Veterinary medicine - Repository of PHD, master's thesis
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Tibial tuberosity–tibial intercondylar midpoint distance in diagnosing patellofemoral instability on the axial CT-images of the knee
No full textCilj: Ocijeniti udaljenost između goljeničnoga čvora i interkondilnoga središta goljenične kosti, TT‒TIM udaljenost, novi mjerni postupak za procjenu izmještenosti pružačkoga sklopa noge na poprečnim CT-slikama koljena u dijagnostici patelofemoralne nestabilnosti.
Materijali i metode: Presječnim retrospektivnim ispitivanjem poprečnih CT-slika 129 koljena, specijalist i specijalizant radiologije u dvotjednom su razmaku zasebno izmjerili udaljenosti između goljeničnoga čvora i dna ugibališta (TT–TG), goljeničnoga čvora i interkondilnoga središta bedrene kosti (TT–FIM) i TT–TIM udaljenost. Zajedno su izmjerili kružne pomake bedrene i/ili goljenične kosti te utvrdili oblik ugibališta. Slaganje izvođača procijenjeno je intraklasnim pokazateljem povezanosti (ICC).
Rezultati: Mogući pragovi TT–TG i TT–FIM udaljenosti bili su >20 ili >24 mm, a TT–TIM udaljenosti >13 ili >15 mm. TT–TIM udaljenost bila je ispravna kirurška mjera visoke istinitosti i dosljednosti (≈90%) i, stoga, najbolji mjerni postupak. Zavisila je samo o spolu, dok su ostale udaljenosti zavisile o dobi, obliku ugibališta, koljenskom i zajedničkom kutu te nagibu bedrene kosti, pri čemu nijedna udaljenost nije zavisila o strani tijela. Gotovo savršeno slaganje izvođača (ICC>0,81) opravdalo je upotrebu CT-uređaja.
Zaključak: TT–TIM udaljenost mjerni je postupak za procjenu izmještenosti pružačkoga sklopa noge u dijagnostici patelofemoralne nestabilnosti, s najnižim mogućim pragom od >13 mm.Objective: To rate the new, tibial tuberosity–tibial intercondylar midpoint (TT‒TIM) distance, evaluating lateralisation of the extensor mechanism of the knee in diagnosing patellofemoral instability.
Materials and methods: In a cross-sectional retrospective imaging study on axial CT-images of 129 knees, a radiology specialist, and a resident separately measured the tibial tuberosity– trochlear groove (TT–TG), tibial tuberosity–femoral intercondylar midpoint (TT–FIM), and the TT–TIM distance. Jointly, they measured the rotational alignment of the femur and/or tibia and evaluated the trochlear shape. Interrater agreement was assessed using intraclass correlation coefficient (ICC).
Results: Possible thresholds for TT–TG and TT–FIM distances were >20, and >24 mm with >13, and >15 mm for TT–TIM distance. TT–TIM distance was a correct surgical measure with high trueness, and precision (≈90%) and, hence, the best measuring method. It was only sexbiased, whereas others depended on age, trochlear shape, knee rotation, general rotation, and the femoral tilt, though none on laterality. The almost perfect interrater agreement (ICC>0.81)
justified the use of a CT-scanner.
Conclusion: TT–TIM distance is a measure of lateralisation of the extensor mechanism of the knee in diagnosing patellofemoral instability with the lowest possible threshold of 13 mm
Surgical treatment methods of head and neck melanoma
No full textMelanom je zloćudni tumor kože koji nastaje iz melanocita i predstavlja značajan udio smrtnih slučajeva od raka kože. Zbog izloženosti UV zračenju često se dijagnosticira u području glave i vrata. Razlikujemo nekoliko tipova melanoma: površinsko šireći, nodularni, lentigo maligna i akralni lentiginozni melanom. Dijagnostika melanoma kože uključuje klinički pregled, dermatoskopsku analizu i, u slučaju sumnje, eksciziju promjene za patohistološku analizu. Definitivna se dijagnoza postavlja patohistološkim nalazom. Identifikacija regionalnih limfnih metastaza, ključnih za prognozu, obuhvaća metode poput limfoscintigrafije i metode intraoperativne detekcije. Regija glave i vrata predstavlja anatomski složeno područje s brojnim žilama, mišićima i limfnim čvorovima, što čini kirurške zahvate na ovom području izuzetno zahtjevnima. Melanomi glave i vrata često su lokalizirani na licu i vlasištu, a njihovo liječenje zahtijeva posebnu pažnju zbog kompleksnosti anatomije i estetskih posljedica. Metastaziranje melanoma u regiji glave i vrata može se odvijati prema precizno definiranim limfnim putevima, ali i parotidnoj žlijezdi, što komplicira njihovo liječenje i mijenja prognozu. Klasifikacija melanoma kože glave i vrata temelji se na TNM stadiju i kliničkim stadijima prema AJCC. Različiti klinički stadiji bolesti vežu se uz specifično vrijeme preživljenja i pomažu u planiranju liječenja. U kirurške metode dijagnostike primarnog melanoma spadaju metode biopsije primarnog tumora i metode biopsije limfnog čvora stražara. Za primarne tumore razlikuju se ekscizijska, incizijska, punch biopsija te biopsija brijanjem. Kirurške metode ekscizije melanoma uključuju široku eksciziju primarnog melanoma, mikrografsku kirurgiju i resekciju tumora vođenu fluorescencijom. Zatvaranje defekta temelji se na principima rekonstrukcijske kirurgije, uz prioritizaciju jednostavnijih metoda prema rekonstrukcijskoj piramidi, s ciljem povratka oblika i funkcije zahvaćene regije. Liječenje regionalnih metastaza melanoma kože glave i vrata uključuje neki oblik limfadenektomije ovisno o proširenosti tumora. Svaka od navedenih kirurških metoda ima svoje komplikacije.Melanoma is a malignant skin tumor that arises from melanocytes and represents a significant portion of skin cancer-related deaths. Due to exposure to UV radiation, it is often diagnosed in the head and neck area. Several types of melanoma are distinguished: superficial spreading, nodular, lentigo maligna, and acral lentiginous melanoma. Diagnosis of skin melanoma involves clinical examination, dermatoscopic analysis, and, if suspicious, excision of the lesion for pathological analysis. The definitive diagnosis is made through histopathological examination. Identification of regional lymph node metastases, crucial for prognosis, involves methods such as lymphoscintigraphy and intraoperative detection. The head and neck region is anatomically complex with numerous vessels, muscles, and lymph nodes, making surgical interventions in this area extremely demanding. Melanomas of the head and neck are often localized on the face and scalp, and their treatment requires special attention due to the complexity of anatomy and aesthetic consequences. Metastasis of melanoma in the head and neck region can occur via precisely defined lymphatic pathways, but also involves the parotid gland, complicating treatment and altering prognosis. Classification of head and neck skin melanoma is based on TNM stage and clinical stages according to AJCC. Different clinical stages of the disease correlate with specific survival times and aid in treatment planning. Diagnostic surgical methods for primary melanoma include biopsy methods of the primary tumor and sentinel lymph node biopsy. For primary tumors, excisional, incisional, punch biopsy, and shave biopsy methods are distinguished. Surgical excision methods for melanoma include wide excision of the primary melanoma, Mohs micrographic surgery, and fluorescence-guided tumor resection. The resulting defect is managed based on principles of reconstructive surgery, prioritizing simpler methods according to the reconstructive ladder, aiming to restore the shape and function of the affected area. Treatment of regional metastases of head and neck skin melanoma involves some form of lymphadenectomy depending on the extent of the tumor. Each of the mentioned surgical methods has its own complications
Correlation of Cytokine Profiles with Prostate-Specific Antigen and Disease Grade in Prostate Cancer
No full textBACKGROUND The development and progression of prostate cancer are multistep processes involving several growth factors, hormones, and cytokines. This study aimed to measure the serum concentrations of different cytokines and determine their correlation with prostate-specific antigen (PSA) levels and disease grade in patients with prostate adenocarcinoma.
MATERIAL AND METHODS This cross-sectional study was conducted from March 2023 to March 2024 at the Clinic of Oncology of the University Hospital Center in Mostar, Bosnia and Herzegovina. Altogether, 50 male patients with prostate adenocarcinoma were included, of whom 28 had no proven metastases (PC group) and 22 had metastatic disease (MPC group). Serum concentrations of total (tPSA), free (fPSA), and complexed (cPSA) PSA were determined using a chemiluminescent microparticle immunoassay, whereas serum concentrations of cytokines were measured using a flow cytometry bead-based assay.
RESULTS The MPC group had higher serum tPSA, fPSA, and cPSA levels than the PC group. The PC group had significantly higher serum levels of monocyte chemotactic protein (MCP)-1 than the MPC group (P=0.008). In the PC group, serum levels of interleukin (IL)-10 significantly correlated with cPSA. In the MPC group, serum concentrations of IL-1ß, tumor necrosis factor (TNF)-alpha, and IL-23 significantly correlated with disease grade.
CONCLUSIONS Our study emphasizes the importance of MCP-1 in the development of prostate cancer, while IL-10 was the only cytokine whose serum level significantly correlated with cPSA. Serum concentrations of IL-1ß, TNF-alpha, and IL-23 may serve as potential biomarkers for disease grade
PREVALENCE, Characteristics, and Awareness of Chronic Kidney Disease in Croatia: The EH-UH 2 Study
No full textBackground. National surveys have reported variable prevalence of chronic kidney disease (CKD), due to differences in the characteristics of the population, study design, equations used for the estimated glomerular filtration rate (eGFR), and definitions. The EH-UH 2 survey is the first study evaluating CKD prevalence, characteristics, and awareness in Croatia. Methods. This was a cross-sectional nationwide observational study designed to assess the prevalence of CKD and cardio–kidney–metabolic risk factors in Croatia, which included 1765 randomly selected subjects. We estimated the prevalence of CKD by means of the albumin-to-creatinine ratio (ACR) and eGFR (CKD-EPI equation). Comorbidities and anthropometric and social factors related to the prevalence of CKD were analyzed, and the CV risk profile was evaluated.
Results. The weighted prevalence of CKD (any stage), CKD stage ≥G3A A2, and CKD defined only as an eGFR 30 mg/g was 15.1%. Older age, male gender, diabetes, ePWV, and uric acid were independently associated with CKD prevalence. The awareness of CKD was 9.5%. Persons unaware of CKD were older with lower income, less education, more frequent diabetes, hypertension (less frequently controlled), and milder renal impairment.
Conclusions. In Croatia, the estimated prevalence of CKD is high, being presented more frequently in men than in women. CKD patients have an unfavorable CV risk profile. The awareness of CKD is very low, reflecting poor health literacy in the general population but also in health-care workers
First real-life data on COVID-19 vaccine effectiveness against hospitalisation and severe disease from the eastern part of the WHO European Region
No full textEfficacy of Wilate Prophylaxis in Reducing Nosebleeds in Patients with Severe VWD – A Post-hoc Analysis of the WIL-31 Study
No full textBackground: Prophylaxis with a von Willebrand factor (VWF) concentrate is recommended in von Willebrand disease (VWD) patients with a history of frequent and severe bleeds. Despite nosebleeds being a frequent manifestation of VWD, few studies have investigated the efficacy of factor prophylaxis in preventing nosebleeds in patients with severe VWD.
Methods: This post-hoc analysis of a prospective, 12-month, phase 3 study assessed the efficacy of wilate in the prevention of nosebleeds in 33 patients aged ≥6 years with severe type 1, type 2 or type 3 VWD. All patients previously participated in a 6-month prospective study of on-demand treatment with any VWF concentrate. Prophylactic efficacy was assessed by comparing total and spontaneous annualized bleeding rates for nosebleeds (TABR and SABR, respectively) during prophylaxis with rates during on-demand treatment.
Results: The mean TABR and SABR for nosebleeds were reduced by 76% and 81% respectively during prophylaxis versus on-demand treatment (2.7 vs 11.0 and 2.1 vs 10.9). During the second 6 months of prophylaxis, mean TABR was 49% lower and mean SABR 57% lower versus the first 6 months. The percentage of patients with zero nosebleeds was 19% during 6 months of on-demand treatment, 55% during the first 6 months of prophylaxis, and 68% during the second 6 months of prophylaxis. The efficacy of wilate in the treatment of breakthrough nosebleeds was rated excellent in 99% of cases.
Conclusion: This post-hoc analysis demonstrated the efficacy of wilate prophylaxis in the prevention and treatment of nosebleeds in children and adults with severe VWD
Presentation of Graves’ orbitopathy within European Group On Graves’ Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III)
No full textBackground: Graves' orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves' Orbitopathy (EUGOGO) tertiary referral centres and initial management over time.
Methods: Prospective observational multicentre study. All new referrals with diagnosis of GO within September-December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012.
Results: Besides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p<0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0-350) vs 6 (0-552) months; p<0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p<0.001) or selenium (22.3% vs 3.0%; p<0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p<0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027).
Conclusion: GO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment
Equivalent: Prostate-specific antigen (PSA) values in patients with low-and high-risk prostatic adenocarcinoma
No full textProstatic adenocarcinoma (PC) comprises around 19% of malignancies in Croa-tian male population. On the basis of PSA value,Gleason score, grading group and clinical stage, PC can be classified into low- and high-risk groups which is significant for different therapeutic regimens and prognostic outcomes.In this retrospective study, we analyzed the difference in preoperative PSA value in a group of 272 patients who underwent radical prostatectomy and were diagnosed with PC adenocarcinoma in our institution in a period from January 1st,2018 untill December 31st,2018.Subsequently, they were divided into low- and high- risk prostatic adenocarcinoma groups. Our results demonstrated positive correlation in preoperative PSA values between the groups and therefore support the use of PSA as one of the parameters in defining low- and high-risk prostatic adenocarcinoma categories.Adenokarcinom prostate čini oko 19% maligniteta u muškoj populaciji Hrvata. Svi dijagnosticirani adenokarcinomi prostate se s obzirom na vrijednost PSA, Gleason zbroj i klinički stadij mogu svrstati u skupine niskog i visokog rizika. U ovoj retrospektivnoj studiji analizirali smo razliku u vrijednostima preoperativnog PSA u skupini od 272 pacijenta kojima je dijagnosticiran adenokarcinom prostate nakon radikalne prostatektomije učinjene u našoj ustanovi u razdoblju od jedne godine (01. siječnja do 31. prosinca 2018.), a koji su podijeljeni u skupine adenokarcinoma prostate niskog i visokog rizika. Rezultati naše studije pokazuju pozitivnu korelaciju u vrijednostima preoperativnog PSA između grupa. Nadalje, rezultati naše analize podupiru upotrebu PSA kao jednog od parametara u definiranju kategorija niskog i visokog rizika karcinoma prostate