Successful dilatation of underexpanded stent with super-high-pressure balloon: A case report.

Dilatation and percutaneous coronary intervention in the presence of calcified lesions is particularly demanding and presents a challenge in the daily work of an interventional cardiologist. Coronary calcification is a marker of the progress of the atherosclerotic process. The existence of calcifying lesions predicts a poorer clinical outcome and is associated with increased mortality and the occurrence of postprocedural major adverse cardiovascular events (MACEs). A male patient who was 61 years old was admitted as a result of ST-elevation myocardial infarction (STEMI) complicated by cardiac arrest caused by in-stent thrombosis of a previously suboptimally expanded stent. The lesion did not respond to a dilation attempt with a noncompliant (NC) balloon; however, an optimal result was obtained with inflation from a super-high-pressure NC balloon (OPN NC) for ultra-high-pressure inflations. Resistant, calcified lesions require a careful and comprehensive approach. The OPN NC balloon has a place in the treatment of this type of lesion. An optimized therapeutic modality after the procedure is imperative to prevent a MACE.

Neutrophil gelatinase-associated lipocalin is a predictor of complications in the early phase of ST-elevation myocardial infarction.

Aim To evaluate a correlation of serum level of neutrophil gelatinase-associated lipocalin (NGAL) to the risk of the occurrence of complications in patients with the early phase of ST-segment elevation myocardical infarction (STEMI) treated with fibrinolytic therapy prior to percutaneous coronary intervention (PCI). Methods A total of 54 patients with the diagnosis of STEMI treated with fibrinolytic therapy (alteplase) prior to PCI were included. Patients were admitted to the Intensive Care Unit (ICU) of Clinic for Heart, Blood Vessel and Rheumatic Diseases in the period January to March 2018. All patients underwent coronary angiography and PCI within the maximum of 48 hours delay after fibrinolysis, according to the hemodynamic and electrical stability and PCI availability. Blood samples were taken immediately after admission prior to fibrinolytic administration. Patients were divided into two groups according to NGAL values (less or more than 134.05 ng/mL). Results Higher values of NGAL have effect on a higher mean systolic and diastolic pressure (p=0.001 and p=0.003, respectively). Patients with higher NGAL values also have higher values of brain natriuretic peptide (p=0.0001) and highly sensitive troponin I (p=0.002). In that group relative risk (RR) for lethal outcome was 6.4 times significantly higher (p=0.002), for the development of heart failure 2.88 times (p=0.0002), for post-myocardial infarction angina pectoris 2.24 times (p=0.0158), and for ventricular rhythm disturbances (ventricular tachycardia, ventricular fibrillation) 1.96 times higher (p=0.0108). Conclusion Increased NGAL value is related to an unfavourable outcome of patients in the early phase of STEMI treated with fibrinolytic therapy prior to PCI.

Therapeutic hypothermia as a treatment option after out-ofhospital cardiac arrest: our experience.

Aim To examine the effects of therapeutic hypothermia on the outcome of patients with the diagnosis of out-of-hospital cardiac arrest (OHCA). Methods The study included 76 patients who were hospitalised at the Medical Intensive Care Unit (MICU) of the Clinical Centre University of Sarajevo, with the diagnosis of out-of-hospital cardiac arrest, following the return of spontaneous circulation. Therapeutic hypothermia was performed with an average temperature of 33oC (32.3 - 34.1o C) on the patients who had coma, according to the Glasgow Coma Scale (GCS). Results Multiple organ dysfunction syndrome (MODS) significantly affected survival (p=0.0001), as its presence reduced patients' survival by 96%. In addition, ventricular fibrillation (VF) as the presenting rhythm, also significantly affected survival (p=0.019). A degree of patient's coma, as measured by the GCS, significantly affected survival (p=0.011). For each increasing point on the GCS, the chance for survival increased twice. Moreover, other physiological factors such as the pH and the lactate serum levels significantly affected patients' survival (p=0.012 and p=0.01, respectively). Conclusion In patients with the diagnosis of OHCA who underwent to the treatment with therapeutic hypothermia, verified VF as a presenting rhythm was a positive predictive factor for their outcome. Therefore, therapeutic hypothermia represents an option of therapeutic modality for this type of patients.

Characteristics and outcome of mechanically ventilated patients with 2009 H1N1 influenza in Bosnia and Herzegovina and Serbia: impact of newly established multidisciplinary intensive care units.

AIM: To describe characteristics and outcome of mechanically ventilated patients admitted to three newly established intensive care units (ICU) in Bosnia-Herzegovina and Serbia for 2009 H1N1 influenza infection. METHODS: The retrospective observational study included all mechanically ventilated adult patients of three university-affiliated hospitals between November 1, 2009 and March 1 2010 who had 2009 H1N1 influenza infection confirmed by real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. RESULTS: The study included 50 patients, 31 male (62%), aged 43±13 years. Median time from hospital to ICU admission was 1 day (range 1-2). Sixteen patients (30%) presented with one or more chronic medical condition: 8 (16%) with chronic lung disease, 5 (10%) with chronic heart failure, and 3 (6%) with diabetes mellitus. Thirty-two (64%) were obese. Forty-eight patients (96%) experienced acute respiratory distress syndrome (ARDS), 28 (56%) septic shock, and 27 (54%) multiorgan failure. Forty-five patients (90%) were intubated and mechanically ventilated, 5 received non-invasive mechanical ventilation, 7 (14%) high-frequency oscillatory ventilation, and 7 (14%) renal replacement therapy. The median duration of mechanical ventilation was 7 (4-14) days. Hospital mortality was 52%. CONCLUSION: Influenza 2009 H1N1 infection in three southeast European ICUs affected predominantly healthy young patients and was associated with rapid deterioration after hospital admission and severe respiratory and multiorgan failure. These emerging ICUs provided contemporary ICU services, resulting in case-fatality rate comparable to reports from well-established ICU settings.

Treatment of IgA nephropathy of adults presented by nephrotic syndrome.

The aim of this retrospective study was to evaluate the results of the immunosuppressive regiment in managing of IgA nephropathy associated with primary nephrotic syndrome at the Nephrology Clinic, University of Sarajevo Clinics Centre in period of 1997-2007. We studied 19 patients (4 women and 15 men) with idiopathic nephrotic syndrome, where pathomorphologic changes of IgA nephropathy were proved by kidney biopsy. The levels of diuresis, proteinuria, albuminemia, lipidemia and kidney function, as measure of efficiency of used therapy, were monitored. The IgA nephropathy present with the nephrotic syndrome was shown in 15.8% (19) patients underwent renal biopsy due to primary nephrotic syndrome in the period of observation. The average age of patients with IgA nephropathy was 34.9+/-14.1 years. Eight patients from this group were treated with corticosteroid therapy (1-1.5 mg/kg of body weight for 4 weeks, followed by 0.5 mg/ kg of body weight until therapeutic response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients), 6 patients with corticosteroids and bolus cyclophosphamide (10-15 mg/kg BW), and in 5/19 patients cyclosporine therapy was used (3 mg/kg BW). Complete remission of nephrotic syndrome was achieved in 42.1% of the patients. In conclusion, in adults patients with primary nephrotic syndrome associated with IgA nephropathy, used immunosuppressive therapy resulted in a high percentage of achieved remissions.

Treatment aspects of primary nephrotic syndrome in adults.

Strict therapy protocol, which would be used universally for certain morphological forms of primary nephrotic syndrome, does not exist. The aim of the study was to show the effects of used therapy protocol in treatment of primary nephrotic syndrome at the Institute of Nephrology, Clinical Center University of Sarajevo in period of 2000-2005. The retrospective analysis covered 48 patients (17 women and 31 men) with idiopathic nephrotic syndrome, where pathomorphological changes were proved by kidney biopsy. Minimal change disease was confirmed with 6 (12.5%) patients. All patients were initially treated with corticosteroids with dose of 1 mg/kg of body weight. Five patients were in the group of primary responders (83.3%) with long term total remission, and 1 patient (16.6%) was a primary responder with 3 relapses in 8 months with a therapy of corticosteroids and bolus of cyclophosphamide. Diffuse mesangial proliferative glomerulonephritis was shown in 13 patients (27.1%). Seven patients from this group were treated with corticosteroid therapy (1 mg/kg of body weight for 4 weeks, followed by 0.5 mg/ kg of body weight until therapeutical response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients). Six patients were treated with corticosteroids and one-month of bolus cyclophosphamide during half of year (10-5 mg/kg of body weight). Total remission was achieved in 37,9% of the patients. The IgA nephropathy presented with the nephrotic syndrome was shown in 10.4% (5) of the patients. Three patients from this group were treated with corticosteroid therapy (1 mg/kg of body weight for 4 weeks, followed by 0,5 mg/ kg of body weight until therapeutical response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients) and.2 patients with corticosteroids and cyclophosphamide (1.5 mg/kg of body weight) during 6 months. Complete remission of nephrotic syndrome from this pathomorphological category was achieved in 2 patients. Membranoproliferative glomerulonephritis was shown in 6 patients (12.5%). All were treated with corticosteroids plus bolus of cyclophosphamide. Partial remission was achieved in one patient. Membranous glomerulonephritis was confirmed in 18 patients (37.5 %). Combined therapy of corticosteroids and bolus of cyclophosphamide was used in 7/18 patients, in 2/18 patients therapy of corticosteroids and per os cyclophosphamide (2 mg/kg of body weight) and in 9/18 patients cyclosporine therapy (3 mg/kg of body weight). Complete remission was achieved in 38.8% of the patients. A high percentage of achieved remissions of primary nephrotic syndrome in adults shows the efficiency of immunomodulating therapy used. Membranoproliferative glomerulonephritis still remains a therapy problem.

[Neuropsychiatric lupus and lupus nephritis as a clinical manifestations of systemic lupus erythematosus]. / Neuropsihijatrijski lupus i lupus nephritis kao klinicke manifestacije lupus erythematosus systemicus-a.

Neuropsychiatric (NP) lupus and lupus nephritis are one of the most profound manifestations of the Systemic lupus erythematosus (SLE), with wide variety of clinical manifestations. Especially NP lupus is the most poorly understood subset of the disease, and the most difficult therapeutic problem. We present case report of female SLE patient with the associated difficult and different clinical manifestations of central and peripheral nervous system disease end renal involvement. Agressive treatment option with intermittent pulsed intravenous cyclophosphamide and corticosteroids after the second month of treatment brought to complete remission of nephrotic syndrome. Improving of life-threating clinical manifestations of NP lupus was obtained after six months treatment by this immunosupressive therapy and included intravenous immunoglobulin 400 mg/kg body weight during five days monthly.

[Analysis of doxazosin efficacy in the treatment of the benign prostatic enlargement]. / Analiza efikasnosti doksazosina u tretmanu benignog prostaticnog uvecanja.

OBJECTIVE: to analyze doxazosin efficacy in the treatment of patients with proved benign prostatic enlargement (BPE), according to the reduction of the level of symptoms and urodynamic obstruction as well as reduction in detrusor contraction duration (DCD). SAMPLE AND METHODOLOGY: 31 BPE patients after fulfilling International Prostatic Symptom score, undergone complete urodynamic measurement (uroflowmetry, cystometry and pressure/flow studies). All methodology of urodynamic measurement and definitions were based on the definitions of the International Continence Society. Three months therapy with doxazosin (4 mg daily) was prescribed to each patient, and the same control examinations were done after the treatment with analysis of all relevant data. RESULTS: A reduction of the symptoms (T-paired test) (I-PSS from average of 12.6 decreased to 6.2; p < 0.0001), has been noticed, improvement of quality of life (from average 2.5 decreased to 1.5; p < 0.0001), as well as increasing of the maximal flow (average Q(max) grew for 1.9 ml/sec; p < 0.05). URA dropped from 39,6 cmH2O to 34,1 cmH2O (p < 0.01), remaining in the obstructive region, although 32% of the patients experienced absolute reduction of obstruction (URA < 29 cmH2O). The most prominent result was a drastic reduction in the duration of the detrusor contraction (average DCD from 105 sec. dropped to average 73.4 sec. with p < 0.0001). Other urodynamic parameters, as well as post void residual urine, were not changed significantly. Than patients were allocated in the two groups based on the pre treatment detrusor contraction duration with cut-off point of 90 sec. and the post treatment characteristics were examined (Wilcoxon test). Both groups were shown reduction regarding I-PSS, (its irritative and obstructive domain), but reduction of 54% for DCD > 90 sec group is better than for the 46% for the other group. Further, there is a difference among groups regarding several important characteristics. DCD > 90 sec. group showed increasing in urinary flow for 21% (p < 0.05), decreasing of URA for 13% (p < 0.05), improvement in the quality of life for the 46% (p < 0.001) as well as reduction in DCD for 32% (p < 0.001), what was not shown in the pretreatment DCD < 90 sec. group. CONCLUSION: Doxazosin is a potent reducer of the symptoms in the treatment of the BPE, enhancing urinary flow and reducing DCD in the first place. Albeit, possibility of urodynamic obstruction reduction and influence to the volume of post void residual urine is limited, thus doxazosin is recommended to the patient with moderate obstruction, prolonged detrusor contraction duration and moderate levels of the symptoms. Patients with pretreatment prolonged DCD will be better responders to the therapy. This finding implicates necessity ofurodynamic measurements before treatment in order to optimize therapeutic effect of drug for individual patient.