Sepsis and septic shock - an observational study of the incidence, management, and mortality predictors in a medical intensive care unit.

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.

Rhabdomyolysis and acute renal failure after gardening.

Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available.

Primary bilateral iliopsoas abscess in an elderly man.

Primary bilateral iliopsoas abscesses in the elderly are very rare in Europe. We report a case of an elderly male misdiagnosed with rheumatic low back pain. The delay in accurate diagnosis and therapy led to severe worsening of his general condition and septic shock.

Bilateral Pseudomonas aeruginosa endogenous endophthalmitis in an immune-competent patient with nosocomial urosepsis following abdominal surgery.

Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness.

Toxic shock syndrome due to group A streptococcal pharyngitis and bacteremia in adults.

Bacteremia and/or toxic shock syndrome are rare complications of streptococcal pharyngitis in adults. This report describes a previously healthy young man with streptococcal toxic shock syndrome who presented with fatigue, high fever, and suspected extensive streptococcal tonsillopharyngitis. Treatment consisted of high-dose antibiotics followed by therapy for consumptive coagulopathy, acute renal failure, and toxic shock syndrome.

The epidemiology and diagnostic approach to acute pulmonary embolism in the university hospital.

The aim of this retrospective study was to evaluate the demographics and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital during a six-year period, and to assess the impact of several risk factors on patients' survival. The study included 165 patients, mean age 69.3 +/- 13.

Toxic shock syndrome due to group A streptococcal pharyngitis and bacteremia in an adult.

Bacteremia and/or toxic shock syndrome is a rare complication of streptococcal pharyngitis in adults. We describe a case of streptococcal toxic shock syndrome in a previously healthy young man who presented with fatigue, high fever, and suspected extensive streptococcal tonsillo-pharyngitis. Therapy consisted of high doses of antibiotics followed by treatment of consumptive coagulopathy, acute renal failure, and toxic shock syndrome.

Inferior vena cava agenesia and a massive bilateral iliofemoral venous thrombosis.

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.

Fatal hyponatremia and other metabolic disturbances associated with psychotropic drug polypharmacy.

Objective: To report a case of fatal hyponatremia, marked hyperglycemia, and acute pancreatitis following simultaneous administration of paroxetine, fluphenazine, haloperidol and olanzapine.

Case Summary: A 44-year-old non-diabetic male was admitted unconsciously, with severe hyponatremia, hyperglycemia and bradypnea. The patient had a history of long-term treatment with paroxetine, fluphenazine, haloperidol and olanzapine.

Survival analysis of 314 episodes of sepsis in medical intensive care unit in university hospital: impact of intensive care unit performance and antimicrobial therapy.

Aim: To evaluate epidemiology of sepsis in medical intensive care unit (ICU) in a university hospital, and the impact of ICU performance and appropriate empirical antibiotic therapy on survival of septic patients.

Methods: Observational, partly prospective study conducted over 6 years assessed all patients meeting the criteria for sepsis at ICU admission at the Sisters of Mercy University Hospital. Clinical presentation of sepsis was defined according to 2001 International Sepsis Definitions Conference.

Acute acalculous cholecystitis in patients with surgical acute renal failure.

Acute acalculous cholecystitis (AAC) developed in 11 (7.7%) of 143 patients with surgical acute renal failure (ARF) who had no prior biliary tract disease. The cause of this potentially fatal complication is multifactorial and include trauma, previous surgery, sepsis, intermittent positive pressure ventilation, total parenteral nutrition, multiple transfusions, hypotension, and opiate sedation.

Acute respiratory distress syndrome after aprotinin infusion.

Objective: To report a case of acute respiratory distress syndrome (ARDS) following first exposure to aprotinin.

Case Summary: A 24-year-old previously healthy white man was treated with aprotinin infusion because of bleeding following tonsillectomy. The patient had never been treated with aprotinin before, including local application of different hemostatics containing the aprotinin component.

Severe pancreatitis as first symptom of mumps complicated with pseudocyst and abscess of pancreas.

A 22-year-old man, a refugee from Bosnia, developed serious pancreatitis complicated with pseudocyst and pancreatic abscess. Staphylococcus aureus was isolated from pus and blood cultures. On day 12 of illness, parotitis and epididymitis appeared with elevated specific IgG antibody levels to the mumps virus.

Acute renal failure complicating severe acute pancreatitis.

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.

A female patient with tuberculous polyserositis, and congenital tuberculosis in her new-born child.

A 24-year-old woman was admitted to our department with sepsis, polyserositis and suspected abdominal tumor immediately after delivery. Effusion analyses suggested an etiology of tuberculosis. The severe general condition of the patient allowed for no invasive diagnostic procedures.

Acute suppurative thyroiditis caused by Salmonella enteritidis.

Acute suppurative thyroiditis in a 47-year-old diabetic woman is reported. Diagnosis was suspected by clinical examination and confirmed by ultrasound, CT-scan and cytological examination. A rare causative agent was isolated--Salmonella enteritidis.

[Pulmonary silicosis complicated by systemic vasculitis].

A patient is described who had been--as a cutter of crystal--for 40 yrs exposed to the silica dust. At regular medical examinations at out-patients' department for pulmonary diseases first stage of pulmonary silicosis had been found and confirmed at the Institute for Occupational Health. Nine years after the retirement the clinical symptoms of febrility, cough, joint and muscular pains appeared together with the difficulties in swallowing and dyspnea even at minor physical activities.

Echographic studies of osmotic agents.

The effectiveness of osmotic agents, acetazolamide (Diamox), urea, glycerol, and mannitol, and massages (5 and 10 minutes) for inducing hypotony in rabbit eyes was evaluated by ultrasonography. Mannitol was found to have the greatest hypotonic effect followed closely by urea and glycerol, then acetazolamide. The difference between the 5 and 10 minute massages was negligible.