Repository of the University of Rijeka, Faculty of Medicine
Not a member yet
7184 research outputs found
Sort by
Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: a Single-center Experience
No full textObjectives. Thrombosis is an increasingly recognized complication of childhood malignancy and its treatment. The incidence and etiology of pediatric cancer-related thrombosis is still not well understood. The aim of this study was to evaluate the preva- lence of common prothrombotic genetic conditions in children with cancer, the frequency of thrombosis, and the role of inher- ited thrombophilia in the development of thrombosis in a pediatric oncology population.
Patients and Methods. Forty-seven children (36 treated for hematological malignancies and 11 for solid tumors) with a median age of 8.8. years (range 0.4 – 19.3 years) were included in the study. Genetic polymorphisms of Factor V Leiden (G1691A), prothrombin G20210A, and methy- lenetetrahydrofolate reductase (MTHFR) C677T were determined by real-time polymerase chain reaction-based DNA analysis.
Results. Four (8.5%) patients were heterozygous for Factor V Leiden, 3 (6.4%) were heterozygous for prothrombin G20210A mutation, and 3 (6.4%) were homozygous for MTHFR C677T mutation. All patients had implanted central venous catheters. Four (8.5%) children had documented thrombosis, three of which were in the upper venous system. Two of the four patients with thrombosis had Factor V Leiden heterozygosity.
Conclusions. Thrombosis is an important complication of childhood cancer. The risk of thrombosis may be increased in patients with Factor V Leiden. In the absence of consensus guidelines, our results support the recommendation for thrombophilia screening in children with cancer
Acetylcholinesterase activity in muscle tissue of Norway lobster Nephrops norvegicus: Importance of body size, season, sex and naturally occurring metals
No full textThe aim of the present study was to determine the levels of acetylcholinesterase (AChE) activity in the tail muscle tissue of wild populations of Nephrops norvegicus from the Northern Adriatic, and correlate it to body size, seasons, sex and the content of mercury, arsenic, cadmium, lead and copper. The animals of both sexes were collected in spring and autumn from two relatively distant fishing grounds. A marked variability of muscle AChE activity was found (0.49 to 11.22 nmol/min/mg prot.), displaying the opposite seasonal trend between two sampling sites. Small, but significant negative correlation has been found between AChE activity and carapace length (rs = - 0.35, p < 0.05). Data reported here provide an essential baseline for future studies of neurotoxicity in crustaceans. The study highlights the necessity for continuous monitoring of potentially toxic metals in edible marine species to avoid possible repercussions of seafood consumption on human health
Therapeutic Approach to Psoriasis - Part One: Topical Drugs
No full textPsorijaza je imunološki posredovana kronična upalna bolest kože i zglobova. Najčešći oblik psorijaze jest vulgarna ili kronična stacionarna psorijaza, a očituje se pojavom eritematoznih plakova prekrivenih srebrnkastim ljuskama, praćenih svrbežom. Rjeđi oblici psorijaze jesu kapljičasta, eritrodermijska i pustulozna psorijaza te psorijaza praćena psorijatičnim artritisom. Procjena težine bolesti vrši se pomoću kliničkih bodovnih sustava, a važna je zbog odabira prikladne terapije. Prvu liniju liječenja blage do srednje teške psorijaze čini lokalna terapija, dok je kod težih oblika bolesti te pacijenata koji nemaju adekvatan odgovor na lokalnu terapiju ili fototerapiju, indicirana sustavna terapija. Postoji mogućnost kombiniranja lokalne i sustavne terapije, a u određenim slučajevima i fototerapije. U skladu sa smjernicama Hrvatskog dermatovenerološkog društva prva linija lokalnog liječenja psorijaze jest fiksna kombinacija kalcipotriola i betametazon propionata jednom dnevno uz mogućnost proaktivnog liječenja dva puta tjedno. U terapiji održavanja prvenstveno se preporučuje fiksna kombinacija kalcipotriola i betametazon propionata jednom ili dva puta tjedno. U slučaju psorijaze lica i intertriginoznih regija preporučuje se započeti liječenje lokalnim kortikosteroidima, a potom nastaviti s lokalnim inhibitorima kalcineurina. Lokalni pripravci u liječenju psorijaze neizostavan su dio liječenja blage do srednje teške psorijaze, ali i potpora liječenju težih oblika psorijaze uz sustavnu terapiju.Psoriasis is an immune-mediated chronic inflammatory skin and joint disease. Psoriasis vulgaris, also known as chronic plaque psoriasis, is the most common type of psoriasis and is characterized by the appearance of erythematous squamous plaques accompanied by itching. Guttate psoriasis, erythrodermic and pustular psoriasis, and psoriasis associated with psoriatic arthritis are less common forms of psoriasis. Clinical scoring systems are used to assess the severity of the disease, which is important for selecting the appropriate therapy. Local therapy is the first line of treatment for mild to moderate psoriasis, while systemic therapy is indicated for more severe forms of the disease and patients who do not respond to local therapy or phototherapy. Combining local and systemic therapy, as well as phototherapy, is an option in some cases. According to the Croatian Dermatovenerological Society's guidelines, the first line of topical treatment for psoriasis is a fixed combination of calcipotriol and betamethasone propionate once daily, with the option of proactive treatment twice a week. A fixed combination of calcipotriol and betamethasone propionate once or twice a week is recommended in maintenance therapy. Topical corticosteroids, followed by topical calcineurin inhibitors, are the treatment of choice for psoriasis of the face and intertriginous regions. Topical psoriasis treatment is essential in the treatment of mild to moderate psoriasis, but it also complements systemic therapy in patients with severe psoriasis
Indications for Interventional Procedures of the Breasts and Axillae
No full textRanom dijagnozom raka dojke postiže se bolje preživljavanje i manje agresivno liječenje. Slikovne metode poput ultrazvuka, mamografije i magnetske rezonancije osnovne su metode oslikavanja dojki kojima se mogu detektirati lezije u vrlo ranoj, neinvazivnoj fazi. Kao zlatni standard u postavljanju dijagnoze koristi se patohistološka analiza tkiva, stoga su biopsije sumnjivih lezija u dojci neizostavni dio obrade. Općenito, slikovno navođena biopsija dojke potrebna je za nepalpabilne lezije, ali se preporučuje i za palpabilne lezije jer poboljšava točnost dijagnoze. Intervencije u dojci navođene ultrazvukom, mamografijom ili magnetskom rezonancijom pouzdane su metode, a postavljanje tkivnog markera nakon biopsija znak je dobre prakse. Poglavito je važno markirati lezije nakon mamografski navođene biopsije, kao i lezije manje od 5 mm jer se lezije mogu potpuno ukloniti te je tada prijeoperacijska markacija znatno otežana. Isti je princip kod neoadjuvantog liječenja kada tumorski proces može u potpunosti regredirati, stoga tkivni marker omogućuje precizno izvođenje kirurškog zahvata. Za markaciju patoloških limfnih čvorova uputno je korištenje specijalno izrađenih markera, dobre vidljivosti pod svim modalitetima oslikavanja, koji omogućuju preciznu markaciju limfnog čvora nakon provedenog neoadjuvantnog liječenja. Prijeoperacijska lokalizacija nepalpabilnih lezija koristi se za optimizaciju kirurške ekscizije radi očuvanja negativnih rubova bez žrtvovanja normalnog tkiva. Ovaj pregledni rad opisuje i minimalno invazivne tehnike, kao što su termalne ablacije, krioablacija i visokofrekventni fokusirani ultrazvuk kao alternativa kirurškoj eksciziji, s ciljem smanjenja broja komplikacija, boljeg kozmetičkog rezultata i skraćenog boravka u bolnici. Ovaj pregledni rad opisuje spektar slikovno navođenih intervencija koje se izvode u Kliničkom bolničkom centru u Rijeci.Early diagnosis of breast cancer leads to better survival and less aggressive treatment. Imaging techniques such as ultrasound, mammography and magnetic resonance imaging are the basic breast imaging techniques that can be used to detect lesions at a very early, noninvasive stage. Pathohistologic tissue analysis is considered the gold standard in diagnosis, so biopsy of suspicious lesions in the breast is an indispensable part of treatment. In general, image-guided breast biopsy is required for nonpalpable lesions, but it is also recommended for palpable lesions as it improves the accuracy of diagnosis. Ultrasound-, mammographic-, or magnetic resonance-guided breast procedures are reliable methods, and placement of a tissue marker after biopsy is a sign of good practice. Marking lesions after mammography-guided biopsy and lesions smaller than 5 mm is particularly important, as these lesions can be completely removed and preoperative marking is then much more difficult. The same principle applies to neoadjuvant treatment, where the tumor may have already completely regressed, so that marking the tissue enables precise surgical intervention. For marking of pathological lymph nodes, it is advisable to use specially markers that are clearly visible under all imaging modalities and allow precise marking of the lymph node during neoadjuvant treatment. Preoperative localization of nonpalpable lesions is used to optimize surgical excision to obtain negative margins without sacrificing normal tissue. This review also describes minimally invasive techniques such as thermal ablation, cryoablation, and high-frequency focused ultrasound as alternatives to surgical excision to reduce complications, achieve better cosmetic results, and shorten hospital stay. This review describes the spectrum of image-guided procedures performed at the Clinical Hospital Center in Rijeka
Elevated lipoprotein (a) – an independent risk factor for cardiovascular disease – recommendations for measuring and treatment
No full textSmjernice međunarodnih stručnih društava ukazuju da je povišena koncentracija lipoproteina(a)
[Lp(a)] u krvi dugoročni neovisni čimbenik rizika za razvitak aterosklerotske kardiovaskularne bolesti (ASKVB), kao i za kalcifikacijsku stenozu aortnih zalistaka. Cilj je ovog članka koji je rezultat konsenzusa nacionalnih stručnjaka iz tog područja predstaviti najnovije spoznaje o dijagnostici i sadašnjim mogućnostima liječenja bolesnika s povišenom koncentracijom Lp(a) u krvi koje su u ovom trenutku skromne, ali i naznačiti buduće mogućnosti liječenja koje su na pomolu. Zaključak koji se može postaviti na temelju dosadašnjih spoznaja upućuje da postoji neposredna korist za bolesnike u mjerenju koncentracije Lp(a), čak i ako potpuno učinkovito farmakološko liječenje još nije dostupno. Mjerenje Lp(a) olakšava bržu i pouzdaniju identifikaciju bolesnika s visokim kardiovaskularnim rizikom i bolje upravljanje tim rizikom, odnosno upućuje na potrebu intenzivnijeg smanjivanja i liječenja ostalih čimbenika rizika za ASKVB ako je Lp(a) značajnije povećan. Izražavanje koncentracije Lp(a) preporučuje se u nmol/L izmjerene metodama kalibriranim kalibratorima čija je koncentracija izražena u nmol/L.The guidelines of international professional societies indicate that elevated concentration of lipoprotein(a) [Lp(a)] in the blood is a long-term independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD), as well as for calcification stenosis of the aortic valves. The aim of this document which was produced as a consensus document of the authors who are national experts in the field is to present the latest knowledge about diagnostics and current treatment options for patients with elevated Lp(a) concentrations in the blood, which are modest at the moment, but also to indicate future treatment options that are on the horizon. The conclusion that can be made on the basis of current knowledge indicates that there is an immediate benefit for patients in measuring the concentration of Lp(a), even if fully effective pharmacological treatment is not yet available. Measurement of Lp(a) facilitates faster and more reliable identification of patients with high cardiovascular risk
and better management of that risk, i.e. it indicates the need for more intensive reduction and treatment of other risk factors for ASCVD if Lp(a) is significantly increased. It is recommended to express the concentration of Lp(a) in nmol/L measured by methods calibrated with calibrators whose concentration is expressed in nmol/L
The triple A model (age, absolute neutrophil count, absolute lymphocyte count‐ AAA ) predicts survival and thrombosis in polycythemia vera
No full textRecurrent Adamantinoma With Fibrous Dysplasia-like Feature
No full textAdamantinoma (AD) is a rare, slow-growing primary malignant bone tumor characterized by a biphasic morphology of clusters of epithelial cells and spindle cell osteofibrous components. A strong relationship between AD and osteofibrous dysplasia (OFD) has been proposed, while fibrous dysplasia (FD) has been rarely associated with AD. We present an AD case that was followed and histologically evaluated 3 times over 6 years with different morphological patterns. The tumor in the primary biopsy and after complete resection showed classical features of AD and osteofibrous-like pattern, while the recurrent lesion presented with exclusively spindle cell morphology and was thus diagnosed as FD. However, the extensive immunohistochemical analysis in all 3 lesions revealed strong reactivity for pancytokeratin, vimentin, p63, and podoplanin, which are characteristic for AD. Although, in the FD-like section of the tumor from the first recurrence the positivity of podoplanin was stronger than pancitokeratin, which was variably positive on spindle cells. The present case highlights the problem of diagnosing AD based on a single biopsy with one tumor’s component predominating over the other, and at the same time emphasizes the importance of using immunohistochemical staining for keratin and podoplanin when the histopathological features of (osteo)fibrous lesion can be linked to AD
Chronic treatment of childhood asthma and MART concept
No full textKasnih osamdesetih godina prošlog stoljeća, kada se shvatilo da je astma dominantno kronična upalna bolest dišnih putova, došlo je do velikih promjena u kliničkom pristupu bolesniku s astmom. Time je završila „bronhodilatacijska era“ i započela je „protuupalna era“ u kojoj su inhalacijski kortikosteroidi (ICS) postali glavni oslonac farmakoterapijskog pristupa astmi. Jedan takav recentan pristup poznat je pod akronimom MART (engl. maintenance and reliever therapy). On podrazumijeva primjenu fiksne kombinacije ICS-a i formoterola koju bolesnik udiše svakodnevno u cilju dugoročnog održavanja kontrole astme (engl. maintenance), ali za istim lijekom poseže i dodatno „po potrebi“ za postizanje olakšanja (engl. reliever). MART je učinkovita farmakoterapijska opcija u djece starije od šest godina koja pate od perzistentne astme. Poglavito je atraktivna za adolescente čija je astma često nezadovoljavajuće kontrolirana uslijed slabe adherencije za kontinuiranim uzimanjem protuupalnih lijekova.In the late 1980s, when it was realized that asthma is predominantly a chronic inflammatory disease of the airways, there were major changes in the clinical approach to patients with asthma. The “bronchodilator era” ended and the “anti-inflammatory era” began in which inhaled corticosteroids (ICS) became the mainstay of the pharmacotherapeutic approach to asthma. One such recent approach is known under the acronym MART (maintenance and reliever therapy). It involves the use of a fixed combination of ICS and formoterol that the patient inhales daily with the aim of long-term maintenance of asthma control, but the same drug is additionally used “as needed” to achieve relief. MART is an effective pharmacotherapeutic option in children older than 6 years who suffer from persistent asthma. It is particularly attractive for adolescents whose asthma is often unsatisfactorily controlled because of poor adherence to continuous anti-inflammatory medication
Size of Extranodal Extension in the Sentinel Lymph Node as a Predictor of Prognosis in Early-Stage Breast Cancer
No full textIntroduction: The presence of extranodal extension (ENE) in sentinel lymph nodes (SLNs) can predict non-SLN metastases in breast cancer (BC) patients; however, the prognostic relevance of its extent remains controversial. The purpose of this study was to examine the predictive role of ENE in SLNs measured by its widest dimension (WD), highest dimension (HD), and the WD/HD ratio for non-SLN involvement, overall, and disease-free survival (OS, DFS) in cT1-2N0 BC patients with positive SLNs.
Materials and methods: A total of 511 women with cT1-2N0 BC and positive SLNs undergoing axillary lymph node dissection were retrospectively enrolled. The associations of ENE's WD, HD, and WD/HD ratio with non-SLN metastases, 5-year OS, and DFS were established through a multivariable modeling approach.
Results: SLNs were ENE-positive in 149 (29.16%) participants, and 133 (26.03%) had non-SLN metastases. During the median 60 (16-60)-month follow-up, 69 (13.50%) patients experienced recurrences, and 62 (12.13%) died. The numbers of SLNs, non-SLNs, and total axillary LNs involved differed between the ENE-negative and ENE-positive groups, as well as between the WD/HD ≤ 1.2 and WD/HD > 1.2 subgroups (all P-values were 1.2 with non-SLN involvement, OS, and DFS (P-values were .003, < .001, and .005, respectively).
Discussion: Despite no predictive value of ENE's WD and HD, the WD/HD ratio > 1.2 was an independent predictor of non-SLN involvement, mortality, and recurrence. ENE's WD/HD ratio could be a valuable indicator for cT1-2N0 BC individuals with positive SLNs for whom further axillary treatment may be beneficial
