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Primary dural lymphoma mimicking meningioma: a clinical and surgical case report
Get PDFINTRODUCTION:
Primary central nervous system lymphoma and its subtype, primary dural lymphoma, are types of non-Hodgkin's lymphoma that only occur in the central nervous system without any dissemination. They are extremely rare cases of extra nodal lymphomas accounting for 1--5% of intracranial tumors. -----
CASE REPORT:
We present a patient diagnosed with primary dural lymphoma in right frontal brain region who underwent surgical resection. Histopathological analysis revealed diffuse B-type large cell non-Hodgkin lymphoma. Patient underwent four cycles of R-CHOP and intrathecal methotrexate protocol. Six months postoperative, no signs of newly onset infiltration were present. -----
DISCUSSION:
Primary dural lymphoma most likely presents with unusual radiological signs, which can easily be mistaken for meningioma, the main differential diagnosis. A thorough immunological, histopathological and clinical patients profile should be conducted in order to establish the certainty of diagnosis. Although there are few treatment options: surgery, radiotherapy or chemotherapy, there is no established treatment protocol
Nicotine dependence in Croatian male inpatients with schizophrenia
Get PDFBACKGROUND:
Patients with schizophrenia have the highest known rates of cigarette smoking, but less is known about their smoking behavior and the differences across geographical regions, including Croatia. The aim of this study was to compare patterns of nicotine dependence between patients with schizophrenia and healthy individuals, and to determine the relationship between clinical presentation and the severity of smoking. -----
METHODS:
This cross-sectional study included 182 recently hospitalized male inpatients and 280 healthy males, who were daily smokers. All participants have fulfilled the Fagerstrom Test for Nicotine Dependence (FTND). Patients were also evaluated by the Positive and Negative Syndrome Scale (PANSS). -----
RESULTS:
Patients had higher FTND total score (p = 0.010), smoked their first cigarette earlier in the morning (p = 0.000), consumed higher number of cigarettes (p = 0.000), while healthy subjects had more difficulties to refrain from smoking in places where it is forbidden (p = 0.000) and smoked more even when they were sick (p = 0.000). While severe dependence was more prevalent in the patient group, light dependence was more frequent in control subjects (p = 0.04). Smoking behavior was not associated with either PANSS total score or any of its subscales and items. -----
CONCLUSIONS:
Smokers with schizophrenia differ from healthy smokers in both smoking behavior and level of dependence. Longitudinal studies are needed to shed more light on the complex relationship between smoking and psychopathology in schizophrenia
Predictors of functional outcome after spinal ependymoma resection
Get PDFAIM:
Spinal ependymomas are among the most common intramedullary neoplasms in both adults and children. While surgical resection is the golden treatment standard, the role chemotherapy and radiotherapy have in patients with spinal ependymomas remains unclear. The aim of this study is to determine the predictors of functional outcome following spinal ependymoma resection to single out patients that may require adjuvant therapy. ----- METHODS:
We conducted a retrospective study on patients that underwent spinal ependymoma resection in our institution in a 10-year period. Magnetic resonance imaging of the spine was used to set the diagnosis of an intradural/intramedullary neoplasm. All patients underwent either gross tumor resection or tumor mass reduction. Histological diagnosis and histopathological grading of spinal ependymoma were done for all collected samples. Patients' general and neurological examination were performed early after the surgery (within the 1st week) and in a 6-month follow-up. ----- RESULTS:
A total of 51 intradural and intramedullary ependymoma resection surgeries on 43 patients were performed. There were slightly more male patients (57%) and the average patient age was 41 years. About 76.5% of patients presented with a tumor affecting one vertebrae level, while 23.5% presented with tumors expanding over two or more spinal regions. Gross tumor resection was achieved in 80% of cases, while 25% of procedures were performed on a recurring ependymomas. Most of the tumors (57%) were classified as G2 histological grade, while 8% were anaplastic ependymomas. In 80% of cases, early postoperative patient status was either better or equivalent to the preoperative one, while in a 6-month follow-up, up to 60% of cases showed a significant improvement over the preoperative status. Different demographic and clinical parameters were not proven to be predictors of postsurgical patient outcome including age, gender, and initial neurological presentation. Interestingly, most tumor characteristics were also not associated with postoperative functional outcome (histological grade, number of vertebrae levels affected, whether it is a primary or recurrent tumor). Even the scope of surgical procedure did not affect the functional outcome. The spinal region affected by the tumor was proven to be a predictor of early postoperative outcome (ρ= 0.346, P = 0.033), with lumbar spine being associated with the best outcomes. As expected, the scope of the surgery and whether gross tumor resection or tumor mass reduction was performed were the only significant predictors of tumor recurrence (ρ= 0.391, P = 0.005). ----- CONCLUSIONS:
Spinal ependymoma resection is an efficient procedure that improves the patient outcomes. Spinal region affected by the tumor is likely to be the most important predictor of functional outcome, while the procedure scope seems to be the most important predictor of tumor recurrence
Serum concentrations of asymmetric and symmetric dimethylarginine are associated with mortality in acute heart failure patients
Get PDFBACKGROUND:
Serum concentrations of asymmetric (ADMA) and symmetric (SDMA) dimethylarginine are established predictors of total and cardiovascular mortality. However, the predictive capacity of ADMA and SDMA for hospital and 3-months mortality of patients with acute heart failure (AHF) is unknown. ----- METHODS & RESULTS:
Out of 152 included AHF patients, 79 (52%) were female, and the mean patient age was 75.2 ± 10.3 years. Hospital and three-month mortality rates were 14.5% and 27.4%, respectively. Serum ADMA and SDMA levels at admission, determined by reversed phase high performance liquid chromatography, were higher in patients having at least one of the three signs implying venous volume overload (enlarged liver, ascites, peripheral edema), a consequence of right-sided heart failure, compared to patients without those signs. Univariable logistic regression analyses revealed a significant positive association of ADMA and SDMA concentrations with hospital mortality [odds ratio (OR) and 95% confidence interval (CI) per standard deviation (SD) increase: 2.22 (1.37-3.79), p = 0.002, and 2.04 (1.34-3.18), p = 0.001, respectively], and 3-months mortality [2.06 (1.36-3.26), p = 0.001, and 2.52 (1.67-4.04), p < 0.001, respectively]. These associations remained significant after adjusting for age, sex, mean arterial pressure, low-density lipoprotein cholesterol, glomerular filtration rate, and N-terminal pro-brain natriuretic peptide. ----- CONCLUSIONS:
We conclude that ADMA and SDMA concentrations are associated with hospital and 3-month mortality and are increased by venous volume overload in AHF patients
Estradiol i signalni putevi regulacije sekrecijske aktivnosti humanog endocerviksa [Estradiol and signaling pathways in the regulation of human endocervix secretory activity]
Get PDFThe secretory epithelium of the human endocervix secretes mucus that changes during the menstrual cycle and, at the time of ovulation, gains properties that allow sperm survival and fertilization. The mechanism modifying the hormonal regulation of these changes is still unknown. Our previous research has shown the expression of GABA-ergic molecules GABAAR and GAD in glandular endocervical cells. Based on the similarity to the respiratory system glandular epithelium, we suggested a role of the GABA-ergic system and CFTR in the hormone regulation of mucus secretion and formation. The aim of the study, performed on eighteen postoperatively obtained samples of human endocervical tissue was to investigate the correlation of CFTR and GABA—ergic molecules expression with blood estradiol concentration, and the correlation of GABAAR and GAD with the intensity of mucin secretion. The results of the study show that the expressions of GAD and GABAAR are neither related to the serum estradiol level, nor to the intensity of mucus secretion. Positive correlation of estradiol and CFTR expression in the apical part of the epithelium, which is attenuated by rising progesterone, confirmed the hypothesis that CFTR may play a role in hormonal regulation of mucus formation
Uloga suvremenih metoda refrakcijske kirurgije u istodobnom oporavku vidne oštrine na blizinu i na daljinu [Role of modern refractive surgery methods in simultaneous recovery of visual acuity at near and distance]
Get PDFINTRODUCTION: Refractive surgery in presbyopia tends to achieve spectacle independence
with minimal optical disturbances. We compared monovision to multifocality procedures
regarding these outcomes.
METHODS: Systematic review of published (till November 21, 2016) randomized controlled
trials comparing any monovision to any multifocality method.
RESULTS: Three trials comparing monovision (monofocal lenses, LASIK) to multifocal
intraocular lenses (MFIOLs; Isert refractive or Tecnis diffractive) and 6 comparing other
MFIOLs to Tecnis were included. Directly, pseudophakic monovision was inferior to Isert and
Tecnis in cataract patients, and LASIK was comparable to Tecnis in refractive surgery. In
network meta-regression pseudophakic monovision in cataract patients was inferior to Tecnis.
LASIK was comparable to Tecnis in refractive surgery. Indirect data suggest also that it tends
to superiority vs. ReZoom or Array refractive MFIOLs. No pooling was possible regarding
adverse events (heterogeneity of assessment and reporting). One quality direct trial indicated
less glare/dazzle with pseudophakic monovision vs. Tecnis in cataract patients. Unaided visual
acuity and contrast sensitivity data were burdened with heterogeneity (assessment, reporting)
and insufficient quality.
CONCLUSIONS: Randomized comparisons of monovision to multifocality are scarce.
Existing estimates regarding spectacle independence and particularly regarding unaided visual
acuity and contrast sensitivity are burdened with uncertainty. Dysphotopsia is less common
with monovision, but estimate uncertainty is high
Transplantacija krvotvornih matičnih stanica u djeteta s Fanconijevom anemijom – prikaz bolesnika [Hematopoietic stem cell transplantation in a child with Fanconi anemia – case report]
Get PDFFanconi anemia (FA) is a rare inherited disorder associated with congenital abnormalities, progressive bone marrow failure and a predisposition for hematological and nonhematological malignant disease. Bone marrow failure initially presents with thrombocytopenia, erythrocyte macrocytosis, followed by granulocytopenia and anemia. Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option for the hemato-logical diseases of FA. We present a boy with pancytopenia as a first manifestation of the FA at the age of 5. The boy is the first FA patient in our country treated with HSCT. The bone marrow from a matched unrelated donor was transplanted. Conditioning regimen we used is based on GEFA03 protocol which includes fludara-bine, cylophosphamide and busulfan together with alemtuzumab and mycophenolate mofetil as GVHD prophy-laxis
Karakterizacija jetrenih tumora kontrastnim ultrazvukom: rezultati iz tercijarnog centra [Characterization of liver tumors by contrast-enhanced ultrasound: single centre experience]
Get PDFAim: To demonstrate the results of contrast-enhanced ultrasound (CEUS) for diagnostic characterization of liver tumors (LT) in a tertiary-care hospital. Patients and methods: Results of CEUS examinations of LT in successively included patients from January 1st 2015 to December 31st 2016 were retrospectively analyzed. Definite diagnosis was made through standardized clinical workup including MRI and/or MSCT, tissue sampling (biopsy or cytology) in cases when imaging was inconclusive, as well as pathohistological analysis of resected specimens in patients that underwent surgery. Results: In 90 patients (48 M, 42 F; age 57±15) 132 LT were analyzed (68 benign and 64 malignant), with average size of 30 (8-130) mm. CEUS demonstrated excellent diagnostic performance to differentiate between benign and malignant LT (sensitivity 98.44%, specifi city 83.82%, AUC 0.91), without adverse reactions. Conclusion: Our results demonstrate high diagnostic accuracy and safety of CEUS for characterization of LT
Svjetlostanični papilarni karcinom bubrežnih stanica u bolesnika s urotelnim papilarnim karcinomom bubrežne nakapnice – prikaz bolesnice [Clear cell papillary renal cell carcinoma in a patient with urothelial papillary carcinoma of renal pyelon – report of a case]
Get PDFAccording to the 2016 WHO classification most common histological types of kidney cancer arising from tubular epithelium are clear cell, papillary, and chromophobe carcinoma. New 2016 WHO classification of the urinary system tumors was complemented by new entities, such as tubulocystic carcinoma associated with the acquired renal cystic disease, carcinoma associated with MiT translocation, carcinoma associated with hereditary leiomyomatosis syndrome, and clear cell papillary renal cell carcinoma. The latter is histologically composed of tubules and papillae aligned with bland clear epithelial cells and characteristic linear nuclear arrangement away from the basal membrane. Immunohystochemical profile is characteristic for this entity. Tumor is described as indolent in nature. We are presenting a case report of a patient with a synchronous clear cell papillary renal cell carcinoma as an incidental finding in a nephrectomy specimen with clinical diagnosis of urothelial (transitional cell) carcinoma in the renal pyelon
Neuroticism and pain catastrophizing aggravate response to pain in healthy adults: an experimental study
Get PDFBackground:
The aim of this study was to investigate the association between neuroticism, pain catastrophizing, and experimentally induced pain threshold and pain tolerance in a healthy adult sample from two regions of the country of Croatia: the island of Korcula and city of Split. -----
Methods:
A total of 1,322 participants were enrolled from the Island of Korcula (n = 824) and the city of Split (n = 498). Participants completed a self-reported personality measure Eysenck Personality Questionnaire (EPQ) and pain catastrophizing questionnaire Pain Catastrophizing Scale (PCS), followed by a mechanical pain pressure threshold and tolerance test. We have explored the mediating role of catastrophizing in the relationship between neuroticism and pain intensity. -----
Results:
The results showed that pain catastrophizing partially mediated the relationship between neuroticism and pain intensity, suggesting the importance of pain catastrophizing in increasing vulnerability to pain. The results also indicated gender-related differences, marked by the higher pain threshold and tolerance in men. -----
Conclusions:
This study adds to the understanding of the complex interplay between personality and pain, by providing a better understanding of such mechanisms in healthy adults. ----