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Lymphoceles in kidney transplant patients
No full textKronična bubrežna bolest je rastući javnozdravstveni problem zbog porasta incidencije, progresivne prirode i ozbiljnih komplikacija. Najčešći uzroci su šećerna bolest tip 2, arterijska hipertenzija i glomerulonefritis. Bolest je često neprepoznata do uznapredovalih stadija, kada je potrebno nadomjesno liječenje dijalizom ili transplantacijom bubrega. Transplantacija je najučinkovitiji način nadomjesnog liječenja. Znatno poboljšava kvalitetu života bolesnika i dugoročno preživljenje, ali nosi rizik od kirurških komplikacija. Jedna od čestih komplikacija transplantacije su limfocele, sa potencijalno ozbiljnim posljedicama. Limfocele nastaju nakupljanjem limfne tekućine zbog oštećenja limfnih puteva tijekom operacije i mogu narušiti funkciju presatka kompresijom uretera i okolnih struktura. Većina limfocela je asimptomatska i slučajan su nalaz na redovnim kontrolama te ne zahtijevaju intervencije, dok je simptomatske limfocele potrebno liječiti. Dijagnosticira se sa ultrazvukom zajedno sa aspiracijom sadržaja radi potvrde i razlikovanja od urinoma. Početno, manje invazivno liječenje uključuje aspiraciju, perkutanu drenažu zajedno sa primjenom sklerozantnih sredstava, ali ima veću stopu recidiva. Invazivne i minimalno invazivne metode su otvorena i laparoskopska marsupijalizacija, te laparoskopska fenestracija limfocele.Chronic kidney disease is a growing public health problem due to its increasing incidence, progressive nature and serious complications. The most common causes are type 2 diabetes, arterial hypertension and glomerulonephritis. The disease is often unrecognized until advanced stages, when replacement treatment with dialysis or kidney transplantation is necessary. Transplantation is the most effective method of replacement treatment. It significantly improves the patient's quality of life and long-term survival, but carries a risk of surgical complications. One of the common complications of transplantation is lymphocele, with potentially serious consequences. Lymphoceles are formed by the accumulation of lymphatic fluid due to damage to the lymphatic vessels during surgery and can impair the function of the graft by compressing the ureter and surrounding structures. Most lymphoceles are asymptomatic and are incidental findings during regular check-ups and do not require intervention, while symptomatic lymphoceles need to be treated. It is diagnosed with ultrasound together with aspiration of the contents to confirm and differentiate from urinoma. Initial, less invasive treatment includes aspiration, percutaneous drainage along with the use of sclerosing agents, but has a higher recurrence rate. Invasive and minimally invasive methods include open and laparoscopic marsupialization, and laparoscopic fenestration of lymphocele
Comparison of the Use of Long-Acting and Oral Antipsychotics in the Treatment of the First Psychotic Episode at the Emergency Department of Psychiatry in the Clinical Hospital Rijeka in the Period 2020–2024 and the Rate of Relapse
No full textPrva psihotična epizoda predstavlja kritičnu prekretnicu u liječenju psihotičnih poremećaja, budući da rana i optimalna antipsihotička intervencija može dugoročno poboljšati kliničke ishode te smanjiti učestalost relapsa. U uvodnom dijelu rada razmotreni su psihotični poremećaji te njihova etiologija i dijagnostika s naglaskom na akutne psihotične poremećaje, mehanizmi djelovanja antipsihotika, izazovi vezani uz adherenciju kod peroralnih pripravaka i komplikacije nepravilnog uzimanja lijekova, kao i prednosti dugodjelujućih formulacija koje pružaju stabilniju razinu lijeka u plazmi i smanjuju fluktuacije koncentracije. Pregled literature naglašava važnost prilagodbe terapije profilu nuspojava i farmakokinetičkim svojstvima, pri čemu dugodjelujuće injekcije omogućuju veću kontrolu tretmana i potencijalno poboljšavaju kvalitetu života bolesnika. Ciljevi su bili retrospektivno ispitati razlike u primjeni dugodjelujućih naspram peroralnih antipsihotika i povezanost s relapsom te utjecaj spola na izbor i opću primjenu antipsihotika kod pacijenata s prvom psihotičnom epizodom. Kod 369 bolesnika hospitaliziranih na Zavodu za urgentnu psihijatriju KBC Rijeka u razdoblju od 2020. do 2024. godine, 72 % je primilo peroralne antipsihotike, a 28 % dugodjelujuće formulacije. Rezultati su pokazali ukupnu stopu relapsa od 22,8 %, bez statistički značajne razlike između oralne (24,1 %) i dugodjelujuće terapije (19,4 %), niti unutar spolnih podskupina. Žene su češće liječene dugodjelujućim aripiprazolom i peroralnim pripravcima, dok su muškarci češće primali dugodjelujuće pripravke općenito, a uz dugodjelujući aripiprazol primali su i dugodjelujući paliperidon, haloperidol i flufenazin. Rasprava ukazuje na prednosti dugodjelujućih antipsihotika u poboljšanju adherencije i moguće smanjenje relapsa, uz ograničenja retrospektivnog dizajna, heterogenosti uzorka i neujednačenog praćenja. Zaključci podupiru potrebu za prospektivnim, multicentričnim studijama s ujednačenim i produljenim praćenjem.The first psychotic episode represents a pivotal turning point in the management of psychotic disorders, given that early and optimal antipsychotic intervention can enhance long-term clinical outcomes and reduce relapse frequency. The introduction of this study examines psychotic disorders, their etiology, and diagnostic approaches, with a particular focus on acute psychotic disorders. It also explores the mechanisms of action of antipsychotics, challenges related to adherence with oral formulations, improper medication intake complications, and the advantages of long-acting injectable formulations that provide more stable plasma drug levels and minimize concentration fluctuations. A literature review emphasizes the importance of tailoring therapy to side effect profiles and pharmacokinetic properties, highlighting that long-acting antipsychotics offer greater treatment control and may improve patients' quality of life. The study aimed to retrospectively assess differences in the use of long-acting versus oral antipsychotics, their association with relapse rates, and the influence of sex on the selection and overall application of antipsychotics in patients experiencing their first psychotic episode. Among 369 patients hospitalized at the Department of Emergency Psychiatry, Clinical Hospital Center Rijeka, between 2020 and 2024, 72% received oral antipsychotics, while 28% were administered long-acting formulations. The overall relapse rate was 22.8%, with no statistically significant difference between oral (24.1%) and long-acting therapy (19.4%), nor within sex subgroups. Female patients were more frequently treated with long-acting aripiprazole and oral formulations, whereas male patients more commonly received long-acting formulations in general, including long-acting aripiprazole, paliperidone, haloperidol, and fluphenazine. The discussion highlights the benefits of long-acting antipsychotics in enhancing adherence and potentially reducing relapse rates, while acknowledging limitations such as the retrospective study design, sample heterogeneity, and inconsistent follow-up. The conclusions support the need for prospective, multicenter studies with standardized and extended follow-up periods
Cystic changes of the pancreas -from diagnosis to the therapy-
No full textCistične promjene gušterače čine raznoliku skupinu gušteračnih bolesti koje se osnovno dijele na epitelne i neepitelne, unutar kojih postoje neoplastične i neneoplastične promjene. Iako su u većini slučajeva asimptomatske, sve češće se otkrivaju zahvaljujući intenzivnijoj upotrebi preciznih slikovnih metoda kao što su kompjutorizirana tomografija (CT), magnetska rezonancija (MR) te endoskopski ultrazvuk (EUS). Najčešće otkrivene cistične promjene jesu intraduktalna mucinozna neoplazma (IPMN), serozni cistadenom (SCA) te mucinozni cistadenom (MCN). Incidencija varira o dobi i spolu, pri čemu je IPMN češći u muškaraca, dok su SCA i MCN češći u žena. Dijagnostička obrada je slikovna, pri čemu se najčešće koriste prethodno spomenute radiološke metode. Postavljanje dijagnoze određene cistične promjene temelji se na morfološkim karakteristikama koje uključuju veličinu promjene, prisutnost septi i/ ili muralnih nodusa te komunikacije sa kanalnim sustavom gušterače. Osim navedenih, važnost pri diferenciranju promjena ima i invazivna dijagnostička metoda- aspiracija tankom iglom pod vodstvom endoskopskog ultrazvuka (EUS- FNA) kojom je omogućena analiza cističnog sadržaja. Analiziraju se citološke karakteristike, koncentracija tumorskih biljega (CEA, CA 19-9) te genetske mutacije (GNAS, KRAS), što doprinosi pri razlikovanju mucnoznih od nemucinoznih lezija. Unatoč tome što su cistične lezije gušterače većinom benigne, mucinozne promjene kao što su IPMN te MCN imaju potencijal za malignu transformaciju. Stoga je pravovremeno prepoznavanje, praćenje te kirurško liječenje ovih lezija važno za sprječavanje razvoja invazivnog karcinoma gušterače. Preporuke za praćenje promjena te odabir terapijske metode temelje se na međunarodnim smjernicama, čiji su kriteriji određeni kliničkim, laboratorijskim i radiološkim parametrima.Cystic lesions of the pancreas represent a heterogeneous group of pancreatic diseases, primarily classified into epithelial and nonepithelial types, within which neoplastic and non-neoplastic changes can occur. Although these lesions are asymptomatic in most cases, their detection has increased due to the more frequent use of advanced imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS). The most commonly identified cystic lesions include intraductal papillary mucinous neoplasms (IPMN), serous cystadenomas (SCA), and mucinous cystadenomas (MCN). The incidence varies according to age and sex, with IPMN being more prevalent in males, while SCA and MCN occur more frequently in females. Diagnostic evaluation primarily relies on imaging techniques, predominantly the aforementioned radiological methods. The diagnosis of specific cystic lesions is based on morphological characteristics including lesion size, presence of septations and/or mural nodules, and communication with the pancreatic ductal system. In addition to imaging, invasive diagnostic methods such as EUS- guided fine needle aspiration (EUS-FNA) play a crucial role in differentiating lesions by enabling cyst fluid analysis. Cytological features, tumor marker concentrations (CEA, CA 19-9), and genetic mutations (GNAS, KRAS) are assessed, which aid in distinguishing mucinous from non-mucinous cystic lesions. Although most pancreatic cystic lesions are benign, mucinous lesions such as IPMN and MCN possess malignant potential. Therefore, timely identification, surveillance, and surgical management of these lesions are critical to prevent progression to invasive pancreatic carcinoma. Recommendations for lesion monitoring and therapeutic decision-making are based on international guidelines, with criteria determined by clinical, laboratory, and radiological parameters
The Power of Movement: Linking Physical Activity with Nutritional Health and Blood Sugar Balance in a Dalmatian Type 2 Diabetic Population
No full textBackground and Objectives: Regular physical activity (PA) and Mediterranean diet (MeDi) adherence independently improve glycemic control and clinical outcomes in type 2 diabetes mellitus (T2DM). This study examined the associations between PA, body composition (BC), MeDi adherence, and glycemic control in Dalmatian T2DM patients. Materials and Methods: A cross-sectional study was conducted at the University Hospital of Split (November–December 2023) during an open call for T2DM patients. Data collected included blood/urine samples, blood pressure, BC, and anthropometrics. MeDi adherence and PA were assessed via the Mediterranean Diet Service Score and the International PA Questionnaire-Short Form. Results: Among 252 participants (median age: 67 years, IQR: 60–73; 51.6% women; median T2DM duration: 10 years, IQR: 6–20), PA levels were low (31.4%, N = 79), moderate (45.2%, N = 114), and high (23.4%, N = 59), with uniformly low MeDi adherence across groups. Low PA was associated with higher body mass index (BMI
Kennedy Terminal Ulcer – the Beginning of the End (a Case Report)
No full textCilj: prikazati rijedak slučaj promjene kože nazvan Kennedyjev ulkus (KTU), koji se javlja u bolesnika u terminalnom stadiju života te naglasiti važnost ovog entiteta u kliničkoj praksi. Prikaz slučaja: Sedamdesetogodišnjoj bolesnici, koja je bila na palijativnom liječenju u stacionaru, utvrđena je rana na sakrumu za koju se zbog njezinih posebnih karakteristika, izgleda, lokalizacije te brzine progresije posumnjalo da se radi o posebnom entitetu i vrsti rane, odnosno o Kennedyjevu ulkusu. Kennedyjev terminalni ulkus neizbježno je oštećenje kože koje se javlja kao dio procesa umiranja. Oskudna literatura sugerira da se Kennedyjevi terminalni ulkusi javljaju iznenada, obično su kruškolikog oblika, locirani u sakralno/kokcigealnoj regiji, crvenožute ili crne boje, izgledom slični abraziji, a javljaju se nedugo prije smrti. Unatoč sveobuhvatnoj njezi i svakodnevnoj brizi i tretmanu, promjena na koži vrlo je brzo progredirala u ulkus IV. stupnja, a bolesnica je nakon sedam dana preminula. Zaključak: U svakodnevnoj praksi o Kennedyjevu terminalnom ulkusu vrlo se malo zna i velik se broj takvih promjena ne otkriva te ih se pogrešno evidentira kao dekubitalne rane. Potrebna su daljnja istraživanja o fenomenu oštećenja kože kod svih palijativnih bolesnika te dodatna edukacija medicinskih djelatnika kako bi se što više pridonijelo ublažavanju boli i dostojanstvenom životu umiruće osobe, ali i ostalih sudionika uključenih u brigu o terminalnom bolesniku.Aim: to present Kennedy terminal ulcer (KTU), a rare case of skin injury that occurs in patients in their terminal stage of life, and to emphasize the importance of this entity in clinical practice. Case report: A 70-year-old woman who was undergoing palliative treatment in the hospital, was diagnosed with a wound on the sacrum. Due to its special characteristics, such as appearance, location, and speed of progression, the wound was suspected not to be an ordinary pressure ulcer but a special entity, the so-called Kennedy terminal ulcer. Kennedy terminal ulcer is an inevitable skin breakdown or deterioration that occurs as part of the dying process. Kennedy terminal ulcers appear suddenly, are usually pear-shaped, located in the sacral/coccygeal region, red – yellow, or black in colour, abrasion-like in appearance, and occur shortly before death. Despite comprehensive care and daily care and treatment, the change on the skin progressed very quickly into a grade IV ulcer, and the patient died after seven days. Conclusion: In everyday practice, very little is known about Kennedy’s terminal ulcer and a many of such changes are not detected and are incorrectly recorded as decubitus wounds. Further research is needed on the phenomenon of skin damage in all palliative patients, as well as for other members involved in the care of dying patient
How to create a faculty development program that transforms medical education according to actual institutional needs: evidence-based approach and experience at the University of Rijeka, Faculty of Medicine, Croatia
No full textBlood Biomarkers in Ischemic Stroke Diagnostics and Treatment—Future Perspectives
No full textStroke is a leading cause of disability and the second most common cause of death worldwide, with its incidence increasing due to an aging population. Early diagnosis is crucial for timely medical intervention. Biomarkers serve as objective indicators to predict outcomes, monitor treatment responses, and assess prognosis. This review examines the evolving landscape of stroke biomarkers, highlighting their potential clinical applications and the challenges hindering their widespread use. Blood biomarkers are readily accessible and provide insight into the pathophysiological processes underlying stroke. This review focuses on neuronal and glial biomarkers, as well as those associated with inflammation, thrombosis, excitotoxicity, and neuroprotection. Also, it focuses on genetic biomarkers. The timing of biomarker measurement is particularly critical in the early stages of stroke, when rapid decision-making is essential, and it requires systematic investigation. Although numerous molecules have been proposed as stroke biomarkers in recent years, none have yet been integrated into routine clinical practice. Stroke biomarkers hold great promise for enhancing diagnosis, risk stratification, and personalized treatment strategies. However, well-designed studies and rigorous validation are necessary to bridge the gap between research findings and clinical implementation. Integrating biomarkers with existing diagnostic tools could revolutionize stroke management and improve patient outcomes. Continued research into blood biomarkers and their clinical utility remains imperative for advancing stroke care
Histological and histomorphometric evaluation of natural bovine bone substitute with hyaluronate in socket preservation—a report of three cases
No full textTooth extraction is physiologically followed by resorption of alveolar bone. Surgical method which aims to minimise this
reduction in alveolar bone with a goal to provide enough bone volume for dental implant insertion is called socket
preservation. The purpose of this article was to asses clinical, histomorphometric and histological results of socket
preservation conducted with natural bovine bone substitute with hyaluronate. Three patients with one or more hopeless teeth
in posterior region planned for extraction and implant placement were included in these case reports. After atraumatic
extractions, empty sockets were filled with the bovine xenograft with hyaluronate, and then covered with collagen sponge.
After 4–7.5 months the samples for biopsy were taken and then implants were inserted. The augmented sites healed
uneventfully and without any complications. The histological specimens demonstrated new bone formation and osteoclastic
activity around the biomaterial, as well as blood vessels in soft tissue. Histomorphometrically, formation of new bone
averaged 24.8% ±4.7% (mean±standard deviation) in bone biopsies taken from the center of the augmented site, while the
residual biomaterial averaged 52.7% ± 4.9% and the soft tissue averaged 22.6% ± 4%. In conclusion, the natural bovine bone
substitute with hyaluronate demonstrated excellent osteoconductive potential for bone regeneration
Is There a Role for Daratumumab Retreatment in Patients with Relapsed/Refractory Multiple Myeloma?
No full textMultiple myeloma (MM) is a hematologic disease characterized by the clonal expansion of malignant plasma cells that accumulate in the bone marrow, leading to osteolytic bone disease, hypercalcemia, anemia, and renal dysfunction. Daratumumab was the first monoclonal anti-CD38 antibody approved for the treatment of MM, initially in relapse/refractory settings and, more recently, for newly diagnosed patients. Increased first-line usage of daratumumab will also substantially change treatment approaches for patients with relapsed/refractory disease. Due to the cost and availability of bispecific T cell redirecting antibodies (BsAbs) and chimeric antigen receptor T cell therapy (CAR-T) in real-life settings in many countries, retreatment with daratumumab in subsequent lines of therapy might be a reasonable choice. Data regarding efficacy and optimal combinations of daratumumab retreatment are lacking, and here we provide a short literature review of available data. We identified only a small number of articles based on retrospective analysis of medical records in real-life settings. A strong consistency in results regarding response rates and treatment duration was noticed among mainly heavily pre-treated MM patients, with approximately half of patients achieving at least partial remission (PR) after retreatment with daratumumab-based protocol. The duration of treatment and time to the next treatment for retreatment episodes were considerable and consistent with clinical expectations for later lines of therapy. The analysis of data in this literature review indicates that daratumumab retreatment may provide meaningful clinical benefit to some patients with relapsed/refractory MM despite having prior exposure. However, further research is needed to identify clinical and biological parameters that may predict favorable responses to daratumumab retreatment
Patients with Higher Pulse Wave Velocity Are More Likely to Develop a More Severe Form of Knee Osteoarthritis: Implications for Cardiovascular Risk
No full textBackground/Objectives: Knee osteoarthritis (KOA) is a progressive degenerative joint disease characterised by low-grade inflammation and is associated with increased cardiovascular (CV) risk and arterial stiffness. Pulse wave velocity (PWV) is a quantitative measure of arterial stiffness and an important tool for detecting subclinical arterial calcification and CV risk. This study aimed to determine whether PWV can distinguish radiographically mild KOA (Kellgren–Lawrence grades 1-2) from severe KAO (Kellgren–Lawrence grades 3-4) in terms of CV risk factors. Methods: A total of 223 postmenopausal women with KOA participated in this cross-sectional study. Assessments included anthropometry, laboratory analyses, blood pressure and PWV measurements, a 6 min walk test, pain evaluation using a visual analogue scale (VAS), and completion of the International Physical Activity Questionnaire (IPAQ). Results: PWV was significantly higher in the severe KOA group (10.53 m/s vs. 8.78 m/s, p 8.4 m/s, compared to the group with PWV ≤ 8.4 m/s. Conversely, eGFR, the 6 min walk test and physical activity of patients were reduced in the group with PWV > 8.4 m/s. A patient with a PWV > 8.4 m/s has a 1.77 times higher chance of developing a more severe form of the disease than a patient with a lower PWV. Conclusions: Patients with a higher PWV are more likely to develop a more severe form of KOA, which is associated with increased cardiovascular risk