Repository of the Sestre milosrdnice University Hospital Center
Not a member yet
502 research outputs found
Sort by
Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: A prospective nonrandomized study
No full textObjective: There is no clear cut-off value of serum parathyroid hormone (PTH) or calcium in which patients are at risk for hypocalcemia after total thyroidectomy. We evaluated the usefulness of serum calcium and PTH concentration measurements after total thyroidectomy in predicting late-occurring hypocalcemia.
Design: A prospective, single-center, non-randomized longitudinal cohort study of 143 patients undergoing thyroidectomy between August 2019 and December 2019 with serum calcium and PTH levels sampled 1 h after surgery and on the first and fifth postoperative day. Hypocalcemia was defined as serum calcium levels < 2.14 mmol/L regardless of clinical symptoms. Normal PTH range was 1.6–6.9 pmol/L.
Measurements: The primary outcome measure was presence of hypocalcemia on the first and fifth postoperative day, analyzed by a logistic regression model. The PTH cut-off value for prediction of hypocalcemia was identified using a ROC curve comparing all three time points using the Youden J index.
Results: Out of 143 patients, 52 (36.4%) had hypocalcemia on the fifth postoperative day. Advanced age, concomitant neck dissection and serum PTH levels < 2.9 pmol/L 1 h after surgery and on the first postoperative surgery day were associated with a high risk of hypocalcemia on the first and fifth postoperative day and need for higher doses of calcium supplements (P < 0.0001, AUC 0.748, 95% CI 0.669–0.817, with 76.92% sensitivity and 71.43% specificity).
Conclusion: Serum PTH level measured immediately postoperatively and on the first postoperative day is a reliable predictor of postoperative hypocalcemia with important clinical implications
Effects of aripiprazole long‐acting injectable antipsychotic on hospitalization in recent‐onset schizophrenia
No full textObjective: Recent‐onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long‐acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first‐line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS.
Methods: This mirror‐image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale—severity of illness (CGI‐S) and Clinician‐Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up.
Results: Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p ¼ 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001).
Conclusion: Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socio‐economic healthcare burden
Kasni nastanak recidivirajuće aneurizmatske tvorbe nakon mikrokirurškog liječenja aneurizme srednje moždane arterije: prikaz slučaja i pregled literature o mogućnostima liječenja
No full textRecurrence of intracranial aneurysm after initial microsurgical or endovascular treatment is uncommon. Although the exact etiology remains unknown, recurrent aneurysms may be observed in surgical patients with big and multiple aneurysms, arterial hypertension, non-atherosclerotic cerebrovascular arteriopathies, as well as in those with a familial history of the disease. Such recurrence can occur over a wide period ranging from several months to years after the initial aneurysm treatment. Still, the occurrence delayed by more than 20 years is rather unusual. Herein, we present a case of a 70-year-old female patient who developed late intracranial aneurysm relapse 30 years after successful microsurgical clipping of the middle cerebral artery aneurysm. We also provide a brief review of relevant literature, discussing the etiology and pathophysiology of aneurysm reappearance, as well as different treatment options available. In conclusion, one should always consider the possibility of intracranial aneurysm recurrence regardless of the mode and time of primary surgery. In such a case, a multidisciplinary management approach using flow diverting endovascular techniques is advised in selected patients.Kasni nastanak recidivirajuće intrakranijske aneurizmatske tvorbe nakon mikrokirurškog liječenja je neuobičajen. Iako točna etiologija ostaje nepoznata, recidiv aneurizme može nastati u kirurških bolesnika s velikim i višekratnim aneurizmama, arterijskom hipertenzijom, neaterosklerotičkom cerebrovaskularnom arteriopatijom, kao i onih s obiteljskom anamnezom u povijesti bolesti. Recidivirajuća se aneurizma može očitovati tijekom dužeg razdoblja, u rasponu od nekoliko mjeseci do nekoliko godina nakon inicijalnog liječenja. Ipak, kasni nastanak aneurizme u vremenu dužem od 20 godina prilično je rijedak. U ovom radu prikazujemo slučaj 70-godišnje bolesnice s recidivirajućom aneurizmom srednje moždane arterije nastalom 30 godina nakon uspješnog mikrokirurškog liječenja. Također donosimo kratak pregled relevantne literature koja govori o etiologiji i patofiziologiji nastanka recidivirajuće aneurizme, kao i o različitim raspoloživim mogućnostima liječenja. Zaključujemo kako uvijek treba voditi računa o mogućnosti nastanka recidivirajuće intrakranijske aneurizme neovisno o načinu liječenja i vremenu proteklom od prvobitnog kirurškog zahvata. U ovakvom se slučaju preporuča multidisciplinarni pristup primjenom metode endovaskularnog preusmjerenog protoka kao najprimjerenije suvremene tehnike u odabranih bolesnika
Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation
No full textBackground: Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages’ mechanics is scarce. This study aimed to assess atrial appendages’ mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesophageal echocardiography (TEE) and to explore its value to predict AFR after PVI. Methods: Consecutive patients with paroxysmal AF undergoing first PVI were analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage’s TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s. Results: This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2 , LA volume index 32 ± 11 mL/m2 ). After a median follow-up of 14 (IQR 10–22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28–1.62, p < 0.001) and LAA ostium surface area (HR 1.58, 95%CI 1.06–1.81, p = 0.033) both independently predicted AFR after single PVI. RAA TDI velocity and SVC ostium surface area were not correlated to AFR. Conclusion: Paroxysmal AF patients with lower LAA TDI tissue velocity and LAA ostium surface area have higher risk of developing AFR after PVI. To our knowledge, this is the first study assessing atrial appendages’ mechanics in predicting AFR after PVI
Role of ganglioside biosynthesis genetic polymorphism in cervical cancer development
No full textCervical cancer is the most common gynaecological cancer in women. Cell mediated immunity plays a significant role in the progression or regression of neoplastic cervical lesions caused by human papilloma virus infection. Engagement of antigen-specific T cell receptors is a prerequisite for T cell activation. The initial events of T cell activation involve the movement of the T cell receptor into specialised microdomains known as lipid rafts. Gangliosides play an active role in the formation, stabilisation and biological functions of lipid rafts. This study aims to determine whether polymorphisms in the genes involved in the biosynthesis of gangliosides represent risk a factor for cervical cancer.
Taqman methods for single nucleotide polymorphism genotyping was used. All subjects carried the homozygous wild-type fenotypes for all analysed genes (CC for gene B4GALT5, AA for gene ST3GAL5, AA for gene ST8SIA1 and CC for gene B4GALNT1). A v2 test showed significant differences in genotype failure for B4GALT5 rs138960078 (v2 ¼ 32.02, df ¼ 1, p ¼ .001) and genotype failure for B4GALNT1 rs144643461 (v2 ¼ 41.03, df ¼ 1, p ¼ .001) between cervical cancer group and control group. Genotype failures were significantly more frequent in the cervical cancer group. Unknown adjacent SNPs to rs138960078 in gene B4GALT5 and rs144643461 in gene B4GALNT1 could be associated with cervical cancer development
Rizik nastanka višestrukih intrakranijskih aneurizmi u iradijacijski liječenih bolesnika s malignom bolešću: prikaz slučaja i pregled literature
No full textNeoplastic etiology of intracranial cerebral aneurysm is rare. Yet, the risk of its development is higher in malignant tumor patients receiving radiation therapy. Due to the possible negative effects of irradiation on intracranial vessel walls, the risk of aneurysm formation after radiation therapy, which is crucial for some types of breast cancer patients, continues to be a matter of debate. The aim of this study was to evaluate the hazard of multiple intracranial aneurysm development in patients with malignant disease undergoing radiation therapy. It is based on literature review and case report of a 77-year-old female patient who underwent surgery for multifocal invasive hormone-receptor positive ductal breast carcinoma of no special type, followed by chemotherapy, adjuvant radiation and hormone therapy. Her comorbidity included arterial hypertension and type 2 diabetes. Six unruptured intracranial aneurysms of different bilateral locations were diagnosed incidentally by multi-slice computed tomography angiography and digital subtraction angiography of cerebral vessels. Due to the bilateral aneurysm multiplicity, tumor characteristics and prognosis, comorbidity and relatively advanced age, the patient was not selected for active endovascular or microsurgical aneurysm treatment but only periodical clinical, oncologic and radiological follow-up was advised. In conclusion, the risk of multiple intracranial aneurysm formation in patients with breast cancer undergoing radiation therapy is low, but still possible. Long-term follow-up and regular cerebral angiographic check-up studies are necessary in selected malignant patients to decrease such a risk and to evade the worst outcome associated with aneurysm rupture.Neoplastička etiologija intrakranijskih aneurizmi je rijetka. Unatoč tomu, rizik za njihov nastanak povećan je u bolesnika s malignim tumorima koji primaju iradijacijsku terapiju. Poslijeoperacijska iradijacija ključna je u liječenju pojedinih tipova karcinoma dojke, ali može imati negativan učinak na stijenku intrakranijskih krvnih žila povećavajući rizik nastanka cerebralnih aneurizmi nakon provedenog zračenja, što je stalni predmet rasprave. Cilj je ovoga rada bio prosuditi rizik nastanka višestrukih intrakranijskih aneurizmi u bolesnice kod koje je provedeno zračenje u svrhu nastavka liječenja maligne bolesti. Rad je temeljen na pregledu literature i prikazu slučaja bolesnice u dobi od 77 godina s tumorom dojke koja je operirana zbog nespecifičnog tipa multifokalnog, invazivnog, hormonski aktivnog duktalnog karcinoma nakon čega su provedeni kemoterapija, zračenje i hormonska terapija. Bolesnica se je također liječila od arterijske hipertenzije i dijabetesa tipa 2. U bolesnice je pomoću višeslojne kompjutorske tomografske angiografije i digitalne subtrakcijske angiografije moždanih krvnih žila dijagnosticirano šest nerupturiranih intrakranijskih aneurizmi obostrane lokalizacije. Uzimajući u obzir smještaj višestrukiih aneurizmi, kao i osobite značajke tumora i prognozu maligne bolesti te komorbiditet i relativno visoku životnu dob, u bolesnice nije provedeno aktivno endovaskularno ili mikrokirurško liječenje nerupturiranih aneurizmi, nego je preporučeno redovito kliničko, onkološko i radiološko praćenje. Zaključujemo kako je rizik nastanka višestrukih intrakranijskih aneurizmi u bolesnica s karcinomom dojke podvrgnutih iradijacijskom liječenju relativno malen, ali ipak moguć. Stoga su dugotrajno kliničko praćenje i redovita angiografska dijagnostička provjera nužni u selekcioniranih bolesnika kako bi se ovaj rizik umanjio i kako bi se spriječio nepovoljan ishod liječenja nastao uslijed moguće rupture cerebralne aneurizme
Velika aneurizma vrška bazilarne arterije predstavljena kao mezencefalični tumor i uzrok jednostranog opstrukcijskog hidrocefalusa: prikaz slučaja i tehnička napomena
No full textCerebral ventricular system is a sporadic location of intracranial aneurysms including those of basilar artery tip. Treatment of such aneurysms remains challenging regardless of endovascular or microsurgical techniques applied. Basilar tip aneurysm presenting as third ventricular mass is rarely associated with obstructive hydrocephalus, mimicking midbrain expansive process and urging precise diagnostics and prompt treatment. Hence, the management of such patients may be delicate, having an uncertain outcome. We report on a case of a patient with unilateral hydrocephalus caused by large basilar tip aneurysm mimicking a midbrain tumor. We also discuss different operative strategies influencing the outcome, including our own endovascular treatment technical modification. A 62-year-old female patient presented with slightly decreased cognition, minor gait disturbances and urinary incontinence. Computed brain tomography revealed a third ventricle mass with unilateral ventricular dilatation, indicating hypertensive obstructive hydrocephalus. Magnetic resonance and digital subtraction angiography identified the third ventricular mass as a large saccular basilar tip aneurysm. The patient was selected for endovascular treatment followed by cerebrospinal fluid derivation. After aneurysm endovascular occlusion and temporary external ventricular drainage, the symptoms diminished and ventricular dilatation decreased. On post-procedure day 10, the hydrocephalus was relieved and external drainage removed. The patient recovered fully and was discharged without neurological deficit. In conclusion, large basilar tip aneurysms associated with obstructive hydrocephalus are rare and best treated by a combination of endovascular obliteration and cerebrospinal fluid ventricular diversion. The possibility of such an aneurysm should always be considered on the differential diagnosis of cerebral ventricular growths.Intrakranijske su aneurizme smještene unutar ventrikulskog sustava rijetke, uključujući one vrška bazilarne arterije. Njihovo je liječenje izrazito zahtjevno, neovisno o primijenjenoj endovaskularnoj ili mikrokirurškoj tehnici. Aneurizme bazilarnoga vrška koje se očituju kao ventrikulska ekspanzivna tvorba u području mezencefalona rijetko su povezane s razvitkom opstrukcijskoga hidrocefalusa, što zahtijeva preciznu dijagnostiku i žurno aktivno liječenje. Postupak je liječenja u ovakvih bolesnika iznimno složen, a ishod neizvjestan. U ovom radu opisujemo slučaj bolesnice s jednostranim hidrocefalusom uzrokovanim velikom aneurizmom bazilarnoga vrška, koja se diferencijalno dijagnostički očitovala kao mezencefalični tumor. Također raspravljamo o različitim mogućnostima operacijskog liječenja od utjecaja na ishod, uključujući i vlastitu tehničku modifikaciju endovaskularnog zahvata. Bolesnica u dobi od 62 godine zaprimljena je zbog blago sniženih kognitivnih sposobnosti, manjeg poremećaja u hodu i urinarne inkontinencije. Kompjutorska tomografija mozga upućivala je na ekspanzivnu tvorbu područja treće klijetke s jednostranim proširenjem postranične klijetke i posljedičnim hipertenzivnim hidrocefalusom. Magnetna rezonancija i digitalna suptrakcijska angiografija razotkrile su ekspanzivnu tvorbu kao veliku sakularnu aneurizmu bazilarnoga vrška. Bolesnica je podvrgnuta endovaskularnom liječenju sa susljednom derivacijom cerebrospinalnoga likvora. Simptomi i proširenje postranične klijetke su se umanjili nakon učinjene endovaskularne okluzije i privremene izvanjske ventrikulske drenaže. Desetog dana od operacije hidrocefalus se u cijelosti povukao pa je izvanjska drenaža uklonjena. Bolesnica se je u potpunosti oporavila te je otpuštena bez neurološkog ispada. Zaključujemo kako su aneurizme bazilarnoga vrška udružene s opstrukcijskim hidrocefalusom rijetke i kako ih je najpovoljnije liječiti kombinacijom endovaskularnog postupka i likvorske ventrikulske derivacije. Na mogućnost nastanka ovakve aneurizme treba uvijek pomisliti u diferencijalnoj dijagnostici cerebralnih ventrikulskih tvorba
Guidelines for diagnosis and management of acute vertigo and dizziness
No full textDijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su ponajprije otorinolaringolozima, specijalistima hitne medicine, liječnicima obiteljske medicine, te ostalim liječnicima u Republici Hrvatskoj koji skrbe o bolesnicima s vrtoglavicom i gubitkom ravnoteže, u primarnoj i bolničkoj zdravstvenoj zaštiti. U izradi smjernica sudjelovali su predstavnici Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata (HD ORL), te predstavnica Hrvatskog neurološkog društva. Prepoznati uzrok akutne vrtoglavice u praksi otežava činjenica da se simptomi oštećenja u različitim organskim sustavima preklapaju, nejasni su i djeluju dramatično. Cilj ovih smjernica je pomoć pri postavljanju dijagnoze kod bolesnika s izraženim simptomima vrtoglavice i pravodobno razlikovanje benigne od životno ugrožavajuće vrtoglavice koja zahtijeva hitno, bolničko liječenje. Smjernice sadrže i detaljne algoritme koji preporučuju postupanja s bolesnikom s napadajem akutne vrtoglavice i gubitkom ravnoteže.Diagnostic-therapeutic guidelines for acute vertigo and dizziness are primarily intended for otolaryngologists, emergency medicine specialists, general practitioners and other physicians in the Republic of Croatia who take care of patients who have vertigo and dizziness in primary and hospital health care. The guidelines were written by representatives of the Croatian Society of Otolaryngology and Head and Neck Surgery (HD ORL), as well as the Croatian Neurological Society. To distinguish the cause of acute dizziness in practice by eliminating the fact that the symptoms of damage in the various organs of the system overlap, is vague and seems dramatical. The purpose of these guidelines is to assist in the diagnosis of patients with severe dizziness symptoms and timely distinction of benign and life-threatening vertigo requiring emergency hospital treatment. The guidelines also contain detailed algorithms that recommend the management of a patient who has acute vertigo and dizziness
Minimalno invazivno liječenje idiopatske siringomijelije uporabom ventilacijskih T-cjevčica za bubnjić: prikaz slučaja i operativne tehnike
No full textSyringomyelia is characterized by a fluid-filled cavity within the spinal cord. Expansion of the syrinx often results in the clinical course of progressive neurologic deficit. Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. However, little is known about idiopathic syringomyelia, which requires specific management. In our paper, an alternative, minimally invasive treatment option for large symptomatic idiopathic cervicothoracic syrinx is described and discussed. We present a case of a 44-year-old male without a history of spinal cord trauma, infection, or other pathologic processes, who presented for thoracic pain. Due to progressive pain and left leg paresis, magnetic resonance imaging (MRI) was performed and revealed extensive septated syringomyelia from T5 to T7 and hydromyelia cranially. We applied minimally invasive technique for shunting the idiopathic syrinx into the subarachnoid space using two Richards modified myringotomy T-tubes. Postoperative MRI revealed significant decrease in the syrinx size and clinical six-month follow-up showed improvement of clinical symptoms. This minimally invasive treatment of syringomyelia was found to be an effective method for idiopathic septated syrinx, without evident underlying cause. However, long-term follow-up and more patients are necessary for definitive evaluation of this technique.Siringomijeliju predstavlja stvaranje šupljina ispunjenih tekućinom unutar kralježnične moždine. Širenje šupljine često dovodi do pojave neuroloških poremećaja koji se postupno pogoršavaju. Operativno liječenje je usmjereno na otklanjanje uzroka siringomijelije, ako je taj uzrok poznat. Međutim, malo se zna o idiopatskoj siringomijeliji koja zahtijeva poseban tretman. U našem članku opisujemo alternativnu, minimalno invazivnu metodu liječenja velike simptomatske idiopatske vratno-prsne siringomijelije. Prikazujemo slučaj 44-godišnjeg bolesnika bez prethodno poznate ozljede, upale ili drugih bolesti kralježnične moždine, koji se žalio na bolove u prsnoj kralježnici. Zbog pogoršanja bolova i slabosti lijeve noge učinjena je magnetska rezonanca koja je pokazala veliku pregrađenu siringomijeliju u razini od 5. do 7. prsnog kralješka i kranijalno posljedičnu hidromijeliju. Primijenili smo minimalno invazivnu tehniku drenaže sirinksa u subarahnoidni prostor uporabom dviju ventilacijskih cjevčica za bubnjić (Richardsove modificirane T-cjevčice). Snimke nakon operacije su pokazale značajno smanjenje sirinksa, a kontrolni pregled nakon šest mjeseci poboljšanje neuroloških simptoma. Ova minimalno invazivna operacija siringomijelije se pokazala učinkovitom metodom u liječenju idiopatskog, membranom pregrađenog sirinksa nepoznate etiologije. Međutim, za konačnu procjenu ove metode potrebno je duže praćenje i veći broj slučajeva
Divovska kavernozna malformacija s neuobičajeno agresivnim kliničkim tijekom: prikaz slučaja
No full textGiant cavernomas (GC) are rare lesions, with less than 50 cases reported so far. Clinical presentation usually involves epileptic seizures and less typically focal neurological deficit, due to repeated hemorrhages and GC mass effect and consequentially increased intracranial pressure. Although individual cases have been reported, due to the rarity and variable imaging appearance, GCs are usually not considered in the differential diagnosis of large hemorrhagic lesions, especially when significant mass effect is present. A 17-year-old boy presented due to severe headache, right-sided weakness, and slurred speech. Symptoms started three days before with occasional headaches, which intensified gradually. Emergency computed tomography revealed a left frontal massive heterogeneous lesion. Soon after, right-sided hemiparesis and speech impairment progressed, and the patient became drowsy with the slightly dilated left pupil. Emergency surgery was performed, and the lobed grayish lesion was entirely removed. Based on the macroscopic appearance, the surgeon assumed it was a metastasis of melanoma. Histopathologic analysis result was cavernoma. GC should be considered as an option in hemorrhagic lesions, especially in the young age population. Emergency surgery for mass lesions is not uncommon in neurosurgery; however, bleeding cavernomas are usually planned for elective surgery due to the specific approach and complications.Divovski kavernomi (DK) su rijetke lezije s manje od 50 dosad opisanih slučajeva. Uobičajena simptomatologija su epileptični napadaji, a rjeđe se manifestiraju žarišnim neurološkim deficitom koji je uzrokovan ponavljanim hemoragijama i posljedičnim povećanjem intrakranijskog tlaka. Iako su objavljeni pojedini slučajevi, zbog rijetke pojavnosti i raznovrsne radiološke prezentacije DK se obično ne razmatraju u diferencijalnoj dijagnostici velikih hemoragičnih ekspanzivnih lezija, pogotovo kada je prisutan značajan kompresivni učinak. Sedamnaestogodišnji dječak se javio liječniku zbog jake glavobolje, blaže desnostrane slabosti i nerazgovijetnog govora. Simtpomi su se javili 3 dana ranije u vidu blagih glavobolja koje su se postupno pojačavale. Hitna kompjutorizirana tomografija je pokazala masivnu hemoragičnu leziju frontalno lijevo. Nedugo zatim desnostrana slabost i nerazgovijetan govor su se pogoršali i bolesnik je postao pospan s blago proširenom lijevom zjenicom. Učinjena je hitna operacija, kružna sivkasta lezija je u cijelosti uklonjena. Na osnovi makroskopskog izgleda kirurg je pomislio da se radi o metastazi melanoma. Histopatološka analiza je pokazala da se radi o kavernomu. DK bi trebalo razmatrati kao mogućnost kod hemoragičnih lezija, pogotovo kod mlađih bolesnika. Hitna operacija kod kompresivnih lezija nije rijetkost u neurokirurgiji, međutim, krvareći kavernomi se obično planiraju za elektivnu operaciju zbog specifičnog pristupa i mogućih komplikacija