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Objective: To present patients with giant cell arteritis (GCA) in our centre over a 10 year period in order to confirm current understanding of giant cell arteritis (GCA) and observe any possible specifities in our cohort. Patients and Methods: In this retrospective study all patients diagnosed with GCA in the Clinical Hospital Centre Rijeka from 1 Jan 2011 to 31 Dec 2021 were included. Data were collected on disease presentation and diagnostic workup at the initial exam, and treatment. Results: A total of 51 patients were included in the study, of which 72.55% patients were female, and 72.55% were over 70. Of 50 patients with available data in medical documentation, 8 (16.00%) had systemic disease (S-GCA), while the rest had cranial disease (C-GCA). Headache, considered also a pathognomonic sign, was the most common initial symptom (88.00% in whole cohort, or 97.62% if S-GCA is excluded). Of 49 patients, all had increased erthyrocyte sedimentation rate. Temporal artery biopsy was positive in 12/16 patients with C-GCA, while temporal artery ultrasound was positive in 12/16 patients. Biopsy or ultrasound was not performed in 18 patients, of which 8 were patients with S-GCA, and data were not available for one patient. No patients had both a biopsy and ultrasound performed. All patients were treated with glucocorticoids, 9.80% were also treated with methotrexate, 7.84% with toclizumab, and one with both methotrexate and azathioprine. Conclusion: These results are comparable to other centres in Croatia and at least one centre abroad., Cilj: Prikazati bolesnike s GCA u našem centru tijekom 10-godišnjeg razdoblja kako bi se potvrdila trenutna saznanja o arteritisu divovskih stanica (GCA) i uočile eventualne specifičnosti naše kohorte. Ispitanici i metode: U retrospektivnu studiju uključeni su svi ispitanici s dijagnosticiranim GCA u Kliničkom bolničkom centru Rijeka od 1. siječnja 2011. do 31. prosinca 2021. Prikupljeni su podatci o njihovoj kliničkoj slici te dijagnostičkoj obradi pri prvom kliničkom pregledu te o terapiji. Rezultati: U studiju je uključen 51 ispitanik, od kojih je 72,55 % ženskog spola te je 72,55 % starije od 70 godina. Od 50 ispitanika za koje postoje podatci u dokumentaciji, 8 (16 %) ih je imalo sistemski oblik (S-GCA), a ostali kranijalni (C-GCA). Glavobolja, koja je ujedno patognomonični znak, bila je najčešći inicijalni simptom (88 % za cijelu kohortu, odnosno 97,62 % ako se isključi S-GCA). Od 49 ispitanika za koje imamo podatke, svi imaju ubrzanu sedimentaciju eritrocita. Biopsija temporalne arterije pozitivna je u 12/16 ispitanika s C-GCA, dok je ultrazvuk bio pozitivan također u 12/16 ispitanika. U 18 bolesnika nije rađena ni biopsija ni ultrazvuk, od kojih su 8 bili bolesnici sa S-GCA te o jednom bolesniku nemamo podatake. Niti jednom pacijentu nisu rađeni i biopsija i ultrazvuk. Svi su ispitanici liječeni s glukokortikoidima, 9,80 % ispitanika je uz to liječeno metotreksatom, 7,84 % s tocilizumabom, dok je jedan od ispitanika liječen s metotreksatom i s azatioprinom. Zaključak: Rezultati su usporedivi s dvama centrima u Hrvatskoj i najmanje jednim inozemnim centrom.

Hereditary angioedema (HAE) is a disorder affecting bradykinin regulation presenting as recurrent cutaneous or mucosal swelling. Treatment options include plasma-derived or human-recombinant C1-inhibitor, icatibant, or ecallantide. Due to the lack of knowledge and experience on the topic, the treatment of choice in pregnancy is plasma-derived C1-inhibitor, and reporting any new experience is recommended. This review presents current guidelines for HAE treatment with a focus on pregnancy and reviews all experience with icatibant use during pregnancy.Our experience of treating a pregnant nC1-INH HAE patient with icatibant is presented, with no adverse effects or abnormalities, to add to the growing knowledge of icatibant use during pregnancy. Considering the limited number of attacks that our patient usually experiences, which continued at more or less the same frequency during pregnancy, we feel icatibant to be a safe choice for on-demand HAE treatment during pregnancy for such cases.

INTRODUCTION Clinical assessment (CA) is frequently used for the evaluation of volume status in peritoneal dialysis (PD) patients despite its subjectivity. Multiple-frequency bioelectrical impedance analysis (MF-BIA) is objective, accurate, and quick, proving to be a promising technique for measuring volume status. The aim of this study was to assess volume status in PD patients using CA and MF-BIA and to compare results. MATERIALS AND METHODS Incident PD patients were prospectively analyzed between January 1, 2014, and January 1, 2016, at the Clinical Hospital Center of -Rijeka, Croatia. Volume status measurements were performed once a month for 6 consecutive months. The presence of symptoms and signs associated with hyper- or hypovolemia were detected by CA. Euvolemia was defined as a symptom-free state or up to 2 symptoms maximum. Patients lacking up to 1.2 L of volume or with up to 1.2 L in excess were considered euvolemic, as measured by MF-BIA. RESULTS A total of 45 PD patients were analyzed; 51% were men, 27% were diabetic, the mean age was 52 ± 26 years, and PD duration was 11.5 ± 6.5 months. In comparison to MF-BIA, CA showed a significant difference in detected hypervolemia between baseline and follow-up (p = 0.708 vs. p = 0.01, respectively) and among all measurements (p < 0.01). Contrary to CA, volume status measured by MF-BIA correlated significantly with systolic and diastolic blood pressure (R = 0.29; p ≤ 0.01 and R = 0.26; p ≤ 0.01, respectively). CA showed low sensitivity (0.24) and high specificity (0.92) in detecting hypervolemia. CONCLUSION MF-BIA is an effective, objective, and safe method for assessing volume status in PD patients. Longitudinal monitoring of body composition changes - including hydration state - leading to adequate therapeutic intervention is a promising and potential application of MF-BIA along with CA.

Background Transient bone marrow oedema (BMO) of the hip presents with pain, is diagnosed by magnetic resonance imaging (MRI), and usually resolves within 6 months. Risk factors include pregnancy. Avascular necrosis of bone and an association with BMO are among the less common presentations of antiphospholipid syndrome (APS). Aim of the work To present a young Croatian female APS patient who developed transient BMO during pregnancy which spontaneously resolved postpartum. Case report After developing left leg deep vein thrombosis and positive lupus anticoagulant at 22 years old, the patient was diagnosed with primary APS. Antinuclear antibody was borderline, but classification criteria for SLE were not fulfilled. She had an early missed abortion during her first pregnancy while receiving low-weight molecular heparin (LWMH) (enoxaparin 40 mg), and her second pregnancy was to term with LWMH, aspirin, and hydroxychloroquine 200 mg daily. During the third trimester of this pregnancy, she developed excruciating bilateral hip pain to the point she could barely walk. Based on an MRI scan, the patient was diagnosed with bilateral BMO of the femoral head. The condition improved and resolved within four months with conservative treatment postpartum, as confirmed by followup MRI. Conclusion Considering that pregnancy and APS are risk factors for BMO, both played a role in the development of BMO and the severity of presentation. This case report presents a differential diagnosis of hip pain in pregnant patients, especially with APS. Although APS is commonly associated with AVN, it may also be associated with transient BMO.

Giant cell arteritis (GCA) or temporal arteritis (TA) is a large-vessel vasculitis of the elderly which, if untreated, can lead to blindness. Glucocorticoids (GCs) remain the main treatment, but high-dose and long-term use can lead to serious side effects. Tocilizumab (TCZ) is increasingly used as an alternative steroid-sparing treatment option with promising results. This case series presents three GCA patients with a refractory form and/or at high risk for side effects treated with TCZ due to diagnoses of glaucoma and osteoporosis. Two of the patients responded to the treatment with good results. All three patients are elderly females who initially presented with classic symptoms of headache and/ or vision loss. The first patient also presented with fever, and the second with jaw claudication. Both of them were treated with pulses of GCs, but since the first also had osteoporosis with vertebral fractures, and the second had glaucoma and remained on high doses, TCZ was introduced. Both patients have since been stable. After approximately five years, the third patient developed TA with rheumatic polymyalgia, which was successfully treated with GCs. Later on TCZ was introduced as GCs could not be discontinued in consideration of the presence of osteoporosis and glaucoma. TCZ was discontinued after the patient developed neutropenia. Our case series presents two successful cases of treating GCA patients with TCZ, solidifying the recommendations for TCZ as a viable option for refractory disease and patients at high risk for side effects., Arteritis divovskih stanica (gigantocelularni arteritis – GCA) ili temporalni arteritis (TA) vaskulitis je velikih žila u starijih osoba koji može uzrokovati sljepoću ako se ne liječi. Kao standardna terapija još se upotrebljavaju glukokortikoidi (GK), ali njihove visoke doze i dugotrajna primjena mogu dovesti do teških nuspojava. Tocilizumab (TCZ) se sve više rabi kao alternativna poštedna steroidna terapija s dojmljivim rezultatima. U ovom radu prikazujemo tri pacijentice koje boluju od GCA refraktornog oblika i/ili se smatraju visokorizičnima zbog dijagnoze glaukoma ili roze, a liječene su TCZ-om koji je u dvije od njih dao dobre rezultate. Sve tri pacijentice starije su žene koje su primarno navele klasične simptome glavobolje i/ili gubitka vida. Prva pacijentica imala je i febrilitet, a druga je imala i klaudikacije čeljusti. Obje su liječene pulsevima GK. S obzirom na to da je prva pacijentica imala i osteoporozu s prijelomima kralježaka, a druga glaukom uz neuspješno sniženje doze GK, uveden je TCZ te su obje pacijentice otad stabilne. U treće pacijentice razvio se TA nakon pet godina reumatske polimijalgije (PMR) uspješno liječene primjenom GK. Budući da ukidanje GK nije bilo moguće, s obzirom na dijagnoze osteoporoze i glaukoma TCZ je uveden poslije, ali je liječenje njime prekinuto nakon razvoja neutropenije. Naš prikaz dviju pacijentica oboljelih od GCA i uspješno liječenih primjenom TCZ-a podupire trenutačne smjernice koje TCZ navode kao održivu opciju za liječenje refraktornih bolesti i/ili bolesnika u kojih je viši rizik od razvoja nuspojava.

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Uvod: Kliničke smjernice za održavanje CVK-a naglašavaju redovitu skrb o mjestu izlazišta katetera i sigurnosnu provjeru položaja. Cilj istraživanja bio je procijeniti prednost uporabe sistema bez šavova za osiguranje položaja katetera i sprječavanje infekcije. Metode: Istraživanje je provedeno pri Zavodu za nefrologiju, dijalizu i transplantaciju bubrega u Rijeci. Praćeno je ukupno 40 bolesnika koji su za potrebe dijaliznog liječenja imali CVK. Bolesnici su podijeljeni u dvije skupine od 20. Za prvu skupinu sistem bez šavova je korišten kao dodatna mjera osiguranja položaja CVK-a, dok je druga skupina služila kao kontrolna skupina u kojoj su korištene uobičajene mjere. Protokol je uključivao mijenjanje obloga i sistema bez šavova jednom tjedno. Rezultati: U prvoj skupini praćeno je 11 bolesnika s privremenim i 9 bolesnika s trajnim kateterima. Tijekom razdoblja ispitivanja uočeno je pet komplikacija, a u jednog bolesnika bili su potrebni dodatni šavovi. U kontrolnoj skupini praćeno je 12 privremenih i 8 trajnih katetera. U četiri su bolesnika bila potrebna dodatna osiguranja šavovima, a zabilježeno je i osam komplikacija. Sistemska infekcija zabilježena je samo kod jednog bolesnika. Primjena sistema bez šavova smanjila je broj komplikacija na 25 %, u usporedbi s kontrolnom skupinom od 40 %. Zadovoljstvo protokolom ocijenjeno je 9,6 / 10 bolesnika, medicinske sestre 9,4 / 10 i nefrolozi 9,8 / 10. Alergijske reakcije nisu zabilježene. Zaključak: Ovo istraživanje potvrđuje prednost upotrebe sistema bez šavova, ali za tako veliko područje uporabe potrebno je pratiti veći broj bolesnika tijekom duljeg razdoblja., Clinical guideline for central venous catheter (CVC) maintenance stresses regular care of the insertion site and safety checks. The study aimed to assess the advantage of using suture-free fi xation system to secure catheter position and prevention of infection. A total of 40 patients with CVC vascular access for hemodialysis were followed from 01/10 through six months at Division of Nephrology, Dialysis and Kidney Transplantation, Rijeka University Hospital Centre. Patients were divided into two groups of 20 patients. In group 1, suture-free fi xation system was used as an additional measure of securing CVC position, while group 2 served as a control group where ordinary measures were used. Protocol saw changing of dressings and suture-free fi xation system once a week. In group 1, 11 patients with temporary and 9 patients with permanent catheters were followed. Five complications were observed during the study period and one patient required additional sutures. In the control group, 12 temporary and 8 permanent catheters were followed. Additional sutures were required in four patients and eight complications were observed. Blood stream infection was observed in only one patient. The use of suture-free fi xation system reduced the number of complications to 25%, compared to 40% in the control group. Satisfaction was rated at 9.6/10 by patients, 9.4/10 by nurses, and 9.8/10 by nephrologists. Allergic reactions were not observed. In conclusion, for such a large area of use, it is necessary to follow patients for a longer period; still this research confi rmed the advantage of using suture-free fi xation system.

Macroamylasemia is a curious condition marked by hyperamylasemia without any other signs or symptoms, most frequently caused by immunoglobulin-amylase complexes that cannot be secreted normally by the kidneys. It usually requires no additional investigation, but must be taken into consideration to avoid unnecessary diagnostics and treatment, which burden both the patient and the healthcare system. A number of studies and reports have described macroamylasemia in combination with other conditions or diseases, one of the more interesting being celiac disease, where a gluten free diet was shown to cure both. Our case presents a young female patient without significant signs or symptoms except for elevated serum amylase discovered by chance, and ignored. Macroamylasemia was considered and confirmed, while celiac disease was subsequently excluded., Makroamilazemija je zanimljivo stanje obilježeno hiperamilazemijom bez ikakvih drugih znakova ili simptoma, najčešće uzrokovana kompleksima imunoglobulina i amilaze koji se ne mogu izlučiti putem bubrega. Najčešće ne zahtijeva proširenu kliničku obradu, ali se mora uzeti u obzir kako bi se izbjegla nepotrebna dijagnostika i liječenje koji mogu predstavljati opterećenje za bolesnika i zdravstveni sustav. Nekoliko studija i prikaza opisuju makroamilazemiju zajedno s drugim stanjima ili bolestima, a jedna od značajnijih je celijakija gdje je primjena bezglutenske dijete osnova liječenja. Naš slučaj predstavlja mladu bolesnicu bez značajnih znakova ili simptoma osim povišene serumske amilaze otkrivene slučajnim probirom. Makroamilazemija je potvrđena bez znakova celijakije, a liječenje nije bilo potrebno.