Acta clinica Croatica最新文献

This study aimed to assess the diagnostic efficacy of ultrasound (US) and shear wave elastography (SWE) in distinguishing benign and malignant axillary lymph nodes in patients with breast cancer. A total of 121 axillary lymph nodes from 61 breast cancer patients (mean age, 52.4±14.6 years) were enrolled between May 2019 and August 2020. Lymph nodes were histopathologically diagnosed through core needle biopsy or surgical excision. B-mode US features (short axis diameter, short-to-long axis diameter ratio, presence of echogenic hilum, presence of asymmetric cortical thickening, cortex thickness) were assessed and SWE measurements (maximum shear wave velocity (SWV_max), minimum SWV (SWV_min), median SWV (SWV_median), mean SWV (SWV_mean)) were performed. There were 45 (37.2%) benign and 76 (62.8%) malignant lymph nodes. The short axis diameter, short-to-long axis diameter ratio, and mean cortical thickness of malignant lymph nodes were significantly higher compared to benign lymph nodes (p<0.001 all). SWV_mean, SWV_median, SWV_max, and SWV_min of malignant lymph nodes were significantly higher than those of benign lymph nodes (p<0.001 for all). Both US and SWE were useful in discriminating between benign and malignant axillary lymph nodes.

The aim of this study was to examine the effect of the lipid parameter non-high-density lipoprotein cholesterol (non-HDL-C) on the occurrence of major cardiovascular event (MACE) in patients after first-time ST-elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (pPCI) and implantation of drug-eluting stent (DES). Seventy-eight patients (54 male and 24 female, median age 58.62±11.14 years) with the diagnosis of first-time STEMI who were treated with pPCI with DES implantation in the period from January 2018 until January 2020 were included in the study. Patients were followed for two years of the intervention for the occurrence of MACE and its association with baseline non-HDL-C, as well as total cholesterol, LDL-C, HDL-C and triglycerides. During 2-year follow-up, 20 (25.6%) patients had MACE. There was no significant difference in baseline parameters such as age, hypertension, presence of diabetes mellitus, and post-interventional use of statin therapy between patients with and without MACE. The levels of baseline lipid parameters were significantly higher in patients who experienced MACE, as follows: total cholesterol (p=0.009), LDL-C (p=0.028) and non-HDL-C (p=0.007). Pearson χ²-test showed that both non-HDL-C and LDL-C were significant predictors of MACE occurrence during 2-year follow-up, but non-HDL-C had a more significant correlation than LDL-C (p=0.007 vs. p=0.028). Our initial report shows that baseline non-HDL-C was a more significant predictor of the occurrence of MACE after first-time STEMI than LDL-C, which reflects the importance of the residual risk of MACE occurrence while enabling identification and close monitoring of high-risk patients.

Modern literature supports primary repair in a wide array of colon injury presentations. The aim of the study was to evaluate the validity of criteria for primary repair of colon injuries. The analysis involved 96 patients with colon injuries. Group 1 (62 patients) underwent the Stone and Fabian (S/F) criteria for primary repair, whereas group 2 (34 patients) underwent the following exclusion criteria for primary repair: significant peritonitis, edema/ischemia of a large area/multiple colonic segments, latent period >8 h, and intraoperative cardiorespiratory instability. The following variables were analyzed: demographic data, mechanism of injury, latent period, distribution of injuries, macroscopic intraoperative finding, and several trauma indices. The mean latent period was shorter in group 2 (1.3±1.1 h) versus group 1 (4.9±3.7 h). Primary repair was more frequent in group 2. There was no difference in the success rate of the primary procedures between the two groups according to Flint grade or S/F criteria. Primary repair is safe and recommended in the first 8 h after injury in hemodynamically and respiratory stable patients without intra-abdominal sepsis.

Diarrhea usually appears early following autologous hematopoietic stem cell transplantation (ASCT) due to toxic mucosal damage and neutropenia. Infectious agents also cause diarrhea in the post-transplantation period, with Clostridium difficile (C. difficile) being most common. In contrast, cytomegalovirus (CMV) enterocolitis is extremely rare after ASCT. We report a case of a 55-year-old male who underwent ASCT for non-Hodgkin lymphoma that was complicated by severe persistent diarrhea resulting in significant hypovolemia and electrolyte imbalance. Prior to transplantation, the patient received rituximab in combination with chemotherapy (R-CHOP/R-DHAP) followed by a bendamustine-based conditioning regimen (BeEAM). After treatment with oral metronidazole, vancomycin and fidaxomicin, diarrhea persisted despite undetectable C. difficile toxin, with elevation of hepatic enzymes. Eventually, CMV infection was diagnosed by real-time polymerase chain reaction and treated with ganciclovir and valganciclovir. Due to hypogammaglobulinemia following previous rituximab treatment, CMV immunoglobulins were also administered. The patient's condition gradually improved with CMV DNA being undetectable in serum. This case shows that diarrhea may be caused by concurrent infection with C. difficile and CMV after ASCT. Bendamustine-induced colitis and prior rituximab treatment may have been additional risk factors in this patient. Therefore, more comprehensive workup of diarrhea is needed in ASCT recipients treated with these agents.

Chronic limb-threatening ischemia (CLTI) is the main cause of major amputation and associated morbidity and mortality. Currently, both endovascular and open surgical methods for below-the-knee (BTK) interventions result in unsatisfactorily short patency rates. The aim of this retrospective single-center study was to evaluate six-month and one-year primary patency and major amputation rate in patients with CLTI treated with distal-leg bypass or BTK endovascular intervention. Overall, 46 patients underwent BTK intervention and 32 were available for follow-up analysis. Nine surgical bypasses and 23 endovascular treatments (balloon angioplasty) were performed. Six-month and one-year primary patency was 5/9 (55%) after bypass and 18/23 (78%) and 16/23 (69%) following endovascular intervention (p=0.20 and p=0.46). Angiography findings, predominantly advanced atherosclerosis, precluded any secondary intervention attempts. At one year post-intervention, the incidence of major amputation was 3/9 (33%) after bypass surgery and 5/23 (22%) following endovascular treatment. Although endovascular intervention for BTK CLTI seems to offer better 12-month patency and lower incidence of major amputation compared to bypass surgery, no statistically significant difference was noted. A randomized trial with more subjects and longer follow-up should be undertaken.

The prevalence of relapses in advanced squamous cell head and neck cancer (SCHNC) is significant, and so is treatment morbidity. There is persistent need for reliable biomarkers in order to better personalize treatment. The purpose of the present study was to evaluate prognostic significance of focal adhesion kinase (FAK) and CD8 expression in human papillomavirus (HPV) negative SCHNC treated with radiotherapy. FAK and CD8 expression was evaluated by immunohistochemical staining. A total of 62 tissue samples were assessed. High expression of FAK was determined in 37.1% and high expression of CD8 in 25.8% of study patients. Patients with high expression of FAK had significantly more relapses than patients with low FAK expression (p=0.04). FAK and CD8 expression had no significant impact on overall survival (OS) (p=0.44 and p=0.48, respectively) and relapse free survival (RFS) (p=0.21 and p=0.31, respectively). However, patients with high expression of FAK and low expression of CD8 had the worst 5-year OS (38.7%) and 5-year RFS (44.3%). Patients with low expression of FAK had significantly less relapses. The prognostic role of FAK and CD8 expression in SCHNC patients treated with radiotherapy was not proven.

Pigmented villonodular synovitis is a rare disease that occurs on synovial tissue within and outside a joint. It can be localized or diffuse. Localized pigmented villonodular synovitis (LPVNS) can occur in any compartment of the knee joint. The aim of this study was to retrospectively analyze our consecutive series of LPVNS of the knee. From January 1999 to December 2018, 10 consecutive patients with LPVNS of the knee underwent surgical treatment at our department. All patients were arthroscopically treated by the senior author by removal of the localized mass and partial synovial resection of the area surrounding the bottom of the lesion. The series included four female and six male patients, mean age 29.5 (range, 17-60) years. Their symptoms prior to the operation lasted from 3 months to 3 years (mean, 11.8 months). At the mean follow-up of 110.9 (range, 11-239) months, none of the patients had recurrence of the disease. Our study confirms the consensus in the literature that LPVNS of the knee should be treated arthroscopically by excision of the localized mass and partial synovectomy of the area surrounding the base of the lesion.

Atrial fibrillation (AF) is the outcome of the rapid onset of abnormal electrical impulses in the atria. These impulses prevent the heart natural pacemaker, which normally controls the heart beat, from doing its job.The heart rate becomes highly asymmetric. The purpose of this case-control study was to determine the role of the connexin-40 (Cx-40) and interleukin-6 (IL-6) gene expression in patients suffering from AF in Pakistan. There were 200 subjects included in this study. The subjects were categorized into two groups as control and AF groups (n=100 each). RNA separated from blood was used for analysis of the Cx-40 and IL-6 gene expression by real-time polymerase chain reaction. The Cx-40 gene expression profile was increased 10.2-fold in AF subjects as compared to 1.9-fold in control group. The IL-6 gene expression profile was decreased 1.5-fold in AF group as compared to 6.1-fold in control group. Results of the study suggest that development of AF in the Pakistani population was linked to the increased expression of Cx-40 gene and lower expression of IL-6 gene.

Mobbing (bullying) at the workplace of nurses is a serious problem in the world today. Its manifestations can be very different, from psychological to physical manifestations, and can be related to the onset of post-traumatic stress disorder. The aim of this study was to examine the experience of mobbing at the workplace of pediatric nurses and its connection with physical manifestations. For this purpose, we conducted a study on 434 nurses/technicians in 18 hospitals in the Republic of Croatia. The research instrument consisted of two questionnaires and personal characteristics of the examinees. The examinees were between the ages of 36 and 45, those who had more than 6 years of experience, those who did not work in shifts, who did not work at the job they wanted, and examinees who believed that the conditions at their workplace were threatening their health, and those whose work was the cause of sick leave in the last year. Among the examinees who had experienced mobbing, compared to those who had not, there was a greater number of those who did not evaluate their cooperation with colleagues and their relationship with superiors positively or did not know how to evaluate that relationship. The results obtained with the Physical Symptoms Inventory scale showed that the examinees who had experienced mobbing had a significantly higher incidence of the examined symptoms for which they visited a doctor. In conclusion, nurses employed at children's wards had a positive association of physical manifestations with the experience of mobbing at the workplace, for which preventive programs should be developed to prevent or reduce its occurrence, but also lifelong learning programs should be developed to empower those nurses who currently show symptoms of mobbing.

In this article, we describe a suturing technique for narrowing a wide or asymmetric columellar base. The study included 30 patients. The mean nostril measurements preoperatively were as follows: right nostril diameter 8.9 mm, left nostril diameter 8.0 mm, and columella width 16.7 mm. Immediately after surgery, we observed significant increases in the mean right and left nostril diameters (11.0 mm and 10.9 mm, respectively, p<0.0001), and a significant reduction in the mean columella width (11.8 mm, p<0.0001). The outcomes were excellent in both functional and cosmetic results.