Boris Filipović-Grčić

Successful use of recombinant activated FVII and aminocaproic acid in four neonates with life-threatening hemorrhage.

Reports on the use of recombinant activated factor VII (rFVIIa) to counteract hemorrhagic shock in neonates and preterm infants are increasing. rFVIIa enhances thrombin generation in situations with impaired thrombin formation and, since thrombin has a crucial role in providing hemostasis, rFVIIa is regarded as a general hemostasis agent. Full thrombin generation is necessary for the formation of a stable fibrin plug resistant to premature fibrinolysis. Antifibrinolytic drugs are not recommended for the treatment of acute bleeding. We report four neonates (one with massive postsurgical hemorrhage after ileostomy and three with severe pulmonary hemorrhage in the course of mechanical ventilation for meconium aspiration syndrome, congenital heart disease and during postoperative resuscitation after cardiac surgery for congenital heart disease) who were successfully treated with multiple administration of rFVIIa (120 μg/kg per dose) and antifibrinolytic therapy — aminocaproic acid (100 mg/kg per dose). In a fibrinolytic environment therapeutic concentrations of rFVIIa may sometimes be insufficient to produce adequate amounts of thrombin necessary for stable clot structure. Laboratory data in three of our patients with pulmonary hemorrhage (low fibrinogen levels with slightly prolonged prothrombin time) supported this thesis, so we blocked fibrinolysis with aminocaproic acid and achieved a complete clinical and laboratory therapeutic effect.

Risk factors for expression and progression of limited joint mobility in insulin-dependent childhood diabetes

We studied the prevalence of limited joint mobility (LJM) in 100 diabetic children and 100 non-diabetic controls. Our objective was to find possible predictors for the expression and progression of LJM and to evaluate the relationship between LJM and other long-term complications of insulin-dependent diabetes mellitus. LJM was present in 36% of diabetic patients aged 2–20 years. It was significantly related to duration of disease and longitudinal glycated haemoglobin (HbA1c) concentrations, pubertal stage, number of ketoacidosis and skin changes. Fourteen patients had peripheral neuropathy, 16 had microalbuminuria, 8 had nephropathy, and 7 had retinopathy. After matching for duration of disease, HbA1c concentrations and pubertal stage, a comparison of the complication rates was made. All long-term complications were significantly associated with LJM. Longer duration of disease and higher mean longitudinal glycated haemoglobin level are independent predictors for expression of LJM. Thus, improvement of metabolic control in diabetic patients before puberty may diminish the expression and progression of LJM.

Skin of the very premature newborn – physiology and care

Skin is a multifunctional human organ. It has a protective, regulatory and sensory function. Skin of the very premature newborn is underdeveloped with defi cient functionality and has to be observed and treated as an immature organ in need of special care and interventions. Appropriate prevention and compensation of water and heat losses is obligatory as preserving the integrity of the skin and therefore of the entire body.

AP081 Non-mandatory cardiopulmonary resuscitation courses for health professionals in Croatia: Who is attending and why?

) for intradermal skin test. Methods: We performed a prospective, randomized study in which healthy adult volunteers were divided into the two analgesic pretreatment groups (ice cube group and 4% lidocaine cream group). We chose the same intervention site of anterior aspect of left forearm in both groups. As a pretreatment, an ice cube in the ice cube group and 5 mg of 4% lidocaine cream in the 4% lidocaine cream group was applied, respectively. Intradermal skin test was performed 1 minute after application of an ice cube, and 40 minutes after application of 4% lidocaine cream, considering the respective time to have an enough analgesic effect. 5 minutes after intradermal skin test, pain was assessed using a 100 mm visual analogue scale (VAS). VAS score of each group was compared using Mann-Whitney U test. Results: A total of 35 volunteers were participated in this study (17: ice cube group, 18: 4% lidocaine cream group). There were no differences in demographic characteristics. The Median VAS score was 20 (0, 35) in the ice cube group and 70 (50, 80) in the 4% lidocaine cream group (p<0.001). Conclusion: Pain intensity in the ice cube group was lower than that in the 4% lidocaine cream group significantly. The ice cube acts more rapidly and has lower cost than 4% lidocaine cream. We suggest the ice cube as an analgesic pretreatment method for the intradermal skin test in the emergency department.