University Medical Centre Ljubljana Research Articles

Usefulness of procalcitonin to differentiate typical from atypical community-acquired pneumonia

The value of elevated serum procalcitonin concentration for differentiating between typical and atypical community-acquired pneumonia was assessed and compared with other parameters that are usually used in clinical practice. Thirty consecutive adult patients with community-acquired bacterial pneumonia admitted to the Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia, were included in this prospective study. Only those patients for whom the etiology of bacterial pneumonia was confirmed participated in the study. The median serum procalcitonin level in patients with typical pneumonia was 7.64 ng/ml (range 0.26-63.16) and in the group with atypical pneumonia 0.80 ng/ml (range 0.13-34.90). A significant difference between the typical and atypical pneumonia groups was found only for the procalcitonin serum concentration on admission. The standard laboratory markers of bacterial infections, such as C-reactive protein, total leukocyte count and immature polymorphonuclear cells, did not discriminate between typical and atypical etiology. Median procalcitonin levels were significantly higher among patients with bacteremic pneumonia. Determination of the procalcitonin level may provide useful additional diagnostic information on the etiology of pneumonia and could have a crucial influence on the initial antimicrobial therapy.

Factors predicting free flap complications in head and neck reconstruction

In this retrospective study, all free flap transfers used for reconstruction following ablation of head and neck tumors in University Medical Centre Ljubljana between the years 1989 and 1999 were analysed. The data taken from the patients' charts covered the demographic profile, the tumor and free flap details (44 variables for each patient). Logistic regression model was used to identify factors associated with free flap failure and complications. One hundred and sixty-two patients with head and neck tumors underwent microsurgical reconstruction. One hundred and ninety-four free flaps were performed with an overall success rate of 85%. Two significant predictors of free flap complication were identified: diabetes and salvage free flap transfer. Patients with diabetes were five times more likely to develop complications associated with free flaps (p = 0.02). Free flap complications were four times more likely to develop after salvage free flap transfer (p = 0.04). In addition, two significant factors predicting free flap failure were identified: salvage free flap transfer (p = 0.019) and use of interposition vein grafts (p = 0.032). After this study we changed our strategy of free flap selection and preoperative evaluation of the patients with head and neck tumors requiring free tissue transfer. Between January 2000 and January 2005 we performed additional 105 free flaps for head and neck reconstruction after tumor resection in 101 patients and our success rate improved to 94.3%.

Congress President's Report: 3rd Slovenian Congress of Nephrology

Therapeutic Apheresis and DialysisVolume 9, Issue 3 p. 193-195 Congress President's Report: 3rd Slovenian Congress of Nephrology Jadranka Buturović-Ponikvar, Jadranka Buturović-Ponikvar Congress President, 3rd Slovenian Congress of Nephrology Professor of Medicine, University of Ljubljana Department of Nephrology, University Medical Center Ljubljana Zaloška 7, 1525 Ljubljana, SloveniaSearch for more papers by this author Jadranka Buturović-Ponikvar, Jadranka Buturović-Ponikvar Congress President, 3rd Slovenian Congress of Nephrology Professor of Medicine, University of Ljubljana Department of Nephrology, University Medical Center Ljubljana Zaloška 7, 1525 Ljubljana, SloveniaSearch for more papers by this author First published: 21 June 2005 https://doi.org/10.1111/j.1774-9987.2005.00251.x Jadranka Buturović-Ponikvar graduated from the University of Belgrade Medical School as valedictorian, awarded by the Serbian Medical Association (GPA 9.93/10). She received her Master's Degree in urology at the Medical School in Belgrade (thesis: Xanthogranulomatous pyelonephritis) in 1983. In 1988 she became a specialist of internal medicine. In 1993 she received her PhD at the Medical School of the University of Ljubljana (thesis: The influence of various factors on hemostasis activation during hemodialysis). In 1994 she became Assistant Professor, in 1999 Associate Professor, and in 2004 Professor of Medicine at the Medical School of the University of Ljubljana. During this period she was employed, first from 1982 to 1988 at the Center for Dialysis and Transplantation, Institute of Urology and Nephrology, University Medical Center Belgrade. From 1988 up to the present she has been employed at the Department of Nephrology, University Medical Center Ljubljana. She was Chief of the Center for Pediatric Dialysis and Transplantation from 1995 to 1999 (until the center was moved to the Department of Pediatrics), and since 1999 she has been Chief of the Ultrasound Unit. Her areas of clinical work and research include: dialysis, apheresis, anticoagulation, acute renal failure, renal transplantation, Doppler ultrasonography (renal arteries, vascular access, renal biopsies), general nephrology. She has been in charge of the Slovenian Renal Replacement Therapy Annual Report since 1999. Her bibliography is accessible on the Web of Science under the following names: buturovic j; buturovic-ponikvar j; ponikvar jb; buturovicponikvar j. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume9, Issue3June 2005Pages 193-195 RelatedInformation

Dermatophyte infections in the Ljubljana region, Slovenia, 1995–2002

We studied dermatophyte infections in patients, examined in the Mycological Laboratory of the Department of Dermatology, University Medical Centre Ljubljana during the period 1995-2002. A total of 42,494 samples were collected from 33,974 patients suspected to have dermatomycosis. Dermatophytes were identified in 8286 (71.2%) positive cultures. Microsporum canis was the most frequent dermatophyte isolated (46.8%), followed by Trichophyton rubrum (36.7%), T. mentagrophytes var. interdigitale (7.9%) and T. mentagrophytes var. mentagrophytes (4.9%). Less frequently isolated were M. gypseum, T. verrucosum, Epidermophyton floccosum, T. tonsurans and T. violaceum. The most common dermatophyte infections included tinea corporis, onychomycosis, tinea pedis and tinea faciei. Zoophilic dermatophytes were most commonly recovered from children and adolescents with tinea capitis, tinea corporis and tinea faciei. Anthropophilic species were identified mostly in adults with tinea pedis, onychomycosis and tinea inguinalis. During the period studied, we recorded a decline in the rate of M. canis infections, while infections produced by T. rubrum increased in frequency.

The emergence of rotavirus genotype G9 in hospitalised children in Slovenia

Rotavirus G9 genotype was thought to be the fifth most common genotype circulating amongst the population. In previous studies in Slovenia, only G1, G3 and G4 genotypes were detected. To determine G and P genotypes of rotaviruses causing dehydrating gastroenteritis in children hospitalised at the University Medical Centre Ljubljana during the winter season 2001-2002. Some data obtained in previous years are included, too. For the G and P genotypes determination, we selected 99 of the total of 565 rotavirus positive samples. RT-PCR was carried out for G gene or partial P gene amplification. The RT-PCR product was used as a template for multiplex nested PCR using genotype-specific primers. In untypable samples, a sequence analysis of a short segment of G or P gene was performed. From the period before July 2001, 183 stool samples were examined using the same methods. Genotype G1 was determined in 37, G4 in 6, and G9 in 28 samples out of 99. Only one sample showed a mixed infection with G1G4 genotype specifics. Following the sequence analysis of the short segment of G gene in 11 G9 genotypes, 2 different clusters of G9 genotype were determined. All samples had the same P genotype--P[8]. G9 genotype had not been detected prior to July 2001. Rotavirus G9 genotype emerged in Slovenia in the year 2001. Two different clusters were determined which have to be further characterised in detail.

Continuous thoracic epidural analgesia compared with intravenous analgesia for postoperative pain management of breast reconstruction with free TRAM flap

Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Center Ljubljana, Ljubljana, Slovenia

Etiology of tick-borne febrile illnesses in Slovenian children.

Annals of the New York Academy of SciencesVolume 990, Issue 1 p. 353-354 Etiology of Tick-Borne Febrile Illnesses in Slovenian Children MAJA ARNEŽ, Corresponding Author MAJA ARNEŽ Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaAddress for correspondence: Maja Arnež, Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia. Voice: + 386 1 522 21 10; fax: + 386 1 522 24 56; [email protected].Search for more papers by this authorTATJANA LUŽNIK-BUFON, TATJANA LUŽNIK-BUFON Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorTATJANA AVŠIČ-ŽUPANC, TATJANA AVŠIČ-ŽUPANC Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorEVA RUŽIĆ-SABLJIĆ, EVA RUŽIĆ-SABLJIĆ Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorMIROSLAV PETROVEC, MIROSLAV PETROVEC Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorSTANKA LOTRIČ-FURLAN, STANKA LOTRIČ-FURLAN Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorFRANC STRLE, FRANC STRLE Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this author MAJA ARNEŽ, Corresponding Author MAJA ARNEŽ Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaAddress for correspondence: Maja Arnež, Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia. Voice: + 386 1 522 21 10; fax: + 386 1 522 24 56; [email protected].Search for more papers by this authorTATJANA LUŽNIK-BUFON, TATJANA LUŽNIK-BUFON Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorTATJANA AVŠIČ-ŽUPANC, TATJANA AVŠIČ-ŽUPANC Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorEVA RUŽIĆ-SABLJIĆ, EVA RUŽIĆ-SABLJIĆ Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorMIROSLAV PETROVEC, MIROSLAV PETROVEC Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorSTANKA LOTRIČ-FURLAN, STANKA LOTRIČ-FURLAN Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this authorFRANC STRLE, FRANC STRLE Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia and Institute of Microbiology and Immunology, Medical Faculty, Zaloška 4, 1525 Ljubljana, SloveniaSearch for more papers by this author First published: 18 July 2008 https://doi.org/10.1111/j.1749-6632.2003.tb07388.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume990, Issue1RICKETTSIOLOGY: Present and Future DirectionsJune 2003Pages 353-354 RelatedInformation

DIAGNOSIS OF URINARY INCONTINENCE TODAY

Background. The aim of this paper is to present a modern approach to the patient with female urinary incontinence, the emphasis being given to diagnostic procedures applied at the University Medical Centre Ljubljana. History taking and clinical examination are of key importance; they serve as the basis for further examinations and procedures. After bacteriological and biochemical tests of urine, the diagnosis of urinary incontinence is confirmed by a one-hour pad test. In tertiary centres, however, urodynamic tests are used to assess the ability of lower urinary tract to collect, void, and prevent involuntary loss of urine. In more complicated cases urodynamic tests are combined with visual examinations (video cystourethrography and ultrasound). In the diagnostic procedures additional functional examinations are sometimes implemented (measurement of urethral electric conductance, ambulatory cystometry), and in certain cases electromyographic measurements of the pelvic floor muscles. Conclusions. The diagnosis of urinary incontinence is a complex and technically demanding process, additionally aggravated by the fact that most intimate segments of human anatomy are involved.

Transtelephonic transmission of electrocardiograms in Slovenia

The transtelephonic transmission of electrocardiograms (ECGs) was introduced in Slovenia in 1996 and has been used regularly since September 1997 by health institutions and patients with cardiovascular diseases. Portable 12-channel ECG equipment weighing less than 200 g is generally used. The diagnostic centre is located in the intensive-care unit at the University Medical Centre Ljubljana. In the first 12 months of regular operation we received 463 calls, 213 of which were diagnostic. The most common reasons for calling were: ischaemic chest pain, atypical chest pain, palpitations and dyspnoea. The most common diagnoses made on the basis of history and the ECG were: acute myocardial infarction, angina pectoris, paroxysmal tachycardias and atypical chest pain. In 40% of cases the cardiologist's advice sufficed; 38% of patients were referred to the emergency room, 29% immediately and 9% only if a suggested therapy did not prove successful; and in 21% of cases new medication or a change of dosage of current medication was suggested. Transtelephonic ECG transmission enables direct communication between general practitioner or patient and cardiologist. With its use, time from onset of symptoms to initiation of treatment is shortened, which reduces disability and mortality due to cardiovascular diseases and improves cost-benefit.

Lnterleukin-6 (IL-6) and soluble receptors for interleukin-2 (slL-2R) in the diagnosis of early severe infection in the critically ill newborns.

The aim of our study was to evaluate the diagnostic accuracy of serial determination of interleukin-6 (IL-6) and soluble receptors of interleukin-2 (sIL-2R) in the diagnosis of early infection in the critically ill newborns and compare it with the routinely used C-reactive protein (CRP). Fourty-six critically ill newborns (median age 8 h, range 1-96 h), treated at the multidisciplinary intensive care unit, Division for Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, were included in the study. Newborns were divided into three groups: group I microbiologically confirmed severe infection (n = 14), group II suspected but not confirmed infection (n = 12) and group III respiratory distress syndrome without laboratory signs of infection. Serum concentrations of IL-6, sIL-2R and CRP were determined on admission and at 12 and 24 h after admission. On admission the concentrations of IL-6 and sIL-2R were significantly higher in group I than in group III, but there was no difference between groups I and II. On admission area under receiver operating characteristic (ROC) curve for IL-6 was 0.756, for IL-2R 0.821 and for CRP 0.799. Repeated determination at 12 h improved diagnostic accuracy for sIL-R and CRP but not for IL-6.

Concomitant infection with tick-borne encephalitis virus and Borrelia burgdorferi sensu lato in patients with acute meningitis or meningoencephalitis.

From September 1992 to August 1993, 338 patients over the age of 15 years presented to the Department of Infectious Diseases, University Medical Centre Ljubljana, with acute lymphocytic meningitis. In 89 of these patients (26.3%) serum IgM and IgG antibodies against tick-borne encephalitis (TBE) virus were detected, and in 59 patients (17.5%) a borrelial etiology of disease was demonstrated by one or more of the following presence of intrathecal antibody production, seroconversion to borrelial antigens, presence of erythema migrans, and/or isolation of Borrelia burgdorferi sensu lato from skin or cerebrospinal fluid. Of the 148 patients who fulfilled criteria for TBE or borrelial infection, concomitant infection with TBE virus and B. burgdorferi sensu lato was demonstrated in 12 patients (3.6% of all patients presenting with acute lymphocytic meningitis). In the majority of patients with concomitant infection the clinical features at presentation were characteristic of, or consistent with, TBE. In addition, during follow-up studies, eight of the 12 patients subsequently developed signs and symptoms compatible with minor and/or major manifestations of Lyme borreliosis. Six patients were diagnoses with neuroborreliosis based on signs or symptoms and/or laboratory tests. These findings show that in patients with acute lymphocytic meningitis or meningoencephalitis, originating in TBE and Lyme borreliosis endemic regions, the possibility of concomitant infection should be considered.

101 EVALUATION OF STANDARD DOSAGE REGIMENS FOR AMIKACIN, GENTAMICIN, NETILMICIN AND VANCOMYCIN

University Medical Centre Ljubljana, Clinical institute of Clinical Chemistry and Biochemistry, Slovenia.

Epidemiological study of a cohort of adult patients with Erythema migrans registered in Slovenia in 1993.

Epidemiological characteristics of 892 adult patients with typical Erythema migrans (Em), registered at Lyme borreliosis Outpatients' Clinic, Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia, in 1993, are presented. Data were gathered prospectively by means of a questionnaire. All the patients were seen by at least one of the four authors of this report. There were 57% females and 43% males aged from 15 to 91 years (median value 44 years, mean 44.4 +/- 14.3 years). The highest number of patients was found in age groups from 30 to 59 years. 73% of the patients quoted a tick bite at the site of later Em and 6% an insect bite; 21% didn't remember any bite. 212 out of 638 patients with a tick bite were able to assess the maximal possible duration of tick attachment: two-thirds quoted 24 hours or less. Interval from a tick bite to the appearance of skin changes was one day to six months (median value 15 days, mean 20.3 +/- 20.6 days) and from the beginning of Em to registration one day to 10 months (median value eight days, mean 17.1 +/- 24.2 days). More than half of the patients were registered in June, July and August. The majority of patients with Em resided in the region of Ljubljana. They were bitten by ticks predominantly near their homes but some of them also quite far away. Slovenia is an endemic region for Lyme borreliosis. The number of cases presented in our report is most likely only a fraction of the real number of patients with Em in the region of Ljubljana and is even further underestimated for other parts of Slovenia.

Treatment of borrelial lymphocytoma.

Treatment results in 65 patients with borrelial lymphocytoma (22 on the ear lobe and 43 on the breast), registered at the Department of Infectious Diseases, University Medical Centre Ljubljana, from January 1986 to March 1995, are presented. When lymphocytoma was the sole manifestation of Lyme borreliosis or associated with erythema migrans only patients were treated orally with doxycycline, phenoxymethylpenicillin or amoxicillin for 14 days, or azithromycin for 5 days (15, 19, six and 12 patients, respectively). When signs and symptoms of disseminated borrelial infection were present (seven patients) or clinically suspected (six patients) patients received ceftriaxone or penicillin G i.v. for 14 days. Lymphocytoma disappeared within a few weeks after the institution of treatment. The speed of regression depended on the duration of lymphocytoma before the institution of therapy. The number of patients was too low and pretreatment characteristics were too heterogeneous to enable a reliable comparison of the efficacy of different antibiotics. It appears that the effectiveness of doxycycline and azithromycin is comparable and that amoxicillin performs well, but some findings may indicate that phenoxymethylpenicillin is less effective than some newer antibiotics. The optimal agent, dosage and duration of therapy for borrelial lymphocytoma have not been determined.

Transbronchial needle aspiration with fiberoptic and rigid bronchoscope in the diagnosis and staging of lung cancer: Debeljak A, Mermolja M, Orel J, Rott T. Institute for Respiratory Diseases, University Medical Centre Ljubljana, 64204 Golnik. Radiol Oncol 1994;28:309–315

Transbronchial needle aspiration with fiberoptic and rigid bronchoscope in the diagnosis and staging of lung cancer: Debeljak A, Mermolja M, Orel J, Rott T. Institute for Respiratory Diseases, University Medical Centre Ljubljana, 64204 Golnik. Radiol Oncol 1994;28:309–315

Thrombocytopenia--a common finding in the initial phase of tick-borne encephalitis.

The aim of this prospective study was to assess the frequency of thrombocytopenia and abnormal liver function tests in the initial phase of tick-borne encephalitis. In 1994, 248 adult patients presented at the Department of Infectious Diseases, University Medical Centre Ljubljana, with acute lymphocytic meningitis or meningoencephalitis and serologically confirmed tick-borne encephalitis virus infection. In 180/248 (72.6%) patients, typical biphasic course of the illness was found and 28/180 (15.6%) patients with biphasic course were examined in both phases of the illness. In 20 out of these 28 (71.4%) patients, thrombocytopenia and leukopenia were found initially, in one (3.6%) patient only leukopenia was recorded and three (10.7%) patients had thrombocytopenia without leukopenia. In four (14.3%) patients leukocyte and thrombocyte values were within the normal range. The lowest leukocyte number was 1.4 x 10(9)/l and the lowest recorded thrombocyte number was 60 x 10(9)/l. Abnormal liver function tests were discovered in four out of 18 patients tested (22.2%). In conclusion, in the initial phase of tick-borne encephalitis thrombocytopenia and abnormal liver function tests may be found. Thrombocytopenia is a common finding with a frequency similar to that of well-known leukopenia, while abnormal liver function tests are relatively rare.