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Radical right upper bilobectomy with resection of five infiltrated ribs and polytetrafluoroethylene (PTFE) reconstruction of right hemithorax : A case report
No full textRadical lung lobectomies can sometimes be challenging. A need for radical surgical resection with clear borders and margins sometimes requires extensive surgery with ribs resection and reconstruction with a muscle flap or artificial materials like PTFE mesh
Resection of a pleuropulmonary solitary fibrous tumor via video-assisted thoracoscopic surgery (VATS) : A case report
No full textPleuropulmonary solitary fibrous tumors are rare mesenchymal neoplasms with intermediate biological potential and rarely metastasize. In some cases (10-30%), solitary fibrous tumors can recur or metastasize. The risk factors include large tumors of at least 10 cm in size, necrotic nonpedunculated tumors, severe atypia, mitotic count of at least four mitoses per 10 highpower fields, and a Ki67 labeling index of at least 2%. Both female and male patients are affected, usually aged 40-70 years. Pleural tumors are usually discovered incidentally and are mostly asymptomatic. They are well-defined on CT scans, often can be lobulated, and show low metabolical activity on PET/CT scans. Radical surgical resection is the best treatment method, and long-term surveillance is advised
Platelet Serotonin (5-HT) Concentration, Platelet Monoamine Oxidase B (MAO-B) Activity and HTR2A, HTR2C, and MAOB Gene Polymorphisms in Asthma
No full textThe complex role of the serotonin system in respiratory function and inflammatory diseases such as asthma is unclear. Our study investigated platelet serotonin (5-HT) levels and platelet monoamine oxidase B (MAO-B) activity, as well as associations with HTR2A (rs6314; rs6313), HTR2C (rs3813929; rs518147), and MAOB (rs1799836; rs6651806) gene polymorphisms in 120 healthy individuals and 120 asthma patients of different severity and phenotypes. Platelet 5-HT concentration was significantly lower, while platelet MAO-B activity was considerably higher in asthma patients; however, they did not differ between patients with different asthma severity or phenotypes. Only the healthy subjects, but not the asthma patients, carrying the MAOB rs1799836 TT genotype had significantly lower platelet MAO-B activity than the C allele carriers. No significant differences in the frequency of the genotypes, alleles, or haplotypes for any of the investigated HTR2A, HTR2C and MAOB gene polymorphisms have been observed between asthma patients and healthy subjects or between patients with various asthma phenotypes. However, the carriers of the HTR2C rs518147 CC genotype or C allele were significantly less frequent in severe asthma patients than in the G allele carriers. Further studies are necessary to elucidate the involvement of the serotonergic system in asthma pathophysiology
Evaluacija blink refleksa između pacijenata s idiopatskom neuralgijom trigeminusa i zdravih dobrovoljaca
No full textThe purpose of the study was to find differences in the parameters of the response to the blink reflex (BR) between patients with idiopathic trigeminal neuralgia (TN) and health volunteers. A prospective cohort study was conducted over 2 years. The TN-subgroup included 15 patients (mean age / SD 62.3 ± 10.7 years). Pain-free and healthy volunteers as a HV-subgroup (mean age
/ SD: 30.8 ± 8.1 years) were recruited from asymptomatic students of dental medicine. Diagnostic parameters were determined by measuring latency to the onset of the BR components from electric stimulation. The following branches of the trigeminal nerve were affected: maxillary branch only (26.7%), mandibular branch only (20%), combined: ophthalmic branch with maxillary branch (6.7 %), and ophthalmic branch with mandibular branch (6.7%) respectively, combined maxillary and mandibular branch (26.7%) and affected all three branches (13.4%). The latencies of the BR, left and right side together, between subgroups were significantly higher for values R1 (homolateral early response), R2 (homolateral late response), R2c latency (contralaterally expressed response) in the TN-subgroup (p 0.05). Blink-reflex parameters (R1, R2 and R2c) were significantly abnormal comparing TN-patients with healthy volunteers. The R3 component of the BR was related to noxious stimuli, likewise by innocuous stimuli.Svrha istraživanja bila je pronaći razlike u parametrima latencija blink refleksa (BR) između pacijenata s idiopatskom neuralgijom
trigeminusa (NT) i zdravih dobrovoljaca. Prospektivna kohortna studija provedena je tijekom 2 godine. Podskupina NT uključivala je 15 pacijenata (srednja dob / SD 62, 3±10, 7 godina). Bezbolni i zdravi dobrovoljci kao podskupina HV (srednja dob / SD: 30, 8±8, 1 godina) regrutirani su od asimptomatskih studenata stomatologije. Dijagnostički parametri određeni su mjerenjem latencije do početka refleksnih komponenti od električne stimulacije. Zahvaćene su sljedeće grane trigeminalnog živca: samo maksilarna grana (26,7%), samo mandibularna grana (20%), kombinirano: oftalmička grana s maksilarnom granom (6,7%), odnosno oftalmička grana s mandibularnom granom (6,7%), kombinirana maksilarna i mandibularna grana (26,7%) i zahvaćene sve tri grane živca (13,4%). Latencije BR-a zajedno lijeve i desne strane između podskupina bile su značajno veće za vrijednosti R1 (homolateralni rani odgovor), R2 (homolateralni kasni odgovor), R2c latencije (kontralateralno izražen odgovor) u NT-podskupini (p0,05). Parametri BR-a (R1, R2 i R2c) bili su značajno abnormalni pri usporedbi NT-pacijenata sa zdravim dobrovoljcima. R3 komponenta refleksa bila je povezana sa noksičnim podražajima, a isto tako s bezazlenim podražajima
Spinalni subduralni hematom povezan s lumbalnom punkcijom - prikaz slučaja
No full textSpinal subdural hematoma caused by lumbar puncture is a rare state of acute blood clot in spinal subdural space, and in some cases, it can be the cause of local compression and consecutive neurological symptoms. We present a 36-year-old female patient who was hospitalized due to persistent headache despite pharmacological therapy. Therefore, we performed lumbar puncture in order to measure intracranial pressure and evaluate cerebrospinal fluid. After lumbar puncture, the patient was complaining of pain in the lumbar region. Emergency magnetic resonance imaging (MRI) of the lumbosacral (LS) region was performed to show acute subdural hematoma of up to 7.3 mm in the dorsal part of the spinal canal at the level of L1 vertebra to the inferior endplate of L4 vertebra. Repeat LS MRI after 3 hours showed unchanged finding. The patient reported gradual regression of pain in the LS region over the next few days, therefore conservative treatment was applied. Patients with a previously known blood clotting disorder and patients on anticoagulation therapy have worse outcome as compared with patients without such disorders. During treatment, it is necessary to monitor patient clinical state and consider the need of surgical treatment.Spinalni subduralni hematom uzrokovan lumbalnom punkcijom je rijetko stanje akutnog nakupljanja krvi u spinalnom subduralnom prostoru, što u nekim slučajevima može dovesti do kompresivnog učinka i razvoja neurološkog deficita. Prikazujemo
bolesnicu u dobi od 36 godina koja je hospitalizirana zbog obrade glavobolja. Učinjena je lumbalna punkcija nakon koje se bolesnica žalila na bol u lumbalnoj kralježnici. Hitno je učinjena magnetska resonancija (MR) lumbalne kralježnice koja je pokazala akutni subduralni hematom od 7,3 mm u dorzalnom dijelu spinalnog kanala od trupa kralješka L1 do donje pokrovne plohe kralješka L4. Ponovljena MR lumbalne kralježnice nakon 3 sata pokazala je nepromijenjen nalaz. Bolesnica je tijekom hospitalizacije cijelo vrijeme urednog neurološkog statusa s postupnom regresijom bolova u lumbalnoj kralježnici te je provedeno konzervativno liječenje. Bolesnici s ranije poznatim poremećajima zgrušavanja krvi i bolesnici na antikoagulantnoj terapiji imaju lošiji ishod liječenja nakon godine dana u odnosu na bolesnike bez poremećaja zgrušavanja krvi. U tijeku liječenja treba pratiti kliničko stanje bolesnika te razmotriti potrebu operativnog liječenja
Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry
No full textBackground and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF).
Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest.
Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19).
Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death
Cholesterol – The Lower the Better?
No full textOdnos razine serumskoga kolesterola i rizika za moždani udar složen je, oprečan i prisutan u širokom rasponu serumskih razina ukupnoga kolesterola, LDL-a i HDL-a. Različite tvari različitog mehanizma djelovanja, ali s istim ciljem snižavanja razine serumskog LDL-a, statini, ezetimib i PCSK9 inhibitori snizuju incidenciju ishemijskoga moždanog udara, što izravno upućuje na uzročno-posljedičnu povezanost snižavanja serumske razine LDL-a i sprječavanja nastanka moždanog udara. Upozorenja o mogućemu povećanom riziku za hemoragijski moždani udar na temelju rezultata SPARCL istraživanja i statistički neznačajno povećanje rizika naznačeno u rezultatima IMPROVE-IT, FOURIER i Cholesterol Treatment Trialist metaanalize moguće upućuju kako bi značajno snižavanje LDL-C-a moglo uzrokovati hemoragijski moždani udar u posebno ranjivoj podskupini bolesnika, osobito u žena i bolesnika s loše reguliranom arterijskom hipertenzijom. S obzirom na to da je hemoragijski moždani udar u usporedbi s ishemijskim moždanim udarom rijedak, zabrinutost zbog mogućega povećanog rizika za hemoragijski moždani udar ne smije zasjeniti dobrobit od primjene lijekova za snižavanje LDL-C-a i boljeg ishoda vaskularnih bolesti u bolesnika liječenih ovom terapijom. Nužno je utvrditi stratifikaciju različitih kategorija bolesnika s obzirom na rizične čimbenike, kao i s obzirom na spol i životnu dob, te primijeniti individualan pristup i personalizaciju liječenja, kako u primarnoj tako i u sekundarnoj prevenciji moždanog udara.The correlation between serum cholesterol levels to stroke risk is complex and contradictory, and exists in a whole scope of serum levels of total cholesterol, LDL and HDL. Different substances with different action mechanisms, but with a shared goal of lowering serum LDL levels, statins, ezetimibe and PCSK9 inhibitors, reduce the incidence of IS (ischemic stroke), which directly suggests a cause-and-effect link between lowering serum LDL levels and preventing stroke. Warnings of a possible increased risk of hemorrhagic stroke (HS) based on the results of the SPARCL study and a statistically insignificant increase in risk indicated in the IMPROVE-IT and FOURIER results, as well as Cholesterol Treatment Trialist meta-analyses may suggest that a significant reduction in LDL-C could cause HS in a particularly vulnerable subgroup of patients, especially in women and patients with poorly regulated arterial hypertension. As HS is rare compared to IS, concerns about potential increased risk of HS should not overshadow the benefits of LDL-C-lowering drugs and better vascular effects in patients treated with this therapy. It is necessary to determine the stratification of different patient categories in terms of risk factors as well as gender and age, and apply an individual approach and personalised treatment in both primary and secondary prevention of stroke
Prikaz rijetkog slučaja hamartoma larinksa
No full textHamartoma (from the Greek language, where hamartia means defect or an error and -oma denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells that are present in abnormal proportions or show a disorganized arrangement. Hamartomas are rarely seen in the head and neck area and especially rare in the larynx. Only few cases of laryngeal
hamartoma have been reported in the literature so far. They are usually manifested by stridor, dysphonia and symptoms associated with airway obstruction. The diagnosis must be confirmed histologically and the method of choice in treatment is complete excision of the lesion. The authors present a case of laryngeal hamartoma of a 43-year-old woman treated for hoarseness and paralysis of the left vocal cord.Hamartom (iz grčkog hamartia, što znači greška, defekt i -oma, označava tumor ili neoplazmu) je benigna masa izgledom slična tumoru, sastavljena od zrelih tkiva ili stanica koje pokazuju poremećaj proporcija ili se pojavljuju u neorganiziranom rasporedu. Hamartomi rijetko zahvaćaju područje glave i vrata, a još rjeđe ih pronalazimo u području larinksa. Dosad je u literaturi opisano samo nekoliko slučajeva laringealnih hamartoma. Najčešće se manifestiraju stridorom, disfonijom te simptomima vezanim uz opstrukciju dišnih putova. Dijagnoza se postavlja patohistološki, a metoda izbora u liječenju je potpuna ekscizija lezije. Autori prikazuju slučaj laringealnog hamartoma u 43-godišnje žene obrađivane zbog promuklosti i pareze lijeve glasnice
Transvenozni pristup za indirektnu karotidno kavernoznu fistulu koristeći odvojive zavojnice: prikaz slučaja i pregled metoda liječenja
No full textCarotid-cavernous fistula (CCF) is a relatively rare pathology with a low incidence compared with other vascular pathologies. They can be classified based on hemodynamics as low- or high-flow fistulas, and anatomically as direct or indirect fistulas. Anatomy of the shunt somewhat dictates the selection of endovascular treatment, meaning the venous or arterial approach and selection of
embolizing materials. Although there is general agreement as to when to access CCF transvenously or transarterialy, which depends on the shunt being direct or indirect, there is no uniform agreement on which occlusion method should be used. Herein, we report a case of an 80-year-old woman treated for indirect CCF using detachable coils. We also provide a brief review of the literature, including recent advances in treatment of said entities. In conclusion, selection of both the approach and material used
depends on the operator’s experience and preference.Karotidno kavernozna fistula je relativno rijetka patologija s niskom incidnecijom u odnosu na ostale vaskularne abnormalnosti. Hemodinamski se dijele na niskoporotočne i visokoprotočne, a anatomski na direktne i indirektne. Anatomija fistule određuje vrstu endovaskularnog tretmana, dakle arterijki ili venski pristup, kaoo I vrstu materijala kojom se vrši embolizacija. Iako postoji opći konsenzus oko primjene arterijskog ili venskog pristupa, ovisno o tome je li fistula direktna ili indirektna, ne postoji uniformni dogovor koja bi se metoda trebala koristiti u pojedinačnim slučajevima. Ovim radom smo prikazali slučaj osamdesetogodišnje bolesnice koja je liječena radi indirektne karotidno kavernozne fistule koristeći zavojnice. Također, prikazan je pregled literature i recentnog napretka u liječenju spomenutih entiteta. Zaključno, kako izbor pristup tako i izbor materijala ovise o iskustvu te preference operatera