SUMMARY Postpericardiotomy syndrome (PPS) is worsening or new formation of pericardial and/or pleural effusion mostly 1 to 6 weeks after cardiac surgery, as a result of autoimmune inflammatory reaction within pleural and pericardial space. Its incidence varies among different studies and registries (2% to 30%), as well as according to the type of cardiac surgery performed. We conducted this retrospective analysis of PPS incidence and diagnostic and treatment strategies in patients referred for cardiac surgery for revascularization, valvular and/or aortic surgery. We retrospectively analyzed 461 patients referred for an urgent or elective cardiac surgery procedure between 2009 and 2015. PPS diagnosis was established using well defined clinical criteria. Demographic and clinical characteristics were used in regression subanalysis among patients having undergone surgery of aortic valve and/or ascending aorta. Within 6 weeks after cardiac surgery, 47 (10.2%) patients had PPS. The median time from the procedure to PPS diagnosis was 14 days. The incidence of PPS was 26% after aortic valve and/or aorta surgery, and 7.9% and 8.3% after coronary bypass and mitral valve surgery, respectively. Among patients subjected to aortic valve and/or aortic surgery, regression analysis showed significant association of fever, C-reactive protein (CRP) elevation between 5 and 100 mg/L, urgent procedure and postoperative antibiotic use with PPS diagnosis, whereas younger age showed near-significant association. All patients had complete resolution of PPS, mostly after corticosteroid therapy, with only 2 cases of recurrent PPS that successfully resolved after colchicine therapy. Pleural drainage was indicated in 15 (32%) patients, whereas only one patient required pericardial drainage. In conclusion, PPS incidence in our retrospective analysis was similar to previous reports. Patients having undergone aortic valve and/or aortic surgery were most likely to develop PPS. The most relevant clinical criteria for diagnosis in these patients were fever, CRP elevation between 5 and 100 mg/L, and pericardial and/or pleural effusion formation or worsening 2 weeks after cardiac surgery.

SAŽETAK: Šećerna bolest sa svojim komplikacijama uzrokuje 9 % ukupne smrtnosti diljem svijeta. Periferna arterijska bolest, uz kardiovaskularne bolesti, najčešća je komplikacija šećerne bolesti, čija prevalencija raste s dobi i duljinom trajanja dijabetesa. Specifičnost periferne arterijske bolesti u dijabetičara jest difuzno zahvaćanje arterijskog sustava, poglavito potkoljeničnih arterija. Posljedično tomu, dijabetes je i dalje glavni uzrok malih i velikih amputacija ekstremiteta, što, uz smanjenje kvalitete života, znatno utječe i na preživljenje bolesnika. Budući da razvijena aterosklerotska bolest uključuje niz komplikacija iz stručne domene različitih užih specijalnosti, poput dijabetičkog stopala, u dijagnostici i liječenju nužno je organizirati multidisciplinarne timove. U tu svrhu u Općoj bolnici "Dr. Josip Benčević" u Slavonskom Brodu organiziran je multidisciplinarni tim sa svrhom ranog prepoznavanja periferne arterijske bolesti te pravodobnog liječenja. Dosadašnje iskustvo iz svakodnevne kliničke prakse pokazuje da je za pravilno funkcioniranje tima nužno imati precizan dijagnostičko-terapijski algoritam kako bi se izbjegle duge liste čekanja za slikovnu obradu koja uključuje dupleks ultrazvuk i višeslojnu kompjutoriziranu tomografiju. Dijagnostički algoritam temeljio se na vrijednostima gležanjskog indeksa, a njegova vrijednost i klinička slika usmjeruju i određuju stupanj hitnosti i tip slikovne obrade. Integriranjem algoritma u on-line registar baze podataka dobili smo mogućnost lakšeg praćenja stope učestalosti, uspješnosti liječenja i ovisnosti o unesenim varijablama. Nadamo se da će takav način rada rezultirati ranijim otkrivanjem simptomatske bolesti, a time i znatnim smanjenjem amputacija donjih ekstremiteta te naposljetku i smrtnosti. SUMMARY: Diabetes and its complications causes up to 9% of total mortality worldwide. Peripheral arterial disease is, in addition to cardiovascular diseases, the most common complication of diabetes with a prevalence that increases with age and the duration of diabetes. The specificity of peripheral artery disease in diabetics is the diffuse involvement of the arterial system, especially the popliteal arteries. Consequently, diabetes is still the main cause of small and large limb amputations, which, in addition to a reduction in the quality of life, significantly affects the survival of patients. Since the developed of atherosclerotic disease involves a number of complications from the professional domain of various subspecialties, such as diabetic foot, it is necessary to organize multidisciplinary teams for the diagnostic and therapeutic purposes. For this purpose, the General Hospital "Dr. Josip Benčević" in Slavonski Brod organized a multidisciplinary team with the goal of early recognition of peripheral artery disease and application of timely treatment. Experience from everyday clinical practice indicates that proper functioning of the team requires an accurate diagnostic and therapeutic algorithm to avoid long waiting lists for imaging, which includes Co...

Introduction: Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium. Patient concerns: A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus , presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock. Diagnosis: Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy. Interventions: By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound. Outcomes: At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram. Conclusion: Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.

Aim: The goal of this study was to determine, for the first time in an east European country, the relationship of 25-hydroxyvitamin D (25(OH)D) serum concentration with extent of coronary artery disease and prognosis in patients with acute coronary syndrome (ACS) during a three-year follow up period. 1-3PAtients And methods: The study included 60 ACS patients hospitalized at cardiology department for ACS between March 2012 and September 2012; and 60 matched controls without ACS. Standard laboratory testing and vitamin D determination were performed in all study patients. In addition, ACS patients underwent coronary angiography and were followed-up for 36 months of ACS for major adverse cardiac events (MACE). ConClusion: There is an association between low serum concentration of 25(OH)D and ACS. Vitamin D level is considerably influenced by diabetes comorbidity. There was no significant association between 25(OH)D and MACE at 36 months in ACS patients.

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