The records of 563 patients admitted to the hospital with diagnosis of acute pancreatitis have been studied retrospectively. The aim of the study was to investigate the prevalence of acute renal failure (ARF) in these patients, and to evaluate the most important risk factors for ARF development and mortality. The prevalence of ARF in studied population was 14%, but only 3.8% of ARF patients with acute pancreatitis had isolated renal failure. Other patients had additional failure of other organ systems, 68.4% of whom had multiorgan failure (MOF) before the onset of ARF. In only 8.9% of ARF patients was the renal system the first organ system to fail. Patients with ARF were significantly older, had more preexisting chronic diseases (including chronic renal failure), usually had MOF, and local pancreatic complications relative these in the group with normal renal function. The development of ARF was directly influenced by severity of acute pancreatitis. The mortality rate in ARF patients was 74.7%, compared to an 7.4% mortality of patients with acute pancreatitis and normal renal function. Preexisting chronic disease, the presence of MOF and their number, local pancreatic complications, and older age of the patients increased mortality in ARF patients. The prognosis of patients with oliguric ARF requiring renal replacement therapy was extremely poor, indicating the importance of prevention of ARF in the patients with acute pancreatitis.

Frequen cy of fac tor II G20210A, factor V Lei den, MTHFR C677T and PAI-1 5G/4G polymor phi sm in patien ts wi th venous throm boem bo li sm: Croa tian case-con trol stu dy Ab stra ctIn tro duc tion: Venous throm boem bo lic di sea se is one of the lea di ng cau ses of mor bi di ty and mor ta li ty in the de ve lo ped wor ld. Iden ti ca tion of he re di ta ry fac to rs of throm bop hi lia is con tri bu ti ng to a bet ter un der stan di ng of the etio lo gy and di sea se pre ven tion. The aim of this stu dy was to as se ss the pre va le nce of fac tor II G20210A, fac tor V Lei den, MTHFR (met hyle ne tet ra hydro fo la te re duc ta se) C677T and PAI-1 (plas mi no gen ac ti va tor in hi bi to r-1) 5G/4G po lymor phis ms in heal thy Croa tian sub jec ts and pa tien ts wi th throm boem bo li sm. Ma te ria ls and met ho ds: This pros pec ti ve stu dy in clu ded 100 throm boem bo lic pa tien ts con se cu ti ve ly ad mit ted to the In ten si ve Ca re Unit, Ses tre Mi los r dni ce Uni ver si ty Hos pi tal and 106 heal thy sub jec ts. Ge no typi ng of fac tor II G20210A, fac tor V Lei den, MTHFR C677T and PAI-1 5G/4G po lymorphis ms was do ne usi ng mel ti ng cur ve ana lysis on Lig ht Cycler 1.2 ana lyzer. Re sul ts: Hete ro zygo tes for Fac tor V Lei den po lymor phi sm we re mo re freque nt in the group of pa tien ts wi th the throm boem bo lic di sea se (16%) than in the con trol heal thy sub jec ts (2.9%), OR (95% CI) = 6.41 (1.81-22.8); P = 0.004. Al le le and ge no type frequen cies of ot her stu died po lymorphis ms did not di er be tween ca ses and con tro ls. Con clu sion: This stu dy con r med the as so cia tion of fac tor V Lei den po lymor phi sm wi th the throm boem bo lic di sea se in Croa tian po pu la tion. Key wor ds: throm bop hi lia; coa gu la tion di sor de rs; po lymor phi sm; FV Lei den; fac tor II; plas mi no gen ac ti va tor in hi bi to r-1; met hyle ne tet ra hydro fo late re duc ta se Re cei ved: De cem ber

Aim To prospectively determine the number of patients with sepsis and septic shock in a medical intensive care unit (ICU) using the Sepsis-3 definition; to analyze patients' characteristics, clinical signs, diagnostic test results, treatment and outcomes; and to define independent risk factors for ICU mortality. Methods This prospective observational study enrolled all patients with the diagnosis of sepsis treated in the medical ICU of “Sestre Milosrdnice” University Hospital Center, Zagreb, between April 2017 and May 2018. Results Out of 116 patients with sepsis, 54.3% were female. The median age was 73.5 years (IQR 63-82). The leading source of infection was the genitourinary tract (56.9%), followed by the lower respiratory tract (22.4%). A total of 35.3% of the patients experienced septic shock. Total ICU mortality for sepsis was 37.9%: 63.4% in patients with septic shock and 24.0% in patients without shock. Independent risk factors for ICU mortality were reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure to early recognize sepsis in the emergency department (OR 6.59, 95% CI 1.09-39.75), higher Sequential Organ Failure Assessment score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57-38.87). Conclusion While reduced mobility level and SOFA score are predetermined characteristics, early recognition of sepsis and the choice of appropriate antimicrobial treatment could be subject to change. Raising awareness of sepsis among emergency department physicians could improve its early recognition and increase the number of timely obtained specimens for microbial cultures.

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The absence of the inferior vena cava is a rare congenital anomaly and represents a modest risk for deep-venous thrombosis. When associated with genetic polymorphism or other hypercoagulable states, the risk can increase several times. A case of young man with the inferior vena cava agenesia and deep-venous thrombosis of both legs triggered by the physical effort is reported. The view that the congenital inferior vena cava malformation represents a predisposition to deep-venous thrombosis in spite of well-developed collateral circulation is supported. In these circumstances, various external triggers (physical effort, hormonal contraception etc) may precipitate thrombosis. Because the patient had no other convincing and permanent risk factors for thrombosis, the lifelong anticoagulant therapy was not recommended.