Based on our data, unmeasured anions provide prediction of mortality of critically ill patients on mechanical ventilation, unlike the traditional acid-base variables which are not accurate predictors of the 28-day mortality rate.

Objective: The aim of our study was to evaluate the frequency of angiographic vasospasm and computed tomography (CT) detectable cerebral ischemia after subarachnoid hemorrhage, the relationship between these events, and the impact on outcome.Patients and Methods: We prospective enrolled 54 patients with subarachnoid hemorrhage treated from March 2011 to January 2013. CT and CT angiography of brain were obtained on the ninth day of rupture regardless of neurological status. The control brain CT and CT angiography were obtained earlier if clinical symptoms implied delayed cerebral ischemia. The outcome was assessed after 6 months using the extended Glasgow Outcome scale scale.Results: Fifty-four percent of the patients recruited had CT angiography vasospasm and 46% had cerebral ischemia on CT scans. Our study shows a strong correlation between angiographic vasospasm and cerebral ischemia visible on CT (P = 0.001) and severity of vasospasm and frequency of ischemia (P = 0.03). Twenty percent of the patients showed ischemia with no demonstrable vasospasm confirming multiple cause of delayed cerebral ischemia. Logistic regression model has shown the strong impact of angiographic vasospasm (P = 0.004, odds ratio = 6.85; 95% confidence interval, 1.83-26.65) and arterial hypertension (P = 0.02, odds ratio = 4.32; 95% confidence interval, 1.16-16.01) on the development of cerebral ischemia. Angiographic vasospasm (P = 0.01) and cerebral ischemia (P = 0.005) were associated with worse 6-month outcome.Conclusion: A strong association exists between angiographic vasospasm and cerebral ischemia on CT although some ischemia occurs in area without vasospasm.

Background/aim: Acid-base disturbances are common in critically ill patients. Some of the most commonly used markers of metabolic acidosis are base defi cit and lactate. Th e aim of this study was to evaluate the correlation between base defi cit and serum lactate and the utility of base defi cit in the assessment of serum lactate levels in critically ill patients on mechanical ventilation. Methods: Th is study was designed as a retrospective, analytical study. We reviewed all arterial gas analyses (base defi cit and lactate levels) of patients on mechanical ventilation. Th e correlation between base defi cit and lactate was assessed by calculation of the Pearson correlation coeffi cient (r) and coeffi cient of determination (R 2). Receiver operating characteristic (ROC) curves were created for base defi cit to detect the presence of hyperlactatemia. Th e SPSS 12.0 software package (Chicago, Illinois) was used for statistical analyses. Results: One hundred forty-two patients participated in the study: including survivors (n=68) and non-survivors (n=74). Th e mean value of base defi cit was 0.512 ± 6.10 mmol/L, and the mean value of serum lactate was 2.04 ± 2.07 mmol/L. Th ere was no diff erence in lactate and base defi cit values between the groups (p=0.101, p=0.106, respectively). Hyperlactatemia was observed in 44 patients (30.98 %). In ROC curve analysis, the area under the curve for base defi cit to detect hyperlactatemia was 0.527. Conclusion: Th is study indicates that base defi cit is not an appropriate marker in the evaluation of real serum lactate values.

Introduction. Malignant fibrous histiocytoma is a fast spreading pleomorphic sarcoma with a high malignant potential. Its spreading is characterized with local invasion and distant metastazes with early onset. Most common localisations of development are extremities, trunk and retroperitoneum. Given the line of rare case and specimen, lack of a clear etiology and mechanisms of this disease, as well as adequate histopathologic findings and intraoperative documentation, we presented current status, discuss putative etiology, histopathology with variant morphology, differential diagnosis and treatment modalities. Case report. We presented a 56-years-old female Serbian with tumor in the thigh that clinically resembles incapsulated hematoma. Computed tomography revealed intramuscular tumor with a heterodense structure and compression on surround tissue. Ex tempore biopsy specimen showed malignant potential of the tumor. Wide and radical excision of the nodule has been done, and definitive histopathological verification revealed malignant fibrous histiocytoma. Conclusion. Malignant fibrous histiocytoma is a most common type of soft tissue sarcomas in adults. Frequent localization is on lower extremities, and every rapidly enlarging nodule in this localization that on computed tomography is like incapsulated hematoma with necrotic zone should alert suspicion on presence of this type of sarcoma. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41007 and Grant no. III41010]