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Lymphoscintigraphy in Lymphedema
No full textLimfedem je kronična bolest progresivnog tijeka koju uzrokuje poremećaj transporta limfe, a manifestira se oticanjem
češće donjih, a ponekad i gornjih ekstremiteta, ovisno o etiologiji. Dijagnoza se postavlja na temelju kliničke slike, pregleda
ultrazvukom i slikovnih pretraga, a liječenje je uglavnom konzervativno, dugotrajno i nezadovoljavajuće, no u novije se
vrijeme uvode i kirurške metode. Limfoscintigrafija, nuklearno medicinska slikovna pretraga koja je jednostavna i neinvazivna,
smatra se metodom izbora u dijagnostici. Uključuje intrakutanu/subkutanu primjenu radiofarmaka u obliku koloidnih čestica
obilježenih radioaktivnim tehnecijem – 99m te dvodimenzijsko ili trodimenzijsko snimanje gama kamerom. Omogućuje
razlikovanje limfedema od edema druge etiologije, procjenu ozbiljnosti bolesti te uspješnosti kirurškog zahvata. Postupak
ipak nije u potpunosti standardiziran, a korištenje semikvantitativnih metoda koje bi trebale pridonijeti procjeni ozbiljnosti
limfedema ovisi o lokalnom iskustvu i znanju.Lymphedema is a chronic, progressive condition caused by impaired lymphatic
transport, leading to edema in the lower and/or upper extremities, depending on the underlying cause.
The diagnosis is based on clinical examination, ultrasound findings, and imaging tests. Treatment is
mostly conservative, usually long-term, and often yielding unsatisfactory results. Recently, surgical options
have also become available. Lymphoscintigraphy, a non-invasive and simple nuclear medicine
imaging technique, is considered the method of choice in diagnostic workup. It consists of intracutaneous
or subcutaneous application of colloidal particles labelled with radioactive technetium-99m and
two-dimensional or three-dimensional gamma camera imaging. Lymphoscintigraphy helps differentiate
lymphedema from edema of another origin, assess disease severity, and evaluate surgery outcome. However,
the procedure is not fully standardized, especially in terms of semiquantitative methods, which are
additionally used in disease staging; however, their implementation varies depending on local experience
and expertise
EFFICACY AND SAFETY OF DRUGS WITH AN EFFECT ON THE INCRETIN SYSTEM IN THE THERAPY OF METABOLIC DISEASES
No full textPretilost, dijabetes, dislipidemija i s njima povezane kardiovaskularne bolesti su metabolički uzrokovane kronične nezarazne bolesti koje prevalencijom i incidencijom poprimaju pandemijske razmjere te čine velik zdravstveni i ekonomski teret na globalnoj razini. Gotovo jednaka patofiziološka osnova navedenih poremećaja omogućava i sličan terapijski pristup, a spasonosnim oružjem u njihovom liječenju smatraju se lijekovi s djelovanjem na sustav inkretina. Predstavnici skupine lijekova s djelovanjem na sustav inkretina su agonisti GLP-1 receptora i inhibitori DPP-4 enzima. Jedinstvena su skupina lijekova među trenutno dostupnim antidijabeticima jer osim regulacije glikemije djeluju protektivno na beta stanice gušterače potičući njihovu proliferaciju, veoma su dobrog sigurnosnog profila s rijetkim nuspojavama i malim rizikom od hipoglikemije te dovode do redukcije tjelesne težine ili su u tom smislu neutralnog učinka. Dodatna prednost ove skupine lijekova je njihov potencijalan kardioprotektivan, hepatoprotektivan, neuroprotektivan i nefroprotektivan učinak koji može smanjiti incidenciju komorbiditeta u pretilih osoba i onih koje boluju od šećerne bolesti tip 2. Najčešće nuspojave inkretinskih lijekova su gastrointestinalne koje su izraženije na početku liječenja i smanjuju se unutar nekoliko dana ili tjedana. Zabrinjavajuća nuspojava zabilježena tijekom kliničkih ispitivanja i u kliničkoj praksi je akutni pankreatitis i karcinom gušterače, no daljnje studije nisu dokazale uzročnu povezanost inkretinskih lijekova i navedenih stanja. Prilikom razmatranja sigurnosti i štetnosti ovih lijekova treba uzeti u obzir njihov kratak vijek na tržištu tijekom kojeg nisu mogli doći do izražaja sve njihove prednosti i nedostatci.Obesity, diabetes, dyslipidemia and related cardiovascular diseases are metabolically caused chronic non-communicable diseases that are reaching pandemic proportions due to their prevalence and incidence and constitute a major health and economic burden on a global scale. The almost identical pathophysiological basis of the mentioned disorders enables a similar therapeutic approach, and drugs with an effect on the incretin system are considered a life-saving weapon in their treatment. Representatives of the group of drugs with an effect on the incretin system are GLP-1 receptor agonists and DPP-IV enzyme inhibitors. They are a unique group of drugs among currently available antidiabetics because, in addition to regulating glycemia, they have a protective effect on beta cells of the pancreas by stimulating their proliferation, they have a very good safety profile with rare side effects and a low risk of hypoglycemia, and they lead to weight loss or have a neutral effect in this sense. An additional advantage of this group of drugs is their potential cardioprotective, hepatoprotective, neuroprotective and nephroprotective effect, which can reduce the incidence of comorbidities in obese people and those suffering from type 2 diabetes. The most common side effects of incretin drugs are gastrointestinal, which are more pronounced at the beginning of treatment and decrease within several days or weeks. A worrisome side effect recorded during clinical trials and in clinical practice is acute pancreatitis and pancreatic cancer, but further studies did not prove a causal connection between incretin drugs and the mentioned condition. When considering the safety and harmfulness of these drugs, one should take into account their short life on the market, during which all their advantages and disadvantages could not come to the fore
Role of microglia in epileptogenesis
No full textStanice mikroglije posreduju brojne važne funkcije unutar središnjeg živčanog sustava uključujući održavanje homeostaze, obnašanje uloge imunoloških stanica i nadzor sinapsi. U patološkim uvjetima događa se izmjena morfoloških i biološko-funkcijskih obilježja mikroglije pa tako u epileptičnom mozgu dolazi do dinamičnih promjena u staničnom profilu mikroglije i različitih uloga u epileptogenezi. Mikroglija ima ključnu ulogu u formiranju proupalnog mikrookoliša u epileptičnom mozgu i time doprinosi epileptogenezi. Upalni milje u SŽS-u, nastao kao posljedica napadaja, potiče hiperekscitabilnost neurona i dovodi do pojave opetovanih epileptičkih napadaja. Napadaj nakon kojeg slijedi proizvodnja proupalnih medijatora koji uzrokuju stvaranje opetovanih napadaja zajednički tvoreći mehanizam pozitivne povratne sprege kojim se potiče epileptogeneza. S druge strane, mikroglija može posredovati i neuroprotektivni učinak poput suzbijanja upale, poticanja odlaganja izvanstaničnog matriksa, pozitivnog utjecaja na integritet bijele tvari, pospješivanja 23 preživljenja neurona i remodeliranja sinapsi. Količina upalnih medijatora, vremenska izloženost moždanog parenhima njihovom djelovanju i ravnoteža između proupalnih te protuupalnih i neuroprotektivnih čimbenika određuju hoće li ishod biti povoljan ili štetan. Upalna komponenta epileptogeneze otvara pitanje novih terapijskih mogućnosti temeljenih na modulaciji upalnog odgovora u mozgu kojim bi se suzbio štetan utjecaj ciljanim djelovanjem na proupalne mehanizme koji produbljuju epilepsiju.Microglia mediate many important functions within the central nervous system, including maintaining homeostasis, acting as immune cells, and monitoring synapses. Under pathological conditions, changes in the morphological and functional characteristics of microglia occur. In the epileptic brain, this leads to dynamic changes in the microglial cell profile and different roles in epileptogenesis. Microglia play a crucial role in the formation of a pro-inflammatory microenvironment in the epileptic brain, thereby contributing to epileptogenesis. The inflammatory milieu in the brain, resulting from seizures, promotes neuronal hyperexcitability and leads to the occurrence of repeated epileptic seizures. A seizure followed by the production of pro-inflammatory mediators, which cause new seizures, collectively forms a positive feedback mechanism that promotes epileptogenesis. On the other hand, microglia can mediate a neuroprotective effect, such as suppressing inflammation, promoting the deposition of extracellular matrix, positively influencing white matter integrity, enhancing neuronal survival, and remodeling synapses. The amount of inflammatory mediators, the temporal exposure of brain parenchyma to their action, and the 24 balance between pro-inflammatory and anti-inflammatory or neuroprotective factors determine whether the outcome will be beneficial or harmful. The inflammatory component of epileptogenesis raises the question of new therapeutic possibilities based on the modulation of the inflammatory response in the brain, which would suppress harmful effects by targeting the pro-inflammatory mechanisms that exacerbate epilepsy
Cutaneous manifestations of polycystic ovary syndrome and their management : graduation thesis
No full textPolycystic ovarian syndrome is a complicated and prevalent metabolic condition affecting
women of childbearing years. The pathophysiology is not fully understood. The thesis focuses
on the complex relationship between PCOS and dermatological conditions. The emphasis is
on understanding how PCOS affects the state of the skin, resulting in acne, hirsutism, and
baldness. The fundamental hormonal disturbances and inflammation mechanisms that cause
those cutaneous conditions in PCOS individuals are reviewed. Furthermore, numerous therapy
approaches, spanning from hormone medications to lifestyle changes, are being evaluated for
their effectiveness in treating PCOS-related skin issues. The emphasis is on encouraging
interaction among dermatologists and endocrinologists in order to customize therapies and
improve the general health of those who suffer from PCOS-related skin symptoms
Male-infertility-associated factor in infertile couples - Distribution in the city of Rijeka and the Primorsko-goranska county : graduate thesis
No full textNeplodnost je definirana kao nemogućnost žačeća unutar 12 mjeseci kontinuiranih spolnih odnosa. Muški faktor kao jedini uzrok neplodnosti nalazi se u otprilike 30% neplodnih parova, a u svijetu unutar opće populacije broj neplodnih muškaraca varira i kreće od 4.5% do 12%. Uzroci neplodnosti etiološki se mogu podjeliti na pretestikularni, testikularni i posttestikularni uzrok. Za dijagnozu muške neplodnosti koristi se spermiogram pomoću kojeg se opisuje oblik neplodnosti. Svrha ovog rada je prikazati mušku neplodnost na području grada Rijeke te Primorsko – goranske županije (PGŽ). U ovom istraživanju sakupljeni su podaci pacijenata koji su došli u Andrološku ambulantu Klinike za urologiju Kliničkog bolničkog centra Rijeka u razdoblju od 2018. i 2023. godine. Pacijenti su analizirani na temelju mjesta stanovanja i nalaza spermiograma. Pacijenti su potom podjeljeni imaju li laku ili tešku neplodnost, oligozoospermiju, astenozoospermiju, oligoastenozoospermiju ili azoospermijui odakle dolaze. Rezultati istraživanja upućuju na uzlazni trend posjeta Androloškoj ambulanti te da najviše pacijenata dolazi s područja grada Rijeke, a najmanje dolazaka je s područja Gorskog kotara. Broj pacijenata s azoospermijom je jednak u Rijeci i na otocima.Infertility is defined as the inability to conceive within 12 months of continuous intercourse. The male factor as the sole cause of infertility is found in approximately 30% of infertile couples, and in the world, within the general population, the number of infertile men varies between 4.5% to 12%. The causes of infertility can be etiologically divided into pre-testicular, testicular and post-testicular causes. For the diagnosis of male infertility, a spermiogram is used to describe the form of infertility. The goal of this paper is to present male infertility in the city of Rijeka and the Primorje-Gorski Kotar County (PGŽ). In this research, the data of patients who came to the Andrology Clinic of the Department of Urology at the Rijeka Clinical Hospital Center between 2018 and 2023 were collected. Patients were analyzed based on their place of residence and their spermiogram findings. The patients were then divided into whether they had mild or severe infertility, oligozoospermia, asthenozoospermia, oligoasthenozoospermia or azoospermia and where they came from. The results of the research indicate an upward trend in visits to the Andrology Outpatient Clinic, and that the majority of patients come from the city of Rijeka and that the fewest arrivals are from Gorski kotar. The number of patients with azoospermia was found to be the same in Rijeka and on the islands of the Primorsko – goranska county
Therapy for the unilateral vocal cord paralysis
No full textJednostrana paraliza glasnice (UVFP) je čest klinički entitet kod bolesnika koji se obraćaju fonijatru te ima značajan utjecaj na kvalitetu života osobe. Najčešći uzrok jednostrane paralize glasnice je ozljeda povratnog laringealnog živca (RLN), koja može nastati zbog jatrogenih uzroka (kirurške traume), ekstralaringealnih malignih bolesti, idiopatskih i neuroloških uzroka, kao i zbog nekirurških trauma. Klinička slika i manifestacije UVFP uključuju gubitak pokreta i mišićnog tonusa glasnice, što dovodi do nepotpunog zatvaranje glotisa, koje može rezultirati disfonijom i aspiracijom. Dijagnostički postupci uključuju laringoskopiju, stroboskopiju i elektromiografiju, koje omogućuju detaljan pregled strukturalnih i funkcionalnih promjena glasnica. Trenutni terapijski tretmani za UVFP uključuju glasovnu terapiju, injekcijsku laringoplastiku, medijalizacijsku tiroplastiku, adukciju aritenoida i tehnike reinervacije larinksa. Cilj svakog terapijskog pristupa je vraćanje normalne fonacijske funkcije bez aspiracije. Glasovna terapija može biti korisna kao samostalni tretman ili u kombinaciji s drugim intervencijama. Injekcijska laringoplastika je minimalno invazivni postupak koji uključuje ubrizgavanje materijala u glasnicu čime se postiže njena medijalizacija i augmentacija. S druge strane, medijalizacijska tiroplastika i aritenoidna adukcija su invazivniji, ali trajniji kirurški postupci kojima se glasnica pomiče bliže sredini kako bi se postiglo bolje zatvaranje glotisa. Tehnike reinervacije larinksa kao što su direktna anastomoza RLN, hipoglosalno-RLN anastomoza, ansa cervikalis-RLN anastomoza, također se koriste kako bi se povratila mišićna masa i tonus glasnica. Izbor terapijskog pristupa mora biti individualiziran za svakog bolesnika, uzimajući u obzir specifične kliničke okolnosti i ciljeve liječenja.Unilateral vocal fold paralysis (UVFP) is a common clinical entity in patients who consult a phoniatrician and significantly impacts a person's quality of life. The most common cause of unilateral vocal cord paralysis is injury to the recurrent laryngeal nerve (RLN), which occurs due to iatrogenic causes (surgical trauma), extralaryngeal malignancies, idiopathic and neurological causes, as well as non-surgical traumas. The clinical presentation and manifestations of UVFP include the loss of movement and muscle tone of the vocal fold, leading to incomplete glottic closure, which can result in dysphonia and aspiration. Diagnostic procedures include laryngoscopy, stroboscopy, and electromyography, which enable a detailed examination of structural and functional changes in the vocal folds. Current treatments for UVFP include voice therapy, injection laryngoplasty, medialization thyroplasty, arytenoid adduction, and laryngeal reinnervation techniques. The goal of any therapeutic approach is to restore normal phonatory function without aspiration. Voice therapy can be beneficial as a standalone treatment or combined with other interventions. Injection laryngoplasty is a minimally invasive procedure that involves injecting material into the vocal fold to achieve its medialization and augmentation. In contrast, medialization thyroplasty and arytenoid adduction are more invasive, but permanent surgical procedures that move the vocal fold closer to the midline to achieve better glottic closure. Laryngeal reinnervation techniques, such as direct RLN anastomosis, hypoglossal-RLN anastomosis, and ansa cervicalis-RLN anastomosis, are also used to restore muscle mass and tone of the vocal folds. The choice of therapeutic approach must be individualized for each patient, considering specific clinical circumstances and treatment goals
CHILDHOOD MULTIPLE ENDOCRINE NEOPLASIA
No full textSindrom multiple endokrine neoplazije naziv je za rijetku skupinu genetski nasljednih poremećaja koje karakterizira istovremena pojava benignih i/ili malignih neoplazmi u dva ili više udaljenih endokrinih organa. Neoplastične endokrine promjene mogu uključivati pojavu benignih neoplazmi poput adenoma, malignih neoplazmi poput karcinoma, ali i metastatskih tumorskih oblika koje se razvijaju u manjeg broja oboljelih. Sindrom se nasljeđuje autosomno-dominantno s vrlo visokom penetrantnošću te se može klinički manifestirati u bilo kojoj dobi, pa i u djece od najranijih mjeseci života, podjednako u dječaka i djevojčica. Klinička prezentacija bolesti ovisi o tipu sindroma MEN, odnosno o vrsti genske mutacije, lokalizaciji, veličini i agresivnosti neoplazije, a radi preciznijeg pristupa dijagnostici i liječenju, od iznimne je važnosti znati pravovremeno prepoznati i međusobno razlikovati tri klinička oblika sindroma MEN: MEN1 (Wermerov sindrom), MEN2 i MEN4, od kojih se MEN2 dodatno dijeli i na MEN2A (Sippleov sindrom) i MEN2B podtip. Većini nositelja mutacije koji se žele ostvariti kao roditelji osjeća zabrinutost radi visokog rizika od prijenosa genetske mutacije na svoje potomstvo, zbog čega je oboljele nužno uputiti na genetsko savjetovanje i informirati ih o mogućnostima in vitro fertilizacije te predimplantacijskom genetskom testiranju . Osim detaljnog specijalističkog pregleda od strane pedijatrijskog endokrinologa, postavljanju konačne dijagnoze točno određenog tipa sindroma MEN u djece uvelike doprinose radiološko-slikovne metode, laboratorijski nalazi krvi i urina te rezultati genetskog testiranja,. Neoplazmama se, neovisno o tipu sindroma MEN, najčešće primarno pristupa kirurškim metodama liječenja.Multiple endocrine neoplasia syndrome is the name for a rare group of genetically inherited disorders characterized by the simultaneous appearance of benign and/or malignant neoplasms in two or more distant endocrine organs. Neoplastic endocrine changes can include the appearance of benign neoplasms such as adenomas, malignant neoplasms such as carcinoma, but also metastatic tumor forms that develop in a smaller number of patients. The syndrome is inherited in an autosomal dominant manner with a very high penetrance and can be clinically manifested at any age, even in children from the earliest months of life, both in boys and girls. The clinical presentation of the disease depends on the type of MEN syndrome, i.e. on the type of gene mutation, localization, size and aggressiveness of the neoplasia, and for a more precise approach to diagnosis and treatment, it is extremely important to be able to timely recognize and differentiate between the three clinical forms of the MEN syndrome: MEN1 (Wermer's syndrome ), MEN2 and MEN4, of which MEN2 is further divided into MEN2A (Sipple syndrome) and MEN2B subtype. Most of the carriers of the mutation who want to become parents feel concerned about the high risk of transferring the genetic mutation to their offspring, which is why it is necessary to refer patients to genetic counseling and inform them about the possibilities of in vitro fertilization and pre-implantation genetic testing. In addition to a detailed specialist examination by a pediatric endocrinologist, radiological-imaging methods, blood and urine laboratory findings, and genetic testing results greatly contribute to the final diagnosis of a specific type of MEN syndrome in children. Neoplasms, regardless of the type of MEN syndrome, are most often treated primarily with surgical methods of treatment
The level of disturbances in self-organization in individuals with complex post-traumatic stress disorder
No full textJedanaesto izdanje Međunarodne klasifikacije bolesti uvelo je novu dijagnozu, KPTSP, čija dijagnoza uz postojanje simptoma iz skupine PTSP-a, podrazumijeva i simptome iz skupine PSO. Simptomi PSO dijele se u tri skupine: afektivna disregulacija, negativno samopoimanje i poremećaji u odnosima. Cilj ovoga rada je istražiti razinu simptoma PSO u kliničkoj populaciji veterana Domovinskog rata u Republici Hrvatskoj oboljelih od KPTSP-a. Istraživanje je provedeno u KBC-u Rijeka na kliničkoj populaciji 159 veterana koji su sudjelovali u izravnim ratnim operacijama tijekom Domovinskog rata i zadovoljavaju kriterije za dijagnozu KPTSP-a. Tijekom jednog susreta prikupljeni su sociodemografski podatci ispitanika i podatci vezani za njihova ratna iskustva pomoću upitnika LEC-5, a potom je svaki ispitanik ispunio ITQ. Za sve simptome PSO prikazani su intenzitet i učestalost. Rezultati istraživanja pokazali su najveći intenzitet simptoma kod afektivne disregulacije (AS = 5,99), zatim unutar skupine simptoma poremećaja u odnosima (AS = 5,86) te najmanje unutar skupine simptoma negativnog samopoimanja (AS = 5,45). Ovo istraživanje pridonjeti će boljem razumijevanju KPTSP-a i doprinjeti postojećim znanstvenim saznanjima vezanim za KPTSP.The eleventh edition of the ICD introduced a new diagnosis, CPTSD, which is a sibling diagnosis to PTSD. The diagnosis of CPTSD, in addition to including symptoms from the PTSD category, also includes symptoms from the DSO category. DSO symptoms are divided into three groups: affective dysregulation, negative self-concept, and disturbances in relationships. This study aims to explore the level of DSO symptoms in the clinical population of Croatian Homeland War veterans who meet the criteria for CPTSD. The research was conducted at the Clinical Hospital Center Rijeka on a clinical population of 159 male veterans who participated in direct war operations during the Homeland War and met the criteria for a CPTSD diagnosis. During an individual session, sociodemographic data and information related to the participants' war experiences were collected using the LEC-5 questionnaire, after which each participant completed the ITQ. Intensity and prevalence were shown for each of the DSO symptoms. The results showed the highest average score within the affective dysregulation symptom cluster (AM = 5,99), followed by the disturbances in relationships symptom cluster (AM = 5,86), and the lowest within the negative self-concept symptom cluster (AM = 5,45). This study provides valuable data that will aid further research od CPTSD
Management of Pediatric Elbow Fractures and Dislocations
No full textPediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes