Acta clinica Croatica最新文献

Lymphedema is a chronic, progressive condition caused by impaired lymphatic transport, leading to edema in the lower and/or upper extremities, depending on the underlying cause. The diagnosis is based on clinical examination, ultrasound findings, and imaging tests. Treatment is mostly conservative, usually long-term, and often yielding unsatisfactory results. Recently, surgical options have also become available. Lymphoscintigraphy, a non-invasive and simple nuclear medicine imaging technique, is considered the method of choice in diagnostic workup. It consists of intracutaneous or subcutaneous application of colloidal particles labelled with radioactive technetium-99m and two-dimensional or three-dimensional gamma camera imaging. Lymphoscintigraphy helps differentiate lymphedema from edema of another origin, assess disease severity, and evaluate surgery outcome. However, the procedure is not fully standardized, especially in terms of semiquantitative methods, which are additionally used in disease staging; however, their implementation varies depending on local experience and expertise.

This rare prospective study investigated 10-year outcomes of acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), and evaluated the role of acute biomarkers and other parameters in predicting clinical severity and prognosis. We included 250 patients and analyzed their baseline (cardiovascular risk factors), laboratory (maximal CK/TnT, acute inflammatory (white blood cells (WBC), hs-CRP), and liver biomarkers (AST/LDH), glomerular filtration rate (eGFR)) and clinical severity parameters (length of hospital stay, in-hospital complications, coronary angiography, and echocardiography (LVEF)). After hospital discharge, 229 patients were followed-up (2011-2022) and grouped according to the presence of major adverse cardiovascular events (MACE). In the acute phase, WBC, hs-CRP, LDH and AST positively correlated with maximal CK/cTnT and total in-hospital complications, and negatively with LVEF; WBC positively correlated with cardiogenic shock and stent diameter, hs-CRP with cardiac arrest and length of hospital stay, and LDH with stent diameter; total in-hospital complications increased the risk of in-hospital mortality and number of significantly stenosed coronary arteries, risk of heart failure, whereas the length of hospital stay negatively correlated with LVEF (p<0.05 all). During 10-year follow-up, LDH and clinical severity parameters (stenosis of LAD/ACx, multivessel CAD, proximal coronary stenosis, Gensini score, in-hospital complications) increased, while the others (normal eGFR and LVEF) reduced the risk of total MACE (p<0.05). In conclusion, acute biomarkers have a role in predicting clinical severity but they have no role in predicting long-term prognosis (except for LDH). Total in-hospital complications, more severe CAD, systolic dysfunction, and worse kidney function may lead to worse in-hospital and long-term outcomes.

The influence of endodontic status on quality of life has not been fully clarified. The aim of this study was to quantify the effect of endodontic status on everyday functioning using the psychometric instrument Oral Impacts on Daily Performances (OIDP) and to correlate endodontic status with quality of life using the OIDP questionnaire. A total of 600 participants were referred to dental radiography for digital orthopantomograms and asked to fill out the OIDP questionnaire. Digital orthopantomograms were analyzed and compared with OIDP results. The correlation between endodontic status and quality of life was tested. The statistical analysis consisted of descriptive statistics, non-parametric statistics, hierarchical multiple regression analysis by enter method, and correlation analysis. The results showed that quality of life was significantly affected by tooth loss (p<0.05). Endodontic treatment on canines and incisors positively correlated with higher OIDP scores, indicating an effect on quality of life (p<0.05). In conclusion, the correlations between variables describing the endodontic status and the quantitative results of the OIDP questionnaire indicate a measurable effect of endodontic disease/health on everyday functioning.

The aim of this research was to examine the rheological parameters of carotid arteries and the frequency of abnormal values in patients with metabolic syndrome (MetS) with and without diabetes mellitus (DM). The sample consisted of 90 subjects and was divided into two equal groups. The first group consisted of patients with MetS but without DM, while the second group had both MetS and DM. We used the values of the peak systolic velocity (PSV) as a reference for pathology. The results showed pathological values of PSV in the right internal carotid artery (ICA) in twelve patients in the MetS + DM group. The study found that the incidence of pathological rheological parameters was higher in subjects with MetS + DM as compared to those with only MetS. Subjects with MetS + DM had higher values of maximum acceleration during systole in various carotid arteries. A subject with MetS + DM also showed total flow obstruction in the left and internal carotid artery (ICA) and a severe narrowing of the right ICA, indicating the presence of carotid artery disease. The study also found that nearly two-thirds of subjects with MetS + DM had pathological values of PSV in the right ICA and slightly fewer in the left ICA. Research on French populations has shown similar results. Eleven patients had pathological values in the left ICA. The frequency of the carotid rheological parameters' abnormalities was significantly higher in the MetS with DM patient group. The frequency of abnormalities in the rheological parameters of carotid circulation was significantly higher in patients with MetS and DM (as compared to non-diabetic patients). In our study, pathological changes were generally more susceptible to ICA. This indicates the importance of screening the rheological parameters of subjects with MetS for the prevention and treatment of cerebrovascular disease.

Our aim in this study was to demonstrate the usefulness of endoscopic rectal ultra- sound scan (ERUS) in providing information that can help surgeons decide on therapeutic approach and type of surgical procedure in patients with rectal cancer. We compared ERUS findings with postoperative pathological data in 41 patients with endoscopic and pathological (PH) diagnosis of rectal cancer. These patients underwent ERUS examination to determine the extent of the disease and the findings were subsequently compared with postoperative pathological diagnosis. After ERUS examination, there were three patients in group T0, five in group T1, 12 in group T2, 17 in group T3, two in group T4, and two patients had a mucinous metastatic type of cancer. After excluding 15 patients who met the exclusion criteria, we compared ERUS findings of 26 patients with their pathological diagnosis to determine the sensitivity and accuracy of ERUS. The total sensitivity of the ERUS in preoperative staging of the tumor stage T0-T4 was 96%. Accuracy was 89%. This study showed that a surgeon can rely on the findings of ERUS performed by an experienced endoscopist before deciding of type of surgical procedure for T0-T2, and even T3 degree of rectal cancer. T3 rectal cancers are in the "gray zone", so both procedures, ERUS and nuclear magnetic resonance imaging (NMR), are needed to decide on the final therapeutic approach. NMR remains the gold standard for staging T4 rectal cancer.

Posterior sternoclavicular dislocation accompanied by clavicular end fracture is an extremely rare injury according to the available literature. We present a case of a young male with this injury, resulting from a vehicle accident, and additionally complicated by a clavicular bone fragment in the proximity of the aortic arch. An initial X-ray showed no signs of bone trauma, which was, however, revealed on a CT scan. Stable fixation of the fragment and sternoclavicular joint was achieved utilizing a plate and screws. The osteosynthetic material was removed after eight weeks due to the plate breaking. There were no complications in the 5-year follow-up period, and a full range of motion was accomplished. We aimed to emphasize the importance of early diagnosis and appropriate surgical management of complicated posterior sternoclavicular dislocations to avoid life-threatening events.

The aim was to determine the diagnostic value of stimulated serum thyroglobulin (sTg) for the follow-up of patients with differentiated thyroid cancer (DTC) and to evaluate whether repeated sTg measurement provides additional clinical benefit in detecting persistent or recurrent structural disease if the initial sTg was negative. The retrospective study included 388 consecutive patients with DTC treated and followed-up between 2004 and 2018 at the Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital. The negative predictive value (NPV) of the first sTg measured 12 months after the initial treatment was compared with NPV of sTg measured annually during 3 consecutive years of follow-up. The first sTg NPV was 99.5% in the group of low-risk patients and 96.1% in the group of intermediate-risk patients. In both low-and intermediate-risk groups, there were no differences between the first sTg NPV and NPV of sTg measured annually during 3 years of follow-up period. Repeated measurement of the sTg after initially negative result had a limited clinical value for detecting persistent or recurrent structural disease and cannot be recommended in routine follow-up of low and intermediate-risk patients with DTC.

This study aimed to evaluate retinal nerve fiber layer thickness in exfoliation syndrome (XFS), present unilaterally, using optical coherence tomography (OCT). This prospective study included 90 examinees with unilateral syndrome. However, examinees with higher intraocular pressure or findings implicative of glaucoma were excluded from the study, as well as examinees with optic nerve changes. In individuals with unilateral XFS, OCT findings were compared between the two groups: the affected eye group and the fellow eye group. The study results show that the average thinning of the retinal nerve fiber layer, especially in the inferior and superior quadrants, has not resulted in visual field defects in examinees with unilateral XFS. In the group of eyes without XFS, 85.55% exhibited reference inferior quadrant thickness values, and 91.11% exhibited reference superior quadrant thickness values. In the group of eyes with manifest XFS, 82.22% exhibited reference inferior quadrant thickness values, and 88.88% exhibited reference superior quadrant thickness values. Most examinees in both groups had normal average retinal nerve fiber layer (RNFL) thickness (72.22%). In examinees with clinically unilateral XFS, RNFL thinning occurs in both eyes before XFS becomes bilateral and before hypertensive intraocular pressure can be measured.

The main objective was to analyze prenatal and obstetric risk factors in relation to the development of disabilities. For that purpose, data on medication, i.e., use of benzodiazepines during pregnancy, gestational weeks, mode of delivery (vaginal or cesarean section), duration of delivery, and fetal presentation were retrieved from medical records and semi-structured interviews with mothers/legal guardians. Trained professionals clinically assessed the children's developmental status (N=107). Fisher exact test with post hoc analysis of standardized residuals showed that a statistically significant number of children with multiple disabilities were born by cesarean section (z=3.7, p<0.001), prematurely (z=4.8, p<0.001), and by mothers using benzodiazepines (z=2.6, p<0.01). Children with autism spectrum disorders were more often delivered post-term (z=2.0, p<0.05) by induced delivery (z=2.9, p<0.01). Children with developmental coordination disorder were more often born post-term (z=2.2, p<0.05). As for the duration of delivery and fetal presentation, there was no statistically significant correlation with developmental disabilities. There is a cumulative risk of developmental disabilities rather than just a single risk factor. More interdisciplinary and longitudinal research on developmental disabilities, including children's educational outcomes should be conducted.

Stage II colorectal cancer (CRC) is a major therapeutic challenge because it is not easy to decide whether patients will benefit from adjuvant chemotherapy or not. This study was designed as a retrospective prognostic study combining standard histopathologic parameters with tumor budding and microsatellite instability. The study included 89 patients on elective treatment for stage II primary colorectal adenocarcinoma from January 2011 to December 2015. Study results indicated that the prognosis of patients with stage II CRC depended on the combination of three factors, (in the order of importance): number of lymph nodes examined; total number of buds per 0.785 mm2 (≥5.5); and positive lymphovascular invasion. There is increasing evidence that tumor biology and non-anatomic characteristics are important in the prognosis and treatment of CRC. One of them is tumor budding which is not yet an integral part of the AJCC staging system. A low number of the lymph nodes examined is associated with high-risk patients. All patients without an adequate number of lymph nodes examined (less than 8 lymph nodes) should a priori be considered a very high-risk group, with a very low survival rate, and chemotherapy should be used.