Search

Introduction: Spontaneous pneumomediastinum (SPM) is an uncommon entity mainly affecting young adult males with a tall, thin body habitus which can be rarely complicated with spontaneus pneumopericardium (SPP)1,2. Case report: 22-year-old female patient was examined in the Emergency Department (ED) due to an acute onset of dyspnoea and severe pain in the left side of the neck, chest and left arm, notably when leaning forward. She denied trauma, physical exertion, coughing, aspiration of foreign body, drug abuse or emesis. On admission, she was afebrile and physical examination revealed symmetric, clear breath sounds and inaudible heart beats without murmur or Hamman’s sign. An arterial blood gas analysis revealed mild hypocapnia: pH 7.443, PaO2 13.09 kPa, PaCO2 4.34 kPa, and SaO2 97%. The complete blood analysis was within normal range apart from lactate dehydrogenase (LDH= 333 U/L). The 12-lead ECG showed sinus tachycardia with normal axis, intervals within the normal range and no sign of low voltage (Figure 1). A chest X-ray showed pneumomediastinum and pneumopericardium (Figure 2), and subsequent chest multi-slice computed tomography confirmed extensive pneumome diastinum with pneumopericardium up to 5 mm in thickness, no signs of pulmonary bullae, or any structural abnormalities in the bronchi or the oesophagus. Echocardiography was done using subxiphoid projection showing no pathology and no hemodynamic repercussions due to pneumopericardium. She was hospitalized and the therapy was absolute bed rest, peroral analgesia and nasal oxygen supply (4 L/min). During hospitalization she was hemodynamically stable and afebrile, therefore no antibiotics were prescribed. The follow-up chest X-ray done 7 days after, showed a complete resolution of SPM and SPP. Thus, she was discharged with a recommendation to avoid physical activity for the next 2 months. At 2-month follow-up visit she was symptom free, with no signs of SMP or SPP (Figure 3). Conclusion: SPM and SPP are benign diseases with low incidences in a young, otherwise healthy adults. When evaluating a young adult in the ED, who presents with chest pain and dyspnoea, it is important to include SPM and SPP in the differential diagnosis if there is reasonable clinical doubt, in order to establish an early diagnosis and avoid potential complications. [ABSTRACT FROM AUTHOR]

Introduction: Aberrant right subclavian artery (ARSA, a. lusoria) is one of the most common congenital arch anomalies. The prevalence of ARSA ranges from 1 to 2%. ARSA originates from aortic arch as most distal branch and has it's own aberrant pathway in mediastinum, most commonly retroesophageal.1 Case report: 67-years old male patient with history of arterial hypertension and type II diabetes mellitus was admitted to our hospital for elective coronary angiography. During previous hospital stay coronary angiography using left radial access with implantation of two stents was done due to acute myocardial infarction. Patient was scheduled for another intervention on bifurcation lesion LAD/D1 (Medina 1,1,1). During procedure right radial access with 6Fr guiding catheter was used. The advancement of any cathethers into the ascending aorta was difficult, so we performed angiography of aortic root which revelead ARSA. The procedure was continued with some specific manipulation of guide wires and cathethers. After reaching a bifurcation lesion, stents were implanted using "culotte” stenting technique (Figure 1). Postprocedural CT angiography was done to confirm ARSA. Exam showed absence of truncus brachiocephalicus, with common carotid ostium, regular position of left subclavian artery and anomalous ostium of right subclavian artery as most distal branch on aortic root which passes behind the oesophagus (Figure 2). Discussion: Congenital arch anomaly are mostly diagnosed sporadically during routine radiological scaning. The reason for that is probably the fact that patients are almost always asymptomatic. If there is some difficulties during coronary angiography and guide wires enter directly to the descending aorta when right radial access is used, ARSA should be considered. Interventions in patients with ARSA is complicated and often requires multiple wires and cathethers changes. Only two cases1 of interventional treatment through ARSA was described in the literature. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The results of recent studies indicate that the size of the left atrium (LA) directly correlates with the incidence of atrial fibrillation (AF). Patients who present with dilation of the LA at the time of the pulmonary veins isolation have an increased risk of AF recurrence and therefore an accurate assessment of LA size is of crucial importance in the selection of patients in whom this procedure is planned. Estimating LA volume provides more accurate measure of LA size which can be measured by a standard (two dimensional) and advanced (three-dimensional) echocardiography, computerized tomography and magnetic resonance. Given the widespread use in everyday clinical practice, and taking into account the high incidence of AF in the general population, echocardiography is emerging as the method of choice in the evaluation of the volume of the LA. The development of advanced echocardiographic technologies such as three-dimensional echocardiography has enabled additional insight into the anatomy and function of the LA. Studies indicate that the LA volumes measured by three-dimensional echocardiography correlate well with those measured by magnetic resonance imaging. On the other hand, it seems that conventional, two-dimensional echocardiography underestimates the volume of the LA and thus the risk of recurrence of patients treated with pulmonary veins isolation.1 In this prospective pilot study we included 20 patients with AF scheduled to pulmonary veins isolation and compared the value of the LA volumes obtained by conventional two dimensional and advanced three-dimensional echocardiography. [ABSTRACT FROM AUTHOR]

Introduction: The satisfaction of junior medical doctors is primarily associated with the training they receive during the residency period and working conditions. Given a considerable brain-drain of medical doctors from the Republic of Croatia, the present research focused on the evaluation of the satisfaction of junior medical doctors., Methodology: The Junior Doctors Committee of the Croatian Medical Chamber prepared a questionnaire on the satisfaction of junior doctors. The relevant questionnaire was available for filling in online in the period from February 1 to March 20, 2016., Results: The questionnaire was completed by 1,531 persons aged between 29 and 35 (mean age 32) of which 67% were females. A 58% of respondents would leave the Republic of Croatia if offered an opportunity. The main reasons for leaving the country include better working conditions (74%), well-regulated healthcare system (64%) and higher wages (64%). In case of staying in the country, their future professional status and development would remain unaltered (44%)., Conclusion: The questionnaire results show a high level of dissatisfaction with the healthcare system, some segments of the specialist training and the mentor role. The analysis of factors affecting the satisfaction of junior doctors will facilitate the preparation and adoption of measures aiming to mitigate the above-mentioned trend.