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Guidelines for the health care of patients with liver cirrhosis: a review
No full textKronične bolesti jetre među kojima je i ciroza važan su uzrok morbiditeta i mortaliteta a samim time i
dugotrajni javnozdravstveni problem. Pretilost, nealkoholna masna bolest jetre, infekcija hepatitisom B ili C,
visoka konzumacija alkohola najčešće su bolesti i rizična ponašanja koja za posljedicu mogu imati cirozu jetre.
Kompenzirana faza bolesti koja je najčešće asimptomatska i dekompenzirana faza s brojnim simptomima i
komplikacijama zahtijevaju različit pristup u liječenju i njezi bolesnika. Smjernice u zdravstvenoj njezi bolesnika
s cirozom naglašavaju ulogu prevencije i otkrivanja bolesti u ranoj fazi kao i edukaciju, nadzor, praćenje i liječenje
specifičnih komplikacija hospitaliziranih bolesnika te važnost palijativne skrbi. Potrebno je povećati svijest među
medicinskim sestrama ali i drugim pružateljima zdravstvenih usluga o važnosti ciroze i potrebi bolesnika s
cirozom za specifičnom zdravstvenom njegom.Chronic liver diseases, including cirrhosis, are an important cause of morbidity and mortality and thus
a long-term public health problem. Obesity, non-alcoholic fatty liver disease, infection with hepatitis B or C, high
alcohol consumption are the most common diseases and risky behaviors that can result in cirrhosis of the liver.
The compensated phase of the disease, which is most often asymptomatic, and the decompensated phase with
numerous symptoms and complications require a different approach in the treatment and care of the patient.
Guidelines in the health care of patients with cirrhosis emphasize the role of prevention and early detection of the
disease, as well as education, supervision, monitoring and treatment of specific complications of hospitalized
patients and the importance of palliative care. It is necessary to increase awareness among nurses and other health
care providers about the importance of cirrhosis and the need for specific health care for patients with cirrhosis
Nurses Activities During the Care of a Polytraumatized Child at the Emergency Surgical Admission
No full textZa optimalno zbrinjavanje pedijatrijskih politraumatiziranih bolesnika neophodno je izvrsno poznavanje i razumijevanje anatomije i patofiziologije djece u usporedbi s odraslim politraumatiziranim pacijentima. Politrauma je medicinski izraz koji opisuje sindrom teških višestrukih ozljeda koje mogu prouzrokovati zakazivanje organa i vitalnih sustava koji prvotno nisu bili zahvaćeni. To je životno ugrožavajuće stanje sa sistemskim traumatskim odgovorom koje predstavlja veliki izazov za dijagnosticiranje i liječenje.
Multidisciplinarni tim, koji uključuje pedijatre, traumatologe, liječnike pedijatrijske intenzivne njege i medicinske sestre odnosno medicinske tehničare, nužan je kako bi se provela početna procjena, reanimacija i liječenje. Rad s malom djecom predstavlja veliki psihološki pritisak na zdravstvene djelatnike. Često su uvjeti u prostorijama za reanimaciju djece ispod optimalnih. S djecom je u takvim situacijama vrlo teško komunicirati. Politraumatizirano dijete zahtijeva kompleksnu medicinsku skrb i pridržavanje standardiziranih smjernica liječenja.For the optimal treatment of pediatric polytraumatized patients, excellent knowledge and understanding of the anatomy and pathophysiology of children is necessary compared to adult trauma patients. Polytrauma is a medical term that describes a syndrome of severe multiple injuries that can cause failure of organs and vital systems that were not initially affected. It is a life-threatening condition with a systemic trauma response that presents a great challenge for diagnosis and treatment. A multidisciplinary team, including pediatricians, traumatologists, pediatric intensive care physicians, and nurses or medical technicians, is necessary to conduct initial assessment, resuscitation, and treatment. Working with young children is putting huge psychological pressure on health professionals. Conditions in the resuscitation areas for children are often suboptimal. In
such situations it is very difficult to communicate with children. A polytraumatized child requires complex medical care and standardized treatment guidelines should be followed
IS THERE A DIFFERENCE IN THE FREQUENCY AND TYPE OF PHYSICAL THERAPY IN PATIENTS DIAGNOSED WITH SPINAL SCOLIOSIS AND KYPHOSIS IN THE SPECIAL HOSPITAL FOR MEDICAL REHABILITATION "BIOKOVKA", MAKARSKA, BEFORE AND AFTER THE COVID19 PANDEMIC (COMPARISON OF 2019
No full textSažetak:
CILJ: Cilj ovog rada je istražiti i usporediti dostupnost i učestalost provođenja fizikalne terapije u osoba s
dijagnozom skolioze i kifoze u Specijalnoj bolnici za medicinsku rehabilitaciju Biokovka Makarska, tijekom
razdoblja prije pandemijske 2019. i pandemijske 2020. godine. Pretpostavlja se da će epidemiološke mjere, koje su u
određeno vrijeme uključivale karantenu i lockdown, utjecati na organizaciju i provođenje fizikalne terapije.
ISPITANICI: Ovo istraživanje obuhvaća 43 ispitanika s dijagnozom skolioze i kifoze (12 ženskog i 31 muškog
spola), u dobi od 10 do 18 godina. Ispitanici su prošli tretman individualne i grupne fizikalne terapije u SBMR:
Biokovka, Makarska u razdoblju od početka mjeseca siječnja prije pandemijske 2019. godine do kraja mjeseca
prosinca pandemijske 2020. godine.
REZULTATI: Rezultati ovog istraživanja nisu utvrdili postojanje statistički značajne razlike frekvencije obuhvata
ispitanika prema godinama: prije pandemijske 2019. godini i pandemijske 2020. godini u SBMR: Biokovka,
Makarska. Prema frekvencijama ambulantnih pregleda po mjesecima uočljivo je da su svi mjeseci u prije
pandemijskoj 2019. godini konstantno bili popunjeni. Stupanjem na snagu zaključavanja (lockdown-a) i karantene u
cijelom svijetu, tako i u SBMR: Biokovka, Makarska vidljivo je da u ožujku, travnju i svibnju 2020. godine nije bilo
ambulantnih pregleda u SBMR: Biokovka, Makarska.
ZAKLJUČAK: Epidemiološke mjere su utjecale na zatvaranje rehabilitacijskog odjela, dolazak i provođenje
fizikalne terapije za osobe s dijagnozom skolioze i kifoze u SBMR: Biokovka, Makarska u pandemijskoj 2020.
godini i to u prvom dijelu godine, dok se u drugom dijelu godine dijelom nadoknadio broj obrađenih ispitanika.Summary:
AIM: The aim of this work is to investigate and compare the availability and frequency of physical therapy in
persons diagnosed with scoliosis and kyphosis in the Special Hospital for Medical Rehabilitation Biokovka,
Makarska during the pre-pandemic 2019.year and pandemic 2020. year. It is assumed that the epidemiological
measures, which for a certain period of time included quarantine and lockdown, will influence the organisation and
implementation of physical therapy.
METHODOLOGY: This research includes 43 participants with a diagnosis of scoliosis and kyphosis (12 female
and 31 male persons), aged 10-18. The respondents underwent the treatment of individual and group physical
therapy in the Special Hospital for Medical Rehabilitation Biokovka, Makarska in the period from the beginning of
January in the pre-pandemic year 2019 to the end of December in the pandemic year 2020.
RESULTS: The results of this research did not establish the existence of a statistically significant difference in the
frequency of respondents according to the years: pre-pandemic 2019 and pandemic 2020. In the Special Hospital for
Medical Rehabilitation Biokovka, Makarska. According to the frequency of outpatient examinations by month, it is
not noticeable that all the months in the pre-pandemic year 2019 were constantly filled. With the entry into the force
of the lockdown and quarantine all over the world, as well as in SBMR: Biokovka, Makarska, it is evident that in
March, April and May 2020 there were no outpatient examinations.
CONCLUSION: Epidemiological measures affected the closure of the rehabilitation department and the arrival and
implementation of physical therapy for people diagnosed with scoliosis and kyphosis in Special hospital for medical
rehabilitation Biokovka, Makarska in the pandemic year of 202
Photon Counting CT detector
No full textRadiologija je jedna od najbrže rastućih grana medicine, a upravo jedan od uređaja koji najbrže prati ovaj razvoj je i uređaj za CT. Znanstvenici su najviše fokusirani na istraživanje poboljšanja parametara rendgenske cijevi i detektora kao najvažnijih dijelova ovog modaliteta oslikavanja. Uz detektor s integriranjem energije koji je danas u širokoj uporabi u sklopu svakodnevne kliničke praske, predmet istraživanja je i detektor s brojačem fotona. Brojne vrline koje se ističu kod nove vrste detektora zaslužne su za opće mišljenje da će u budućnosti ova nova tehnologija zavladati CT uređajima u kliničkoj praksi poboljšavajući akviziciju brojnih dijagnostičkih i intervencijskih postupaka. Smatra se da ova tehnologija radiologiju uvodi u novu eru upravo svojom poboljšanom prostornom i kontrastnom rezolucijom, smanjenjem šuma i povećanjem omjera kontrasta i šuma, ali i novim mogućnostima kao što su oslikavanje više kontrastnih sredstava istovremeno te višeenergetsko oslikavanje. Poboljšanja vidljivost joda pruža dodatne dijagnostičke mogućnosti te točniju diferencijaciju benignih i malignih suspektnih lezija. Znatno manja veličina piksela na ovom detektoru nudi gotovo dvostruko povećanje prostorne rezolucije, a samim time i povećanje učinkovitosti doze zračenja. Korištenje detektora s brojačem fotona je zato pogodno i kod pedijatrijskih bolesnika, a javlja se i širok spektar mogućnosti low-dose oslikavanja u svrhu preventivnog screeninga karcinoma. Procesi poput tzv. razgradnje materijala i spektralnog oslikavanja su još u procesu istraživanja, ali imaju veliki potencijal da optimiziraju buduću svakodnevnu kliničku praksu. Potrebno je još rada i objavljenih rezultata istraživanja, no zasigurno će ova tehnologija jednog dana olakšati posao radiološkog tehnologa i radiologa.Radiology is one of the fastest growing branches of medicine, and precisely one of the devices that follows this development the fastest is the computerized tomography device. Scientists are most focused on research into improving the parameters of the X-ray tube and detector as the most important parts of this imaging modality. In addition to the detector with energy integration, which is widely used today as part of everyday clinical practice, the subject of research is also a Photon countng detector. The numerous virtues that stand out in the new type of detector are responsible for the general opinion that in the future this new technology will dominate CT devices in clinical practice, improving the acquisition of numerous diagnostic and interventional procedures. It is believed that this technology ushers radiology into a new era precisely with its improved spatial and contrast resolution, noise reduction and increase of contrast and noise ratio, but also with new possibilities such as simultaneous imaging of multiple contrast agents and multi-energy imaging. Improvements in the visibility of iodine contrast agent provide additional diagnostic possibilities and more accurate differentiation of benign and malignant suspected lesions. The significantly smaller pixel size on this detector offers an almost two-fold increase in spatial resolution, and thus an increase in radiation dose efficiency. The use of a detector with a photon counter is therefore also suitable for pediatric patients, and there is also a wide range of low-dose imaging options for the purpose of preventive cancer screening. Processes such as the material decomposition and spectral imaging are still in the research process, but have great potential to optimize future daily clinical practice. More work and published research results are needed, but surely this technology will one day make the work of radiologic technologists and radiologists easier
Radiotracers in PET
No full textU nuklearno-medicinskoj dijagnostici, kod PET/CT-a, za dobivanje podataka o metaboličkim promjenama unutar organa, koriste se radiofarmaci, radioaktivno obilježeni spojevi sastavljeni od radioaktivnog izotopa i molekule nosača čime je omogućena vizualizacija morfoloških i funkcionalnih promjena organa i tkiva. PET/CT je suvremeni dijagnostički uređaj koji se sastoji od cirkularnog niza PET detektora i klasičnog CT uređaja, čime je postignuta detekcija anihilacijom nastalih parova fotona i njihova anatomska lokalizacija. Budući da su radioaktivni izotopi, kao dijelovi PET radiofarmaka, pozitronski emiteri, njihova proizvodnja traži upotrebu ciklotrona što može biti ograničavajući faktor u njihovoj dostupnosti. Postupnim napretkom kroz povijest, različite metode morfološkog prikaza postale su nedostatne za dijagnostiku pojedinih bolesti te su zato otkriveni i razvijani različiti radiofarmaci koji se danas koriste u mnogim granama medicine, prvenstveno u onkologiji, neurologiji i kardiologiji. Najčešće upotrebljavan radiofarmak kod većine indikacija je 18F-FDG, no razvijen je široki spektar i drugih radiofarmaka koji pokazuju veći stupanj specifičnosti za pojedine metaboličke procese. Time je u onkologiji omogućena precizna detekcija i evaluacija malignih tvorbi i metastaza, određivanje stupnja bolesti, procjena odgovora na terapiju i ostalo. Osim toga, indiciranjem PET/CT-a kod neuroloških bolesnika, uz upotrebu radiofarmaka moguće je otkriti i analizirati mnoge neurološke promjene uzrokovane Alzheimerovom ili Parkinsonovom bolešću i epilepsijom. Također, PET radiofarmaci imaju klinički značaj i u kardiologiji, kod procjene vijabilnosti i perfuzije srčanog mišića, ali i u detekciji različitih upalnih stanja.In nuclear medicine diagnostic procedures, specifically in PET/CT, in order to obtain information on metabolic changes within organs, radioactively labelled compounds composed of radioactive isotopes and carrier molecules called radiotracers are used, which enables the visualization of morphological and functional changes in organs and tissues. PET/CT is a modern diagnostic modality consisting of circular array of PET detectors and a classic CT scanner, which enables detection of annihilation produced photon pairs and their anatomical localization. Since radioactive isotopes, as parts of PET radiotracers, are positron emitters, their production requires the use of cyclotron, which can be limiting factor in their availability. With gradual progress throughout history, different methods of morphological imaging became insufficient for the diagnosis of certain diseases and that is why various radiotracers were discovered and developed, which are today used in many medical fields, primarily in oncology, neurology and cardiology. The most commonly used radiotracer for most indications is 18F-FDG, but a wide spectrum of other radiotracers, that show higher specificity for certain metabolic processes has been developed. In oncology, this enables precise detection and evaluation of malignant formations and metastases, staging, assessment of response to therapy etc. In addition, by indicating PET/CT in neurological patients, with the use of radiotracers, it is possible to detect and analyse many neurological changes caused by Alzheimer’s or Parkinson’s disease and epilepsy. Also, PET radiotracers have clinical significance in cardiology, when assessing the viability and perfusion of the cardiac muscle, but also in the detection of various inflammatory conditions
The role of the operating nurse in the perioperative preparation of the patients undergoing videothoracoscopy
No full text: Uvođenje video-potpomognute torakoskopske (VATS) tehnike dovelo je do novog pristupa u torakalnoj kirurgiji. VATS se izvodi uvođenjem torakoskopa kroz male rezove u stijenci prsnog koša, čime se maksimizira očuvanje mišića i tkiva. Zbog niske stope morbiditeta i mortaliteta, VATS je trenutno tehnika izbora u većini torakalnih zahvata. U odnosu na torakotomijske zahvate, resekcija pluća VATS-om povezana je sa smanjenim curenjem zraka, manjom učestalošću aritmija, upalnih komplikacija, postoperativne boli i nižom razinom sistemskih upalnih markera u krvi. Smanjenje učestalosti poslijeoperacijskih komplikacija skraćuje duljinu boravka u bolnici, a osobito je korisno u bolesnika s visokim rizicima za torakotomijske zahvate. Uloga operacijske medicinske sestre u osiguravanju kvalitetne skrbi bolesnika iznimna je u perioperacijskom razdoblju ovih bolesnika. Medicinska sestra se smatra bitnim članom kirurškog tima i mogućim nositeljem promjena za unaprjeđenje u sigurniji zdravstveni sustav. Uz provođenje perioperacijske skrbi bolesnika koji se podvrgavaju videotorakoskopskim kirurškim zahvatima, medicinske sestre moraju i raspolagati komunikacijskim vještinama pri kontaktu s bolesnicima i njihovim obiteljima te pružati personaliziranu skrb bolesnicima.The introduction of the video-assisted thoracoscopic technique (VATS) has led to a new approach to thoracic surgery. VATS is performed by inserting a thoracoscope through small incisions in the chest wall, maximally sparing muscle and tissue. Because of its low morbidity and mortality rates, VATS is currently the technique of choice for most thoracic surgical procedures. In comparison to thoracotomy procedures VATS lung resection is associated with reduced air leakage, lower frequency of arrhythmias, inflammatory complications,postoperative pain and lower level of systemic inflammatory markers in the blood. This reduction in postoperative complications shortens the length of hospital stay and is particularly beneficial in high-risk patients who cannot tolerate thoracotomy. The role of the scrub nurse in ensuring quality patient care is exceptional in the perioperative period of these patients. The nurse is considered as an essential member of the surgical team and a possible subject transforming to safer healthcare system.In addition, to providing perioperative care to patients undergoing videothoracoscopic surgery, nurses must also be skilled in communication with patients and their families, providing personalized patient care
The role of radiological imaging in the diagnosis of acute appendicitis
No full textAkutni apendicitis je upala crvuljka. Vrlo je često stanje u općoj radiološkoj praksi i jedan je od glavnih razloga za hitnu operaciju u mlađih pacijenata. Dijagnozu je važno postaviti na vrijeme kako bi se izbjegle po život opasne komplikacije. Radiološke slikovne metode igraju ključnu ulogu u dijagnozi akutnog apendicitisa budući da povećavaju dijagnostičku točnost i doprinose diferencijalnoj dijagnozi, procjeni komplikacija te preoperatvinom planiranju. Najčešće korišteni modaliteti su ultrazvuk, kompjuterizirana tomografija i magnetna rezonancija. Ta tri modaliteta daju detaljan prikaz anatomije crvuljka, ukazuju na zadebljanje stijenke i znakove upale, prikazuju vaskularizaciju crijeva te daju uvid u razvoj mogućih komplikacija. Prva metoda izbora je ultrazvuk zbog svoje sigurnosti i dostupnosti. Akutni apendicitis se na UZV-u prikazuje kao aperistaltična tubularna struktura promjera većeg od 6mm. CT ima veću osjetljivost i specifičnost od ultrazvuka, ali se ne preporučuje kao prva metoda izbora zbog korištenja ionizirajućeg zračenja. Magnetna rezonancija je dobra zamjena za kompjuteriziranu tomografiju s obzirom na sličnu osjetljivost i specifičnost. MRI ne koristi ionizirajuće zračenje, međutim može produžiti vrijeme postavljanja dijagnoze i nije lako dostupna metoda te se uglavnom rabi za postavljanje dijagnoze akutnog apendicitisa u trudnoći.Acute appendicitis is inflammation of the appendix. It is a very common condition in general radiological practice and is one of the main reasons for emergency surgery in younger patients. It is important to make the diagnosis in time to avoid life-threatening complications. Radiological imaging methods play a key role in the diagnosis of acute appendicitis since they increase diagnostic accuracy and contribute to differential diagnosis, assessment of complications and preoperative planning. The most commonly used modalities are ultrasound, computed tomography and magnetic resonance. These three modalities provide a detailed view of the anatomy of the worm, indicate thickening of the wall and signs of inflammation, show the vascularization of the intestine and provide insight into the development of possible complications. The first method of choice is ultrasound due to its safety and availability. Acute appendicitis appears on US as an aperistaltic tubular structure with a diameter greater than 6 mm. CT has greater sensitivity and specificity than ultrasound, but is not recommended as the first method of choice due to the use of ionizing radiation. Magnetic resonance imaging is a good substitute for computed tomography due to similar sensitivity and specificity. MRI does not use ionizing radiation, however, it can increase the time of diagnosis and is not an easily available method and is mainly used to diagnose acute appendicitis in pregnancy
Epidemiological characteristics of patients treated for acute mental illnesses in the Split-Dalmatia County Department of Emergency Medicine before and during the COVID-19 epidemic
No full textCilj: Cilj ovog završnog rada je utvrditi učestalost pojavnosti bolesnika s psihijatrijskim dijagnozama na
Zavod za hitnu medicinu Splitsko-dalmatinske županije prije, tijekom i nakon pandemije COVID-19.
Materijali i metode: Ovo presječno istraživanje obuhvaća sve pacijente koji su primali medicinsku skrb
u razdoblju od 01. ožujka 2019. do 01. ožujka 2022. godine u Zavodu za hitnu medicinu. Korišteni su
podaci prikupljeni putem informacijskog sustava e-Hitna Zavoda za hitnu medicinu Splitsko-dalmatinske
županije, a zadovoljavali su kriterij uključenja prema medicinskoj dijagnozi za psihijatrijske bolesti
prema MKB-u (F00-F99) te obuhvaćeno vremensko razdoblje.
Rezultati: Temeljem analize prikupljenih podataka u promatranom razdoblju ukupni broj provedenih
intervencija bio 12232, a najveći broj intervencija bio je u pretpandemijskom razdoblju. Broj ispitanika u
obje skupine bio je skoro podjednak, udio muškog spola iznosio je 51,6%, dok je 48,4% ispitanika bio
ženskog spola. Najveći udio intervencija na ispitanicima, čak 52,4% zabilježen je u dobnoj skupini od 18
do 50 godina života, a najmanji postotak intervencija očekivano je bio u životnoj dobi od rođenja do 17
godina života 4%. Najveći broj intervencija proveden je tijekom ljetnih mjeseci (lipanj, srpanj i kolovoz)
prije, tijekom i poslije pandemije COVID-A9 bolesti.
Zaključci: Tijekom trajanja COVID-19 pandemije evidentiran je najmanji broj intervencija za razliku od
razdoblja prije i poslije. Osobe muškog spola u dobi od 18 do 50 godina češće su tražile pomoć na
Zavodu za hitnu medicinu u odnosu na osobe ženskog spola iste dobi. Primijećena je veća učestalost
intervencija tijekom ljetnih mjeseci.Objective: The aim of this final work is to determine the frequency of patients with psychiatric diagnoses
in the Department of Emergency Medicine of the Split-Dalmatia County before, during and after the
COVID-19 pandemic.
Materials and methods: This cross-sectional study includes all patients who received medical care in the
Department of Emergency Medicine between March 1, 2019 and March 1, 2022. The data collected
through the e-Emergency Service of the Emergency Medicine Information System of the Split-Dalmatia
County were used, and they met the inclusion criteria according to the medical diagnosis of psychiatric
diseases according to the ICD (F00-F99) and the time period covered.
Results: Based on the analysis of the collected data in the observed period, the total number of
interventions was 12,232, and the largest number of interventions was in the period before the pandemic.
The number of respondents in both groups was almost equal, the proportion of men was 51.6%, while
48.4% of the respondents were women. The largest share of interventions on respondents, as much as
52.4%, was recorded in the age group from 18 to 50 years, and the lowest percentage of interventions was
expected in the age group from birth to 17 years, 4%. The largest number of interventions were carried
out during the summer months (June, July and August) before, during and after the COVID-19 pandemic.
Conclusions: During the duration of the COVID-19 pandemic, the lowest number of interventions was
recorded, in contrast to the periods before and after. Men between the ages of 18 and 50 sought help at the
Emergency Medicine Department more often than women of the same age. A higher frequency of
interventions was observed during the summer month
Acute leukemias in childhood
No full textCiljevi istraživanja: Utvrditi ukupan broj djece dobi do 18 godina oboljelih od akutne leukemije, koji su dijagnosticirani i liječeni u Kliničkom bolničkom centru Split, u razdoblju od 1.1.2014. do 31.12.2020. godine. Utvrditi njihovu spolnu i dobnu raspodjelu, analizirati citomorfološke, citokemijske, imunofenotipizacijske i citogenetske karakteristike te ishod bolesti.
Ispitanici i metode: Retrospektivno istraživanje provedeno je na Kliničkom zavodu za patologiju, sudsku medicinu i citologiju KBC-a Split. U istraživanje su uključena djeca dobi do 18 godina kojima je akutna leukemija dijagnosticirana temeljem citomorfološkog i citokemijskog nalaza aspiracijske punkcije koštane srži. Uvidom u medicinsku dokumentaciju bolničkog informacijskog sustava i arhive Kliničkog zavoda za patologiju, sudsku medicinu i citologiju KBC-a Split prikupljeni su potrebni podatci.
Rezultati: U razdoblju od 01.01.2014. do 31.12.2020. godine dijagnosticirano je i liječeno 28 bolesnika dječje dobi: 61% djevojčica i 39% dječaka. Medijan životne dobi bio je 3 godine (min-max, 3 mjeseca - 17 godina i 7 mjeseci). Najveći broj liječene djece je u dobnoj skupini od 1 do 3 godine (46%). U 86% ispitanika dijagnosticirana je akutna limfoblastična leukemija, dok je u 11% ispitanika dijagnosticirana akutna mijeloična leukemija. U jedne ispitanice postavljena je dijagnoza promijelocitne leukemije. Među dijagnosticiranim limfoblastičnim leukemijama dominira akutna limfoblastična leukemija B imunofenotipa u 96% ispitanika i to common-B ALL u 91% ispitanika. U 9% ispitanika dijagnosticirana je pre-B ALL. Prosječan broj blasta po uzorku koštane srži je 64% (min-max, 24-98). PAS pozitivni blasti prisutni su u 50% uzoraka bojenih PAS metodom, dok je fokalna pozitivnost uočena u 4% uzoraka. Mijeloperoksidaza (POX) pozitivni blasti prisutni su u 4% uzoraka bojenih POX metodom, dok su POX negativni blasti dijagnosticirani u 65% uzoraka. Samo fokalno pozitivno bojenje na ANAE prisutno je u jednog ispitanika u kojih je primijenjeno ANAE citokemijsko bojenje. Negativni ANAE blasti prisutni su u 31% uzoraka. Citogenetskom analizom uredan kariogram prisutan je u 23% ispitanika dok su u 31% ispitanika nađene istovremeno i strukturne i numeričke promjene. U 89% pacijenata nakon primijenjenog liječenja na Pedijatrijskom odjelu KBC Split postignuta je remisija.Zaključak: U ispitivanom razdoblju akutna leukemija dijagnosticirana je u 28 pacijenata dječje dobi uz predominaciju limfoblastične leukemije B imunofenotipa. Tijekom liječenja u Kliničkom bolničkom centru Split postignuta je remisija u većine bolesnika. Citomorfološka analiza koštane srži i razmaza periferne krvi nadopunjena citokemijom još uvijek je temeljna dijagnostička pretraga na osnovu koje se postavlja dijagnoza akutne leukemije i indicira daljnja obrada.Objectives: The purpose of this study was to determine the total number of children under 18 years with acute leukemia, diagnosed and treated at the University Hospital of Split between 1.1.2014 and 31.12.2020., in relation to age and gender as well as to analyze cytomorphological, cytochemical, immunophenotyping and cytogenetic characteristics and disease outcomes.
Subjects and methods: A retrospective study was conducted at the Clinical Department of Pathology, Forensic Medicine and Cytology of the University Hospital of Split. Study included patients up to 18 years of age who were diagnosed with acute leukemia based on cytomorphological and cytochemical findings on bone marrow aspirates. The medical records were retreved from data base and archives of the Clinical Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split.
Results: Between 01.01.2014 and 31.12.2020, 28 children were diagnosed and treated for acute leukemia: 61% were girls and 39% were boys. Median age was 3 years (ranged 3 months-17 years and 7 months). The majority of children were in the 1-3 years age group (46%). In 86% of children acute lymphoblastic leukemia was diagnosed, whereas acute myeloid leukemia was diagnosed in 11% of cases. One child was diagnosed as promyelocytic leukemia. Among the diagnosed lymphoblastic leukemias, B immunophenotype dominated in 96% cases and 91% of them were common-B ALL. Pre-B ALL immunophenotype was diagnosed in 9% of cases. The average number of blasts per bone marrow aspirate were 64% (min-max, 24-98). PAS positive blasts are present in 50% of samples analyzed by PAS method, while focal positivity is noted in 4% of samples. Myeloperoxidase (POX) positive blasts are present in 4% of aspirates analyzed by POX method, while POX negative blasts were diagnosed in 65% of aspirates. Focal ANAE positivity was present in one case. Negative ANAE blasts were present in 31% of samples. Cytogenetic analysis showed no chromosomal abnormalities in 23% of children, while both structural and numerical abnormalities were found in 31% of children. During therapy administered at the Pediatric Department, University Hospital of Split, remission was achieved in 89% of children.
Conclusion: In the study period, acute leukemia were diagnosed in 28 children, most of which are acute lymphoblastic leukemia of B immunophenotype. During therapy remission was achieved in most patients. Cytomorphologic analysis of bone marrow aspirates and periferal blood smears, supplemented by cytochemistry is still the basic method for acute leukemia diagnosis and the method by which additional analysis are indicated
FREQUENCY AND SIGNIFICANCE OF CYTOLOGICAL DIAGNOSIS OF LYMPHOCYTIC TYPE OF PLEURAL EFFUSION
No full textCilj rada: Ciljevi ovoga rada bili su odrediti udio limfocitnog tipa izljeva (LPI) u ukupnome broju pleuralnih izljeva (PI), udio citološki dijagnosticiranih malignih bolesti u ukupnome broju LPI te odrediti raspodjelu LPI prema dobi, spolu i kliničkoj dijagnozi.
Mateijali i metode: U istraživanje je uključeno 116 uzoraka PI analiziranih na Odjelu za kliničku citologiji KBC Split od 1.siječnja do 31.prosinca 2021 godine. Od tog broja bilo je 69 uzoraka s dijagnozom LPI koji su dalje statistički obrađivani.
Klinički podatci dobiveni su iz arhive medicinske dokumentacije.
Uzorkovanje PI izvršeno je na Odjelu za pulmlogiju KBC Split, a uzorci su analizirani po standardnim citomorfološkim kriterijima na Odjelu za kliničku citologiju, KBC Split.
Rezultati: Od 116 uzoraka PI bilo je 69 LPI (59,5%). Prosječna dob pacijenata bila je 72 godine ( SD=11,247). Raspodjela LPI prema spolu bila je otprilike jednaka, muškaraca (53,6%) i žena (46,4%).
7 (10,2%) pacijenata je imalo prethodno dijagnosticiran Covid-19. Od toga su 4 pacijenta ( 5,8%) uz Covid-19 imali i malignu dijagnozu u anamnezi, a 3 pacijenta (34,35%) su bili bez maligne dijagnoze.
Od ostalih dijagnoza iz povijesti bolesti najčešće su bile kardiovaskularne bolesti ( 20,6%), benigne novotvorine (17,5%) i respiratorne bolesti ( 12,2%).
Zaključak: Citologija ima značajnu ulogu u dijagnostici uzroka pleuralnih izljeva. Citološkom analizom može se postaviti definitivna dijagnoza na brz, jednostavan i visoko specifičan način. Kod malignih izljeva može utvrditi porijeklo malignih stanica i tako odrediti osnovu bolest. Utvrđeno je da su kardiovaskularne bolesti najčešći ne maligni uzrok kako PI, tako i LPI. Covid-19 je nova bolest i stoga nema puno istraživanja o povezanosti Covida-19, pleuralnih izljeva i malignih bolesti. U ovome istraživanju 10,2% ispitanih pacijenata imalo je Covid-19. 5,8% pacijenata imalo je i malignu dijagnozu u anamnezi. Potrebna su daljnja istraživanja da bi se utvrdila moguća povezanost Covida-19 i pleuralnih izljeva.Research objective: The objectives of this research were to determine the proportion of lymphocyte-type effusions (LPI) in total pleural effusions (PI), the proportion of cytologically diagnosed malignancies in total LPI and to determine the distribution of LPI by age, sex and clinical diagnosis.
Materials and methods: The study included 116 PI samples analyzed at the Department of Clinical Cytology, University Hospital Center Split from January 1 to December 31, 2021. Of that number, there were 69 samples with a diagnosis of LPI that were further statistically processed.
Clinical data were obtained from the archives of medical records.
PI sampling was performed at the Department of Pulmonology, University Hospital Center Split, and samples were analyzed according to standard cytomorphological criteria at the Department of Clinical Cytology, University Hospital Center Split.
Results: Of the 116 PI samples, 69 were LPI (59.5%). The average age of the patients was 72 years (SD = 11,247). The distribution of LPI by gender was approximately equal, men (53.6%) and women (46.4%).
7 (10.2%) patients had previously been diagnosed with Covid-19. Of these, 4 patients (5.8%) had a history of malignant diagnosis in addition to Covid-19, and 3 patients (34.35%) had no malignant diagnosis.
Of the other diagnoses in the history of the disease, the most common were cardiovascular diseases (20.6%), benign neoplasms (17.5%) and respiratory diseases (12.2%).
Conclusion: Cytology plays a significant role in diagnosing the causes of pleural effusions. Cytological analysis can make a definitive diagnosis in a quick, simple, and highly specific way. In malignant effusions, it can determine the origin of malignant cells and thus determine the basis of the disease. Cardiovascular disease has been found to be the most common non-malignant cause of both PI and LPI. Covid-19 is a new disease and therefore there is not much research on the association of Covid-19, pleural effusions and malignancies. In this study, 10.2% of the patients examined had Covid-19. 5.8% of patients also had a history of malignancy. Further research is needed to determine the possible association of Covida-19 and pleural effusions