Acta clinica Croatica最新文献

The aim of this paper is to present data on hospitalized patients in Zagreb clinics and hospitals, from 2007 to 2021. This paper is a continuation of our previous paper, but for a different time period. All data were collected from the official patient registry of the Zagreb Antirabies Clinic, which operates within the Reference Center for Rabies at Andrija Štampar Teaching Institute of Public Health. During this period, there were 9960 patients examined for injuries inflicted by animals, of which 98 (0.98%) were hospitalized in different departments and hospitals in Zagreb due to wound severity. All the hospitalized patients were examined to exclude the possible risk of rabies. The official patient registry of the Zagreb Antirabies Clinic is the source of the presented data, which were collected and analyzed retrospectively. We conducted a descriptive analysis. The ages of the hospitalized patients ranged from 17 days to 82 years, 55 (56.12%) were adults, and 43 (43.88%) were children; among the adults, there were 29 (29.59%) men and 26 (26.53%) women, while among the children there were 25 (25.51%) boys and 18 (18.37%) girls. The most common causes of hospitalization after an animal bite were infectious diseases (cat-scratch disease, rat-bite fever) and severity of wounds, which is comparable to the data available from other countries. There is no statistically significant difference in the frequency of hospitalization between children and adults, while dogs are statistically significantly more likely to inflict injuries that result in hospitalization than other animals. However, no specific anatomical location exhibited a statistically significant higher frequency of bites compared to others, as one might expect.

The gold standard for pertrochanteric fractures is closed reduction with traction and intramedullary osteosynthesis. A significant number of patients report knee pain after surgery, which could be associated with gonarthrosis and traction. In this research we wanted to determine if managing knee pain affects the rehabilitation of patients. There were three groups: the first group received a post-operative intra-articular (IA) injection containing methylprednisolone with lidocaine; the second group received the same combination periarticularly (PA); and the control group did not receive any form of injection. We measured the Visual Analogue Scale (VAS) score on the 3rd and 12th postoperative days, as well as six weeks after surgery. We measured knee range of motion (ROM) on the 12th postoperative day and six weeks after surgery. We calculated the Harris Hip Score (HHS) on the 3rd day and six weeks postoperatively. There were 27 patients. Preoperative Kellgren-Lawrence and VAS pain scores were similar. The IA group demonstrated the lowest VAS pain score after six weeks. ROM did not improve between groups on the 12th day and six weeks postoperatively. HHS was best in the IA group after 6 weeks. Injection of methylprednisolone with lidocaine into the knee improved postoperative rehabilitation in patients with knee osteoarthritis undergoing ipsilateral cephalomedullary fixation for a pertrochanteric fracture.

Postoperative cognitive dysfunction (POCD) is a newly developed cognitive function deficit after surgery. The aim of the study was to determine the incidence of POCD after anesthesia and possible risk factors. A prospective study was conducted on 90 patients scheduled for elective surgery under general (60 patients) or regional (30 patients) anesthesia. Each patient completed the Montreal cognitive assessment (MoCa) test the day before and the day after surgery. Data on comorbidities, previous COVID-19 infection, demographic and anesthesia related data were also collected. The day after surgery, POCD defined according to the 2 scores rule was present in 38 (42.2%) patients. A lower level of education (p=0.023), previous COVID-19 infection (p=0.032), higher Charlson comorbidity index (CCI) (p=0.014), and general anesthesia (p=0.035) were identified as risk factors, whereas a statistically significant negative correlation with preoperative (p=0.001) and postoperative result (p=0.001) was proven for age. The results indicated that a significant proportion of patients after general or regional anesthesia developed POCD depending on patient education, CCI, COVID-19 infection, and type of anesthesia. It was also shown that older age correlated with poorer MoCa test result independently of anesthesia. These factors can be identified before the procedure under anesthesia, thus offering the possibility of adjusting anesthesia and postoperative care in patients at risk of developing POCD.

The aim was to compare corneal densitometry, haze development, visual and refractive results after photorefractive keratectomy (PRK) performed with different epithelial removal techniques. This study included 42 patients (84 eyes) who underwent PRK with one eye de-epithelialized with 20% ethanol solution (PRK-a group) and another one with rotating brush (PRK-b group). The procedures were performed by the same surgeon on the same laser platform after comprehensive preoperative assessment. Follow up examinations of the patients were scheduled on postoperative day 4, then 1, 3 and 12 months postoperatively. Faster recovery of visual acuity was achieved in the PRK-b group during 12-month postoperative period but differences were statistically nonsignificant. Haze was significantly less present in the brush group measured 12 months after surgery. Also, eyes in the PRK-b group returned close to its basal corneal densitometry values faster than those that underwent PRK-a. Short-term visual recovery occurred faster in the PRK-b group. Less haze development and better corneal transparency were achieved in the PRK-b group throughout the 12-month follow-up period. However, both procedures showed great results and patient satisfaction was high regardless of the de-epithelialization method.

Our study aimed to analyze the correlation of cancer-related parameters with tumor regression grade (TRG) and disease-free survival (DFS) by gender in 192 rectal cancer patients operated on after neoadjuvant long-course chemoradiotherapy (LCCRT). Preoperative diagnostics revealed no significant gender differences in any clinical parameters other than obesity (p=0.031). We found that slightly overweight men had a lower incidence of distant metastases (p=0.042). The post-LCCRT pathologic finding showed that women had more positive lymph nodes (ypN, p=0.002) while no other pathologic parameter differed significantly between the genders. Overall, a poor response to therapy correlated with a shorter time to disease progression (p=0.002). Women achieved ypN0 in 50% of cases, but only 27% had a good TRG compared to 40.5% of men (p=0.073). Women had a worse DFS than men, even when complete response to therapy was achieved (p=0.003), and greater depth of residual tumor invasion (ypT, p=0.035) and higher ypN (p=0.002) correlated with shorter DFS. Positive resection margins (p<0.001), higher ypN stage (p=0.003), and poor TRG (p=0.025) correlated with shorter DFS in men. We conclude that women have a poorer response to LCCRT with the possibility that therapeutic approach to the neoadjuvant treatment of rectal cancer may be gender-specific.

We present a clinical case of a 59-year-old man, father of two children, who complained of irritative voiding of the bladder. An unknown retrovesical structure was detected by ultrasound and computed tomography, and was surgically removed later. Histopathologic analysis reported uterine tissue with a leiomyoma, thus the diagnosis of persistent müllerian duct syndrome (PMDS) was established. It is a rare disorder characterized by the appearance of müllerian derivatives (fallopian tubes, uterus, and upper two-thirds of vagina) in males with normally developed external and internal genitalia. Patients usually present with cryptorchidism and inguinal hernia. Irritative voiding has not yet been described as the main symptom of PMDS. The major complications of the disorder are infertility, testicular tumorigenesis, and malignant transformation of müllerian structures. To the best of our knowledge, in addition to our case, only one case of PMDS with uterine leiomyoma has been described in the literature so far.

This study aimed to determine the relationship between the concentration of thyroid peroxidase antibodies (TPO-Ab) and thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in patients with chronic lymphocytic thyroiditis. This cross-sectional study included 144 patients diagnosed with chronic lymphocytic thyroiditis whose mean age was 46±15 years at the time of diagnosis. According to their TSH concentration, the patients were either euthyroid or hypothyroid. After 59 patients were excluded due to TSH levels below the reference range, no TPO-Ab findings, substitution therapy, immune hyperthyroidism, or TPO-Ab and TSH levels outside the reso- lution limits of the laboratory tests, 85 patients remained in the study. A positive correlation was found between TPO-Ab and TSH concentration within the euthyroid and hypothyroid range and a negative correlation between TPO-Ab and FT4 concentration. The result suggests that the TSH and TPO-Ab concentration could be used to identify individuals at risk for the development of hypothyroidism in the general population.

The etiology of inflammatory bowel disease (IBD) is unknown. Data on the incidence and prevalence in different regions can help identify factors relevant to the occurrence of IBD. From 2000 to 2014, 517 patients were newly diagnosed with IBD, including 329 (63.6%) patients with ulcerative colitis (UC) and 188 (36.4%) patients with Crohn's disease (CD). The incidence of UC was 71.4/100,000 in the 2000-2010 period and 30.5/100,000 in the 2011-2014 period. The incidence of CD was 37.5/100,000 in the 2000-2010 period and 21/100,000 in the 2011-2014 period. The prevalence of IBD showed an increasing trend during the study period. It increased from 3/100,000 in 2000 to 109.5/100,000 in 2014 for UC, and from 2.5/100000 in 2000 to 63.3 in 2014 for CD. The results from Osijek-Baranja County are consistent with most studies on IBD, except for the distribution by gender and education. There was a statistically significantly higher number of males with CD compared to UC, and patients diagnosed with CD had a significantly higher level of education.

Tumor invasion of carotid arteries (CA) is found in 2%-7% of patients with head and neck cancer (HNC). There are no standardized criteria to evaluate the invasion. Tumor invasion of CA is assessed by using computerized tomography (CT) and magnetic resonance imaging. Ultrasound was also used but the method has not become daily routine. The aim of this study was to examine the effect of tumor invasion on CA dynamics and to evaluate the role of ultrasonography in the diagnosis of invasion. The study was conducted on two groups of 22 patients each. The first group consisted of patients with confirmed HNC and CA infiltration, while the second group consisted of patients without any data of HNC. Motion of the CA wall was assessed using ultrasound from which a CA was segmented and then the amount of motion was assessed by optical flow calculation. All patients with a CT-verified CA infiltration had an altered CA motion. The research showed that tumor-infiltrated CA had an altered dynamic when viewed on ultrasound.

Atrial septal aneurysm is a congenital abnormality that may occur as an isolated malformation or in combination with other cardiac abnormalities. More than half of the cases of atrial septal aneurysm are associated with an atrial shunt. We present a case with a thrombus at a giant atrial septal aneurysm associated with atrial septal defect and thrombus in the left atrial appendage, detected by transesophageal echocardiography after cerebral ischemic events. To the best of our knowledge, this combination has not been described in the literature so far.