radiological damages degree.

Mushroom poisoning.

In the research we included a total of 207 subjects with the dismissal diagnosis of "mycetismus", who were treated at the Department of Infectious Diseases, General Hospital Osijek, during the 1983-1992 period. 32 of them were children. There were 44.93% of men, 39.61% of women and 15.45% of children. The latent time > 6 hours was determined in 51 (25%) and < 6 hours in 75% of subjects. In 156 of patients with the latent time > 6 hours, "false" poisoning occured, while 51 patients experienced real mushroom toxins poisoning. At the admission to the hospital, in patients with the latent time > 6 hours, a pathological PT (protrombine time) was established only in women, leukocytosis in both women and children, increased concentration of GGT (gamma-glutamin-transferase) in men, increased AST (aspartate-aminotransferase) and ALT (alanin-aminotransferase) only in women, and increased urea in both women and children. After 24 hours, control measuring established high values of AST and ALT extended PT uremia and exalted amount of ammonia in blood in 11 of patients (2 men, 7 women and 2 children). They had severe liver and kidney damage, the most probably caused by Amanita phalloides toxins. The latent time lasted 9 to 13 hours. Of the 11 above mentioned patients, 2 women, aged 74 and 43, and one girl, aged 6, died. No pathological laboratory parameters were established in 40 of subjects with the latent time of 6 and more hours, and the disease manifested through vomiting and diarrhea that lasted for several days. These subjects most probably suffered from mushroom toxins poisoning. Mushroom toxins irritate the mucuous membrane of the gastrointestinal tract, and there are many such poisonous mushrooms. There were no mortalities in this group of subjects.

Esomeprazole versus pantoprazole for healing erosive oesophagitis.

The aim of this study was to compare the efficacy of esomeprazole and pantoprazole with regard to healing and relief from gastroesophageal reflux disease-related symptoms. I this multicentre, randomized, single-blind study 180 patients (ITT population) diagnosed with endoscopically proven GERD grade A,B,C received esomeprazole (40 mg once daily (o.d.), n = 90) orpantoprazole (40 mg o.d., n = 90). Healing and relief from GERD-related symptoms were assessed at first and final visit (after 4 or 8 weeks of treatment). Esomeprazole 40 mg provided significantly greater healing than pantoprazole 40 mg after 4 weeks of treatment in patients with EE (77.8% vs. 72.2%). Esomeprazole-treated patients were healed after up to 8 weeks of treatment similar those treated with pantoprazole (92.2% vs. 91.1%). The proportion of heartburn-free days was similar in patients treated with esomeprazole and to those treated with pantoprazole.

The results of Helicobacter pylori eradication on repeated bleeding in patients with stomach ulcer.

The triple therapy of Helicobacter pylori eradication prevents repeated bleeding from stomach ulcer. The aim of this one-way blind prospective study was to evaluate the efficiency of the two-week triple therapy for Helicobacter pylori eradication in preventing renewed bleeding in patients with stomach ulcer within one year. This research included 60 hospitalized patients with bleeding stomach ulcer and positive Helicobacter pylori infection, 34 men and 26 women (average age 59.7 years). The patients were given therapeutic scheme of omeprazol--amoxicilin--metrodinazol (OAM) eradication for 14 days. Eradication of H. pylori infection was defined as lack of proof of the infection one month or several months after therapy suspension. By applying triple OAM therapy within two weeks the eradication was successful in 72%. In the group of 17 H. pylori positive patients there were 8 patients (47.6%) with repeated stomach ulcer and 3 patients (18%) with bleeding. Within the group of 43 H. pylori negative patients there were only 2 patients (4.65%) with repeated stomach ulcer and 1 patient (2%) with bleeding, during the observed period of 12 months. This research confirms the hypothesis about the necessity of eradication of Helicobacter pylori infection in patients with bleeding stomach ulcer as prevention of repeated bleeding.

Encephalitis or encephalopathy during an influenza-A epidemic.

Six female patients with encephalitis, mean age 36.5 (17-60) years, were admitted to the hospital during the 2000-2001 influenza A (H1N1) epidemic in the Osijek--Baranja County. In three (50.0%) patients, the manifestation of encephalitis occurred on day 4 or 5, and in two (33.3%) patients within 24-48 hours of the onset of influenza symptoms. The disease manifestations included headache, elevated body temperature, generalized fatigue, and consciousness disturbance through coma. Three (50.0%) patients had grand mal seizures. Pathologic electroencephalography findings were recorded in all six (100%) patients, whereas computed tomography showed cerebral edema in three (50.0%) patients. Elevated levels of hepatic enzymes and peripheral blood leukopenia were found in two (33.3%) patients in whom encephalitis developed early upon the onset of influenza. One (16.6%) of these patients died, whereas permanent sequels remained in the other two (33.3%) patients.

The incidence of stroke in Baranya county (east Croatia).

The aim of this retrospective study was to provide a survey of the incidence of stroke in Baranya, Croatia, on patients examined at Beli Manastir Health Center Department of Emergency from November 1, 1997 (the time of Baranya reintegration into the legal system of the Republic of Croatia after the war) till December 31, 2001. A total of 513 patients with symptoms of cerebrovascular diseases, or one patient every third day on an average, were examined. Total incidence of stroke was 16.09 per 10,000 population. The majority of patients were in the 61-80 age group with an incidence of 46.94/10,000 after the age of 60, 15-fold that was recorded in younger age groups. The most common risk factors recorded in examined group included hypertension, heart diseases, hyperlipidemia and diabetes mellitus. Total stroke mortality was 38.38%, whereas mortality in patients with hemorrhagic and ischemic stroke was 62.85% and 33.52%, respectively. The ratio of ischemic and hemorrhagic stroke in study subjects was 5:1, and in the causes of death 2.5:1. Out of 81 deceased stroke patients, 96.3% died within first 28 of admission. All of the patients with hemorrhagic stroke died within first 28 days, most within first 7 days (81.8%), whereas 94.9% of patients with ischemic stroke died within first 28 days.