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Fibrous Dysplasia – A Rare Occurence in the Temporal Bone: A Case Report
No full textCilj: Fibrozna je displazija rijedak, dobroćudan poremećaj u kojem tijelo zdrave koštane elemente zamjenjuje vezivnim tkivom. Ovaj prikaz slučaja prezentira bolesnicu s fibroznom displazijom temporalne kosti koja odstupa od tipične kliničke slike – zahvaćenost temporalne kosti te incidencija bolesti u odrasloj dobi vrlo je rijetka pojavnost. Prikaz slučaja: 61-godišnja bolesnica prezentira se glavoboljom, šumom u uhu te oslabljenim sluhom. Zamjedbena nagluhost inicijalno je dijagnosticirana tijekom audiološke obrade. Kompjutorska tomografija (engl. computerized tomography; CT) mozga prikazuje ekspanzivnu, oštro ograničenu leziju dorzalnog dijela piramide lijeve temporalne kosti sa širenjem u mastoidne celule. Magnetska rezonancija (MR) piramida temporalnih kosti i unutrašnjeg uha prikazuje dvije ekspanzivne formacije – jednu u području klivusa i drugu u piramidi lijeve temporalne kosti. Kombinirani nalazi CT-a i MR-a ukazuju na to da se radi o fibroznoj displaziji, no potrebna je patohistološka potvrda kako bi se isključio malignitet. Stoga je učinjena mastoidektomija s redukcijom tvorbe. Pristigao patohistološki nalaz prikazuje sklerotičnu kost s nepravilnim koštanim trabekulama. Takve promjene odgovaraju fibroznoj displaziji. Učinjen je low-dose CT (LDCT) cijelog tijela koji ukazuje da nema promjena u sklopu osnovne bolesti. Za leziju u području klivusa neurokirurg se odlučio za pristup wait and watch s obzirom na to da je pacijentica poslije operacije asimptomatska. Bolesnica je pod redovitom kontrolom otorinolaringologa i neurokirurga, s dobrim funkcionalnim rezultatima, bez subjektivnih tegoba u vidu glavobolje, dok je sluh ostao stacionaran. Zaključak: Ovaj prikaz slučaja ističe važnost operativnog liječenja u svrhu potvrđivanja dijagnoze te redovitog praćenja u odabranim slučajevima fibrozne displazije temporalne kosti.Aim: Fibrous dysplasia is a rare and benign disorder, in which normal bone elements are replaced by fibrous tissue. Temporal bone involvement and adult onset of disease is least frequently reported. Case Report: A case of fibrous dysplasia of temporal bone in a 61-year-old female which presented with a headache, tinnitus and hearing loss is reported. Sensorineural hearing loss was the initial finding on the audiogram. Computed tomography showed an expansive, strictly limited sclerotic lesion of the dorsal part of the pyramid of the left temporal bone spreading into the mastoid cells. Magnetic resonance of the temporal bone and inner ear showed two expansive formations – one in the clivus and the other in the pyramid of the left temporal bone. Both CT and MRI pointed to fibrous dysplasia, but definite histopathological finding was required to exclude malignancy. Mastoidectomy with a reduction of lesion was performed. Histopathological examination revealed sclerotic bone with irregular bony trabeculae – fibrous dysplasia. Whole body low-dose computed tomography was performed and no other occurrences of fibrous dysplasia were detected. For the clival lesion neurosurgeon decided for the „wait and watch policy“ as the patient was asymptomatic after the surgery. Patient is under regular follow-up for both otorhinolaryngologist and neurosurgeon with good functional results, without subjective complaints of headaches, while hearing remained stationary. Conclusion: This case highlights the importance of surgery as a confirmation for diagnosis and regular follow-up in selective cases of temporal bone fibrous dysplasia
CHANGE IN GINGIVAL VOLUME AND QUALITY OF LIFE FOLLOWING INITIAL PERIODONTAL THERAPY IN SMOKERS
No full textCiljevi istraživanja: Ciljevi istraživanja bili su kvantificirati promjene u volumenu mekog tkiva uslijed inicijalne parodontne terapije u nepušača i pušača s parodontitisom koristeći novi digitalni pristup, te utvrditi povezanost tih promjena s kliničkim parodontnim parametrima. Nadalje, OHIP upitnik prilagođen za parodontne bolesti preveden je na hrvatski jezik i validiran, te je procijenjen utjecaj parodontnih bolesti i inicijalne parodontne terapije na kvalitetu života ispitanika (QoL). Ispitanici i metode: U istraživanje je uključeno 20 nepušača i 19 pušača s parodontitisom. Svi su ispitanici podvrgnuti kliničkom parodontološkom pregledu i intraoralnom skeniranju na početku i 8 tjedana nakon terapije. Digitalni modeli su superponirani, a promjene u volumenu su kvantificirane i korelirane s kliničkim parametrima. Valjanost i pouzdanost hrvatske verzije OHIP-a testirana je na 150 ispitanika - 50 parodontno zdravih, 50 s gingivitisom i 50 s parodontitisom. Procijenjen je utjecaj parodontnih bolesti na kvalitetu života. Analizirane su promjene kvalitete života uslijed inicijalne parodontne terapije. Rezultati: Promjena volumena u skupini nepušača iznosila je 149,1 mm3 (95% CI; 92,4-238,9) u maksili, 115,1 mm3 (55,9-205,1) u mandibuli i 267,4 mm3 (160,4-510,5) kada su promatrane obje čeljusti. U skupini pušača promjena volumena bila je 109,9 mm3 (21,9-52,3), 102,6 mm3 (54,6-151,9), odnosno 210,5 mm3 (122,2-336) u maksili, mandibuli i objema čeljustima. Promjene volumena pokazale su značajnu korelaciju s kliničkim parametrima, osobito s dubinom sondiranja, PISA-om i indeksima krvarenja i plaka. Inicijalna parodontna terapija značajno je poboljšala kvalitetu života kod nepušača s parodontitisom. Zaključak: Inicijalna parodontna terapija uzrokuje značajno smanjenje volumena mekih tkiva u obje skupine, bez značajnih razlika obzirom na pušački status. Hrvatska verzija OHIP upitnika može se smatrati primjerenom za mjerenje utjecaja parodontnih bolesti na QoL. Parodontne bolesti, osobito parodontitis, negativno utječu na kvalitetu života pacijenata. Inicijalna terapija može poboljšati kvalitetu života kod nepušača s parodontitisom.Objectives: The study aimed to quantify changes in soft tissue volume induced by nonsurgical
periodontal therapy (NSPT) in non-smokers and smokers with periodontitis using a novel digital
approach, and to correlate these changes with clinical periodontal parameters. Moreover, the
study aimed to translate and validate the condition-specific Oral Health Impact Profile (OHIP) in
the Croatian cultural context and assess the impact of periodontal diseases and NSPT on quality
of life (QoL).
Patients and Methods: Twenty non-smokers and 19 smokers with periodontitis were included
in the investigation. All participants underwent clinical periodontal examination and intraoral
scanning at baseline and 8 weeks after NSPT. The digital models were superimposed, and
changes in volume were analyzed and correlated with clinical periodontal parameters. The
validity and reliability of the Croatian version of OHIP were tested on 150 individuals - 50
periodontally healthy, 50 with gingivitis and 50 with periodontitis. The impact of periodontal
diseases on QoL was assessed. Changes in QoL induced by NSPT were analyzed.
Results: NSPT induced a significant reduction in soft tissues in both groups. The median change
in volume in the non-smoking group was 149.1 mm3 (95% CI: 92.4-238.9) in the maxilla, 115.1
mm3 (55.9-205.1) in the mandible and 267.4 mm3 (160.4- 510.5) when combining both jaws. In
the smoking group, the median volume change was 109.9 mm3 (21.9-52.3), 102.6 mm3 (54.6
151.9), and 210.5 mm3 (122.2- 336) in the maxilla, mandible and both jaws, respectively.
Clinical periodontal parameters significantly correlated with volume changes, particularly
probing depth, PISA, and bleeding and plaque scores. NSPT significantly improved the QoL in
non-smokers with periodontitis.
Conclusion: Analysis showed significant reduction in soft tissue volume following NSPT, albeit
without significance between smokers and non-smokers. The condition-specific Croatian version
of the OHIP instrument can be considered adequate to measure the impact of periodontal
diseases on QoL. Periodontal diseases, especially periodontitis, have a negative effect on the
patient's QoL. NSPT can improve QoL in non-smokers with periodontitis
Quantification and Predictors of Hemoglobin Drop, Hidden Blood Loss and Irrigation Fluid Retention in Shoulder Arthroscopy
No full textBackground: Shoulder arthroscopy is a common, minimally invasive surgery, but the resulting postoperative blood loss remains poorly understood. In this study, we quantified the intraoperative and postoperative blood loss, the hemoglobin (Hb) drop, and the effects of irrigation fluid retention, as well as the influence of solutions administered through infusions. Methods: A prospective observational study of 49 patients undergoing arthroscopic rotator cuff tear (RCT) repair was conducted. Their preoperative and postoperative Hb levels were measured, along with the intraoperative and postoperative blood loss. Irrigation fluid retention was analyzed, and multiple regression was used to assess the factors contributing to Hb drops. Results: The intraoperative blood loss amounted to 36.46 ± 20.34 mL, while the total blood loss reached 791.17 ± 280.96 mL, with 94.64% occurring postoperatively. The postoperative Hb drop (2.06 ± 0.74 g/dL) was significantly greater than the intraoperative Hb drop (0.11 ± 0.06 g/dL) (p < 0.001). An older age (p = 0.02) and male sex (p = 0.025) significantly predicted the postoperative Hb drop, while irrigation fluid retention and administration of crystalloids and colloids had no notable effects. Capsulotomy was associated with a small but significant increase in intraoperative blood loss (p < 0.01). Increased intraoperative blood loss correlated with greater irrigation fluid retention (r = 0.41, adjusted R2 = 0.152, p < 0.001). Conclusions: In shoulder arthroscopy, the postoperative blood loss and Hb drop are significantly greater than the intraoperative blood loss and Hb drop, as well as the fluid gain, emphasizing the need for careful monitoring, especially in high-risk patients. Future studies should investigate the potential impacts of low-molecular-weight heparin on postoperative bleeding after shoulder arthroscopy
Management of liver sinusoidal obstruction syndrome/veno-occlusive disease in adults: a 2025 perspective from an international expert group
No full textinusoidal obstruction syndrome (SOS) formerly known as Veno-occlusive disease (VOD) is a potentially fatal complication that occurs mainly after haematopoietic cell transplantation, especially allogeneic transplantation. The liver is the principal organ affected, though other organs, such as the lungs, may also be involved to a lesser extent. The condition is characterised by obstruction of the hepatic venules, leading to sinusoidal congestion, hepatic ischaemia and, in severe cases, fulminant liver failure. Recent refined diagnostic criteria, published by the European Society for Blood and Marrow Transplantation in 2023, provide a more accurate method of detecting SOS/VOD, allowing earlier intervention and better stratification of patients according to the severity of their disease. This article focuses on liver SOS/VOD and discussing key risk factors, new diagnostic methods and therapeutic strategies, with an emphasis on the early use of defibrotide, which remains the reference treatment for severe SOS/VO
Congenital pseudoarthrosis of the clavicle
No full textUrođena pseudoatroza ključne kosti iznimno je rijetka anomalija obilježena nesrastanjem medijalne i lateralne osifikacijske jezgre. Prvi put je opisana 1910. godine i od tada je zabilježeno tek tristotinjak slučajeva. Pojavnost ove anomalije je oko 1:150.000, a dijagnoza se većinom postavi u adolescentskoj dobi. U ranijoj dobi često se previdi jer se zadebljanje ključne kosti protumači kao posttraumatski kalus. Ključna kost je prva kost koja osificira intrauterino s razvijenim osifikacijskim centrima (medijalni i latealni) već sredinom četvrtog tjedna gestacije, koji se međusobno spoje krajem sedmog tjedna. Veći dio ključne kosti razvija se iz medijalnog dijela (oko 80%). Prvi radiološki znakovi okoštavanja medijalnog kraja vide se između 13. i 14. godine života. Etiologija još uvijek nije razjašnjena. Jedna teorija povezuje pojavu povišenog pritiska potključne arterije, druge ju povezuju s intrauternim položajem fetusa ili kao mogući nasljedni poremećaj. Liječenje prirođene pseudoartroze ključne kosti kontraverzno je. Opisani slučajevi većinom su liječeni konzervativno, osobito ako su bili asimptomatski. Kirurški su pak liječeni oni s funkcionalnim ograničenjima, iz estetskih razloga, te djeca koja su osjećala progresivnu bol. Kirurško liječenje se preporučuje i kod djece kojima su ulomci razmaknuti više od 1 cm. Predložene tehnike za stabilizaciju su različite: intramedularna Kirschnerova žica, pločica i vijci, Steinmannov čavao te vanjska fiksacija. U većini slučajeva potreban je koštani transplantat, osobito u starije djece, a najčešće mjesto donora je krista ilijaka. Optimalna dob za operativno liječenje jest između treće i šeste godine života, kada je mogućnost komplikacija najmanja. Prijelomi ključne kosti i urođena pseudartroza teško se razlikuju kod male djece, osobito pri prvom pregledu. Iako je urođena pseudartroza rijetka, treba na nju misliti jer neliječena u predškolskoj dobi može imati lošije ishode u kasnijoj dobi. Autori u ovom radu daju pregled dosadašnjih spoznaja o urođenoj pseudoartrozi ključne kosti te razmatraju terapijske postupke.Congenital pseudarthrosis of the clavicle is an extremely rare anomaly characterized by the failure of fusion between the medial and lateral ossification centers. First described in 1910, only about 300 cases have been documented since. The incidence of this anomaly is approximately 1 in 150,000, with diagnosis mostly occurring in adolescence. In early childhood, it is often overlooked as clavicular thickening may be misinterpreted as a post-traumatic callus. The clavicle is the first bone to ossify in utero, with developed ossification centers (medial and lateral) by the middle of the fourth week of gestation, which fuse by the end of the seventh week. Most of the clavicle develops from the medial part (around 80%). The initial radiographic signs of ossification at the medial end become visible between the ages of 13 and 14. The precise etiology of this malformation remains unclear. One theory links it to increased pressure from the subclavian artery, while others associate it with fetal intrauterine positioning or a possible hereditary disorder. The treatment of congenital pseudarthrosis of the clavicle is controversial. Most documented cases have been treated conservatively, especially if asymptomatic. Surgical intervention is reserved for those with functional limitations, esthetic concerns, or progressive pain. Surgery is also recommended in children with a gap between fragments exceeding 1 cm. Various stabilization techniques have been proposed, including intramedullary Kirschner wire, plates and screws, Steinmann pins, and external fixation. Bone grafting is often required, especially in older children, with the iliac crest being the most common donor site. The optimal age for surgical treatment is between three and six years, as complication rates are lower. Clavicle fractures and congenital pseudarthrosis are challenging to distinguish in young children, especially during initial examination. Although congenital pseudarthrosis is rare, it should be considered as untreated cases in preschool years may result in poorer outcomes later. The authors of this paper provide a review of current knowledge on congenital pseudarthrosis of the clavicle and discuss therapeutic approaches
Intussusception in children : graduation/master's thesis
No full textIntussusception is a common pathology that affects primarily children from different age groups. It has several causes but for the majority the etiology is unknown. Anatomical abnormalities are mainly involved in this pathological process whether they already exist or are the products of inflammatory processes. Viral infections play an important role in intussusception formation. The clinical presentation is variable according to the severity and age group but principally is characterized by the triad of symptoms of pain, a palpable sausage- shaped abdominal mass, and currant-jelly stool. Sometimes the presentation can be completely atypical, mimicking other pathologies or being completely asymptomatic. The diagnostic process can be challenging. Physicians need a high level of suspicion due to the variability of symptoms. This method is called enema, and it is the non-surgical treatment for intussusception. We have several types according to the meaning of propulsion used, varying from simple saline solution to barium. If the enema fails or complications are present such as peritonitis or perforation, then surgical intervention is required. The operation consists in opening the abdomen, reaching the intussusception point, gently entangling the intestine, and repositioning everything in the abdominal cavity.Laparoscopy reduces the risk of infection, complications and traumas that an open surgery can cause
Pharmacogenomics - impact on cytochrome p450 system and drug metabolism
No full textTo sum up pharmacogenomics is a broad and evolving field in genetics and pharmacological perspective. The CYP enzyme system plays a central role in metabolizing approximately 75 % of all medication. This system is categorized into 3 families- CYP1, CYP2 and CYP3. The isoforms CYP3A4 and CYP2D6 alone make about 50 % the drug metabolism. Genetic polymorphisms, that can be grouped according to different types of metabolizers such as UM, EM, IM and PM significantly affect efficacy and toxicity of prescribed drugs. But not only the genetic predisposition is responsible for the metabolization of medications, also external factors such as other drugs, that can act as CYP inducers and CYP inhibitors, or diseases have a big impact on activity of biotransformation and can be summarized under the term phenoconversion. Postmortem studies demonstrate how important it is to consider those drug- drug-gene interactions are. To reduce the risk of adverse events and increase the therapeutic effect of prescribed drugs, databases such as CPIC, PharmGKB and PharmVar provide clinical guidelines to help physicians to avoid inadequate prescriptions and provide proper dosages. Integrating pharmacogenomic testing into routine medical practice becomes more and more essential. Doing so will enhance patient safety, support personalized medicine and ensure effective and save treatment for everyone
How nutrition influences the gut - brain axis : graduation thesis
No full textNutrition is a fundamental part of human health, playing a key role in regulating many physiological functions. One crucial system that is influenced by nutrition is the gut-brain axis. This axis can be described as a complex and bidirectional communication network between the gastrointestinal tract and the brain. Additionally, it is involved in different processes, such as neurotransmitter production, immune system regulation, and maintaining various physiological processes in balance. An important part of this network is the gut microbiota, which is a diverse community of microorganisms living within a dynamic ecosystem. These microbes produce byproducts known as postbiotics or metabolites, which can either support or disrupt gut-brain communication. Through their role in gut-brain signaling, these compounds significantly influence metabolic health, immune function, and gastrointestinal health. Diet is believed to be one of the most powerful modulators of the gut microbiome. Research shows that a well-balanced diet, rich in vegetables, fruits, whole grains, and unsaturated fatty acids coming from sources such as olive oil, nuts, and fish, alongside moderate intake of meat and dairy, can most effectively support a healthy and diverse microbial community. Those dietary patterns help reduce inflammation, restore balance, and improve symptoms associated with gut-related disorders. However, any metabolite disturbances may contribute to a wide range of health issues, including metabolic syndrome, cognitive and mental health disorders, autoimmune conditions, and inflammatory bowel diseases. As demonstrated by numerous studies, diet can serve as an effective addition to both therapeutic and preventive strategies in the management of various diseases
Oxidative stress in cardiac surgery
No full textOksidacijski stres tijekom i nakon kirurških zahvata predstavlja značajan patofiziološki izazov jer može dovesti do oštećenja stanica, pokretanja upalnog odgovora i razvoja brojnih poslijeperacijskih komplikacija. Tijekom operacija, osobito pri korištenju CPB-a, dolazi do povećanog stvaranja ROS-a koji premašuje kapacitet antioksidacijskih obrambenih mehanizama organizma. Glavni izvori ROS-a su ishemijsko-reperfuzijska ozljeda, mehaničko oštećenje tkiva, kontakt krvi s umjetnim površinama i promjene tjelesne temperature tijekom operacije. Oksidacijski stres pridonosi upalnim procesima i oštećenju ključnih biomolekula poput lipida, proteina i DNA, što dovodi do disfunkcije miokarda, aritmija, akutnog oštećenja bubrega i neurokognitivnih komplikacija. Smanjenje oksidacijskog stresa ključno je za očuvanje funkcije organa i poboljšanje poslijeoperacijskog ishoda. Terapijski pristupi uključuju farmakološke metode, poput primjene antioksidacijskih vitamina C i E, trimetazidina, NAC-a i statina, koji pomažu u neutralizaciji ROS-a i očuvanju mitohondrijske funkcije. Nefarmakološke strategije, uključujući optimizaciju tjelesne temperature, korištenje biokompatibilnih materijala u CPB sustavu, prilagodbu perfuzije i primjenu tehnika ishemijskog prekondicioniranja i postkondicioniranja, dodatno doprinose zaštiti tkiva. Naglašena je važnost individualiziranog pristupa pacijentu, prepoznavanju rizika i implementacije kombiniranih terapijskih strategija kako bi se smanjila učestalost komplikacija i poboljšao klinički ishodOxidative stress during and after cardiac surgery represents a significant pathophysiological challenge, contributing to cellular damage, triggering inflammatory responses, and leading to various postoperative complications. During cardiac surgery, particularly when using CPB, the production of reactive oxygen species increases beyond the capacity of the body’s antioxidant defense systems. Major sources of ROS include ischemia-reperfusion injury, mechanical tissue damage, contact between blood and artificial surfaces, and fluctuations in body temperature during surgery. Oxidative stress promotes inflammatory processes and damages key biomolecules such as lipids, proteins, and DNA, resulting in myocardial dysfunction, arrhythmias, acute kidney injury, respiratory disorders, and neurocognitive complications. Reducing oxidative stress is crucial for preserving organ function and improving postoperative outcomes. Therapeutic approaches involve pharmacological methods, such as the use of antioxidant vitamins C and E, trimetazidine, N-acetylcysteine, and statins, which help neutralize ROS and protect mitochondrial function. Non-pharmacological strategies, including temperature control, use of biocompatible materials in CPB systems, perfusion optimization, and ischemic pre-conditioning and post-conditioning techniques, further contribute to tissue protection. The importance of an individualized approach to patient care, risk identification, and the implementation of combined therapeutic strategies to reduce complication rates and enhance clinical outcomes has been emphasized
Treatment of chondral knee lesions
No full textPhysical activity is an important component of health and well-being for people of all ages.
Unfortunately, physical activity also carries a risk of injury. The knee joint, due to its location and complex functioning, is very susceptible to damage. The annual incidence of any clinically diagnosed soft-tissue knee injury for the whole population is estimated to be 720 per 100,000 persons [1]. The knee is the most commonly injured joint by adolescent athletes, with an estimated 2.5 million sports-related injuries presenting to emergency departments annually. [2].
The term chondral knee lesions refer to a damage or an alteration of the physiological structure of the articular cartilage of the knee joint. The cartilage is a white smooth tissue covering the epiphyses of the bones where they come together to form joints. Its function is to reduce friction during movement and provide cushioning to absorb impact. When the cartilage is damaged, it can lead to pain, swelling and reduced function of the knee