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Pleural and pericardial effusions combined with ascites in a patient with severe sunitinib-induced hypothyroidism
No full textTo best of our knowledge, this is the first reported case of pericardial and pleural effusions combined with ascites, precipitated with severe sunitinib-induced hypothyroidism. A 58-year-old man presented in our emergency department due to dyspnoea and dry cough. Sixteen months earlier, the patient underwent left nephrectomy due to metastatic renal cell adenocarcinoma (RCC), and therapy with sunitinib was initiated postoperatively. Thyroid function was not assessed during the therapy. On admission, all laboratory findings were within normal range. Computed tomography of the chest detected voluminous bilateral pleural effusions and mild pericardial effusion, and echocardiography revealed pericardial effusion. Thoracocentesis was carried out three times, and cytological examination showed no signs of malignant cells. After assessment of the thyroid function, neglected hypothyroidism was registered. Substitution therapy with levothyroxine was initiated, and thyroid function normalised 2 weeks later. Few days after the last thoracocentesis, his condition suddenly got worse. Thoracocentesis was repeated, and microbiological analysis of the exudate came positive for Klebsiella pneumoniae and Streptococcus pneumoniae. Despite the implemented therapeutic measures, his clinical condition progressively deteriorated. The patient died 27 days after the admission, hospital-acquired pneumonia was identified as the cause of death. Our case emphasises the necessity of careful monitoring and management of side-effects in patients who receive sunitinib. Hypothyroidism is a known cause of pleural, pericardial and abdominal effusions, as reported in several case reports. Timely initiation of substitution levothyroxine therapy can decrease unnecessary pauses in the therapy with sunitinib, as well as prevent development of severe symptoms
Multiple Non Ossifying Fibromas in 20 year old patient with Speckled Lentiginous Nevus syndrome; Jaffe-Campanacci syndrome?
No full textSpeckled lentiginous nevus syndrome is a recently described syndrome with male to female ratio of 4:3; usually present at birth but may appear during first years of life. Cafe au lait macules can be topped by either browns or black macules or papules. Patients usually present with musculosceletal and neurological anomaly at ipsilateral site. Nonossifying fibromas (NOFs) are the most common benign bone tumor in children. The tumors affected long bones as the humerus, the tibia, the femur, the fibula. Approximately 8 % of people with NOF will have more than one tumor. It is uncommon to have more than two or three tumors except in certain very rare conditions like Jaffe - Campanacci 's syndrome. This syndrome can present only with skin patches and NOFs, but also as a part of more severe systemic presentation like cardiovascular, renal, ocular abnormalities and mental retardation
Increased calcium-independent lipoprotein phospholipase A2 but not protein S100 in patients with schizophrenia
No full textBackground: The aim of this paper was to investigate serum concentrations of calcium-independent lipoprotein phospholipase A2 (PLA2) and protein S100 in schizophrenia patients in comparison to healthy controls and correlate them with the clinical severity, duration, and number of schizophrenia relapses.
Subjects and methods: This study included 65 schizophrenia patients and 70 controls. Schizophrenia was diagnosed according
to DSM-IV-TR criteria. Clinical severity was determined by PANSS. PLA2 and protein S100 concentration were assessed by the enzyme-linked immunosorbent assay (ELISA).
Results: PLA2 concentrations were higher in patients with schizophrenia, whereas protein S100 concentrations were not. Higher
concentrations of PLA2 were positively correlated with the duration of illness and number of episodes, as determined by multivariate analysis.
Conclusion: PLA2 might be considered a possible biochemical trait marker for schizophrenia. Further research with larger and more homogeneous clinical samples is required
Sociodemographic characteristics influence pain perception in non-small cell lung cancer patients
No full textUvod: Karcinom pluća najčešća je maligna bolest u muškaraca, a u žena se nalazi na trećem mjestu. Nedvojbeno je da oboljeli, uz ostale simptome, trpe bol. Svrha rada: Istraživanje je provedeno kako bi se utvrdilo postoji li utjecaj sociodemografskih karakteristika na percepciju boli mjerenoj analogno-vizualnom ljestvicom među oboljelima od karcinoma pluća ne-malih stanica. Metode: Ovo primijenjeno, opservacijsko, unicentrično istraživanje imalo je dva kraka: 1) presječni krak, i 2) prospektivni, kohortni krak. Rezultati: U istraživanje je ukupno uključen 41 bolesnik s medijanom dobi 61 (56–68) godina. Ovo istraživanje pokazalo je da subjektivna percepcija boli jest povezana s dobi i urbaniziranošću mjesta boravka te kako su s intenzivnijim subjektivnim osjećajem boli bile povezane mlađa dob (≤ 60 godina vs. > 60 godina, p=0,026) i gradska naselja (grad vs. selo, p=0,031). Dob je bila neovisno i statistički značajno povezana i s relativnom promjenom boli nakon terapije (Wald=5,914; ss=1; p=0,015). Zaključci: Koliko dob, spol, način življenja, mjesto stanovanja pa i sam mentalitet mogu utjecati na doživljaj boli vrijedno je uzeti u obzir kako bi se takvim pacijentima omogućila što bolju skrb i kvaliteta života u godinama borbe s malignom bolešću.Background: Lung cancer is the most common malignant disease in men and the third most common in women worldwide. Pain in these patients is a leading and debilitating symptom, among others. Objectives: The aim of this research was to determine the relationship between the sociodemographic characteristics and pain perception, as measured by visual analogue scale for pain, in patients with non-small cell lung cancer. Methods: This observational, single centre study included both a cross-sectional and prospective cohort design. Results: Forty-one patients with a median age of 61 years (range 56–68) were included. This study showed that subjective perception of pain is related to age and place of residence. Younger patients (≤ 60 years old, p=0.026) and those residing in cities (p=0.031) reported feeling worse pain. Age was independently and statistically associated with the relative relief of pain after analgesic therapy (Wald=5.914; ss=1; p=0.015). Conclusion: Age, lifestyle, place of residence, and mentality should be considered when evaluating pain perception in patients suffering from chronic pain related to malignant disease in order to provide the best possible medical treatment with the goal of improving quality of life
Evaluation of Periodontal Parameters in Patients with Early Stage Chronic Lymphocytic Leukemia
No full textSvrha rada: Procjenjivao se parodontni status ispitanika s KLL-om u ranom stadiju i uspoređivao s parodontnim statusom zdravih ispitanika u kontrolnoj skupini te analizirala veza između parodontoloških i hematoloških parametara bolesnika s KLL-om. Materijali i metode: Pregledano je 60 ispitanika: 30 oboljelih od KLL-a – u stadiju Rai 0 (ispitna skupina) te 30 zdravih osoba iste životne dobi (kontrolna skupina). Kriteriji za isključivanje bili su: postojanje neke druge sistemske bolesti ili stanja (npr. dijabetes), već provedena parodontna terapija, liječenje antibioticima tijekom posljednja tri mjeseca i uzimanje lijekova. Socijalno-demografski podatci prikupljeni su upitnikom. Ispitanicima s najmanje osam zuba obavljen je kompletan parodontološki pregled i određeni su API, PBI, PPD, REC i CAL. Medicinski podatci oboljelih od KLL-a preuzeti su iz njihove medicinske dokumentacije, a hematološki parametri očitani su iz nalaza krvne pretrage. Rezultati: Skupine su se međusobno razlikovale s obzirom na dob, broj zuba i učestalost odlazaka stomatologu (p 0,05), nego samo za REC (F = 4,601; p 0,05). Zaključak: Rezultati ovog istraživanja pokazali su da su oboljeli od KLL-a imali lošiji parodontni status negoli zdravi ispitanici. Uzročno-posljedična veza između parodontoloških i hematoloških parametara nije dokazana.Objective: To assess periodontal conditions in patients with early stage CLL and to compare it with the periodontal status of age matched healthy controls and to analyze the relationship between periodontal and hematological parameters in CLL patients. Materials and Methods: 60 subjects were examined: 30 patients with CLL Rai 0 (test group) and 30 age-matching healthy individuals (control group). The exclusion criteria were: presence of other systemic disease or condition (e.g. diabetes), history of treatment for periodontitis, use of antibiotics during the last 3 months, use of medications. Socio-demographic data were obtained by means of a questionnaire. Participants with at least 8 teeth underwent a full mouth examination assessing API, PBI, PPD, REC and CAL. Medical data for CLL patients were collected from the patients’ records, while hematological data were obtained from the hemogram. Results: Difference between groups was statistically significant for age, number of teeth and frequency of dental checkups (p0.05), only for REC (F=4.601; p0.05). Conclusion: The results of this study showed that patients with CLL had worse periodontal status compared to healthy subjects. Causal relationship between periodontal and hematological parameters was not proved
Krivulja učenja operacije mrene metodom fakoemulzifikacije specijalizanata na Klinici za oftalmologiju Kliničkog bolničkog centra Sestre milosrdnice
No full textThe aim of the study was to analyze the resident learning process of phacoemulsification cataract surgery and to assess the resident phacoemulsification learning curve. This prospective study comprised 86 consecutive cases of phacoemulsification performed using standard technique by eight residents over a one-year period at Clinical Department of Ophthalmology, Sestre milosrdnice University Hospital Center in Zagreb. Operative data on each case included resident and attending surgeon, date of operation, step-by-step success questionnaire, and intraoperative complications. Postoperative data included visual acuity at one-month postoperative visit and postoperative complications. Eighty-six operations were performed under the supervision of attending surgeon. The mean best-corrected visual acuity improved from 0.47±0.25 to 0.8±0.25 postoperatively. Intraoperative complications occurred in 13 (15.12%) cases and continued to decrease throughout residency training. The mean number of individually performed steps per operation increased throughout residency (from 7.6 to 9.0). There was one early postoperative complication, endophthalmitis, which was successfully treated, and no other postoperative complications occurred. Resident surgical competency can be improved by maximizing the number of cataract procedures since the complication rates and the number of individually performed steps improved continuously with increasing surgical experience.Cilj ove studije bio je prikazati proces i krivulju učenja specijalizanata oftalmologije i optometrije u operaciji katarakte metodom fakoemulzifikacije. U ovom prospektivnom istraživanju izvedeno je 86 uzastopnih operacija katarakte metodom fakoemulzifikacije koju su u razdoblju od jedne godine na Klinici za oftalmologiju KBC “Sestre milosrdnice” učili specijalizanti oftalmologije uz nadzor iskusnih operatera. Prikupljeni operativni podatci uključili su specijalizanta operatera, mentora, datum operacije, upitnik uspješnosti po koracima operacije i intraoperacijske komplikacije. Poslijeoperacijski se pratila najbolje postignuta korigirana vidna oštrina operiranih nakon mjesec dana te razvoj poslijeoperacijskih komplikacija. Ukupno je učinjeno 86 operacija uz stalni nadzor iskusnijih operatera. Najbolje korigirana vidna oštrina operiranih poboljšala se sa srednje vrijednosti od 0,47±0,25 na 0,8±0,25 poslijeoperacijski. Intraoperacijske komplikacije su nastupile u 13 (15,12%) operacija, ali se njihova učestalost tijekom vremena u procesu učenja smanjila. Prosječan broj samostalno učinjenih koraka po pojedinoj operaciji za svakog specijalizanta se povećao tijekom procesa učenja (prosječno od 7,6 do 9,0). Poslijeoperacijski se samo u jednog bolesnika razvio endoftalmitis, dok druge poslijeoperacijske komplikacije nisu zabilježene. Kirurške vještine specijalizanata se mogu poboljšati povećanjem broja i učestalosti učinjenih operacija tijekom vremena, jer učestalost intraoperacijskih komplikacija opada, a uspješnost svladavanja pojedinih koraka operacije raste s povećanjem kirurškog iskustva