Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Review Case Reports
[Spontaneous rupture of the spleen in infectious mononucleosis: case report and review of the literature].
Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Abdominal pain is uncommon in infectious mononucleosis, and splenic rupture should be strongly considered whenever abdominal pain occurs. The onset of pain may be insidious or abrupt. The pain is usually in the left upper quadrant. ⋯ We report on a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy.
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The aim of this paper is to present the latest developments in therapy and prophylaxis of deep vein thrombosis in gynecology and obstetrics. ⋯ The data presented in the paper have been extracted from the Current Contents database. In the introduction, the coagulation cascade is described, and certain coagulation abnormalities caused by deficiency or decreased activity of coagulation factors are highlighted. The most prominent signs of deep vein thrombosis in pregnant women are swelling and tenderness of the affected leg, sometimes accompanied with fever and leucocytosis. In pelvic thrombosis, swelling of the leg is often absent and such a condition may be mistaken for other abdominal emergencies. The diagnostic algorithm for deep vein thrombosis starts with the clinical Wells criteria. To confirm the diagnosis it is necessary to visualize the thrombus by one of the imaging methods. The value of D-dimer is limited by its low positive predictive value, particularly in pregnant women. Low weight molecular heparin's have lately almost replaced standard heparin in the treatment of the deep vein thrombosis in pregnant women for providing advantages of subcutaneous application, no need of laboratory control of coagulation parameters, lower risk of bleeding, and lower incidence of osteoporosis and heparin-induced thrombocytopenia. We list the recommendations of the American College of Chest Physicians published in 1991, which stratify pregnant women with deep vein thrombosis according to their medical history and laboratory parameters. We have specified the proposed approach according to: history of deep vein thrombosis due to transient risk factors; previous idiopathic deep vein thrombosis without anticoagulant therapy; previous deep vein thrombosis with thrombophylia; previous idiopathic deep vein thrombosis on anticoagulant therapy; laboratory-proven thrombophilia with no history of deep vein thrombosis; and recurrent deep vein thrombosis. Pregnant women with artificial heart valves may undergo one of three proposed treatments. Long preoperative hospitalization, prolonged operative procedures, extensive injuries of blood vein vessels on radical procedures, frequently present accompanying malignant disease or previous irradiation therapy and postoperative bed-ridden period after major gynecologic procedures increase the risk of perioperative development of deep vein thrombosis. It is necessary to appraise this risk, classify patients in one of the four groups, and administer appropriate measures. Patients at a low risk of developing thromboembolic incidents are those younger than 40, undergoing procedures lasting less than 30 minutes and without other risk factors. The risk is moderate in patients aged 40-60 without other risk factors, or those aged under 40 having malignancy have high risk. Patients at a very high risk are those with a history of deep vein thrombosis, thrombophilia or pelvic exenteration. In the last decade there has been a great advancement in the diagnostics and treatment of deep vein thrombosis. The discovery of genetic disorders predisposing the patient to the development of a thromboembolic incident (thrombophilia) has changed our position concerning the duration of anticoagulant therapy, and nowadays it can last from several months to a lifetime regimen, depending on the underlying mechanism causing the incident. A significant improvement in therapy has occurred with the introduction of low molecular weight heparins in clinical practice. Their therapeutic value is equal to standard heparin, and their advantages include easier dosage and less nursing time as well as in a lower incidence of side effects such as haemorrhage. For these reasons, low molecular weight heparin has almost completely replaced standard heparin in the western world.
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Review
[Immunopathogenesis of hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome].
Hantaviruses (HTV) cause two serious human diseases: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS), posing a considerable public health problem worldwide. Immunopathogenesis has been suggested to be involved in both HFRS and HPS. A common feature of hantavirus diseases is an increased microvascular bed permeability, suggesting that vascular endothelium is a prime target of virus infection. ⋯ The immunopathologic disorders accompanying HFRS/HPS are complex. As there is no appropriate animal model to investigate HFRS/HPS immunopathogenesis, we mostly rely on in vitro and rare clinical studies. Additional efforts in the research of immunopathogenesis caused by HTV, may contribute to better understanding of HFRS/HPS characteristics and course of disease, and improve the treatment and prevention.
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Thromboembolism (TE) is a well-known and potentially fatal complication after injury and orthopedic surgery. Thromboembolic prophylaxis is generally recognized as a factor of significant interest concerning posttraumatic comorbidity and mortality. In this context, the aim of the study was to analyze hospital mortality 24 hours after injury, and to assess the proportion of fatal pulmonary embolism in overall hospital mortality. Finally, the purpose of the study was to explore the possible correlation between different prophylactic approaches and hospital mortality. ⋯ A significant reduction in the mortality, especially due to fatal pulmonary embolism after injury, was clearly demonstrated. This could be explained by improvements in the management of trauma and organized TE prevention.
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Heart rate variability (HRV) is a physiological phenomenon which reflects the influence of the autonomic nervous system on the heart work. The research in HRV has not been limited to the domain of basic and clinical cardiology, mostly with the aim of stratifying the risks of sudden death from malignant arrhythmias among patients with myocardial infarction (MI), but over the past few years the research has been done and studies have been published also in the area of neurology. Likewise acute MI, acute ischemic stroke leads to autonomic dysbalance and lowered HRV. However, literature lacks relevant data on autonomic dysbalance after the acute phase of ischemic stroke. The aim of this study was to assess the level of autonomic dysbalance in patients after the acute phase of ischemic stroke. ⋯ As in MI, the values of HRV stay significantly lower after the acute phase of the disease in patients who have suffered ischemic stroke compared to healthy persons of the same age.