Hemolytic-uremic syndrome (HUS) is a leading cause of Introduction: acute renal failure in infant... more Hemolytic-uremic syndrome (HUS) is a leading cause of Introduction: acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF). A previously healthy 4-year old Caucasian girl Case presentation: developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis. Early start of plasmapheresis and meticulous supportive Conclusions: treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.
Cilj ove retrospektivne studije bila je analiza učestalosti, rizičnih faktora, primjene preventiv... more Cilj ove retrospektivne studije bila je analiza učestalosti, rizičnih faktora, primjene preventivnih mjera te antimikrobnog liječenja nozokomijalnih infekcija stečenih u ranom poslijeoperacijskom razdoblju u 392 odrasla kardiokirurška bolesnika liječena u Jedinici intenzivnog liječenja (JIL) kardiokirurških bolesnika Klinike za anesteziologiju i intenzivno liječenje Kliničkog bolničkog centra (KBC) Rijeka od 1. siječnja do 31. prosinca 2015. Kriteriji za proglašenje nozokomijalne infekcije uključivali su tri skupine pacijenata: pacijente s pozitivnim mikrobiološkim kulturama uzetim rutinski prilikom prijma u JIL (urinokultura, bris nosa, VAT), pacijente s pozitivnim mikrobiološkim kulturama nakon 24 sata od prijma u JIL uz dinamsku nestabilnost, Clinical Pulmonary Infection Score (CPIS skor) 1-6 ili zbog znakova infekcije sternalne rane te pacijente s negativnim mikrobiološkim kulturama, ali sa CPIS skorom većim >6. Učestalost nozokomijalnih infekcija u JIL iznosila je 10 %, s mo...
We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulato... more We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulatory support (MCS) for the treatment of the Lyme carditis associated with refractory cardiogenic shock. Fulminant Lyme myocarditis in young adult male patient led to a sudden onset of acute, severe biventricular heart failure with progressive cardiogenic shock, and multiorgan failure immediately after admission.The previously healthy 28-year-old man was admitted to hospital with dyspnea, atrial flutter with 160/min ventricles rate, normotension, cardiomegaly, and incipient cardiogenic pulmonary edema on chest x-ray. Within the next 24 hours, the acute heart failure (AHF) progressed to the refractory cardiogenic shock with severe systemic hypotension, respiratory distress, anuria, liver congestion, and laboratory evidence of extremely high level of the anaerobic metabolism in the arterial blood (pH 7.16; HCO3 12.3 mmol/L; BE -14.6; lactates level 17 mmol/L). The transesophageal echo imaging showed severe dilatation and global biventricular akinesis, with left ventricular ejection fraction of 5%. The diagnosis of acute fulminant myocarditis of unknown etiology was reached. Since the patient did not respond rapidly to vasoactive and supportive therapy, MCS was immediately inserted. Broad differential diagnosis of fulminant myocarditis was considered and disseminated Borrelia infection was serologically confirmed and appropriate antimicrobial therapy was started from the fifth day after admission. MCS used over the next 26 days was successfully integrated with pharmacologic support and artificial ventilation in therapy. The patient was discharged from hospital after 65 days with a complete restoration of bilateral heart ejection fraction.This case shows that the clinical course of the Lyme carditis can present uncommonly with profound cardiovascular collapse and the MSC implementation should be considered in the early stage of drug resistant hemodynamic instability. Rapid transfer to the cardiac center where the MCS is available for all patients with signs and symptoms of AHF due to confirmed or suspected Lyme carditis would be recommended, as this treatment could be the only life-saving method.
Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infant... more Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after ...
Nozokomijalne (intrahospitalne) infekcije su infekcije stečene najmanje 48 sati nakon hospitaliza... more Nozokomijalne (intrahospitalne) infekcije su infekcije stečene najmanje 48 sati nakon hospitalizacije ili ambulantnog liječenja ili najviše 48 sati nakon otpusta iz bolnice. U novije doba u nozokomijalne infekcije ubrajaju se i infekcije medicinskog osoblja koje su stečene prigodom njege i liječenja bolesnika. Nozokomijalne infekcije kirurške rane su infekcije koje se javljaju unutar 30 dana od učinjene operacije (1). Učestalost i UČESTALOST, RIZIČNI FAKTORI, PREVENCIJA I LIJEČENJE NOZOKOMIJALNIH INFEKCIJA U ODRASLIH KARDIOKIRURŠKIH BOLESNIKA U JEDINICI INTENZIVNOG LIJEČENJA TIJEKOM 2015. GODINE U KLINIČKOM BOLNIČKOM CENTRU RIJEKA
Hemolytic-uremic syndrome (HUS) is a leading cause of Introduction: acute renal failure in infant... more Hemolytic-uremic syndrome (HUS) is a leading cause of Introduction: acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF). A previously healthy 4-year old Caucasian girl Case presentation: developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis. Early start of plasmapheresis and meticulous supportive Conclusions: treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.
Cilj ove retrospektivne studije bila je analiza učestalosti, rizičnih faktora, primjene preventiv... more Cilj ove retrospektivne studije bila je analiza učestalosti, rizičnih faktora, primjene preventivnih mjera te antimikrobnog liječenja nozokomijalnih infekcija stečenih u ranom poslijeoperacijskom razdoblju u 392 odrasla kardiokirurška bolesnika liječena u Jedinici intenzivnog liječenja (JIL) kardiokirurških bolesnika Klinike za anesteziologiju i intenzivno liječenje Kliničkog bolničkog centra (KBC) Rijeka od 1. siječnja do 31. prosinca 2015. Kriteriji za proglašenje nozokomijalne infekcije uključivali su tri skupine pacijenata: pacijente s pozitivnim mikrobiološkim kulturama uzetim rutinski prilikom prijma u JIL (urinokultura, bris nosa, VAT), pacijente s pozitivnim mikrobiološkim kulturama nakon 24 sata od prijma u JIL uz dinamsku nestabilnost, Clinical Pulmonary Infection Score (CPIS skor) 1-6 ili zbog znakova infekcije sternalne rane te pacijente s negativnim mikrobiološkim kulturama, ali sa CPIS skorom većim >6. Učestalost nozokomijalnih infekcija u JIL iznosila je 10 %, s mo...
We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulato... more We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulatory support (MCS) for the treatment of the Lyme carditis associated with refractory cardiogenic shock. Fulminant Lyme myocarditis in young adult male patient led to a sudden onset of acute, severe biventricular heart failure with progressive cardiogenic shock, and multiorgan failure immediately after admission.The previously healthy 28-year-old man was admitted to hospital with dyspnea, atrial flutter with 160/min ventricles rate, normotension, cardiomegaly, and incipient cardiogenic pulmonary edema on chest x-ray. Within the next 24 hours, the acute heart failure (AHF) progressed to the refractory cardiogenic shock with severe systemic hypotension, respiratory distress, anuria, liver congestion, and laboratory evidence of extremely high level of the anaerobic metabolism in the arterial blood (pH 7.16; HCO3 12.3 mmol/L; BE -14.6; lactates level 17 mmol/L). The transesophageal echo imaging showed severe dilatation and global biventricular akinesis, with left ventricular ejection fraction of 5%. The diagnosis of acute fulminant myocarditis of unknown etiology was reached. Since the patient did not respond rapidly to vasoactive and supportive therapy, MCS was immediately inserted. Broad differential diagnosis of fulminant myocarditis was considered and disseminated Borrelia infection was serologically confirmed and appropriate antimicrobial therapy was started from the fifth day after admission. MCS used over the next 26 days was successfully integrated with pharmacologic support and artificial ventilation in therapy. The patient was discharged from hospital after 65 days with a complete restoration of bilateral heart ejection fraction.This case shows that the clinical course of the Lyme carditis can present uncommonly with profound cardiovascular collapse and the MSC implementation should be considered in the early stage of drug resistant hemodynamic instability. Rapid transfer to the cardiac center where the MCS is available for all patients with signs and symptoms of AHF due to confirmed or suspected Lyme carditis would be recommended, as this treatment could be the only life-saving method.
Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infant... more Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after ...
Nozokomijalne (intrahospitalne) infekcije su infekcije stečene najmanje 48 sati nakon hospitaliza... more Nozokomijalne (intrahospitalne) infekcije su infekcije stečene najmanje 48 sati nakon hospitalizacije ili ambulantnog liječenja ili najviše 48 sati nakon otpusta iz bolnice. U novije doba u nozokomijalne infekcije ubrajaju se i infekcije medicinskog osoblja koje su stečene prigodom njege i liječenja bolesnika. Nozokomijalne infekcije kirurške rane su infekcije koje se javljaju unutar 30 dana od učinjene operacije (1). Učestalost i UČESTALOST, RIZIČNI FAKTORI, PREVENCIJA I LIJEČENJE NOZOKOMIJALNIH INFEKCIJA U ODRASLIH KARDIOKIRURŠKIH BOLESNIKA U JEDINICI INTENZIVNOG LIJEČENJA TIJEKOM 2015. GODINE U KLINIČKOM BOLNIČKOM CENTRU RIJEKA
Uploads
Papers by Dino Mijatovic