Acta clinica Croatica最新文献

Intraoperative hypertension (IOHTA) during neck surgery is undesirable because this type of surgery has a propensity to bleed profoundly even in normotensive anesthesia. The purpose of our study was to detect predictors of IOHTA in patients undergoing neck surgery. This single center retrospective study included 880 adult patients who underwent neck surgery under general anesthesia. The impact of gender, age, comorbidity, difficult tracheal intubation, anesthesia duration, and induced hypotension on IOHTA was studied. IOHTA was present in 57 (6.7%) patients. The highest incidence of IOHTA was recorded in patients with ASA 4 status and those with Cormack-Lehane grade 4,: (22.2% and 21.4%, respectively). Significantly more patients with hypertension, hyperlipoproteinemia and ventricular extrasystoles had IOHTA compared with patients without these comorbidities. Statistically significant predictors of IOHTA were age (OR 1.438; 95% CI 1.144-1.808; p=0.002), cardiac arrhythmia (OR 1.702; 95% CI 1.129-2.566; p=0.011), Cormack-Lehane grade (OR 1.407; 95% CI 1.054-1.878; p=0.020), and duration of anesthesia (OR 1.005; 95% CI 1.001-1.008; p=0.005). The risk of IOHTA occurrence was lower in patients with induced hypotension (OR 0.024; 95% CI 0.003-0.185; p=0.000). During neck surgery, special attention is needed in patients of older age, those with cardiac arrhythmia, difficult intubation, and longer anesthesia duration because they are at risk of IOHTA.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that most commonly affects the young, working, female population. Musculoskeletal manifestations are one of the most prevalent and presenting features in SLE. Arthralgia, myalgia, non-erosive arthritis, myositis but also tenosynovitis and enthesitis are present in more than 90% of SLE patients. Although not considered very severe SLE manifestations, they significantly affect the patient's quality of life and daily functioning. Clinical assessment of joints, tendons, entheses, and muscles is still the gold diagnostic standard. There are many radiological imaging methods, i.e., classic radiograms, ultrasound, bone scintigraphy, and magnetic resonance imaging that provide morphological information regarding damage and activity of musculoskeletal diseases in SLE and other rheumatic diseases. Musculoskeletal ultrasound stands out as an accessible and affordable method. Recognizing musculoskeletal manifestations may help establish an early diagnosis of SLE and assess disease activity, thus leading to early initiation of treatment and preventing chronic and irreversible changes with a beneficial effect on the quality of life.

The aim was to measure sphenoid sinus volume on the basis of computed tomography data post processing and to investigate the possible relationship with age, gender and mastoid pneumatization. Sphenoid sinus volume was measured using the semi-automatic post processing algorithm of MSCT DICOM datasets of 66 patients. There were 35 female and 31 male subjects. Median age was 54 (range 17-84) years. Datasets were selected retrospectively from computer archives of our hospital radiology department. Subjects with healthy sphenoid sinuses were included. Relationship of total sphenoid volume with age, gender and mastoid pneumatization was analyzed. Data acquisition was performed using Siemens Somatom Emotion scanner. Measurements were performed using volumetric module of Syngo 2006G software. Virtual endoscopy and three-dimensional volume rendering were also performed. Median sphenoid total volume (left and right together) was 10.12 cm³. Median volume of the right mastoid was 4.86 cm³ and 5.31 cm³ on the left side. We found a significant positive correlation between total sphenoid volume and both left and right mastoid pneumatization (Spearman ρ=0.528, p<0.001 and ρ=0.450, p<0.001, respectively). Sphenoid volume was positively correlated with age, but without statistical significance (ρ=0.186; p=0.136). Sphenoid volumes were larger in males than in females, but mastoid air cells showed no gender difference. In conclusion, volumetric measurements of paranasal sinuses may be accurately performed on the basis of MSCT data post processing. Sphenoid volume was positively correlated with mastoid pneumatization and age. Virtual endoscopy and 3D volume rendering may accurately display anatomic structures of sphenoid sinuses.

Although earlier studies showed higher values of wall shear stress in neurovascular conflict, hemodynamic patterns in the blood vessel after microvascular decompression are unknown. This study aimed to analyze the hemodynamic features of the offending artery preoperatively and postoperatively using computational fluid dynamics. We retrospectively analyzed 11 patients with trigeminal neuralgia who were surgically treated in our department during 2022. All patients underwent pre- and postoperative computed tomography angiography. Hemoscope software was used for computational fluid dynamics analysis. This analysis included 11 patients, median age 71 years (54.5% of female patients). Superior cerebellar artery was the most common offending vessel. In all 11 patients, elevated values of wall shear stress were found in the area of neurovascular contact. Postoperatively, with improvement of the patient clinical status, there was also a decrease in wall shear stress. Computational fluid dynamics analysis of offending vessels in trigeminal neuralgia can be a useful tool in preoperative planning and in assessing treatment outcomes and prognosis.

The main objective of this study was to investigate the prevalence of insufficient serum 25-hydroxyvitamin D level in a sample of neurological patients and to compare it to the estimate in the general Croatian population. The secondary aim was to test for the possible significant differences in vitamin D2 insufficiency between the groups of patients according to gender, season, region, vitamin D3 supplementation, and diagnosis of autoimmune disease. This retrospective study involved 371 neurological patients in one-year period. The data collected included gender, age at the time of admission, region, season at the time of admission, main neurological diagnosis at discharge, serum 25-hydroxyvitamin D level at the time of hospitalization, and use of vitamin D3 substitutes prior to hospitalization. The proportion of neurological patients with 25-hydroxyvitamin D insufficiency (<75 nmol/L) was estimated at 74.66% (95% confidence interval, p<0.0001), which is slightly lower than in the Croatian general population. There were no significant differences in 25-hydroxyvitamin D insufficiency according to gender, season and region. Significant differences in 25-hydroxyvitamin D insufficiency were found according to vitamin D3 supplementation and diagnosis of autoimmune disease.

Hypertensive nephropathy (HN) is characterized by kidney damage due to chronic high blood pressure. Podocytes play a crucial role in the pathogenesis of HN, thus, nephrin could be important in the early diagnosis of HN. The aim of the study was to investigate the association of urinary nephrin (u-nephrin) levels with clinical and laboratory characteristics in patients with HN and to test diagnostic relevance of u-nephrin as an early biomarker of HN. In this cross-sectional study, 114 subjects were recruited, 84 patients with chronic hypertension (CH) and 30 healthy controls. All patients with CH were classified according to the urinary microalbumin/creatinine ratio (UM/CR) and according to the chronic kidney disease (CKD) stage. Urine samples were collected to estimate the u-nephrin level by ELISA and to determine UM/CR. Blood samples were used for biochemical analyses. We found elevated u-nephrin in 78.3% of normoalbuminuric subjects with CH. The levels of u-nephrin increased gradually with the stage of CKD. ROC curve plotted for u-nephrin showed 89.7% sensitivity and 88.8% specificity, while UM/CR showed a sensitivity of 44.8% and specificity of 86.1% to detect HN in the early stage. It is concluded that u-nephrin can be useful as an early biomarker of HN.

The aim of the study was to evaluate the impact of the COVID-19 pandemic on the number of patients presenting to the emergency room with acute appendicitis and subsequent results of surgical treatment. Our single center retrospective study was conducted in Sestre milosrdnice University Hospital Center, Zagreb, Croatia. We analyzed data on the patients diagnosed with acute appendicitis, their duration of symptoms, length of hospital stay, histopathologic diagnosis, and operative techniques, recorded from September 1, 2019 to October 17, 2020. The results showed a statistically significant increase in the ratio of open laparotomies (p=0.006) and ratio of perforated appendicitis (p=0.047) during the COVID-19 pandemic in relation to the pre-pandemic period. The time between symptom onset and hospitalization, measured in days, did not demonstrate a statistically significant increase (p=0.379), and minor increase in the postoperative length of stay was not statistically significant either (p=0.879).

Muir-Torre syndrome is a rare form of hereditary nonpolyposis colorectal cancer syndrome; simplified, it is an association of at least one sebaceous skin tumor and at least one visceral malignancy. It follows an autosomal dominant pattern of inheritance. We present a case of a recurrent sebaceous carcinoma of the eyelid in a patient previously operated on for colorectal carcinoma. During his treatments, he was examined by experts in different medical fields. After genetic counseling, he also underwent genetic testing.

Patients with prostate cancer are often in psychological distress and pain preoperatively. The aim of this study was to examine the effects of preoperative anxiety, depression and pain on the quality of postoperative recovery and acute postoperative pain after radical prostatectomy. One hundred and sixty patients scheduled for open or laparoscopic radical prostatectomy were enrolled in a prospective observational study. Psychological distress was assessed with the State-Trait Anxiety Inventory (STAI-S and STAI-T) and Center for Epidemiological Studies Depression Scale (CES-D). Postoperative recovery was assessed on postoperative days 1-3 using the Quality of Recovery-40 score (QoR-40). Numeric rating scale 0-10 was used to assess the intensity of postoperative pain at rest and on movement at 1, 6 and 24 hours post-surgery. In linear regression models, STAI-S was predictor of QoR-40 on postoperative days 1-3 (ß=-17.32; p<0,001, ß=-0.345; p=0.004, and ß=-0.326; p=0.002, respectively), and preoperative pain was predictor of pain at rest (ß=0.666; p=0.008) and on movement (ß=0.691; p=0.006). In logistic regression models, preoperative pain was predictor of clinically significant pain at rest (OR, 2.86; 95% CI 1.11-7.36) and STAI-S of clinically significant pain on movement (OR, 2.21; 95% CI, 1.08-4.52). In conclusion, state anxiety had negative impact on QoR and acute pain after radical prostatectomy. Preoperative pain was associated with acute postoperative pain.

Over 1.5 million new cases of chronic hepatitis C virus (HCV) infection occur each year, infecting an estimated 58 million people worldwide. We aimed to find differences in peripheral blood count, liver enzymes and degradation products between HCV infected and healthy controls, and their impact on detection of the disease and discrimination of the diseased from non-diseased subjects. We performed laboratory testing for peripheral blood count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (γ-GT) and bilirubin in 40 HCV patients and 40 healthy controls. There were statistically significant differences in leukocytes (p=0.001), ALT (p<0.0001), AST (p<0.0001), ALP (p<0.0001), γ-GT (p<0.0001), total bilirubin (p<0.018) and indirect bilirubin (p<0.030) between the HCV infected and control groups. On multiple regression, the independent variables of HCV titer (p=0.5091), granulocytes (p=0.7061) and total bilirubin (p=0.2022) showed no impact on liver lesion estimated by a dependent variable of γ-GT. On logistic regression, only AST [p=0.0112, odds ratio (OR)1.2161, area under the curve (AUC) 0.887] and γ-GT (p=0.0283, OR 1.1041, AUC 0.815) showed a statistically significantly positive predicting value when discriminating healthy subjects and diseased patients. In conclusion, HCV titer, granulocytes and total bilirubin did not show a statistically significant impact on hepatic lesion expressed by γ-GT, whereas only AST and γ-GT showed a statistically significant positive predicting value to discriminate infected patients from healthy controls. Each unit increase in AST and γ-GT resulted in 21.6% and 10.4% higher possibility of HCV infection, respectively.