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Biomedical subjects

M Sabljar-Matovinović

Publications and source records attributed to M Sabljar-Matovinović.

17 recordsLinked to original sources
PubMed2002

Persistent cervical intersegmental artery and aortic arch coarctation.

A 15-year-old girl presented with upper extremity hypertension and continuous precordial murmur. Arteriography revealed aortic coarctation proximal to the origin of the left subclavian artery. An anomalous artery originated from the aortic arch, between the left common carotid artery and the stenosis. It ascended cranially and filled an angiomatous vascular formation on the left side of the neck. The "angioma" drained into the left subclavian artery. The embryological explanation of the described anomaly is difficult, but probably related to hemodynamic alterations following the prestenotic increase in blood pressure. This may have impaired the obliteration of cervical intersegmental arteries, resulting in the persistence of one of the first three intersegmental arteries as the anomalous branch of the aortic arch. The angiomatous vascular formation in the neck could be the consequence of altered development of anastomoses between the muscular twigs of both vertebral and deep cervical artery. The vessel draining the vascular formation was probably the thyrocervical trunk. Since there were no overt collateral channels or signs of left ventricular hypertrophy by electrocardiography and echocardiography, it seems that the aberrant collateral flow was hemodynamically significant and reduced the afterload on the myocardium. Although the pattern of collateral flow in our case might be considered extremely rare, it is important in preoperative planning and interpretation of imaging studies.

Adolescent↗
PubMed2001

Pelvic neurilemmoma.

A case of a 37-year-old man admitted to our Department of Internal Medicine for medical evaluation of hypertension is reported. The patient had a 4-year history of oscillating hypertension prior to admission, however, with no major subjective complaints, except for pollakisuria. Clinical and biochemical assessment revealed no damage to target organs. Laboratory parameters showed normal values, except for hyperlipidemia. On routine ultrasonography of the pelvis confirmed a pelvic tumor of uncertain etiology, with no abdominal lymph node enlargement. No signs of metastasis were found. The patient was transferred to the Department of Surgery, where the tumor was removed in toto. Histopathologic analysis of the tumor, 11 x 8 x 8 cm in size, composed of cellular and mixoid areas with traces of collagenous connective tissue, necrosis, and tiny calcifications with scattered palisading nuclei and Verocay bodies, pointed to the diagnosis of a benign tumor, i.e. neurilemmoma. Postoperatively, the patient's subjective state was excellent, with normal blood pressure values, and without pollakisuria. A very large space-occupying lesion was responsible for compression of the neighboring organs, especially urinary bladder, resulting in pollakisuria. To our knowledge, pelvic localization of neurilemmoma, particularly a large one, is rare.

Adult↗
PubMed2000

Pheochromocytoma with negative urinalysis in pregnancy.

We present a rare case of adrenal pheochromocytoma in pregnancy, with serial 24-h urine specimen collections showing normal concentrations of catecholamine metabolites. The diagnosis was based on clinical presentation, abdominal ultrasound, and magnetic resonance imaging, and was confirmed on post-operative pathohistological examination. Clinical suspicion of pheochromocytoma in pregnancy should be sufficient to implement adequate therapeutic measures, regardless of urine catecholamine concentrations.

Adrenal Gland Neoplasms↗
PubMed2000

Renal vascular resistance in essential hypertension: duplex-Doppler ultrasonographic evaluation.

Duplex Doppler ultrasonography has been validated as a noninvasive method to evaluate hemodynamic features of renal blood flow in renal and intrarenal arteries in patients with various renal diseases. The significance of duplex Doppler sonography in the evaluation of renal vascular resistance in essential hypertension has not yet been clearly determined. The aim of the present study was to evaluate the renal vascular resistance in patients with essential hypertension by measuring intrarenal arterial resistance (RI) and to correlate RI with renal functional tests and other clinical and laboratory data. Duplex Doppler ultrasonography was used to measure RIs in intrarenal arteries in 128 patients with essential hypertension and 61 age-matched normotensive control examinees. The renal vascular resistance index (RI) was determined by use of Doppler ultrasound. Hypertension was classified according to the 1997 Joint National Committee Guidelines (JNC-VI). Mean RI in hypertensive patients was 0.66 +/- 0.05 (+/- sd) and in healthy controls 0.60 +/- 0.03 (+/- sd) (p = 0.0001). RI correlated significantly with patient's age (r = 0.577, p = 0.001), duration of hypertension (r = 0.335, p= 0.001), stage of hypertension according to the JNC-VI classification (r = 0.315, p = 0.006), creatinine clearance (r = -0.383, p = 0.001), systolic blood pressure (SBP, r = 0.41, p = 0.001) and mean blood pressure (MBP, r = 0.30, p = 0.002). RI values did not correlate significantly with plasma renin concentration (r = -0.198 NS), diastolic blood pressure (DBP, r = 0.17, p = 0.06), and cardiac pulse (r = -0.10, p = 0.16). Multiple regression analysis showed that independent variables for RI were the patient's age (multiple R = 0.53, signif. F = 0.001) and systolic blood pressure (multiple R = 0.57, signif. F = 0.03). The renal Doppler resistance index (RI) is increased in essential hypertension and it correlates with renal functional tests as well as with patient's age, duration of hypertension, with a stage of hypertension according to the JNC-VI classification, and with systolic and mean blood pressure. The increased renal vascular resistance (RI) in hypertensive patients could be a sign of developing hypertensive nephrosclerosis and consequently renal failure. The utilization of the renal vascular resistance index (RI), provides a new noninvasive parameter in the followup of patients with essential hypertension.

Adult↗
PubMed2000

Metastasis of renal adenocarcinoma to the pelvic region.

Adenocarcinoma is among the most common tumors with a 95% incidence. Renal tumor metastases can occur by the lymphatic, lymphohematogenous, or hematogenous route. A 59-year-old female with metastasis of renal adenocarcinoma, at an unusual localization is presented. Diagnosis was made by ultrasound and cytologic examination, computerized tomography, angiography, and tumor biopsy. Tumor biopsy was the sole successful technique to detect the metastasis of renal adenocarcinoma.

Adenocarcinoma↗
PubMed1995

The diagnostic capacity of serum amyloid A protein for early recognition of kidney allograft rejection.

We used new micro-ELISA test with sequence-specific antibody for every day monitoring of serum amyloid A protein (SAA) in 20 patients with kidney allografts in order to facilitate an early diagnosis of rejection. Altogether 44 SAA peaks were observed (beside those caused by surgery) and 22 of them were caused by allograft rejections. When allograft rejection occurred in postsurgical period (first 4 days), SAA levels rose to mean 706 +/- 161 mg/l while initial SAA peaks (caused by surgical trauma) reached the mean value 306 +/- 55 mg/l. The statistical significance was very high, P < 0.0001. In all nine rejection episodes in this period SAA peaks were higher than 400 mg/l, so we chose this level as a reference limit for this period. SAA peaks caused by allograft rejection in later period were also markedly higher (mean 461 +/- 176 mg/l) than those caused by infections or other complications (mean 133 +/- 82 mg/l, P < 0.001). Baseline mean level was 9 +/- 5 mg/l. In all 13 rejection episodes in this period SAA peaks were higher than 200 mg/l, so we chose this level as a reference limit for this period. In 20 of 22 rejection episodes (91%) SAA elevation predicted rejection and usually started to rise sharply 2 days before it. An excellent correlation between kidney allograft rejection and SAA reaction was found in this study (better than with CRP reaction) so we recommend everyday monitoring of SAA concentrations in patients with kidney allograft as a valuable aid in the early diagnosis and prediction of acute allograft rejection.

C-Reactive Protein↗
PubMed1995

[Acute pancreatitis caused by Ascaris lumbricoides in acute renal failure: case report].

A 26-year-old female patient with severe acute pancreatitis caused by Ascaris lumbricoides and consecutive acute renal failure is described. Acute pancreatitis is mostly caused by gallstones and acute or chronic alcohol ingestion. Ascariasis as an etiologic factor of acute pancreatitis does not occur very often except in the tropical and subtropical regions, where it is widely distributed. The goal of this case report was to worn the clinicians to pay attention to this, in our country rarely occurring cause of acute pancreatitis. In special circumstances of great migration of refugees and displaced persons with very low hygienic standards this rare possibility should be taken into account.

Acute Disease↗
PubMed1994

Renal vascular resistance in diabetic nephropathy: duplex Doppler US evaluation.

PURPOSE: To evaluate duplex Doppler sonography to assess renal vascular resistance (RVR) in diabetic patients. MATERIALS AND METHODS: Resistive indexes (RIs) and pulsatility indexes (PIs) were measured in intrarenal arteries of 144 patients with diabetes mellitus and 61 control subjects. RIs and PIs were compared for control subjects and patients with diabetic nephropathy and correlated with laboratory and clinical findings. RESULTS: In control subjects, the mean RI was 0.595 +/- 0.033 (standard deviation) and mean PI was 1.001 +/- 0.105. Elevated RIs and PIs accompanied progression of nephropathy. Statistically significant (P < .001) correlations were observed between both RI and PI and serum creatinine level, creatinine clearance rate, systolic and diastolic blood pressure measurements, and patient age. CONCLUSION: Doppler indexes reflect increased RVR in diabetic nephropathy and correlate with laboratory and clinical parameters, but RI and PI measurements offer no advantages over these parameters to predict disease progress or in patient care.

Adolescent↗
PubMed1994

Intrarenal duplex Doppler sonographic evaluation of unilateral native kidney obstruction.

RIs were measured in intrarenal arteries in 66 kidneys of 33 examinees without renal impairment and in 42 kidneys of 21 patients with unilateral urinary obstruction. The mean RI in normal kidneys was 0.593 +/- 0.040. Patients with unilateral obstruction had a mean RI of 0.709 +/- 0.039 in obstructed kidneys and a mean RI of 0.591 +/- 0.033 in contralateral nonobstructed kidneys. Statistically significant differences have been noticed in the groups of normal versus obstructed kidneys (P < 0.001) and of obstructed versus contralateral nonobstructed kidneys (P < 0.001). The mean dRI was 0.118 +/- 0.034 in patients with unilateral obstruction, and it was 0.014 +/- 0.012 in examinees without renal impairment (P < 0.001). A comparison of RI values between the right and left kidneys in a patient with unilateral obstruction proved more useful than using a 0.7 RI cutoff value in a Doppler sonographic diagnosis of unilateral obstruction.

Adult↗
PubMed1993

Clinical relevance of serum amyloid A protein monitoring in urinary tract infections.

We have evaluated the clinical relevance of monitoring acute phase proteins in severe urinary tract infection. Body temperature, white blood cell count, erythrocyte sedimentation rate, serum amyloid A protein (SAA), C-reactive protein (CRP), alpha-1-antichymotrypsin (ACT) and alpha-1-acid glycoprotein (AGP) were determined daily in sera from 18 treated patients. Two patterns of response could be identified: responders and non-responders whose therapy had to be changed. Mean values for each acute phase protein were calculated daily in both responders and non-responders. Statistical evaluation of the significance between the means for each protein was also performed on a daily basis and showed P < 0.01 for SAA and CRP on day 3, for ACT on day 5, and for AGP on day 6. SAA and CRP appear to be the most reliable markers for antimicrobial therapy monitoring in patients with urinary tract infections.

Adult↗
PubMedDate not supplied

[Continuous renal replacement therapy].

Acute renal failure (ARF) is a common clinical condition with significant mortality. Although intermittent hemodialysis (IHD) represents a standard method of renal replacement therapy in ARF, novel methods of continuous renal replacement therapy (CRRT) are becoming more important. CRRT allows an excellent control of uremia, volume and acid-base status, avoiding at the same time rapid fluctuations in effective plasma volume, plasma osmolality, or blood pressure. Methods of CRRT differ with respect to the predominant way of solute removal, utilizing convective clearance (continuous ultrafiltration and hemofiltration), diffusive clearance (continuous hemodialysis), or a combination of the both (continuous hemodiafiltration). Based on their properties, CRRT represent method of choice in the treatment of hemodynamically unstable patients with ARF.

Acute Kidney Injury↗
PubMedDate not supplied

[The tumor lysis syndrome: case report and review of the literature].

Tumor lysis syndrome is specific acute renal failure. This syndrome is usually a complication of cytostatic therapy in patients with acute lymphoblastic leukemia and lymphoblastic lymphoma. Tumor cell lysis following chemotherapy may lead to metabolic complications and renal failure. We report herein, two patients with acute lymphoblastic leukemia who developed tumor lysis syndrome after chemotherapy. Furthermore, we describe important measures to prevent tumor lysis syndrome in high risk patients.

Adolescent↗
PubMedDate not supplied

[Evaluation of mean volume of urinary erythrocytes in the evaluation of the cause of hematuria. Relation between pH and urinary osmolarity].

A new method for differentiation of glomerular from nonglomerular hematuria is presented. Mean volume of erythrocytes in glomerular hematuria is decreased, and these erythrocytes are abnormally small in size, so called microcytes. On the other hand, in nonglomerular hematuria the volume of erythrocytes is the same as the volume of erythrocytes in the peripheral blood from the same patient. Those are normocytes. A statistically significant difference in volume of erythrocytes was found between glomerular and nonglomerular erythrocytes. The osmolality and pH of urine had no influence on volume of erythrocytes in hematuria. Our results show that the analysis of mean corpuscular volume of urine erythrocytes may be helpful in determining the origin of hematuria.

Erythrocyte Count↗
PubMedDate not supplied

[Rhabdomyolysis: case report and review of the literature].

We report a case with rhabdomyolysis, myoglobinuria and acute renal insufficiency. Rhabdomyolysis has been due to toxic effect of ethanol and excessive physical activity. The characteristics of rhabdomyolysis, the outlines of therapy and prevention of recurrence of rhabdomyolysis have been described.

Adult↗