Tjasa Ivosevic, L. Rankovic-Nicic, Ljubiša Mirić, A. Jotić, Bojana Bukurov
Introduction. General anesthesia is frequently employed in neck surgery procedures. However, in patients at high risk for general anesthesia, regional anesthesia options, such as the superficial cervical plexus block, warrant careful consideration. Patients with mediastinal lymph node enlargement face an elevated risk of airway obstruction and hemodynamic mediastinal instability during anesthesia induction. In selected neck surgeries, including thyroglossal cyst excision, thyroglossal fistula repair, bronchial cyst removal, thyroidectomy, and lymph node excision, the superficial cervical plexus block presents a viable and secure alternative to general anesthesia. Case report. This report details the case of a patient with mediastinal lymphadenopathy and multiple brain metastases who underwent cervical lymph node excision. Given the patient?s severe comorbidities, pronounced risk of complete distal airway obstruction, hemodynamic instability, and the potential for compression effects from mediastinal mass, a superficial cervical block was administered. This block facilitated effective perioperative analgesia without inducing respiratory or cardiovascular instability. Conclusion. The superficial cervical plexus block emerges as a prudent alternative to general anesthesia in high-risk patients necessitating cervical lymph node excision procedures. Its utilization should be considered in such cases to enhance patient safety and perioperative management.
{"title":"Cervical plexus block - safe anesthesia for the patients with massive mediastinal lymphadenopathy","authors":"Tjasa Ivosevic, L. Rankovic-Nicic, Ljubiša Mirić, A. Jotić, Bojana Bukurov","doi":"10.2298/sarh230218083i","DOIUrl":"https://doi.org/10.2298/sarh230218083i","url":null,"abstract":"Introduction. General anesthesia is frequently employed in neck surgery procedures. However, in patients at high risk for general anesthesia, regional anesthesia options, such as the superficial cervical plexus block, warrant careful consideration. Patients with mediastinal lymph node enlargement face an elevated risk of airway obstruction and hemodynamic mediastinal instability during anesthesia induction. In selected neck surgeries, including thyroglossal cyst excision, thyroglossal fistula repair, bronchial cyst removal, thyroidectomy, and lymph node excision, the superficial cervical plexus block presents a viable and secure alternative to general anesthesia. Case report. This report details the case of a patient with mediastinal lymphadenopathy and multiple brain metastases who underwent cervical lymph node excision. Given the patient?s severe comorbidities, pronounced risk of complete distal airway obstruction, hemodynamic instability, and the potential for compression effects from mediastinal mass, a superficial cervical block was administered. This block facilitated effective perioperative analgesia without inducing respiratory or cardiovascular instability. Conclusion. The superficial cervical plexus block emerges as a prudent alternative to general anesthesia in high-risk patients necessitating cervical lymph node excision procedures. Its utilization should be considered in such cases to enhance patient safety and perioperative management.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68732548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanja Vucic, S. Valjarević, Dejan Radaljac, N. Čolić, Andjelina Jovanovic
Introduction. Laryngeal edema is a rare complication of Angina Ludovici. Infections of this region are mostly of dentogenic origin, less often caused by tonsillitis or other infections in the pharynx. We present a case of a patient with laryngeal edema and dyspnea caused by a lower jaw tooth infection and an ipsilateral submandibular abscess. Case outline. The clinical picture of our patient progressed rapidly. From toothache, painful swelling of the floor of the oral cavity, submandibular and submental regions, bilaterally, all the way to life-threatening dyspnea. A flexible nasopharyngolaryngoscopy was performed. Swelling of the base of the tongue on the left side was observed, along with pronounced edema of the aryepiglottic fold on the same side, which narrowed the breathing space. Since the breathing space was significantly reduced, the patient was urgently hospitalized. The surgical treatment was carried out in the form of an external incision and drainage of the abscess collection of the left submandibular region, with the use of oxygen support and parenteral therapy, in accordance with the recommendations from the available medical literature. Constant monitoring of saturation levels indicated a significant improvement after just a few hours of medicamentous therapy. Conclusion. The goal of our work is to point out a very rare but serious complication, laryngeal edema, which can lead to airway obstruction even in the first few days of the development of the infection, and endanger the life of the patient.
{"title":"Edema of the larynx - an emergency caused by Angina Ludovici","authors":"Sanja Vucic, S. Valjarević, Dejan Radaljac, N. Čolić, Andjelina Jovanovic","doi":"10.2298/sarh230510065v","DOIUrl":"https://doi.org/10.2298/sarh230510065v","url":null,"abstract":"Introduction. Laryngeal edema is a rare complication of Angina Ludovici. Infections of this region are mostly of dentogenic origin, less often caused by tonsillitis or other infections in the pharynx. We present a case of a patient with laryngeal edema and dyspnea caused by a lower jaw tooth infection and an ipsilateral submandibular abscess. Case outline. The clinical picture of our patient progressed rapidly. From toothache, painful swelling of the floor of the oral cavity, submandibular and submental regions, bilaterally, all the way to life-threatening dyspnea. A flexible nasopharyngolaryngoscopy was performed. Swelling of the base of the tongue on the left side was observed, along with pronounced edema of the aryepiglottic fold on the same side, which narrowed the breathing space. Since the breathing space was significantly reduced, the patient was urgently hospitalized. The surgical treatment was carried out in the form of an external incision and drainage of the abscess collection of the left submandibular region, with the use of oxygen support and parenteral therapy, in accordance with the recommendations from the available medical literature. Constant monitoring of saturation levels indicated a significant improvement after just a few hours of medicamentous therapy. Conclusion. The goal of our work is to point out a very rare but serious complication, laryngeal edema, which can lead to airway obstruction even in the first few days of the development of the infection, and endanger the life of the patient.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68732449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tatjana Arsenijevic, Aleksandar Stepanovic, Marina Nikitovic
Malignant pleural mesothelioma (MPM) is a rare malignancy with a poor prognosis. In recent years, significant progress has been made in the treatment of this disease, including surgical and radiotherapy techniques, systemic and immunotherapy. Due to the wide range of clinical presentations, lack of phase III randomized trials, and heterogeneity in treatment approach, the treatment of malignant pleural mesothelioma remains challenging regardless of available diagnostic and therapeutic guidelines. The limited possibility to avoid critical healthy organs (particularly lungs) which can lead to severe, and even fatal radiation-induced toxicity, makes high-dose radical radiotherapy very demanding. Thus, the majority of patients in the era of conventional radiotherapy were mostly referred to no more than palliative radiotherapy only. Technological development in radiotherapy such as respiratory gating, 4D computed tomography (4DCT), intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic techniques, and proton therapy, made a step forward in treating malignant pleural mesothelioma with this modality. Today, MPM radiotherapy can be considered in various indications, alone or in combination with surgery and systemic treatment. However, many questions remain open, and further investigation is needed especially in dose escalation possibility and lung sparing.
{"title":"The role of radiotherapy in the treatment of malignant pleural mesothelioma - possibilities and controversy","authors":"Tatjana Arsenijevic, Aleksandar Stepanovic, Marina Nikitovic","doi":"10.2298/sarh230727104a","DOIUrl":"https://doi.org/10.2298/sarh230727104a","url":null,"abstract":"Malignant pleural mesothelioma (MPM) is a rare malignancy with a poor prognosis. In recent years, significant progress has been made in the treatment of this disease, including surgical and radiotherapy techniques, systemic and immunotherapy. Due to the wide range of clinical presentations, lack of phase III randomized trials, and heterogeneity in treatment approach, the treatment of malignant pleural mesothelioma remains challenging regardless of available diagnostic and therapeutic guidelines. The limited possibility to avoid critical healthy organs (particularly lungs) which can lead to severe, and even fatal radiation-induced toxicity, makes high-dose radical radiotherapy very demanding. Thus, the majority of patients in the era of conventional radiotherapy were mostly referred to no more than palliative radiotherapy only. Technological development in radiotherapy such as respiratory gating, 4D computed tomography (4DCT), intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic techniques, and proton therapy, made a step forward in treating malignant pleural mesothelioma with this modality. Today, MPM radiotherapy can be considered in various indications, alone or in combination with surgery and systemic treatment. However, many questions remain open, and further investigation is needed especially in dose escalation possibility and lung sparing.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135711388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Developmental variations of the inferior cava vein (IVC) rarely cause symptoms, and they were detected during routine examinations performed for other reasons. The prevalence in the general population is between 0.07% and 8.7%. Various anomalies of the IVC can be seen depending on abnormal regression or abnormal persistence of embryonic veins. They are usually associated with more complex intracardiac and atrioventricular septal defects, partial anomalous pulmonary venous connection, and pulmonary atresia. Case Outline. We presented the 18th-month-old patient with double IVC, IVC interruption, azygos, and hemiazygos continuation associated with aortic coarctation. The vein malformation was discovered during percutaneous balloon angioplasty of the aortic re-coarctation and confirmed by using cross-sectional imaging modalities. Our patient had no symptoms of IVC malformation. Conclusion. In clinical practice, double IVC should be suspected in patients with recurrent pulmonary emboli. Another important point in practice is the identification of those anomalies to avoid potential complications of retroperitoneal surgery and cannulation during cardiac surgery
{"title":"Association of bilateral inferior vena cava with azygos and hemiazygos continuation and aortic coarctation in a child","authors":"Stasa Krasic, Vesna Topic, Vladislav Vukomanovic","doi":"10.2298/sarh220721106k","DOIUrl":"https://doi.org/10.2298/sarh220721106k","url":null,"abstract":"Introduction. Developmental variations of the inferior cava vein (IVC) rarely cause symptoms, and they were detected during routine examinations performed for other reasons. The prevalence in the general population is between 0.07% and 8.7%. Various anomalies of the IVC can be seen depending on abnormal regression or abnormal persistence of embryonic veins. They are usually associated with more complex intracardiac and atrioventricular septal defects, partial anomalous pulmonary venous connection, and pulmonary atresia. Case Outline. We presented the 18th-month-old patient with double IVC, IVC interruption, azygos, and hemiazygos continuation associated with aortic coarctation. The vein malformation was discovered during percutaneous balloon angioplasty of the aortic re-coarctation and confirmed by using cross-sectional imaging modalities. Our patient had no symptoms of IVC malformation. Conclusion. In clinical practice, double IVC should be suspected in patients with recurrent pulmonary emboli. Another important point in practice is the identification of those anomalies to avoid potential complications of retroperitoneal surgery and cannulation during cardiac surgery","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135759596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Radunović, T. Milicic, Martina Bosic, I. Jeremic, Drasko Dacic, S. Pavlov-Dolijanovic
Introduction. Pfeifer-Weber-Christian disease (PWCD) is a rare inflammatory disorder of the subcutaneous fatty tissue. Angiolipoma, is a benign adipocytic soft tissue tumor composed of mature adipose tissue and small vascular proliferations. Treatment with corticosteroids could lead to proliferation of fat tissue but the stimulation of angiolipoma growth during corticosteroid therapy is extremely rare. Case outline. We describe a case of a 46-year-old female patient with histopathological confirmation two rare diseases PWCD and benign multiple subcutaneous non-infiltrative angiolipomas. Angiolipomas were treated conservatively. Treatment for PWCD was prednisone 20 mg/day. Due to poor control of PWCD and rapid angiolipomas growth on forearms corticosteroids were discontinued after two months of use. Administration of oral Cyclosporine A led to a rapid remission of the PWCD, and with no new growth of angiolipomas. Conclusion. The successful therapy with the Cyclosporine A supports the hypothesis that PWCD is a T cell mediated autoinflammatory condition. Rapid growth of angiolipoma during corticosteroid therapy is an extremely rare condition.
{"title":"Corticosteroid treatment and growth of angiolipomas in patient with two rare diseases: Pfeifer-Weber-Christian disease and benign multiple subcutaneous angiolipomas","authors":"G. Radunović, T. Milicic, Martina Bosic, I. Jeremic, Drasko Dacic, S. Pavlov-Dolijanovic","doi":"10.2298/sarh200114033r","DOIUrl":"https://doi.org/10.2298/sarh200114033r","url":null,"abstract":"Introduction. Pfeifer-Weber-Christian disease (PWCD) is a rare inflammatory disorder of the subcutaneous fatty tissue. Angiolipoma, is a benign adipocytic soft tissue tumor composed of mature adipose tissue and small vascular proliferations. Treatment with corticosteroids could lead to proliferation of fat tissue but the stimulation of angiolipoma growth during corticosteroid therapy is extremely rare. Case outline. We describe a case of a 46-year-old female patient with histopathological confirmation two rare diseases PWCD and benign multiple subcutaneous non-infiltrative angiolipomas. Angiolipomas were treated conservatively. Treatment for PWCD was prednisone 20 mg/day. Due to poor control of PWCD and rapid angiolipomas growth on forearms corticosteroids were discontinued after two months of use. Administration of oral Cyclosporine A led to a rapid remission of the PWCD, and with no new growth of angiolipomas. Conclusion. The successful therapy with the Cyclosporine A supports the hypothesis that PWCD is a T cell mediated autoinflammatory condition. Rapid growth of angiolipoma during corticosteroid therapy is an extremely rare condition.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68717587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Tomasevic-Todorovic, Tatjana Nožica-Radulović, Tamara Popovic, S. Milićević, Damjan Savic, T. Spasojevic, K. Boskovic
Introduction/Objective. Patients with rheumatoid arthritis (RA), osteoarthritis and fibromyalgia, alongside chronic pain, often suffer from functional disabilities, as well as cognitive dysfunction. The aim of this study is to compare the intensity of pain, symptoms of depression, anxiety, and memory ability among rheumatic patients with chronic pain and to compare rheumatic patients to a control group of healthy participants. Methods. The cross-sectional study, which included 110 (82 women; 28 males) patients with chronic pain, was done at the Special Hospital for Rheumatic Diseases, Novi Sad. Depression was determined by Beck?s Depression Inventory, anxiety was diagnosed by Spielberger?s anxiety test and memory was assessed by the Wechsler Memory Scale. Results. Mean pain intensity in patients with fibromyalgia were statistically significantly higher compared to patients with osteoarthritis and RA (p < 0.05). A statistically significant difference in the psychological status of patients (p < 0.001) and patient memory (p < 0.05) with chronic pain was established, compared to patients in the control group. There was no statistically significant difference in the psychological status of patients, patient memory level and pain intensity in patients with positive fibromyalgia test results in comparison to rheumatic patients not meeting the criteria for fibromyalgia. Patients with osteoarthritis had a statistically significantly lower memory coefficient in comparison to patients with RA and fibromyalgia. Conclusion. In RA, osteoarthritis, and fibromyalgia patients, clinical factors such as pain, depression, and anxiety play an active role in cognitive impairment and should be considered when planning treatment.
{"title":"Neuropsychological manifestations in rheumatic patients with chronic pain","authors":"S. Tomasevic-Todorovic, Tatjana Nožica-Radulović, Tamara Popovic, S. Milićević, Damjan Savic, T. Spasojevic, K. Boskovic","doi":"10.2298/sarh211109004t","DOIUrl":"https://doi.org/10.2298/sarh211109004t","url":null,"abstract":"Introduction/Objective. Patients with rheumatoid arthritis (RA), osteoarthritis and fibromyalgia, alongside chronic pain, often suffer from functional disabilities, as well as cognitive dysfunction. The aim of this study is to compare the intensity of pain, symptoms of depression, anxiety, and memory ability among rheumatic patients with chronic pain and to compare rheumatic patients to a control group of healthy participants. Methods. The cross-sectional study, which included 110 (82 women; 28 males) patients with chronic pain, was done at the Special Hospital for Rheumatic Diseases, Novi Sad. Depression was determined by Beck?s Depression Inventory, anxiety was diagnosed by Spielberger?s anxiety test and memory was assessed by the Wechsler Memory Scale. Results. Mean pain intensity in patients with fibromyalgia were statistically significantly higher compared to patients with osteoarthritis and RA (p < 0.05). A statistically significant difference in the psychological status of patients (p < 0.001) and patient memory (p < 0.05) with chronic pain was established, compared to patients in the control group. There was no statistically significant difference in the psychological status of patients, patient memory level and pain intensity in patients with positive fibromyalgia test results in comparison to rheumatic patients not meeting the criteria for fibromyalgia. Patients with osteoarthritis had a statistically significantly lower memory coefficient in comparison to patients with RA and fibromyalgia. Conclusion. In RA, osteoarthritis, and fibromyalgia patients, clinical factors such as pain, depression, and anxiety play an active role in cognitive impairment and should be considered when planning treatment.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68726257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Jarakovic, M. Petrović, D. Ivanišević, Bojan Mihajlović, M. Kovacevic, I. Popov
Introduction/Objective. The optimal percutaneous coronary intervention (PCI) in patients with non-ST elevated myocardial infarction (NSTEMI) and multivessel coronary artery disease (CAD) is still not clear. The aim of our study was to examine intrahospital and long term major adverse cardiovascular and cerebrovascular events (MACCE) in this group of patients. Methods. This retrospective study included 225 patients with NSTEMI and multivessel CAD treated with PCI at the Institute of Cardiovascular Diseases of Vojvodina. Three groups were formed: complete one stage PCI; complete multi stage PCI and culprit only PCI. We have analyzed intrahospital and one year follow up MACCE and mortality after three years in all three groups. Results. Complete one stage PCI was performed in 112 (49.8%), complete multi stage PCI in 70 (31.3%) and culprit only PCI in 43 (19.1%) of patients. Patients with multi stage complete PCI had lowest mortality in comparison with one stage and culprit only PCI, respectively, both intrahospital (0% vs. 0.9% or 20.9%, p < 0.0005) and after one year (0% vs. 2.7% or 30.2%, p < 0.0005) and three years (4.3% vs. 5.4% or 32.6%, p < 0.0005). There was no significant difference in other MACCE between groups both intrahospital and after one year. Conclusion. In our study, multi stage PCI significantly reduces intrahospital, one year and three years follow up mortality in patients with NSTEMI and multivessel CAD.
{"title":"Complete versus culprit only revascularization in non-ST-segment elevation myocardial infarction and multivessel coronary artery disease","authors":"M. Jarakovic, M. Petrović, D. Ivanišević, Bojan Mihajlović, M. Kovacevic, I. Popov","doi":"10.2298/sarh220210002j","DOIUrl":"https://doi.org/10.2298/sarh220210002j","url":null,"abstract":"Introduction/Objective. The optimal percutaneous coronary intervention (PCI) in patients with non-ST elevated myocardial infarction (NSTEMI) and multivessel coronary artery disease (CAD) is still not clear. The aim of our study was to examine intrahospital and long term major adverse cardiovascular and cerebrovascular events (MACCE) in this group of patients. Methods. This retrospective study included 225 patients with NSTEMI and multivessel CAD treated with PCI at the Institute of Cardiovascular Diseases of Vojvodina. Three groups were formed: complete one stage PCI; complete multi stage PCI and culprit only PCI. We have analyzed intrahospital and one year follow up MACCE and mortality after three years in all three groups. Results. Complete one stage PCI was performed in 112 (49.8%), complete multi stage PCI in 70 (31.3%) and culprit only PCI in 43 (19.1%) of patients. Patients with multi stage complete PCI had lowest mortality in comparison with one stage and culprit only PCI, respectively, both intrahospital (0% vs. 0.9% or 20.9%, p < 0.0005) and after one year (0% vs. 2.7% or 30.2%, p < 0.0005) and three years (4.3% vs. 5.4% or 32.6%, p < 0.0005). There was no significant difference in other MACCE between groups both intrahospital and after one year. Conclusion. In our study, multi stage PCI significantly reduces intrahospital, one year and three years follow up mortality in patients with NSTEMI and multivessel CAD.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68727350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danijela Agić, I. Milošević, G. Mitić, I. Kavecan, S. Stojić
Introduction. Niemann-Pick disease type B is an autosomal recessive disease caused by sphingomyelinase deficiency resulting in sphingomyelin accumulation in macrophages of various organs. Visceral involvement includes spleen enlargement, thrombocytopenia, dyslipidemia, sphingomyelin deposition in lung and liver, and bleeding risk. This is a rare disease and literature data about pregnancy in this setting are scarce. We present two favorable pregnancy outcomes in a patient with Niemann-Pick disease type B along with the review of the literature. Case outline. At the time of the first intended pregnancy, the patient was 34 years old. She had an extremely enlarged spleen, mild restrictive pulmonary disorder, hyperlipoproteinemia type IIb, thrombocytopenia with impaired aggregation tests. Cesarean section was indicated. She was prepared for delivery with platelet concentrates and prophylactic use of antibiotic. In the 36th week of gestation a Cesarean section without complications was performed. The newborn?s anthropometric parameters were BW 2490, BL 47 cm, HC 32 cm, and Apgar score was 7/8. Infant?s development was normal. Three years later in the second wanted pregnancy the same examinations were done. The planned Cesarean section was done without complication after the same procedures, including prophylactic use of antibiotics and platelet concentrates, and healthy female child was born. Conclusion. A multidisciplinary approach in female patients who suffer from lysosomal storage disease such as Niemann-Pick disease type B is essential and a favorable course is possible despite all risks.
介绍。尼曼-匹克病B型是一种常染色体隐性遗传病，其病因是鞘磷脂酶缺乏导致鞘磷脂在各器官巨噬细胞内积聚。内脏受累包括脾脏增大、血小板减少、血脂异常、肺和肝脏鞘磷脂沉积以及出血风险。这是一种罕见的疾病，关于在这种情况下怀孕的文献资料很少。我们提出了两个有利的妊娠结局在尼曼-匹克病B型患者以及文献综述。大纲。第一次怀孕时，患者34岁。她有脾脏极度肿大，轻度限制性肺疾病，IIb型高脂蛋白血症，血小板减少伴聚集试验受损。建议剖宫产。她准备用血小板浓缩物分娩，并预防性使用抗生素。妊娠第36周行剖宫产，无并发症。新生儿吗?人体测量参数BW 2490, BL 47 cm, HC 32 cm, Apgar评分7/8。婴儿吗?S发育正常。三年后，在第二次怀孕时，做了同样的检查。计划剖宫产在完成相同手术后无并发症，包括预防性使用抗生素和血小板浓缩物，健康的女婴出生。结论。多学科方法治疗溶酶体贮积病(如B型尼曼-皮克病)的女性患者是必要的，尽管存在各种风险，但仍有可能获得良好的治疗过程。
{"title":"Monitoring of pregnancies with successful deliveries in a Niemann-Pick disease type B patient - case report and literature review","authors":"Danijela Agić, I. Milošević, G. Mitić, I. Kavecan, S. Stojić","doi":"10.2298/sarh220225017a","DOIUrl":"https://doi.org/10.2298/sarh220225017a","url":null,"abstract":"Introduction. Niemann-Pick disease type B is an autosomal recessive disease caused by sphingomyelinase deficiency resulting in sphingomyelin accumulation in macrophages of various organs. Visceral involvement includes spleen enlargement, thrombocytopenia, dyslipidemia, sphingomyelin deposition in lung and liver, and bleeding risk. This is a rare disease and literature data about pregnancy in this setting are scarce. We present two favorable pregnancy outcomes in a patient with Niemann-Pick disease type B along with the review of the literature. Case outline. At the time of the first intended pregnancy, the patient was 34 years old. She had an extremely enlarged spleen, mild restrictive pulmonary disorder, hyperlipoproteinemia type IIb, thrombocytopenia with impaired aggregation tests. Cesarean section was indicated. She was prepared for delivery with platelet concentrates and prophylactic use of antibiotic. In the 36th week of gestation a Cesarean section without complications was performed. The newborn?s anthropometric parameters were BW 2490, BL 47 cm, HC 32 cm, and Apgar score was 7/8. Infant?s development was normal. Three years later in the second wanted pregnancy the same examinations were done. The planned Cesarean section was done without complication after the same procedures, including prophylactic use of antibiotics and platelet concentrates, and healthy female child was born. Conclusion. A multidisciplinary approach in female patients who suffer from lysosomal storage disease such as Niemann-Pick disease type B is essential and a favorable course is possible despite all risks.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68728145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanja Gašić, Sonja Smiljic, Z. Milanović, M. Gasic, Sladjana Ilic, Ivan Bogosavljevic, M. Dejanović, V. Nestorovic, Tamara Matić
Introduction/Objective. Vitamin D not only plays a role in calcium and phosphorus metabolism, but also has antiproliferative, prodifferentiation, anti-inflammatory and immunomodulatory effects. The aim of this study was to investigate the association between vitamin D deficiency in individuals with autoimmune Hashimoto's thyroiditis. Methods. A total of 156 patients were enrolled and divided into two groups. First group included 108 patients with 25(OH) D insufficiency, and second included 48 individuals with normal 25 (OH) D levels. All participants underwent a detailed clinical examination, laboratory tests for thyroid function (T3, fT4, TSH, thyroid antibodies (TPO-Ab, and TG -Ab)), as well as ultrasound scanning (thyroid volume and Doppler characteristics). Results. The patients with vitamin D insufficiency (n = 108 (69.2%)) were predominantly female and had a higher BMI than the patients with normal vitamin D levels. The group with vitamin D insufficiency had statistically significantly higher TSH levels. The prevalence of positive thyroid antibodies was higher in the vitamin D insufficiency group, while thyroid volume, ATS, and ATI resistance index, as well as the prevalence of positive CD signals, were significantly higher in the vitamin D insufficiency group. 44 of the 156 subjects were diagnosed with thyroiditis (28.2%). The mean serum level of 25 (OH) D was statistically notably lower in patients with thyroiditis [20.23 ? 8.10 ng / mL)] than in the group without thyroiditis [(25.44 ? 8.38 ng/mL)], p < 0.001. Conclusion. There was an association between vitamin D insufficiency and hypothyroidism in subjects with Hashimoto's thyroiditis.
介绍/目标。维生素D不仅在钙、磷代谢中起作用，还具有抗增殖、促分化、抗炎和免疫调节作用。本研究的目的是调查自身免疫性桥本甲状腺炎患者维生素D缺乏之间的关系。方法。共有156名患者入组并分为两组。第一组包括108例25(OH) D不足的患者，第二组包括48例25(OH) D水平正常的患者。所有参与者都进行了详细的临床检查，甲状腺功能(T3, fT4, TSH，甲状腺抗体(TPO-Ab和TG -Ab))的实验室检查，以及超声扫描(甲状腺体积和多普勒特征)。结果。维生素D不足患者(n = 108(69.2%))以女性为主，BMI高于维生素D水平正常的患者。维生素D不足组的TSH水平在统计学上显著升高。维生素D不足组甲状腺抗体阳性患病率较高，而维生素D不足组甲状腺体积、ATS、ATI抵抗指数以及CD阳性信号患病率均明显较高。156例受试者中有44例(28.2%)被诊断为甲状腺炎。甲状腺炎患者血清中25 (OH) D的平均水平明显降低[20.23 ?8.10 ng / mL)]比非甲状腺炎组(25.44 ?8.38 ng/mL)]， p < 0.001。结论。桥本甲状腺炎患者维生素D不足与甲状腺功能减退之间存在关联。
{"title":"Relationship between low vitamin D levels with Hashimoto thyroiditis","authors":"Sanja Gašić, Sonja Smiljic, Z. Milanović, M. Gasic, Sladjana Ilic, Ivan Bogosavljevic, M. Dejanović, V. Nestorovic, Tamara Matić","doi":"10.2298/sarh220608035g","DOIUrl":"https://doi.org/10.2298/sarh220608035g","url":null,"abstract":"Introduction/Objective. Vitamin D not only plays a role in calcium and phosphorus metabolism, but also has antiproliferative, prodifferentiation, anti-inflammatory and immunomodulatory effects. The aim of this study was to investigate the association between vitamin D deficiency in individuals with autoimmune Hashimoto's thyroiditis. Methods. A total of 156 patients were enrolled and divided into two groups. First group included 108 patients with 25(OH) D insufficiency, and second included 48 individuals with normal 25 (OH) D levels. All participants underwent a detailed clinical examination, laboratory tests for thyroid function (T3, fT4, TSH, thyroid antibodies (TPO-Ab, and TG -Ab)), as well as ultrasound scanning (thyroid volume and Doppler characteristics). Results. The patients with vitamin D insufficiency (n = 108 (69.2%)) were predominantly female and had a higher BMI than the patients with normal vitamin D levels. The group with vitamin D insufficiency had statistically significantly higher TSH levels. The prevalence of positive thyroid antibodies was higher in the vitamin D insufficiency group, while thyroid volume, ATS, and ATI resistance index, as well as the prevalence of positive CD signals, were significantly higher in the vitamin D insufficiency group. 44 of the 156 subjects were diagnosed with thyroiditis (28.2%). The mean serum level of 25 (OH) D was statistically notably lower in patients with thyroiditis [20.23 ? 8.10 ng / mL)] than in the group without thyroiditis [(25.44 ? 8.38 ng/mL)], p < 0.001. Conclusion. There was an association between vitamin D insufficiency and hypothyroidism in subjects with Hashimoto's thyroiditis.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68729149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Mićić, S. Polovina, Z. Lončar, K. Doklestić, P. Gregorić, V. Arsenijević, M. Ceranic, D. Micić, N. Ivancević
Introduction/Objective. The development of acute insulin resistance after surgery intervention is associated with the type and magnitude of operation and tissue injury. The aim of our study was to compare insulin sensitivity assessed by homeostatic model assessment of insulin resistance (HOMA-IR) and C-reactive protein (CRP) before and after laparoscopic and open cholecystectomy during seven days follow-up. Methods. In total, 92 patients were divided into two groups: laparoscopic cholecystectomy (Group 1) (n = 61) and open cholecystectomy (Group 2) (n = 31). Glucose, insulin and CRP levels were measured at day 0 and one, three and seven days postoperatively. Glucose, insulin and CRP were determined using commercial assay on Roche Cobas 6000 automated analyzer (Roche Diagnostics, Manheim, Germany). Results. There was no statistical difference between studied groups concerning age (p = 0.626), BMI (p = 0.548), glucose (p = 0.947), insulin (p = 0.212), HOMA-IR (p = 0.390) and CRP (p = 0.546) at day 0. At day one, higher values of CRP were found in group 2 compared with group 1 (p = 0,046). At day three, significantly higher values of glucose and HOMA-IR were found in group 2 compared with group 1 (p = 0.025, p = 0.036, respectively). Conclusion. Increase in CRP precedes deterioration of insulin sensitivity measured by HOMA-IR after cholecystectomy. Impairment of insulin sensitivity was more pronounced at third postoperative day in group with open cholecystectomy. On the basis of our results, laparoscopic cholecystectomy induced less impairment in insulin sensitivity and lower inflammatory response.
{"title":"Insulin sensitivity and C-reactive protein levels after laparoscopic and open cholecystectomy - seven days follow-up","authors":"D. Mićić, S. Polovina, Z. Lončar, K. Doklestić, P. Gregorić, V. Arsenijević, M. Ceranic, D. Micić, N. Ivancević","doi":"10.2298/sarh221024075m","DOIUrl":"https://doi.org/10.2298/sarh221024075m","url":null,"abstract":"Introduction/Objective. The development of acute insulin resistance after surgery intervention is associated with the type and magnitude of operation and tissue injury. The aim of our study was to compare insulin sensitivity assessed by homeostatic model assessment of insulin resistance (HOMA-IR) and C-reactive protein (CRP) before and after laparoscopic and open cholecystectomy during seven days follow-up. Methods. In total, 92 patients were divided into two groups: laparoscopic cholecystectomy (Group 1) (n = 61) and open cholecystectomy (Group 2) (n = 31). Glucose, insulin and CRP levels were measured at day 0 and one, three and seven days postoperatively. Glucose, insulin and CRP were determined using commercial assay on Roche Cobas 6000 automated analyzer (Roche Diagnostics, Manheim, Germany). Results. There was no statistical difference between studied groups concerning age (p = 0.626), BMI (p = 0.548), glucose (p = 0.947), insulin (p = 0.212), HOMA-IR (p = 0.390) and CRP (p = 0.546) at day 0. At day one, higher values of CRP were found in group 2 compared with group 1 (p = 0,046). At day three, significantly higher values of glucose and HOMA-IR were found in group 2 compared with group 1 (p = 0.025, p = 0.036, respectively). Conclusion. Increase in CRP precedes deterioration of insulin sensitivity measured by HOMA-IR after cholecystectomy. Impairment of insulin sensitivity was more pronounced at third postoperative day in group with open cholecystectomy. On the basis of our results, laparoscopic cholecystectomy induced less impairment in insulin sensitivity and lower inflammatory response.","PeriodicalId":22263,"journal":{"name":"Srpski arhiv za celokupno lekarstvo","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68730031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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