Tamara Kovačević-Preradović1,2, Bojan Stanetić1,2, Ljiljana Kos1,2, Vlastimir Vlatković2,3 1Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina, 2Medical School, University of Banja Luka, Banja Luka, Bosnia and Herzegovina, 3Department of Nephrology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; Case presentation

Uvod. Poremecaji funkcije desnog srca su prediktori lose prognoze kod pacijenata na programu hronicne hemodijalize (HD). U ovoj studiji ispitivana je validnost ehokardiografije u procjeni sistolne i dijastolne funkcije desne komore kod pacijenata na HD. Metode. Istraživanjem je obuhvaceno 30 pacijenata (55±11 godina) na hronicnoj HD kojima su rađene standardna 2D ehokardiografija i tkivni Doppler, prije i nakon HD. Rezultati. Ispitivanje sistolne funkcije desne komore prije i poslije HD je pokazalo da su frakciona promjena povrsine – FAC (36%±11 vs. 34%±11, p=0,464) i amplituda sistolne pokretljivosti anulusa trikuspidne valuvle –TAPSE (25,2mm±4,8 vs. 24,2mm±5, p=0,207) bile u granicama normalnih vrijednosti, nezavisno od smanjenja ukupnog volumena krvi nakon HD, dok je frakciono skracenje – Fs (43,8%±11,6 vs. 39,3%±13,2, p=0,014) bilo znacajno manje nakon HD, sto pokazuje zavisnost ovog parametra od smanjenja cirkulatornog volumena. Tei indeks desne komore pokazao je normalne vrijednosti, nezavisno od smanjenja punjenja desne komore nakon HD (0,59±0,44 vs. 0,69±0,27, p=0,18). Evaluacija dijastolne funkcije desne komore preko brzina transtrikuspidnog protoka (E talas, E/A) pokazala je znacajno smanjenje brzina nakon smanjenja volumena poslije HD, dok je odnos brzina E/E’ (6,02±3,19 vs. 5,66±1,83, p=0,599) ostao u granicama normalnih vrijednosti i nakon HD. Zakljucak. Ehokardiografska procjena sistolne funkcije desne komore pomocu FAC i TAPSE, kao i procjena globalne funkcije miokarda pomocu Tei indeksa, su pouzdane metode kod pacijenata na HD, posto se njihove vrijednosti nisu mijenjale u uslovima smanjenja cirkulatornog volumena nakon HD. Kao pouzdan parametar za procjenu dijastolne funkcije kod pacijenata na HD se može koristiti odnos brzina E/E’, koji se u ovom istraživanju nije znacajno mijenjao usljed smanjenja volumena krvi nakon HD.

Introduction: Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction, occurring in approximately 4% of patients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. Case report: In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients.

Aims: Valproate is an antiepileptic drug with a wide spectrum efficacy in the management of various types of seizures and epileptic syndromes. It still makes the first choice drug in many forms of paediatric epilepsy syndromes. Although many side effects of valproate are well known, there is still difficulty in recognising of nocturnal enuresis as seldom but possible side effect of this drug. Methods: We describe six well documented cases of secondary nocturnal enuresis as a sole side effect owing to valproate therapy. All children (5 boys and 1 girl) had known epilepsy; idiopathic generalised epilepsy (4) and cryptogenic focal epilepsy (2) respectively. All but two of the children took valproate as monotherapy when manifesting this problem. The average dosage of valproate amounted 650mg/d. Enuresis embraced in three cases a comprehensive psychological and urological examination and treatment. Results: After sodium valproate was discontinued in the clinical setting, the symptoms disappeared in all patients. Conclusion: The nocturnal enuresis can lead to substantial functional impairment in everyday life and can be very irksome for the patient and his family. The purpose of this work is to highlight the possible side effects of this drug that all clinicians should be aware of when using it as an antiepileptic agent, particularly as there are still very few literature on this problem.