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Kidney transplantation in children
No full textMetoda koja se preferira u liječenju terminalne faze zatajenja bubrega u pedijatrijskoj populaciji je transplantacija bubrega. Koliko su bubrezi bitni kao jedan od vitalnih organa pokazuju njegove brojne funkcije. Kada neka od kroničnih bolesti bubrega dovede do njegovog zatajenja, dolazi do narušene homeostaze organizma, te se stvara potreba za nadomještanjem bubrežne funkcije dijalizom ili transplantacijom. Najčešća stanja koja dovode do završnog stadija bubrežne bolesti u djece su kongenitalne anomalije bubrega, glomerulonefritisi i opstruktivna nefropatija.
Za konačni uspješni ishod transplantacije jednako su bitni adekvatna priprema pacijenta, precizna kirurška tehnika i praćenje pacijenta nakon transplantacije. Vezano uz pripremu za transplantaciju, bitna imunološka, kirurška, urološka, psihosocijalna te pitanja vezana uz maligne bolesti i komorbiditete treba uzeti u obzir. Kirurška tehnika transplantacije bubrega je složena jer se radi o dva odvojena, a povezana operacijska zahvata – eksplantaciji i implantaciji organa. Pri tome je potrebno obratiti pozornost na specifičnosti dječje anatomije i izazove koje ona sa sobom nosi. U praćenju pedijatrijskih pacijenata nakon transplantacije stavlja se naglasak na održanje odgovarajuće imunosupresije te prevenciju infekcija, razvoja kardiovaskularnih i malignih bolesti, usporenog rasta, anemije i negativnih utjecaja na psihičko zdravlje. Za život nakon transplantacije najvažnija je kontinuirana podrška obitelji.
Svakom je djetetu u Republici Hrvatskoj, kod kojega postoji potreba za transplantacijom bubrega, pružena najsuvremenija skrb u ovom području. Hrvatska je kao dio Eurotransplanta u sustavu organizirane i uspješne razmjene organa, što rezultira boljim preživljenjem i uspješnijom budućnosti svakog djeteta s terminalnim zatajenjem bubrega.The preferred method for treating end-stage renal failure in the pediatric population is kidney transplantation. The importance of kidneys as one of the vital organs is demonstrated by their numerous functions. When one of the chronic kidney diseases leads to its failure, the body's homeostasis is disrupted, creating the need to replace kidney function through dialysis or transplantation. The most common conditions leading to end-stage kidney disease in children are congenital kidney anomalies, glomerulonephritis, and obstructive nephropathy.
For a successful transplantation outcome, adequate patient preparation, precise surgical technique, and posttransplantation patient monitoring are equally important. Regarding preparation for transplantation, important immunological, surgical, urological, psychosocial, and issues related to malignant diseases and comorbidities must be considered. The surgical technique of kidney transplantation is complex because it involves two separate yet connected surgical procedures – explantation and implantation of the organ. Attention must be paid to the specifics of pediatric anatomy and the challenges it presents. In monitoring pediatric patients after transplantation, emphasis is placed on maintaining appropriate immunosuppression and preventing infections, cardiovascular and malignant diseases, growth restriction, anemia, and negative impacts on mental health. Continuous family support is crucial for life after transplantation.
Every child in the Republic of Croatia who needs a kidney transplant is provided with the most advanced care in this field. As part of Eurotransplant, Croatia is involved in an organized and successful organ exchange system, resulting in better survival and more successful future for every child with end-stage renal failure
Diagnostics and methods of treatment of testicular varicocele
No full textVarikocela je medicinsko stanje u kojem se u skrotumu nalaze proširene vene pampiniformnoga pleksusa. Varikocela se najčešće pojavljuje na lijevoj strani, a glavni uzrok toga je okomit tok lijeve sprematične vene koja je pod okomitim kutom ulijeva u lijevu renalnu venu. S druge strane desna renalna vena se pod oštrim kutom ulijeva u donju šuplju venu, te je manja šansa za moguće zaostajanje venske krvi na toj strani. Prevalencija varikocele u prosječnoj muškoj populaciji iznosi 15%. Najčešće se varikocele otkriju tijekom rutinskog fizičkog pregleda ili kod obrade neplodnosti. Varikocele se pojavljuju kao mekane kvržice iznad testisa, najčešće na lijevoj strani skrotuma.
Prema smjernicama Američkog urološkog udruženja i Američkog društva za reproduktivnu medicinu, kliničke varikocele treba liječiti kod muškaraca u paru koji se već duže vrijeme bezuspješno trude oploditi partnericu, ako su ispunjeni sljedeći uvjeti: varikocela je opipljiva, par ima potvrđenu neplodnost, žena ima normalnu ili potencijalno ispravljivu plodnost, ili muški partner ima jedan ili više abnormalnih parametara sjemena ili rezultate testova funkcije sperme. Liječenje varikocele indicirano je kod pacijenata koji se podvrgavaju ispitivanju zbog neplodnosti i imaju simptome, poput bolnog skrotuma. Postoje snažni dokazi da operacija varikocele može obnoviti volumen testisa i poboljšati parametre sjemena. Liječenje varikocele može se provoditi na dva načina: operativno i neoperativno. Pri donošenju odluke o metodi liječenja varikocele, važno je razmotriti prednosti i nedostatke pristupa koji je odabrao liječnik.Varicocele is a medical condition characterized by enlarged veins of the pampiniform plexus in the scrotum. It most commonly appears on the left side due to the vertical flow of the left spermatic vein, which enters the left renal vein at a right angle. Conversely, the right renal vein enters the inferior vena cava at an acute angle, reducing the chance of venous blood stasis on that side. The prevalence of varicocele in the average male population is 15%. Varicoceles are often discovered during routine physical examinations or infertility assessments. They appear as soft lumps above the testis, most commonly on the left side of the scrotum.
According to the guidelines of the American Urological Association and the American Society for Reproductive Medicine, clinical varicoceles should be treated in men in couples who have been unsuccessfully trying to impregnate the partner for an extended period if the following conditions are met: the varicocele is palpable, the couple has documented infertility, the woman has normal or potentially correctable fertility, or the male partner has one or more abnormal semen parameters or results from sperm function tests. Treatment of varicocele is indicated in patients undergoing infertility evaluation who have symptoms, such as a painful scrotum. There is strong evidence that varicocele surgery can restore testicular volume and improve semen parameters. Varicocele treatment can be conducted in two ways: surgical and non-surgical. When deciding on the method of varicocele treatment, it is important to consider the advantages and disadvantages of the approach chosen by the physician
Significance of early screening for diabetic retinopathy in the European Union and the Republic of Croatia
No full textDijabetička retinopatija (DR) je česta kronična mikrovaskularna komplikacija šećerne bolesti. DR dovodi do postupnog gubitka vida i najčešći je uzrok sljepoće u EU. U proliferacijskoj DR su prisutne neovaskularizacije i vitrealna hemoragija. U dijagnostici se koriste oftalmoskopija, OCT, FA, digitalna retinografija i OCTA. U liječenju se najčešće koriste anti-angiogena i laserska terapija. U probiru za DR zlatnim standardom se smatra retinalna fotografija koja omogućuje pohranjivanje slika na računalo. Smatra se da je najbolji interval između očnih pregleda jedna ili dvije godine. U probir je bitno uvesti digitalne tehnologije i umjetnu inteligenciju. U Švedskoj postoji probir bolesnika s DR-om na lokalnoj razini. Mađarska je osmislila program za poboljšanje zdravlja osoba sa šećernom bolešću pri čemu se koristi mobilni kombi s digitalnom retinalnom kamerom. U Irskoj se koristi biomikroskop u sklopu probira. Danska je uspostavila Registar za DR nazvan Diabase koji automatski elektronički registrira podatke pregleda. U Portugalu 5 regija zasebno provodi program probira. U Finskoj i Norveškoj uvedeni su projekti telemedicine kojima se olakšava dostupnost probiru. Slovenija je uvela probir bolesnika s DR-om od 2010. godine. Engleska provodi nacionalni program probira od 2004. godine. Škotska je uvela nacionalni program probira od 2003. godine i automatizirani sustav za očitanje slika digitalne retinografije. Probir bolesnika s DR-om ima ključnu ulogu u prevenciji i sprječavanju progresije DR-a čime se smanjuje učestalost sljepoće u osoba sa šećernom bolešću. Cilj ovog rada je približiti mogućnosti i prednosti probira DR-a široj akademskoj zajednici kako bi se doprinijelo poboljšanju zdravlja osoba sa šećernom bolešću.Diabetic retinopathy (DR) is a usual chronic microvascular complication which occurs in diabetes. DR causes gradual visual impairment and is a typical cause of sightlessness in the EU. Neovascularization and vitreal hemorrhage are present in proliferative DR. Ophthalmoscopy, OCT, FA, digital retinography and OCTA are used in diagnostics. Anti-angiogenic and laser therapy are most often used as treatment. In screening for DR, retinal photography is considered the gold standard, which allows images to be stored on a computer. It is considered that the best interval between eye examinations is one or two years. It is essential to introduce digital technologies and artificial intelligence into screening. In Sweden, there is screening for DR at the local level. Hungary has designed a program to raise life quality in patients with diabetes using a mobile van containing digital retinal camera. In Ireland, a biomicroscope is used as part of screening. Denmark has established a Registry for DR called Diabase which automatically electronically registers all examination data. In Portugal, 5 regions carry out a screening program separately. Telemedicine projects have been introduced in Finland and Norway to facilitate access to screening. Slovenia has introduced DR screening since 2010. England has been running a national screening program since 2004. Scotland has introduced a national screening program since 2003, and an automated system for reading digital retinography images has also been introduced. The screening for DR plays a crucial role in preventing and stopping the progression of DR, thereby reducing the incidence of blindness in diabetic patients. The aim of this work is to bring the possibilities and benefits of DR screening to wider academic community in order to improve the health of patients with diabetes
VITAMIN D AND NON-ALCOHOLIC FATTY LIVER DISEASE – A RETROSPECTIVE STUDY
No full textVitamin D igra važnu ulogu u zdravlju naših kostiju, imunološkom sustavu i regulaciji upale. Nova istraživanja upućuju na poveznicu deficita ovog vitamina s MASLD-om, poremećajem jetre s visokom pojavnošću u današnjem društvu. To stanje se opisuje kao steatoza jetre u odsustvu pretjeranog konzumiranja alkohola s prisutnim barem jednim faktorom metaboličkog sindroma. Cilj ove retrospektivne analize bio je vidjeti utjecaj vitamina D na vrijednosti CAP-a, LSM-a, te jetrenih enzima, dominantno GGT i ALT.Vitamin D plays an important role in the health of our bones, the immune system and the regulation of inflammation. New research points to a link between the deficiency of this vitamin and MASLD, a liver disorder with a high incidence in today's society. It is described as hepatic steatosis in the absence of excessive alcohol consumption with at least one factor of the metabolic syndrome present. The aim of this retrospective analysis was to see the influence of vitamin D on the values of CAP, LSM, and liver enzymes, mainly GGT and ALT
Atopic dermatitis: current and emerging therapeutic options
No full textAtopijski dermatitis je česta upalna kožna bolest koja uzrokuje intenzivan svrbež i vidljive kožne lezije, što značajno utječe na kvalitetu života pacijenata. Tradicionalno liječenje bilo je nespecifično, često neuspješno, s raznim nuspojavama. Novi terapijski pristupi obuhvaćaju raznolike strategije, uključujući ciljane agense, lokalne i sistemske lijekove, fototerapiju te psihosocijalnu podršku. Lokalna farmakološka terapija uključuje primjenu kortikosteroida, imunomodulatora poput takrolimusa te lokalnih antibiotika za sekundarne infekcije. Sustavni kortikosterodi primjenjuju se samo kao kratkotrajna opcija za akutna pogoršanja srednje teških i teških oblika bolesti, izbjegavajući njihovu dugotrajnu upotrebu radi sprečavanja rebound efekta. Biološka terapija, kao što je dupilumab, cilja specifične upalne medijatore, dok JAK inhibitori moduliraju brojne citokine uključene u patogenezu bolesti. Sustavni konvencionalni imunosupresivi poput ciklosporina i metotreksata koriste se za teže oblike bolesti, ali zahtijevaju strogo praćenje zbog mogućih nuspojava. Inovativne terapije poput lokalnih inhibitora JAK-a i PDE4 pokazuju obećavajuće rezultate. Također, eksperimentalne terapije kao što su roflumilast, difamilast, tapinarof i brepocitinib, te bakterioterapija sa Staphylococcus hominis A9, istražuju se kao potencijalne opcije u liječenju atopijskog dermatitisa. Osim dostupnosti pojedinih terapijskih opcija, u kontroli atopijskog dermatitisa nužan je individualni pristup svakom pacijentu.Atopic dermatitis is a common inflammatory skin disease that causes intense itching and rash, significantly impacting patient's quality of life. Traditional treatments have been nonspecific, often unsuccessful, and accompanied by various side effects. New therapeutic approaches encompass diverse strategies, including targeted agents, local and systemic pharmacological therapies, phototherapy, and psychosocial support. Local pharmacological therapy includes the use of corticosteroids, immunomodulators such as tacrolimus, and topical antibiotics for secondary infections. Systemic corticosteroids are used only as a short-term option for acute exacerbations of moderate to severe disease, avoiding long-term use to prevent rebound effects. Biological therapy, such as dupilumab, targets specific inflammatory mediators, while JAK inhibitors modulate multiple cytokines in the pathogenesis of the disease. Systemic traditional immunosuppressants like cyclosporine and methotrexate are used for more severe forms of the disease but require strict monitoring due to potential side effects. Innovative therapies such as topical JAK inhibitors and PDE4 inhibitors show promising results. Additionally, experimental therapies like roflumilast, difamilast, tapinarof, and brepocitinib, as well as bacteriotherapy with Staphylococcus hominis A9, are being investigated as potential options in the treatment of atopic dermatitis. In addition to the question of the availability of certain therapeutic options, an individual approach to each patient is necessary in the control of atopic dermatitis
The role of PET/CT in the diagnosis of thyroid cancer
No full textKarcinomi štitnjače čine 1% svih zloćudnih novotvorina, a najčešći su među zloćudnim novotvorinama štitnjače. Pozitronska emisijska tomografija/kompjutorizirana tomografija (PET/CT) može se primijeniti u dijagnostici karcinoma štitnjače kod sumnje na recidiv bolesti i udaljene metastaze. PET/CT daje slikovni prikaz funkcije, veličine, izgleda i anatomskog položaja tumorske lezije. Indikacija za primjenu kod diferenciranih karcinoma štitnjače, kao što su papilarni i folikularni, je povišena vrijednost tireoglobulina u serumu iznad 10 ng/mL u pacijenata liječenih totalnom tireoidektomijom i radioaktivnom ablacijom uz negativni 131I scintigram. Radiofarmaci koji se koriste u dijagnostici diferenciranih karcinoma štitnjače su fluor-18 fluorodeoksiglukoza (18F-FDG) kod jod negativnih karcinoma i jod-124 ( 124I) ili fluor-18 tetrafluoroborat (18F-TFB) kod jod pozitivnih karcinoma, ukoliko su dostupni za kliničku primjenu. 18F-FDG PET/CT ima prognostički značaj jer veći unos fluorodeoksiglukoze u stanice ukazuje na slabije diferencirani i agresivniji karcinom štitnjače lošije prognoze. Radiofarmaci koji se koriste u dijagnostici medularnog karcinoma su fluor-18 fluorodeoksiglukoza (18F-FDG), fluor-18 fluorodopa (18F-DOPA) i galij-68 analozi somatostatina. Indikacija za primjenu kod medularnog karcinoma je povišena vrijednost kalcitonina i CEA u serumu uz negativan radiološki nalaz kod sumnje na postojanje metastaza u tijelu. Kod povišenog kalcitonina preporuča se primjena 18F-DOPA PET/CT-a, a kod povišenog CEA 18F-FDG PET/CT. Kod anaplastičnog karcinoma primjenjuje se 18F-FDG PET/CT koji omogućuje procjenu proširenosti i resektabilnosti tumora, kao i terapijskog odgovora.Thyroid carcinomas account for 1% of all malignant neoplasms and are the most common of all malignant thyroid neoplasms. Positron emission tomography/computed tomography (PET/CT) can be used in the diagnosis of thyroid cancer in cases of suspected disease recurrence and distant metastases. PET/CT provides an image of the function, size, morphology and anatomical location of the tumor lesion. The indication for use in differentiated thyroid cancers, such as papillary and follicular, is an elevated serum thyroglobulin level of more than 10 ng/mL in patients who have been treated with total thyroidectomy and radioactive ablation with negative 131I scintigram. Radiopharmaceuticals used in the diagnosis of differentiated thyroid cancers are fluorine-18-fluorodeoxyglucose (18F-FDG) in iodine-negative cancers and iodine-124 (124I) or fluorine-18-tetrafluoroborate (18F-TFB) in iodine-positive cancers, if available for clinical application. 18F-FDG-PET/CT has prognostic significance, as a higher uptake of fluorodeoxyglucose in the cells indicates a less differentiated and more aggressive thyroid carcinoma with a poorer prognosis. Radiopharmaceuticals used in the diagnosis of medullary carcinoma are fluorine-18-fluorodeoxyglucose (18F-FDG), fluorine-18 fluorodopa (18F-DOPA) and gallium-68 analogs of somatostatin. The indication for use in medullary carcinoma is elevated calcitonin and CEA levels in serum with negative radiologic findings in the case of suspected metastases in the body. The use of 18F-DOPA PET/CT is recommended when calcitonin is elevated and 18F-FDG PET/CT when CEA is elevated. In the case of anaplastic carcinoma, 18F-FDG PET/CT is used to assess the extent and resectability of the tumor, as well as the therapeutic response
Ingestion of Fluids of the Ocular Surface Containing Eye Drops of Imidazole Derivatives—Alpha Adrenergic Receptor Agonists as Paragons
No full textAccidental poisonings by ingesting conjunctival fluid mixed with eye drops commonly involve alpha-2 adrenergic receptor agonists and tetrahydrozoline. These substances are recognized in commonly reported ingestions. Victims of all ages, otherwise in good health, often present as pale and lethargic to the emergency department (ED) after unintentionally ingesting topical eye medication. While eye drop poisoning cases in childhood include accidents during the play and poisonings in adults mean either suicide attempts or side effects caused by the systemic absorption of the substance, fluid of the ocular surface is a risk to all age groups. With this in mind, this study aimed to summarize data in the literature on tetrahydrozoline and alpha-2 adrenergic receptor agonists as dangerous medications, even when administered in low-bioavailability forms, such as eye drops. With this aim, a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of relevant studies was conducted. A search of PubMed, Scopus, Web of Science, and EBSCOhost yielded nine studies that met the rigorous inclusion criteria. The primary studies were subject to a meta-analysis once a quality appraisal of the studies and a narrative synthesis of the extracted data had been conducted. The author hopes that this information will provide observations that will lead to better designs for over-the-counter eye drops, off-label drug usage policies, and parental attention
Treatment Procedure for Adolescents with Carbon Monoxide Poisoning and Treatment in a Hyberbaric Chamber – a Case Report
No full textCilj: Prikaz nenamjernog trovanja ugljičnim monoksidom adolescenata, čije zbrinjavanje još uvijek nije u potpunosti razrađeno te zahtijeva razvoj profesionalnog algoritma zbog učinkovite prevencije i pravovremenog liječenja. Detaljno je prikazana dijagnostika, kao i postupci zbrinjavanja akutnog trovanja ugljičnim monoksidom. Prikaz slučaja: 16-godišnji bolesnik zaprimljen je na odjel intenzivne njege zbog poremećaja svijesti nejasne etiologije. Heteroanamnestički se doznaje da je bolesnik pronađen u obiteljskoj kući bez svijesti. Bio je pothlađen uz drhtavicu i pjenu na ustima. Tijekom primarne obrade bolesnik je postavljen na monitoring vitalnih funkcija uz potporu kisikom na masku te parenteralnu hidraciju. Pri prijamu reagirao je jedino na bolni podražaj. Laboratorijski nalaz ukazivao je na kombiniranu acidozu, uz povišenu razinu karboksihemoglobina, zbog čega je nastavljena terapija 100-postotnim kisikom te je postavljena dijagnoza akutnog trovanja ugljičnim monoksidom. Iz laboratorijskih nalaza očitovala se povišena razina upalnih i bubrežnih parametara uz blago povišenu razinu laktata. Na radiogramu grudnih organa nije bilo znakova pneumotoraksa, ali su bili prisutni inicijalni znakovi respiratornog distresa. U svrhu liječenja bio je organiziran transport u barokomoru. Uz liječenje u barokomori te mnogobrojne suportivne mjere liječenja, pacijent je uspješno izliječen. Zaključak: Intoksikacija ugljičnim monoksidom predstavlja dijagnostički izazov te je i kod našeg bolesnika opisano opsežno i složeno liječenje. Faktori koji značajno pridonose smrtnosti jesu vrijeme proteklo od dolaska bolesnika na hitni prijam do početka liječenja te stanje u kojem pacijent pristiže na hitni prijam i koncentracija karboksihemoglobina u krvi pacijenta.Aim: presentation of unintentional carbon monoxide poisoning in adolescents, whose care is still underdeveloped and requires a professional algorithm for effective prevention and timely treatment. Diagnostics as well as treatment procedures for acute carbon monoxide poisoning are presented in detail. Case report: A 16-year-old patient was admitted to the intensive care unit due to a disorder of consciousness of unclear aetiology. Heteroanamnesis data indicated that the patient was found unconscious in the family home, he was also hypothermic, shivering and foaming at the mouth. During the primary treatment, the patient was placed on monitoring of vital functions with oxygen on a mask and parenteral hydration. On admission, he reacted only to a painful stimulus. The laboratory findings indicated combined acidosis, with an elevated level of carboxyhaemoglobin, for the stated reason therapy with 100% oxygen was continued and the patient was diagnosed with acute carbon monoxide poisoning. The laboratory analyses revealed an elevated level of inflammatory and renal parameters with slightly elevated lactate level. No signs of pneumothorax were present on the X-ray, but initial signs of respiratory distress were present. With treatment in hyperbaric chamber and numerous supportive treatment measures, the patient was successfully cured. Conclusion: Carbon monoxide intoxication represents a diagnostic challenge, and extensive and complex treatment was described in our patient as well. Factors that significantly contribute to mortality are: the time elapsed from the patients' arrival at the emergency department to the start of treatment, the condition in which the patient arrives at the emergency department and the concentration of carboxyhaemoglobin in the patients' blood
Recompensation of Decompensated Liver Cirrhosis with Newly Diagnosed Chronic Myeloproliferative Disease and the Issue of Giving Up Liver Transplantation – a Case Report
No full textCilj: Prikazati izniman i rijedak medicinski obrat u kojem je dekompenzirana ciroza jetre prešla u kompenziranu fazu, s naglaskom na značajnom poboljšanju stanja ciroze koje je eliminiralo potrebu za transplantacijom jetre, uz prisutnost podliježuće mijeloproliferativne bolesti. Prikaz slučaja: 63-godišnja pacijentica zaprimljena je na Zavod za gastroenterologiju u Klinički bolnički centar Rijeka zbog prisutnosti ascitesa nepoznate etiologije. U razdoblju od 2018. do 2022. hospitalizirana je tri puta. Nakon detaljnih kliničkih i seroloških analiza postavljena je dijagnoza alkoholne ciroze jetre. Iako je preliminarna priprema za ortotopičnu transplantaciju jetre započeta, od postupka se odustalo zbog detektirane aktivne infekcije hepatitisom A i nepridržavanja propisane terapije. Radi inteziviranja bolesti pacijentica je razvila edem ekstremiteta, fluktuacije u tjelesnoj težini i ikterus. Redovite paracenteze, s dodatkom 20 % humanih albumina, bile su nužne. Pacijentica je kontinuirano konzumirala alkohol, a pridržavanje propisane terapije također nije bilo dosljedno. Tijekom 2021. godine postavljena joj je i dijagnoza policitemije rubre vere, što je dodatno kompliciralo njezino stanje. Međutim, krajem 2022. godine primijećeno je poboljšanje u laboratorijskim nalazima i kliničkoj slici, što je rezultiralo prijelazom iz dekompenzirane faze ciroze jetre u kompenziranu fazu. Pretpostavlja se da je razlog ovog obrata posljedica dosljednog pridržavanja propisane terapije i apstinencije od alkohola. Zaključak: Ovaj slučaj potvrđuje da dekompenzirana alkoholna ciroza jetre ne vodi nužno do terminalne faze bolesti. Strogim pridržavanjem terapije, redovitim kontrolama i suzdržavanjem od alkohola moguće je znatno poboljšanje pacijentovog stanja do te mjere da transplantacija jetre više nije potrebna. Osim toga, ovaj slučaj naglašava važnost integriranog multidisciplinarnog pristupa kod pacijenata s cirozom jetre i pridruženom mijeloproliferativnom bolesti, kao bitnog prediktora tijeka i ishoda bolesti.Aim: To present an exceptional and rare medical turnaround in which decompensated cirrhosis of the liver moved into the compensated phase, with an emphasis on significant improvement in the state of cirrhosis that eliminated the need for liver transplantation, in the presence of an underlying myeloproliferative disease. Case report: A 63-year-old female patient was admitted to the Institute of Gastroenterology at clinical hospital centre Rijeka (KBC Rijeka) due to the presence of ascites of unknown aetiology. During the following period (2018-2022), she was hospitalized three times. After detailed clinical and serological analyses, a diagnosis of alcoholic liver cirrhosis was made. Although the preliminary preparation for orthotopic liver transplantation was started, the procedure was abandoned due to detected active hepatitis A infection and non-adherence to the prescribed therapy. Due to the intensification of the disease, the patient developed oedema of the extremities, fluctuations in body weight and jaundice. Regular paracentesis, with the addition of 20% human albumin, was necessary. The patient continuously consumed alcohol, and adherence to the prescribed therapy was also inconsistent. In 2021, she was diagnosed with polycythaemia rubra vera, which further complicated her condition. However, at the end of 2022, an improvement in laboratory findings and clinical picture was observed, which resulted in the transition from the decompensated phase of liver cirrhosis to the compensated phase. The reason for this reversal is assumed to be a consequence of consistent adherence to the prescribed therapy and abstinence from alcohol. Conclusion: This case confirms that decompensated alcoholic liver cirrhosis does not necessarily lead to the terminal stage of the disease. Through strict adherence to therapy, regular check-ups and abstinence from alcohol, there is a possibility of a significant improvement in the patient's condition to the extent that a liver transplant is no longer necessary. In addition, this case highlights the importance of an integrated multidisciplinary approach in patients with liver cirrhosis and associated myeloproliferative disease as an important predictor of disease course and outcome
Significance of PD-L1 and Tumor Microenvironment in Laryngeal Squamous Cell Cancer
No full textBackground: Despite the considerable advancement in the field of medicine over recent decades, laryngeal cancer continues to be a challenge. The field of immune oncology has generated promising immunomodulation therapies and opened up new ways of treatment. Methods: Our retrospective study included 102 patients diagnosed with laryngeal squamous cell cancer (LSCC). Immunohistochemistry was used to evaluate the expression of PD-L1 and tumor microenvironment cells (CD4, CD8, CD68 and CD163). Results: PD-L1 expression showed statistically significant positive correlations with all examined tumor microenvironment cells. Patients with high CD68 and CD163 expression intratumorally (p = 0.0005 and p = 0.006, respectively) had statistically significant shorter disease-specific survival. Moreover, a statistically shorter time to recurrence was found in patients with high CD68 intratumoral and CD8 overall counts (p = 0.049 and p = 0.019, respectively). Also, high CD8 overall (>23%) and CD68 intratumoral (>2.7%) expression were statistically significant predictors of recurrence (p = 0.028, OR = 3.11 and p = 0.019, OR = 3.13, respectively). Conclusions: Higher CD68 and CD163 expression represented significantly worse prognosticators for clinical outcomes in patients with LSCC. In order to determine which LSCC patients will benefit from anti-PD-1/PD-L1 inhibitors, it is crucial to elucidate the relationship between PD-L1 expression, immune cell distribution and prognosis in LSCC patients