Veterinary medicine - Repository of PHD, master's thesis
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Pathogenesis and Therapy of Oral Carcinogenesis
No full textOral squamous cell carcinoma (OSCC) is the most common malignant tumor of the head and neck with an extremely poor five-year survival rate of approximately 50 to 55%, despite significant advances in diagnostic and therapeutic procedures over the past three decades [...
Two portraits of Celestin Medović as a starting point in considering the possibility of diagnosing bilateral blepharoptosis
No full textCilj: Autori prikazuju dva medicinski zanimljiva portreta poznatoga hrvatskog slikara Mata Celestina Medovića, s ciljem rasprave o mogućnostima dijagnosticiranja obostrane blefaroptoze prikazanih osoba. Materijal i metode: Portreti su analizirani u skladu s postulatima ikonodijagnostike. S diferencijalno-dijagnostičkog aspekta prikazani su hipotetski uzroci stečene, obostrane blefaroptoze. Također je analiziran prikaz ovog kliničkog znaka na djelima poznatih europskih slikara 14. – 20. stoljeća te hrvatskih slikara 19. – 20. stoljeća. Rezultati: Mogući uzrok ptoze na Portretu starice mogao bi biti aponeurotski, uzrokovan atrofijom mišića gornje vjeđe. Ne može se sa sigurnošću isključiti niti okularni oblik miastenije gravis. Mogući uzrok blefaroptoze na Portretu Konavoke je miastenija gravis s pozitivnim antitijelima na mišić-specifičnu tirozin kinazu, s obzirom na evidentnu atrofiju lijevog m. massetera. U oba slučaja može se raditi i o miogenoj blefaroptozi uzrokovanoj okularnom miopatijom ili okulofaringelanom mišićnom distrofijom. Ostali mogući uzroci blefaroptoze kod portretiranih žena isključeni su s većom ili manjom sigurnošću. Analogno principima medicine temeljene na dokazima, zaključci ikonodijagnostičke analize klasificiraju se u skupine: A (gotovo sigurno), B (vjerojatno), C (nesigurno), D (nevjerojatno) i E (nemoguće). Zaključak prikazane analize pripadao bi skupini B, što znači da su naša zapažanja „vjerojatno točna“, uzevši u obzir da se ista temelje isključivo na kliničkim zapažanjima, bez uvida u povijesne okolnosti ili dokumente koji bi to mogli potvrditi. Komparativnom analizom prisutnosti kliničkog znaka ptoze na djelima poznatih europskih slikara od 14. do 20. stoljeća isti smo detektirali na ukupno jedanaest slika. Na djelima hrvatskih majstora 19. i 20. stoljeća ptoza je detektirana na četiri slike i jednoj brončanoj bisti. Zaključak: Ovaj rad nas podsjeća na važnost poznavanja kliničke propedeutike, nasuprot danas prevladavajućem medicinsko-tehnološkom pristupu koji favorizira brojne, često nepotrebne procedure u procesu postavljanja dijagnoze. Možda tzv. „muzejske vizite“, s ciljem poboljšanja sposobnosti uočavanja kliničkih znakova na umjetničkim slikama od strane studenata medicine, jednom postanu i dio nastavnog programa na hrvatskim sveučilištima.Aim: The authors present two medically interesting portraits of the famous Croatian painter Celestin Medović, with the aim of discussing the possibilities of diagnosing bilateral blepharoptosis. Material and methods: The portraits were analyzed in accordance with the postulates of iconodiagnosis. Hypothetical causes of acquired bilateral blepharoptosis are presented from the differential-diagnostic aspect. The presence of this clinical sign was also analyzed in the works of famous European painters from the 14th to the 20th centuries and Croatian painters of the 19th and 20th centuries. Results. Ptosis in “Portrait of an Old Woman” could be aponeurotic, caused by atrophy of the muscles of the upper eyelid. The ocular form of myasthenia gravis cannot be ruled out with certainty either. Muscle-specific tyrosine kinase myasthenia gravis is a possible cause of ptosis in “Portrait of a Lady from Konavle,” especially because of the left masseter muscle atrophy. Ocular myopathy or oculopharyngeal muscle dystrophy can also be a reason for bilateral blepharoptosis in both cases. Other possible causes of blepharoptosis in the portrayed women are excluded with greater or lesser certainty. Analogous to the principles of evidence- based medicine, the conclusions of the iconodiagnostic analysis are classified into four groups: A (almost certain), B (probable), C (uncertain), D (improbable), and E (impossible). The conclusion of the presented analysis would belong to group B, which means that our observations are “probably correct,” considering that they are based solely on clinical observations without insight into historical circumstances or documents that could confirm this. Through a comparative analysis of the presence of the clinical sign of ptosis in the works of famous European painters from the 14th to the 20th centuries, we found the same in a total of 11 paintings. In the works of Croatian painters of the 19th and 20th centuries, ptosis was detected in four paintings and one bronze bust. Conclusion: This paper reminds us of the importance of knowing clinical propaedeutics, in contrast to the medicaltechnological approach prevailing today, which favors numerous, often unnecessary, procedures in the process of establishing a diagnosis. Maybe the so-called “museum visits” with the aim of improving the ability of medical students to observe clinical signs on art paintings will become part of the curriculum at Croatian universities
Multidrug-Resistant Bacteria in Surgical Intensive Care Units: Antibiotic Susceptibility and β-Lactamase Characterization
No full textMultidrug-resistant (MDR) bacteria of the utmost importance are extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). In this study, an evaluation of MDR bacteria in surgical intensive care units in a tertiary referral hospital was conducted. The study aimed to characterize β-lactamases and other resistance traits of Gram-negative bacteria isolated in surgical intensive care units (ICUs). Disk diffusion and the broth dilution method were used for antibiotic susceptibility testing, whereas ESBL screening was performed through a double disk synergy test and an inhibitor-based test with clavulanic acid. A total of 119 MDR bacterial isolates were analysed. ESBL production was observed in half of the Proteus mirabilis, 90% of the Klebsiella pneumoniae and all of the Enterobacter cloacae and Escherichia coli isolates. OXA-48 carbapenemase, carried by the L plasmid, was detected in 34 K. pneumoniae and one E. coli and Enterobacter cloacae complex isolates, whereas NDM occurred sporadically and was identified in three K. pneumoniae isolates. OXA-48 positive isolates coharboured ESBLs belonging to the CTX-M family in all but one isolate. OXA-23 carbapenemase was confirmed in all A. baumannii isolates. The findings of this study provide valuable insight of resistance determinants of Enterobacterales and A. baumannii which will enhance surveillance and intervention strategies that are necessary to curb the ever-growing carbapenem resistance rates
The intercondylar tibial eminence fracture
No full textPrijelomi interkondilarne eminencije značajne su ozljede koje primarno pogađaju djecu u dobi od 8 do 14 godina. Ovi prijelomi nastaju uslijed traume, najčešće pri hiperekstenziji koljena ili fleksiji protiv otpora uz vanjsku rotaciju tibije. Kod djece, prednji križni ligament ostaje netaknut, dok dolazi do prijeloma koštane eminencije, s obzirom na to da je ligament snažniji od nezrele kosti. Interkondilarna eminencija ključna je za stabilnost koljena jer služi kao hvatište prednje križne sveze. Dijagnoza prijeloma temelji se na kliničkom pregledu i slikovnim metodama. Simptomi uključuju bol, oticanje, ograničenu pokretljivost i nestabilnost zgloba. Radiološke tehnike, poput RTG-a, CT-a i MR-a, ključne su za postavljanje dijagnoze. Meyers-McKeeverova klasifikacija, temeljena na RTG-u, razvrstava prijelome od minimalnog pomaka (tip I) do kominutivnih prijeloma (tip IV). MR pruža detaljniji prikaz ozljeda mekih tkiva i pomaka prijeloma. Liječenje ovisi o težini ozljede. Neoperacijski pristup, uključujući imobilizaciju i
rehabilitaciju, primjenjuje se kod prijeloma s minimalnim pomakom (tipovi I i neki tip II). Složeniji slučajevi (tipovi III i IV) zahtijevaju kirurško liječenje. Artroskopska repozicija i unutarnja fiksacija (ARIF) predstavlja zlatni standard jer omogućuje preciznu repoziciju uz minimalno oštećenje mekih tkiva. Fiksacija se provodi šavovima ili vijcima, ovisno o dobi pacijenta i složenosti prijeloma. Komplikacije uključuju zaostalu nestabilnost, ukočenost zgloba (artrofibroza) i, rijetko, oštećenje ploče rasta ili loše sraštanje prijeloma. Pravovremeno liječenje i rehabilitacija ključni su za očuvanje stabilnosti koljena i sprječavanje dugoročnih posljedica.Fractures of the intercondylar eminence are a significant injury primarily affecting children aged 8 to 14 years. These fractures occur due to trauma such as hyperextension or forced flexion combined with external tibial rotation. In pediatric
cases, the anterior cruciate ligament remains intact while the bony eminence fractures, given the ligament's strength relative to the immature bone. The intercondylar eminence is critical for knee stability, acting as the ACL's attachment
site. Diagnosing fractures involves clinical examination and imaging. Symptoms include pain, swelling, restricted movement, and instability. Radiographic techniques, such as X-rays, CT, and MRI, are essential. The Meyers-McKeever classification,
based on X-rays, categorizes fractures from minor displacement (Type I) to comminution (Type IV). MRI-based systems, like the Green classification, provide detailed insight into soft tissue damage and fracture displacement. Treatment depends on severity. Nonoperative approaches, including immobilization and rehabilitation, are suitable for minimally displaced fractures (Types I and some Type II). Conversely, more severe cases (Types III and IV) require surgical intervention. Arthroscopic reduction and internal fixation (ARIF) is the preferred method, offering precise fracture alignment with minimal soft tissue damage. Fixation uses sutures or screws, tailored to patient age and fracture complexity. Post-treatment complications include residual instability, joint stiffness (arthrofibrosis) and, rarely, growth plate damage or malunion. In conclusion, fractures of the intercondylar eminence demand timely and precise management to restore knee stability and
prevent long-term disability
Equivalent: Paneth cell-like component in prostate cancer - case report
No full textAdenokarcinom prostate s neuroendokrinom diferencijacijom u obliku komponente koja nalikuje Panethovim stanicama je vrlo rijedak entitet. Raspršene neuroendokrine stanice nalik Panethovima mogu se naći u većini opisanih slučajeva, iako se nalaze i primjeri s predominantnom komponentom navedenih stanica. One sadrže eozinofilne citoplazmatske inkluzije, a nedostaju im androgeni receptori te su stoga imuni na hormonsku terapiju, a što je jedan od glavnih razloga da ih patolozi prepoznaju. Prema dostupnoj literaturi, klinički ishod takvih tumora ovisi o standardnim parametrima, ponajprije o gradusu konvencionalne komponente karcinoma prostate. Ovdje opisujemo 54-godišnjeg bolesnika s adenokarcinomom prostate koji pokazuje neuroendokrinu diferencijaciju tipa stanica nalik Panethovim.Prostate adenocarcinoma with Paneth cell-like neuroendocrine diff erentiation is a rare entity. Foci of scattered cells and small clusters are found in the majority of described cases, although cases with predominant Paneth cell-like features have also been recorded. Th ese cells contain eosinophilic cytoplasmic inclusions and lack androgen receptors, and are consequently immune to hormone therapy. It is, therefore, important for pathologists to recognize them. According to literature, clinical outcome depends on the standard grading of the conventional prostate cancer component. We report a case of a 54 year-old patient with prostatic adenocarcinoma showing Paneth celllike neuroendocrine diff erentiatio
Lung long distance: histopathological changes in lung tissue after COVID-19 pneumonia
No full textAim: To investigate histopathological changes in the lung tissue of long-COVID patients.
Methods: In this cross-sectional study, transbronchial lung biopsy was performed in long-COVID patients with persisting symptoms and radiological abnormalities. Histopathologic analyses were performed by using hematoxylin-eosin, Martius, Scarlet and Blue, Movat's, thyroid transcription factor 1, CD34, and CD68 staining.
Results: Adequate biopsy samples were obtained from 29/32 patients. The median (Q1-Q3) time from disease onset to biopsy was 13 (9-20) weeks. We observed several histopathologic patterns: DAD with vascular abnormalities (VA) (n=8); VA with inflammatory pattern (n=4); inflammatory pattern (n=13), and fibrotic pattern (n=4). VA included capillary thrombi, dilated venules, and dissection of small pulmonary arteries. DAD with VA was detected up to the 9th week from the onset of disease; inflammatory pattern from the 8th to 28th week (4 patients with this pattern biopsied in the 11th-13th week had accompanying VA); and a predominantly fibrotic pattern was found at weeks 8, 10, 48, and 49.
Conclusion: Our study observed a slow recovery of lung tissue with long-lasting DAD and VA, likely followed by interstitial inflammation or focal fibrosis. These findings might be the underlying cause of the slow recovery of long-COVID patients
Blood pressure measurement and assessment of arterial structure and function: an expert group position paper
No full textMeasuring blood pressure (BP) and investigating arterial hemodynamics are essential in understanding cardiovascular disease and assessing cardiovascular risk. Several methods are used to measure BP in the doctor's office, at home, or over 24 h under ambulatory conditions. Similarly, several noninvasive methods have been introduced for assessing arterial structure and function; these methods differ for the large arteries, the small ones, and the capillaries. Consequently, when studying arterial hemodynamics, the clinician is faced with a multitude of assessment methods whose technical details, advantages, and limitations are sometimes unclear. Moreover, the conditions and procedures for their optimal implementation, and/or the reference normality values for the parameters they yield are not always taken into sufficient consideration. Therefore, a practice guideline summarizing the main methods and their use in clinical practice is needed. This expert group position paper was developed by an international group of scientists after a two-day meeting during which each of the most used methods and techniques for blood pressure measurement and arterial function and structure evaluation were presented and discussed, focusing on their advantages, limitations, indications, normal values, and their pragmatic clinical application
Correlation between the transection line localization and future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy
No full textPresadnice kolorektalnog karcinoma su najčešći sekundarni tumori jetre, a standardne resekcije često nisu indicirane zbog neadekvatnog ostatnog volumena jetre (engl. FLR- Future liver remnant). Radi toga su razvijene različite metode za indukciju jetrene hipertrofije, a najnovija od njih je ALPPS (engl. „Associating liver partition and portal vein ligation for staged hepatectomy") koji zahtijeva daljnju znanstvenu evaluaciju. Cilj ovog istraživanja bio je analizirati povezanost svake od tri transekcijske linije i hipertrofije FLR-a koristeći precizne CT volumetrijske metode kod bolesnika s presadnicama kolorektalnog karcinoma. Dodatni cilj bio je procijeniti hipertrofiju FLR-a i kliničke ishode nakon sinkronog ALPPS-a i standardnih hepatektomija. Provedeno je retrospektivno, multicentrično istraživanje u kojem su se koristili podaci o bolesnicima iz KBC Zagreb i ALPPS registra pri KBC Zurich. Na perioperativnim radiološkim snimkama učinjena je CT volumetrija, a istraživanjem su obuhvaćena 164 bolesnika s ALPPS-om, 53 bolesnika sa sinkronim ALPPS-om i 112 bolesnika sa standardnom hepatektomijom. Rezultati su pokazali da hipertrofija FLR-a ovisi o vrsti transekcijske linije (χ2 = 9,36, p = 0,009). Desna lateralna transekcijska linija bila je povezana sa značajno većim stupnjem hipertrofije u usporedbi sa središnjom linijom (83,2% prema 62,5%, p = 0,037). Preoperativni volumen FLR-a negativno je korelirao s hipertrofijom FLR (r = -0,5580, dF = 162, p = <0,0001). Sinkroni ALPPS nije utjecao na hipertrofiju FLR-a, ali je bio povezan s lošijim kliničkim ishodima, dok se regeneracija jetre nakon 6-12 mjeseci nije značajno razlikovala između ALPPS skupine i standardne hepatektomije. Možemo zaključiti da se regionalni volumeni jetre mogu pouzdano izmjeriti korištenjem CT volumetrije, a naše je istraživanje dokazalo da hipertrofija FLR-a ovisi o lokalizaciji transekcijske linije te volumenu FLR-a tijekom prve faze ALPPS-a.Colorectal metastases (CRLMs) are the most common secondary liver tumors, and standard resections are often not indicated due to inadequate functional future liver remnants (FLR). Consequently, various methods for inducing FLR hypertrophy were developed, with the most recent being "associating liver partition and portal vein ligation for staged hepatectomy" (ALPPS), which still requires scientific evaluation. The aim of the study was to analyze the correlation between one of the three liver transection lines and FLR hypertrophy using precise CT volumetry methods in patients with CRLMs. An additional goal was to evaluate FLR hypertrophy and the outcomes associated with synchronous ALPPS and standard hepatectomies. A retrospective, multicentric study was conducted using patient data from UHC Zagreb and the ALPPS registry established by UHC Zurich. CT volumetry was performed on perioperative images, and the study included 164 patients with ALPPS, 53 patients with synchronous ALPPS, and 112 patients with standard hepatectomy. The results demonstrated that FLR hypertrophy depends on the type of transection line (χ2 = 9.36, p = 0.009, df = 2). The right lateral transection line was associated with a significantly higher degree of hypertrophy when compared to the central line (83.2% vs. 62.5%, p = 0.037). The preoperative volume of FLR correlated negatively with FLR hypertrophy (r = -0.5580, dF = 162, p = <0.0001). Synchronous ALPPS did not affect FLR hypertrophy, but it was associated with worse clinical outcomes, while liver regeneration after 6–12 months was similar in the ALPPS and standard hepatectomy groups. We can conclude that regional liver volumes can be reliably evaluated using CT volumetry, and our research proved that FLR hypertrophy depends on the localization of the transection line and FLR volume during the first stage of ALPPS