Repository of the Sestre milosrdnice University Hospital Center
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Metode nuklearne medicine u dijagnostici i liječenju neuroblastoma visokog rizika – prikaz slučaja
No full textNeuroblastom je najčešći ekstrakranijalni solidni tumor dječje dobi širokog spektra biološkog ponašanja, pri čemu kategorija visokog rizika ima značajan udio u smrtnosti od raka u dječjoj dobi. Metode nuklearne medicine neophodne su ne samo tijekom dijagnostičkog postupka i procjene kategorije rizika, već imaju svoje mjesto i kao jedan od segmenata u multimodalnom liječenju bolesti visokog rizika. Prikazat ćemo slučaj bolesti visokog rizika, obzirom na dob djeteta i prisutnost metastaza, s naglaskom na važnost multidisciplinarnog pristupa u dijagnostici i terapiji
Solitary Clear Cell Renal Cell Carcinoma Metastasis to the Eyelid: A Case Report
No full textIntroduction: This study is a case of solitary clear cell renal cell carcinoma (ccRCC) eyelid metastasis in a 66-year-old man as the first sign of a primary tumor. ccRCC usually spreads to the lungs, mediastinum, bones, liver, and brain, while ocular metastases are rare. Case Presentation: Solitary metastasis presented as a solid mass in the central third of the upper eyelid, which has been growing for 3 weeks. Treatment included tumor removal and blepharoplasty. Histopathological examination showed metastasis of clear cell renal carcinoma. A thorough examination revealed a primary tumor on the lower pole of the right kidney. A right nephrectomy was performed, and histopathology showed ccRCC. Postoperative examinations showed no signs of local or systemic disease. Sunitinib malate was administered to the patient. Conclusion: The eyelid metastasis in this case was still solitary and had been discovered before the existence of the primary tumor was known. Ocular metastasis of renal carcinoma is a rare initial manifestation of the disease and therefore requires a multidisciplinary approach in the treatment of these patients
Is vitamin D associated with disease activity in patients with axial or peripheral spondyloarthritis? A real-life study
No full textVitamin D plays important role in inflammatory rheumatic diseases, which in turn rose an interest for investigating association of its deficiency with disease activity. In this research we aimed to evaluate this matter in the context of spondyloarthritis (SpA), together with treatment modalities and bone density in people diagnosed with axial or peripheral SpA in real-life setting. In our study we enrolled 99 patients with diagnosis of SpA treated at the tertiary level rheumatology department. Serum 25(OH)D levels, treatment modality (NSAIR or DMARDs), disease activity, tobacco smoking habits, mineral density of bone, supplementation and seasonal variations were assessed. We used standardized questionnaires such as ASDAS-CRP, BASFI and joint count, among many others, to evaluate some of the mentioned parameters. Sixty-five percent of patients had vitamin D deficiency. We found marginaly higher activity of disease in subjects with low vitamin D. In cases of peripheral SpA, there was a significant association of higher number of swollen joints and lower vitamin D levels. Additionally, the significant correlation was seen between normal serum vitamin D and supplementation. In our real-life study of patients with SpA we found a significant percentage of vitamin D deficit, with a tendency of slightly higher disease activity in those patients.In order to clarify the impact of the vitamin on disease activity in SpA and the supplementation recommendations for patients with these conditions, the conduction of further studies is required
Habilitation of congenital muscular torticollis – case reports
No full textTortikolis je prirođeni ili stečeni nagnuti položaj glave praćen povišenim tonusom mišića sternokleidomastoideusa (m. SCM) uz ograničenu pokretljivost vratne kralježnice. Karakteristično, glava je flektirana prema skraćenom SCM mišiću, dok je lice rotirano na suprotnu stranu. Jedan je od tri najčešća deformiteta lokomotornog sustava, odmah nakon displazije kuka i deformacija
stopala. Liječi se habilitacijom u obliku vježbi, ali na raspolaganju su i injekcije botulinum toksina, ortoze za vrat ili operacija. Dob djeteta prilikom početka liječenja, kao i intenzitet habilitacije, najvažniji su doprinoseći čimbenici koji određuju trajanje i ishod liječenja. Prikazujemo slučajeve dva djeteta s tortikolisom. U prvom radi se o ženskom djetetu rođenom hitnom sekcijom u 38. tjednu gestacije u stavu zatkom iz prve trudnoće urednog tijeka. Pregled dječjeg fizijatra učinjen je u dobi od šest tjedana, na kojem se klinički prezentira ljevostranim tortikolisom, te se odmah uključuje u habilitaciju ambulantno i kroz dnevnu bolnicu. Roditelji su kod kuće svakodnevno višekratno provodili vježbe prema edukaciji više od jedan sat. U dobi od devet mjeseci i deset dana postignuta je rezolucija malpozicije; lateralna fleksija i rotacija vrata bile su slobodne. U drugom slučaju radi se o muškom djetetu rođenom u terminu vaginalno iz prve trudnoće komplicirane manjim krvarenjem. U 14. danu života ultrazvukom su verificirane hiperehogene promjene u desnom m. SCM-u. U dobi od pet tjedana pregledan je od strane dječjeg fizijatra i
uključen u habilitaciju istim modalitetom i dinamikom. Roditelji su kod kuće provodili propisane vježbe manje od jedan sat. U dobi od dvije godine i četiri mjeseca i dalje perzistira asimetričan položaj glave, iako nešto blaže ekspresije. Zaključno, uz habilitaciju ambulantnim putem i kroz dnevnu bolnicu neizostavno je svakodnevno, višekratno i intenzivno provođenje vježbi prema edukaciji strane roditelja kod kuće kako bi se ranije postigao optimalni ishod habilitacije kongenitalnog mišićnog tortikolisa.Torticollis is a congenital or acquired tilted head position accompanied by an increased tone of the sternocleidomastoid muscle (SCM) with limited neck mobility. Characteristically, the head is flexed towards the shortened SCM, while the face is rotated to the opposite side. Following foot deformities and hip dysplasia, it is one of the three most prevalent locomotor deformities. Exercises are performed as a type of habilitation, other options include botulinum toxin injections, neck orthoses, and surgery. The most significant determinants of treatment duration and outcome are the age at the beginning of treatment and the intensity of habilitation. We present two cases of torticollis. In the first: a female child delivered in a breech position at 38 weeks via emergency section from a first normal-course pregnancy. The pediatric physiatrist revealed left-sided torticollis at the age of six weeks and referred to habilitation in outpatient settings and throughout the daycare hospital. Parents carried out the exercises at home for more than one hour daily. The resolution of malposition was accomplished at nine months and ten days; lateral flexion and neck rotation were within normal range. In the second: a male child delivered vaginally at term from a first pregnancy complicated by minor bleeding. On the 14th day of life, hyperechoic changes in the right SCM were verified by an ultrasound. After examining the child at five weeks of age, the pediatric physiatrist recommended habilitation of the same modality and dynamics. However, parents carried out the exercises for less than one hour. At two years and four months, the asymmetrical head position persists, although with milder expression. In conclusion, in addition to habilitation in outpatient settings and through the day-care hospital, it is necessary to perform exercises multiple times daily at home to achieve the optimal outcome sooner
The value of C-reactive protein and peritoneal cytokines as early predictors of anastomotic leak after colorectal surgery
No full textObjectives: The aim of this study was to evaluate the accuracy of serum C-reactive protein (CRP) and intraperitoneal CRP, interleukin-6, and tumor necrosis factor-alpha in early diagnostics of anastomotic leakage in the first 4 postoperative days after colorectal surgery. Methods: Between January 2023 and June 2023, one hundred patients with colorectal carcinoma were operated on with primary anastomosis. Ten patients had anastomotic leak (10%). Results: Based on serum CRP, a patient with a leak will be detected with a 78% probability on postoperative day 3 with values above 169.0 mg/L and on postoperative day 4 with values equal to 159.0 mg/L and above. Intraperitoneal CRP values greater than 56 mg/L on the fourth postoperative day indicate a 78% probability of a diagnosis of leakage. An anastomotic leak will be detected with a 70.0% probability based on an IL-6 value on the first day, at a cut-off value of 42,150. The accuracy of TNF-alpha in predicting anastomotic leak in the first two days is 70% at values higher than 78.00 on the first and 58.50 on the second postoperative day. Conclusion: In this study serum CRP proved to be the most accurate in predicting anastomotic dehiscence after colorectal surgery
Plan upravljanja istraživačkim podacima (PUIP) Thyrogenemark
No full textPlan upravljanja istraživačkim podacima u svrhu projekta Thyrogenemark, HRZZ IP 2019/0
Management of a rapidly enlarging supraclavicular mass of unknown aetiology
No full textIntramuscular haemangiomas are benign tumours showing an extremely rare occurrence and making up less than 1% of all haemangiomas. The goal of this case report is to share our experience in treating a patient with an extremely rare intramuscular haemangioma, which occurred in the supraclavicular region VB level of the neck and extended towards the infraclavicular space, localised within and inferior to the trapezius muscle. The lesion was diagnosed by using multimodal imaging and a wide excision was performed with intraoperative feeding vessel ligation and a good postoperative result. The main difficulties regarding diagnosis and treatment include a lack of evidence-based guidelines, due to limited publications on this topic, the nature of the lesion frequently showing obscure anatomic localisation deep within muscles and unclear delineation, various anatomic origin requiring an individual treatment approach, inconclusive radiologic signs as well as non-specific symptoms
Correlation between Structural and Functional Changes in Patients with Raised Intraocular Pressure Due to Graves’ Orbitopathy
No full textThis study explores the complication of secondary intraocular pressure (IOP) elevation and consequent glaucoma development in Graves’ orbitopathy (GO), an autoimmune disorder associated with hyperthyroidism. Utilizing Octopus 900 visual field testing and optical coherence tomography (OCT), the research established correlations between functional and structural changes in optic nerve regions in patients with GO and patients with GO with elevated IOP (GO IOP) groups. A comparison with primary open-angle glaucoma (POAG) was conducted in a cohort of 182 subjects. The study identifies optic nerve head parameters that effectively differentiate changes in GO and GO IOP groups. In the GO group, the strongest correlation between structural and functional changes was observed in sector 7, while in the GO IOP group, it was in sectors 1 and 7. For POAG, correlation was found in six sectors. Elevated IOP in GO correlates with structural and functional impairments similarly to early glaucoma. Risk factors for GO-related elevated IOP included older age, longer duration of thyroid disease, and higher anti-thyroglobulin values. The study highlights the significance of regular IOP measurements, visual field assessments, and OCT examinations in GO patients. Early antiglaucoma intervention is warranted when characteristic structural and functional changes and/or risk factors are identified
Masqueraded sebaceous gland carcinoma of the lower eyelid in a young pregnant patient
No full textThe purpose of this case report is to present misdiagnosed sebaceous gland carcinoma of the lower eyelid with rapid growth in a young woman during pregnancy. Eyelid sebaceous gland carcinoma is a relatively rare tumor and a disease primarily of older patients. It occurs more commonly in oriental populations and with a predilection for the upper eyelid. Early diagnosis and appropriate treatment may help improve disease control and patient survival