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Subcutaneous Tumor of the Upper Eyelid: Infestation by Dirofilaria repens
No full textDirofilaria ist eine zoonotische Wurmerkrankung, die durch einen Parasiten der Gattung Dirofilaria verursacht wird. Dirofilaria sind in mediterranen Ländern, wie Italien, Frankreich, Griechenland und Kroatien, einheimisch. Zu den Betroffenen zählen meist Hunde, Wölfe, Füchse oder andere nicht menschliche Säugetiere, Menschen sind nur selten betroffen. Die Ansteckung des Menschen erfolgt durch Anthropoden, deren Zwischenwirt und Überträger Mücken sind. Im Unterhautgewebe paaren sich ausgewachsene Würmer und bilden Mikrofilarien, die sich im peripheren Blut befallener Tiere befinden. Die se werden durch Stechmücken aufgenommen und entwickeln sich dort zu infektiösen Larven. Diese sog. Drittlarven werden während des Saugaktes auf den Menschen übertragen. Die ausgewachsenen Würmer können hier nicht das Stadium sexueller Reife erreichen, weshalb sich Mikrofilarien nicht im Menschen entwickeln. Dirofilaria immitis hat eine weltweite Ausbreitung, wohingegen Dirofilaria repens derzeit nur in Europa, Asien und Afrika vorkommt. Der Befall des Menschen zeigt sich für gewöhnlich durch ein punktuelles Knötchen (der ausgewachsene Fadenwurm ist durch das Immunsystem eingekapselt) in der Nähe des infizierten Mückenstichs. Klinische Formen sind okular, subkutan und manchmal sogar pulmonal. Von 6 der 40 verschiedenen Arten der Dirofilaria (D. immitis, D. repens, D. straita, D. tenuis, D. ursi und D. spectans) ist bekannt, dass sie Krankheiten beim Menschen verursachen können. Dabei handelt es sich um unilaterale Infektionen, die meist subkonjunktival sind und eine orbitale Dirofilaria/Dirofilaria des Augenlides zur Folge haben. Es können aber auch intravitreale oder orbitale Fälle sein. Patienten haben eine tastbare Masse. Die meisten dokumentierten Fälle dieser Art beim Menschen können der Dirofilaria repens zugeordnet werden. Bei der Differenzialdiagnose von Tumoren subkutanen periokularen Gewebes muss ein Befall, wie er durch Dirofilaria repens verursacht wird, in Betracht gezogen werden
Određivanje vrijednosti tireoglobulina u citološkom aspiratu u svrhu otkrivanja recidiva i metastaza na vratu u bolesnika s diferenciranim karcinomom štitnjače: značaj anti-Tg protutijela
No full textThe worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy (FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNATgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites.Svjetska incidencija diferenciranog karcinoma štitnjače (DTC) u porastu je posljednjih desetljeća najvjerojatnije zbog povećane uporabe ultrazvuka (US) i US vođene aspiracijske biopsije tankom iglom (FNA). Nakon provedene tireoidektomije, onkološko praćenje uključuje US i US vođenu FNA i citološku analizu aspirata ukoliko se otkriju sumnjivi cervikalni limfni čvorovi (LN ) ili tkivo u ležištu štitnjače. Kako je poznato da serumska protutijela na tireoglobulin (sTgAb) utječu na vrijednost serumskog Tg (sTg) kao tumorskog markera, cilj našeg istraživanja je procijeniti korisnost određivanja Tg u aspiratima suspektnih lezija (FNA-Tg) u prisutnosti sTgAb. Ova retrospektivna studija obuhvatila je 149 bolesnika s DTC-om i 159 uzoraka sumnjivih LN ili tkiva u ležištu štitnjače. Očekivano su razine sTg pokazale obrnutu korelaciju s razinom sTgAb (p <0,05), ali su vrijednosti FNA-Tg imale značajnu pozitivnu korelaciju s vrijednošću FNA-TgAb (p <0,05). Našim rezultatima smo pokazali pozitivnu korelaciju vrijednosti sTg i FNA-Tg (p <0,05), ali ne i korelaciju između sTgAb i FNA-TgAb, kao niti sTgAb i FNA-Tg. Zaključujemo da vrijednosti sTgAb ne utječu na FNA-Tg te da je određivanje FNA-Tg visoko učinkovita metoda dijagnostike regionalnih metastaza DTC. Međutim, preporučuje se kombinirana upotreba s citologijom za procjenu suspektnih čvorova vrata jer se citolologijom mogu istodobno otkriti metastaze i drugih tumora
Trebamo li liječiti bol u starijih palijativnih onkoloških bolesnika drukčije?
No full textOpioids are considered the cornerstone of pain management in palliative care. Available data suggest that older patients use different analgesics and lower opioid doses compared to younger patients. However, it has not been elucidated yet whether such dosing is associated with worse pain levels or shorter survival in the palliative care setting. We evaluated the relationship among pain scores, quality of life, opioid dose, and survival in palliative care cancer patients in a hospice setting. A total of 137 palliative care cancer patients were analyzed prospectively. We divided patients into two groups using the age of 65 as a cut-off value. Younger patients exhibited significantly higher pain ratings (5.14 vs. 3.59, p=0.01), although older patients used almost 20 mg less oral morphine equivalent (OME) on arrival (p=0.36) and 55 mg OME/day less during the last week (p=0.03). There were no differences in survival between the two groups (17.36 vs. 17.58 days). The elderly patients also used nonsteroidal analgesics less often and paracetamol more often. Hence, using lower opioid doses in older palliative care cancer patients does not result in worse pain rating, and could be a plausible approach for pain management in this patient group.Opioidi se smatraju jednim od osnovnih lijekova u liječenju boli u palijativnoj skrbi. Dostupni podaci ukazuju na to da stariji bolesnici uzimaju drukčije analgetike uz niže doze opioida u usporedbi s mlađim bolesnicima. Međutim, nije razjašnjeno utječe li takvo doziranje opioida na lošije liječenje razine boli ili kraće preživljenje u uvjetima palijativne skrbi. Analizirali smo odnos razine boli, kvalitete života, doze opioida i preživljenja u palijativnih onkoloških bolesnika koji su bili hospitalizirani u hospiciju. Ukupno je 137 palijativnih bolesnika analizirano prospektivno. Bolesnici su podijeljeni u dvije skupine pri čemu se dob od 65 godina uzimala kao granica između skupina. Mlađi bolesnici su izražavali višu razinu boli prilikom dolaska u hospicij (5,14 prema 3,59, p=0,01), iako su stariji bolesnici koristili gotovo 20 mg manje oralnog morfij ekvivalenta (OME) na dan dolaska te čak 55 mg OME manje na dan tijekom zadnjeg tjedna (p=0,03). Nije bilo razlika u preživljenju između dviju skupina bolesnika (17,36 prema 17,58 dana). Starija skupina bolesnika također je nesteroidne antireumatike uzimala rjeđe, a paracetamol češće od mlađe skupine. Uzimanje nižih doza opioida u starijih onkoloških bolesnika u palijativnoj skrbi nije rezultiralo lošijom razinom boli pa bi to mogao biti razuman pristup liječenju boli u ovoj skupini bolesnika
Astrocitom kralježničke moždine niskog stupnja malignosti u odraslih: prikaz osobne serije bolesnika i pregled literature
No full textAstrocytoma is the second most common intramedullary tumor of predominantly low-grade malignancy in adult patients. Adult astrocytomas have better-quality prognosis compared with astrocytomas in children. Although a standardized surgical management protocol for spinal cord glioma is currently unavailable, surgery of low-grade astrocytoma should be aimed at gross total resection to preserve neurological function and to improve the outcome. Herein, we present a personal case series of four consecutive adult spinal cord astrocytoma patients who were operated on during the last few years. Tumor resection was performed in all patients utilizing microsurgical technique and intraoperative neurophysiologic monitoring. We also provide a literature review of the treatment of intramedullary astrocytoma in adults and discuss contemporary surgical management and prognosis.Astrocitom kralježničke moždine je tumor pretežito niskog stupnja malignosti koji je po učestalosti drugi intramedularni tumor u odraslih u kojih je njegova prognoza znatno povoljnija u usporedbi s prognozom u djece. Unatoč tomu što standardizirani protokol za kirurško liječenje gliomskih tumora kralježničke moždine zasad ne postoji, cilj ovakvog liječenja trebao bi biti usmjeren ka uklanjanju tumora u cijelosti kako bi se očuvala neurološka funkcionalnost i poboljšala uspješnost liječenja. U ovom radu dajemo prikaz osobne serije tijekom nekoliko posljednjih godina susljedno operiranih četvero odraslih bolesnika s astrocitomom kralježničke moždine u kojih je tumor mikrokirurški uklonjen uz pomoć intraoperacijskog neurofiziološkog praćenja. U radu također donosimo pregled literature o liječenju intramedularnih astrocitoma u odraslih, raspravljajući o suvremenom kirurškom liječenju ovakvih tumora i prognozi bolesti
Sonografija ovojnice optičkog živca je obećavajući alat u procjeni porasta intrakranijskog tlaka u bolesnika liječenih u neurološkoj intezivnoj skrbi
No full textOptic nerve sheath diameter (ONSD) enlargement is detectable in traumatic brain injury patients with raised intracranial pressure (ICP). The aim was to assess its value in neurological patients suspected to have increased ICP. Patient clinical imaging data and hospitalization outcome were analyzed. Patients were divided into groups according to brain pathology and level of consciousness with Glasgow Coma Score (GCS). Poor hospitalization outcome was assessed by modified Rankin scale (mRS) >3. Data obtained by ocular sonography performed in acute setting were compared with data of 100 control subjects. Data were expressed as mean ± SD. Intergroup comparison was performed by Student’s t-test. Data of 34 patients (63+16 years) were suitable for analysis, including 8 primary intracerebral hemorrhage (PICH), 8 subarachnoid hemorrhage (SAH), 12 PICH or SAH and intraventricular hemorrhage (IVH), 4 tumors and 2 ischemic strokes. The mean ONSD was 5.86+0.69 mm in patients versus 4.38+0.41 mm in controls (p<0.01). ONSD was 6.28+0.61 mm in patients with GCS <8 and 5.77+0.55 mm in other patients (p<0.05). ONSD was 5.72+0.59 mm in
PICH versus 6.20+0.65 mm in PICH/SAH with IVH (p=0.1). ONSD was 5.73+0.38 mm in SAH in comparison to PICH/SAH with IVH (p=0.05). There was no statistically significant difference in optic nerve diameter between patients and controls (2.48+0.28 mm vs. 2.39+0.33 mm; p>0.05). Pronounced enlargement of ONSD was observed in patients with ICH or SAH with IVH, and in patients with GCS 3).Povećanje promjera ovojnice optičkog živca (POOŽ) vidljivo je u bolesnika s traumatskom ozljedom mozga s povećanim intrakranijskim tlakom. Cilj je bio procijeniti njegovu vrijednost u neuroloških bolesnika sa sumnjom na porast intrakranijskog tlaka. Analizirani su klinički podaci, nalazi slikovnog prikaza i ishod hospitalizacije. Bolesnici su podijeljeni u skupine prema moždanoj patologiji i razini svijesti prema rezultatu na Glasgow Coma Score (GCS). Nepovoljan ishod procijenjen je modificiranom Rankinovom skalom (mRS) >3. Podaci okularne sonografije u akutnim uvjetima uspoređeni su s podacima 100 zdravih kontrolnih osoba. Vrijednosti su prikazane kao srednje vrijednosti i standardne devijacije. Usporedba između skupina provedena je Studentovim t-testom. Za analizu su bili prikladni podaci 34 bolesnika (63+16 godina): 8 primarnih intracerebralnih krvarenja (PICK), 8 subarahnoidnih krvarenja (SAK), 12 PICK ili SAK s intraventrikulskim krvarenjem (IVK), 4 tumora i 2 ishemijska moždana udara. U bolesnika je prosječni POOŽ bio 5,86+0,69 mm u usporedbi s 4,38+0,41 mm u kontrolnih osoba (p0,05). Izrazito je povećanje POOŽ zabilježeno u bolesnika s ICK ili SAK s IVK te u bolesnika s GSK 3)
Differences in self-reported symptoms in patients with chronic odontogenic and non-odontogenic rhinosinusitis
No full textPurpose: To evaluate the possible differences in self-reported symptoms between patients with chronic odontogenic rhinosinusitis (CORS) and patients with chronic non-odontogenic rhinosinusitis (CnORS).
Materials and methods: The study included 64 patients diagnosed with chronic rhinosinusitis according to EPOS guidelines. 32 patients had CORS, and the control group were 32 patients with CnORS. Patients were matched according to gender and age. All the patients underwent a CT scan evaluated by a radiologist, and were evaluated by an oral surgeon and otorhinolaryngologist before being assigned to one of the groups. The severity of the symptoms was assessed through questioners SNOT-22 (sino-nasal outcome test) and VAS (visual analogue scale) symptom score. Kolmogorov-Smirnov's, Fisher's and Mann-Whitney U test were used in the statistical analysis of the data.
Results: People with CORS show similar symptomatology on SNOT-22 score to patients with CnORS, with no significant statistical difference between any of the SNOT-22 symptoms. VAS symptom score showed that odontogenic group had a significantly higher score for fever (p = .004) and halitosis (p = .003).
Conclusion: Halitosis and fever might be the most important symptoms in differentiating between CORS and CnORS symptomatology. Better diagnostic tools, such as VAS symptom score might help medical professionals to be quicker at recognizing CORS specific symptomatology, and help them treat the disease as early and adequately as possible
Guidelines for laryngeal cancer
No full textOvo su službene smjernice Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata za liječenje bolesnika s karcinomom grkljana u Republici Hrvatskoj. Liječenje karcinoma larinksa predstavlja izazov budući da je potrebno u cijelosti odstraniti tumor, a u isto vrijeme maksimalno sačuvati sve laringealne funkcije. To naočigled predstavlja jednostavni koncept liječenja, ali kako to postići i u isto vrijeme zadovoljiti onkološke postulate liječenja i sačuvati funkcije, nije jednostavno odgovoriti u slučaju bilo kojeg bolesnika s karcinomom larinksa, za što je potreban multidisciplinarni pristup i tim za svakog bolesnika. Smjernice sadržavaju novosti u dijagnostičkom i terapijskom pristupu navedenih bolesnika, od zadnjih smjernica koje su bile usvojene 2012. godine na godišnjem sastanku u Vukovaru.This is the official guideline endorsed by the Croatian ENT and head and neck society in the care of laryngeal cancer patients in the Republic of Croatia. The aim of any clinician involved in the treatment of laryngeal squamous cell carcinoma should be to cure the disease whilst maintaining maximal laryngeal function. Whilst this seems a simple concept, deciding how best to achieve this aim in any given patient is often difficult and results in well-rehearsed complex discussions within multi-disciplinary team (MDT) meetings. These guidelines contain updates in the diagnostic and therapeutic approach in patients with laryngeal cancer since the last edition of the guidelines which was accepted at the annual meeting in Vukovar in 2012
Evaluation of Primary Hyperparathyroidism in Hormone Receptor-Positive Breast Cancer Patients Using [99mTc] Tc-MIBI SPECT/CT and Ultrasound
No full textBreast cancer (BC) patients receiving advanced specific anti-neoplastic treatments are at increased risk for cancer treatment-induced bone loss. The guidelines recommend bone mineral density (BMD) testing by dual-energy X-ray absorptiometry (DXA) and
exclusion of secondary causes for low BMD such as primary hyperparathyroidism (PHPT)
Vitamin D and Neurotrophin Levels and Their Impact on the Symptoms of Schizophrenia
No full textIntroduction: Vitamin D is involved in brain development and functioning, as well as in regulation of neurotrophic factors. Changes in the expression of those factors are possibly responsible for morphologic abnormalities and symptoms in patients suffering from schizophrenia.
Objective: The main goal of this research was to investigate the interrelationship between vitamin D, nerve growth factors (NGF, brain-derived neurotrophic factor [BDNF], and neuregulin-1 [NRG1]), and schizophrenia symptom domains.
Methods: This research included 97 inpatients diagnosed with schizophrenia. Schizophrenia symptoms were assessed using the
Positive and Negative Syndrome Scale (PANSS). Blood samples were taken in order to analyze concentrations of vitamin D, BDNF, NRG1, and NGF growth factors. The obtained results were used in a multiple regression analysis.
Results: The vitamin D concentration positively affected the concentration of NRG1 (F = 8.583, p = 0.005) but not the concentration of other investigated growth factors (BDNF and NGF). The clinical characteristics and symptom domains of schizophrenia seemed to be unaffected by the concentrations of vitamin D, BDNF, and NGF, while the NRG1 concentration significantly affected positive symptom domains of schizophrenia (F = 4.927, p = 0.030).
Conclusion: The vitamin D concentration positively affected NRG1 levels but not schizophrenia symptomatology as measured by PANSS. The association between the two could be intermediated via NRG1
Rijedak slučaj metastaze invazivnog lobularnog karcinoma dojke u endometrij
No full textMetastases to the female genital tract from extra-genital primary cancers are uncommon and usually occur during widespread metastatic disease. Breast cancers are the most frequent primaries, predominantly the lobular type. Here, we report a case of a 55-year-old woman with breast cancer endometrial metastasis who presented with postmenopausal vaginal bleeding. We highlight the importance of endometrial sampling to confirm the diagnosis and distinguish primary from metastatic cancer of the endometrium since the treatment and prognosis of these conditions are entirely different.Metastaze u ženski spolni sustav ekstragenitalnih primarnih karcinoma su rijetke te su najčešće znak uznapredovale bolesti. Lobularni histološki tip karcinoma dojke je najčešće primarno sijelo metastaza u ženski spolni sustav. U radu je prikazan rijedak slučaj 55- godišnje bolesnice s endometralnom metastazom karcinoma dojke koja se prvotno prezentirala sa simptomima vaginalnog krvarenja u poslijemenopauzi. Istaknuta je važnost biopsije endometrija u postavljanju točne dijagnoze i razlikovanju primarne od metastatske bolesti endometrija s obzirom na činjenicu kako se njihovo liječenje i prognoza u potpunosti razlikuju