Introduction. Pneumomediastinum is defined as the presence of free air in the mediastinum. Primary, idiopathic, spontaneous pneumomediastinum is very rare and it affects healthy children with no identifiable cause. Secondary pneumomediastinum may be caused by underlying respiratory disorders, iatrogenic causes or trauma. The most common clinical sign of pneumomediastinum is subcutaneous emphysema, and the most common symptoms are acute chest pain and dyspnea. The diagnosis is confirmed by a chest X-ray or chest computed tomography. Pneumomediastinum is rarely associated with pneumothorax, pneumoperitoneum, and pneumorrhachis. Case Report. In this report, we present a case of a spontaneous pneumomediastinum in a child aged 2 years and 6 months. A child was admitted to our hospital due to massive subcutaneous emphysema. On admission, the patient was without a history of chest trauma or any chronic respiratory tract diseases. He had a mild upper respiratory tract infection 6 days before admission. The diagnosis of pneumomediastinum was confirmed by chest X-ray and computed tomography. After conservative treatment, on the eighth day of hospitalization, there was a complete regression of the pneumomediastinum with normalization of the clinical and radiological findings. Conclusion. Spontaneous pneumomediastinum is the most common benign condition that spontaneously regresses after conservative treatment. Life-threatening complications require surgical decompression. The use of antibiotic therapy in the prophylaxis of mediastinitis has not been proven to be useful. Opinions on the routine use of chest computed tomography in patients with spontaneous pneumomediastinum are still not uniform.
{"title":"Spontaneous pneumomediastinum with pneumothorax, pneumorrhachis and pneumoperitoneum in a child: A case report","authors":"Milica Plazacic, Milena Bjelica, Gordana Vilotijević-Dautović","doi":"10.2298/mpns2206193p","DOIUrl":"https://doi.org/10.2298/mpns2206193p","url":null,"abstract":"Introduction. Pneumomediastinum is defined as the presence of free air in the mediastinum. Primary, idiopathic, spontaneous pneumomediastinum is very rare and it affects healthy children with no identifiable cause. Secondary pneumomediastinum may be caused by underlying respiratory disorders, iatrogenic causes or trauma. The most common clinical sign of pneumomediastinum is subcutaneous emphysema, and the most common symptoms are acute chest pain and dyspnea. The diagnosis is confirmed by a chest X-ray or chest computed tomography. Pneumomediastinum is rarely associated with pneumothorax, pneumoperitoneum, and pneumorrhachis. Case Report. In this report, we present a case of a spontaneous pneumomediastinum in a child aged 2 years and 6 months. A child was admitted to our hospital due to massive subcutaneous emphysema. On admission, the patient was without a history of chest trauma or any chronic respiratory tract diseases. He had a mild upper respiratory tract infection 6 days before admission. The diagnosis of pneumomediastinum was confirmed by chest X-ray and computed tomography. After conservative treatment, on the eighth day of hospitalization, there was a complete regression of the pneumomediastinum with normalization of the clinical and radiological findings. Conclusion. Spontaneous pneumomediastinum is the most common benign condition that spontaneously regresses after conservative treatment. Life-threatening complications require surgical decompression. The use of antibiotic therapy in the prophylaxis of mediastinitis has not been proven to be useful. Opinions on the routine use of chest computed tomography in patients with spontaneous pneumomediastinum are still not uniform.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75340441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maja Stankov, Darka Hadnadjev-Simonji, M. Basta-Nikolic, J. Ristić
Introduction. The lungs are one of the most common sites of metastases from carcinomas and sarcomas. Secondary pulmonary tumors are typically multiple, oval in shape and located in the lung periphery. Cavitation of metastatic pulmonary nodules is extremely rare and most often occurs in primary squamous cell carcinomas of the head and neck and the cervix. Case Report. We report the case of a 62-year-old man presenting with dysphagia for solid foods and weight loss in the last two months. The patient had a history of long-term smoking and regular alcohol consumption. A barium meal showed irregular stricture in the proximal esophagus, highly suspicious of malignancy. Computed tomography of the neck and thorax showed tumor infiltration of the cervical and proximal part of the thoracic esophagus and multiple cavitary and solid pulmonary metastases. Conclusion. High-resolution computed tomography of the chest and radiological features such as a wall nodules, irregular internal contour of the cavity and spiculated edges allow precise characterization of cavitary metastatic lesions.
{"title":"Cavitary pulmonary metastases: A case report","authors":"Maja Stankov, Darka Hadnadjev-Simonji, M. Basta-Nikolic, J. Ristić","doi":"10.2298/mpns2210311s","DOIUrl":"https://doi.org/10.2298/mpns2210311s","url":null,"abstract":"Introduction. The lungs are one of the most common sites of metastases from carcinomas and sarcomas. Secondary pulmonary tumors are typically multiple, oval in shape and located in the lung periphery. Cavitation of metastatic pulmonary nodules is extremely rare and most often occurs in primary squamous cell carcinomas of the head and neck and the cervix. Case Report. We report the case of a 62-year-old man presenting with dysphagia for solid foods and weight loss in the last two months. The patient had a history of long-term smoking and regular alcohol consumption. A barium meal showed irregular stricture in the proximal esophagus, highly suspicious of malignancy. Computed tomography of the neck and thorax showed tumor infiltration of the cervical and proximal part of the thoracic esophagus and multiple cavitary and solid pulmonary metastases. Conclusion. High-resolution computed tomography of the chest and radiological features such as a wall nodules, irregular internal contour of the cavity and spiculated edges allow precise characterization of cavitary metastatic lesions.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74699254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jelena Djurica, Dunja Becejac, Sonja Adamovic, Sonja Mitic, Tijana Djukic, D. Lendak
Introduction. Sepsis is the body?s response to infection, leading to tissue and organ damage. Although fever was considered to be an important sign of sepsis, it has been shown that half of the critically ill patients with sepsis do not have fever at the time of diagnosis. Absence of high body temperature may be a serious disruption of the thermoregulatory response to infection and therefore a reflection of the disease severity. The aim of this study was to determine the percentage of patients with sepsis without fever, and to compare the clinical presentation and outcome of the disease in febrile and afebrile patients. Material and Methods. A retrospective study included 597 patients with sepsis who were divided into two groups: the first included patients with elevated body temperature (? 37.7 ?) and the second included patients who were afebrile (< 37.7 ?). Demographic data, clinical, laboratory and microbiological data, gas analysis parameters, length of hospitalization, and data on the disease outcome were collected and analyzed for all patients. Results. The results show that 41.9% of patients with sepsis did not have fever in the first 24 hours of hospitalization. In the group of afebrile patients, the average age was higher (67.38 ? 14.63 vs. 61.38 ? 18.96 years; p < 0.001) and comorbidities were more common. Patients with elevated body temperature had a significantly lower degree of organ dysfunction measured by the Sequential Organ Failure Assessment score compared to afebrile patients. There were 29.2% of patients with lethal outcome in the group of afebrile patients compared to 18.4% of deceased febrile patients. Conclusion. We conclude that the absence of fever does not rule out the diagnosis of sepsis, but on the contrary, it is associated with greater organ dysfunction and higher mortality, while the elderly are a particularly vulnerable group.
介绍。败血症是身体吗?对感染的反应，导致组织和器官损伤。虽然发烧被认为是脓毒症的重要标志，但已有研究表明，一半的脓毒症危重患者在诊断时没有发烧。没有高体温可能是对感染的体温调节反应的严重破坏，因此反映了疾病的严重程度。本研究的目的是确定无发热脓毒症患者的百分比，并比较发热和不发热患者的临床表现和结果。材料和方法。一项回顾性研究包括597例败血症患者，他们被分为两组:第一组包括体温升高(?37.7℃)，第二组为发热患者(< 37.7℃)。收集并分析所有患者的人口统计数据、临床、实验室和微生物学数据、气体分析参数、住院时间和疾病结局数据。结果。结果显示，41.9%的脓毒症患者在入院前24小时内没有发热。发热组患者平均年龄较高(67.38 ?14.63 vs. 61.38 ?18.96年;P < 0.001)，合并症更为常见。与发热患者相比，体温升高的患者在序贯器官衰竭评估评分中器官功能障碍程度明显较低。发热患者组中有29.2%的患者死亡，而死亡的发热患者中有18.4%死亡。结论。我们的结论是，不发烧并不排除败血症的诊断，相反，它与更大的器官功能障碍和更高的死亡率有关，而老年人是一个特别脆弱的群体。
{"title":"Fever and sepsis - dangerous controversies","authors":"Jelena Djurica, Dunja Becejac, Sonja Adamovic, Sonja Mitic, Tijana Djukic, D. Lendak","doi":"10.2298/mpns2212344d","DOIUrl":"https://doi.org/10.2298/mpns2212344d","url":null,"abstract":"Introduction. Sepsis is the body?s response to infection, leading to tissue and organ damage. Although fever was considered to be an important sign of sepsis, it has been shown that half of the critically ill patients with sepsis do not have fever at the time of diagnosis. Absence of high body temperature may be a serious disruption of the thermoregulatory response to infection and therefore a reflection of the disease severity. The aim of this study was to determine the percentage of patients with sepsis without fever, and to compare the clinical presentation and outcome of the disease in febrile and afebrile patients. Material and Methods. A retrospective study included 597 patients with sepsis who were divided into two groups: the first included patients with elevated body temperature (? 37.7 ?) and the second included patients who were afebrile (< 37.7 ?). Demographic data, clinical, laboratory and microbiological data, gas analysis parameters, length of hospitalization, and data on the disease outcome were collected and analyzed for all patients. Results. The results show that 41.9% of patients with sepsis did not have fever in the first 24 hours of hospitalization. In the group of afebrile patients, the average age was higher (67.38 ? 14.63 vs. 61.38 ? 18.96 years; p < 0.001) and comorbidities were more common. Patients with elevated body temperature had a significantly lower degree of organ dysfunction measured by the Sequential Organ Failure Assessment score compared to afebrile patients. There were 29.2% of patients with lethal outcome in the group of afebrile patients compared to 18.4% of deceased febrile patients. Conclusion. We conclude that the absence of fever does not rule out the diagnosis of sepsis, but on the contrary, it is associated with greater organ dysfunction and higher mortality, while the elderly are a particularly vulnerable group.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73774582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Modern treatment of Hodgkin?s lymphoma has led to a cure in 60-90% of patients. The problem are patients in whom disease relapse occurs, or the disease is refractory to initial therapy. The standard relapse treatment is the application of high-dose chemotherapy with autologous stem cell transplantation. However, about half of patients experience treatment failure after autologous stem cell transplantation. Despite the application of new therapeutic modalities, the disease relapses, so allogeneic stem cell transplantation is the method of choice in further treatment. Haploidentical transplantation - yes/no. The donor for an allogeneic transplant can be related or unrelated to human leukocyte associated antigen-matched or haploidentical related. Allogeneic transplantation is used in Hodgkin?s lymphoma because of the strong effect of the graft against lymphoma. The dilemmas of whether a haploidentical donor compared to a related/unrelated matched donor are better and when treating of Hodgkin?s lymphoma with allogeneic stem cell transplantation are presented in this paper. Conclusion. Allogeneic transplantation is still the only potentially curative therapeutic option to treat Hodgkin?s lymphoma. In order for the treatment outcome to be as good as possible, it is necessary to precisely define the pre-transplant conditioning, as well as the selection of the donor. Randomized multicenter studies provide answers to all doubts.
{"title":"Haploidentical donor the donor of choice in the treatment of relapse Hodgkin’s lymphoma","authors":"Marija Elez, M. Todorovic-Balint","doi":"10.2298/mpns22s1054e","DOIUrl":"https://doi.org/10.2298/mpns22s1054e","url":null,"abstract":"Introduction. Modern treatment of Hodgkin?s lymphoma has led to a cure in 60-90% of patients. The problem are patients in whom disease relapse occurs, or the disease is refractory to initial therapy. The standard relapse treatment is the application of high-dose chemotherapy with autologous stem cell transplantation. However, about half of patients experience treatment failure after autologous stem cell transplantation. Despite the application of new therapeutic modalities, the disease relapses, so allogeneic stem cell transplantation is the method of choice in further treatment. Haploidentical transplantation - yes/no. The donor for an allogeneic transplant can be related or unrelated to human leukocyte associated antigen-matched or haploidentical related. Allogeneic transplantation is used in Hodgkin?s lymphoma because of the strong effect of the graft against lymphoma. The dilemmas of whether a haploidentical donor compared to a related/unrelated matched donor are better and when treating of Hodgkin?s lymphoma with allogeneic stem cell transplantation are presented in this paper. Conclusion. Allogeneic transplantation is still the only potentially curative therapeutic option to treat Hodgkin?s lymphoma. In order for the treatment outcome to be as good as possible, it is necessary to precisely define the pre-transplant conditioning, as well as the selection of the donor. Randomized multicenter studies provide answers to all doubts.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79080871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. The most common clinical manifestation of endometrial cancer is postmenopausal bleeding, as well as irregular uterine bleeding. Far less often, endometrial cancer may also be present in postmenopausal women without bleeding. The aim of our study was to examine the incidence of endometrial cancer in asymptomatic postmenopausal women with a thickened endometrium. Material and Methods. The research included 251 asymptomatic postmenopausal women with endometrial thickness over 4 mm established by ultrasound. Exploratory curettage was performed in all the patients, followed by histopathological examination of the obtained material. Results. The average age of the respondents was 65.38 ? 26.69 years. The average thickness of the endometrium was 15.68 ? 5.06 mm. Of all the patients, 70.13% presented with benign endometrial disease; endometrial polyps were found in 58.18% and simplex hyperplasia of the endometrium without atypia in 11.95%. Endometrial cancer was found in 1.59% of patients, ovarian cancer metastasis in 0.4%, and endometrial hyperplasia with atypia in 1.59% of patients. All cases of endometrial cancer were diagnosed in patients with endometrial thickness over 11 mm. Conclusion. The approach to asymptomatic women with endometrial hyperplasia should be individual. Exploratory curettage/hysteroscopy should be recommended to patients with endometrial thickness over 11 mm in order to detect and evaluate for endometrial cancer. Asymptomatic women with endometrial thickness of 4 - 10 mm should be further examined, especially in case of associated risk factors or other ultrasound parameters that indicate more serious endometrial pathology.
{"title":"Endometrial carcinoma in asymptomatic postmenopausal women with a thickened endometrium","authors":"L. Mladenović-Segedi, M. Pantelić, D. Stajic","doi":"10.2298/mpns2212333m","DOIUrl":"https://doi.org/10.2298/mpns2212333m","url":null,"abstract":"Introduction. The most common clinical manifestation of endometrial cancer is postmenopausal bleeding, as well as irregular uterine bleeding. Far less often, endometrial cancer may also be present in postmenopausal women without bleeding. The aim of our study was to examine the incidence of endometrial cancer in asymptomatic postmenopausal women with a thickened endometrium. Material and Methods. The research included 251 asymptomatic postmenopausal women with endometrial thickness over 4 mm established by ultrasound. Exploratory curettage was performed in all the patients, followed by histopathological examination of the obtained material. Results. The average age of the respondents was 65.38 ? 26.69 years. The average thickness of the endometrium was 15.68 ? 5.06 mm. Of all the patients, 70.13% presented with benign endometrial disease; endometrial polyps were found in 58.18% and simplex hyperplasia of the endometrium without atypia in 11.95%. Endometrial cancer was found in 1.59% of patients, ovarian cancer metastasis in 0.4%, and endometrial hyperplasia with atypia in 1.59% of patients. All cases of endometrial cancer were diagnosed in patients with endometrial thickness over 11 mm. Conclusion. The approach to asymptomatic women with endometrial hyperplasia should be individual. Exploratory curettage/hysteroscopy should be recommended to patients with endometrial thickness over 11 mm in order to detect and evaluate for endometrial cancer. Asymptomatic women with endometrial thickness of 4 - 10 mm should be further examined, especially in case of associated risk factors or other ultrasound parameters that indicate more serious endometrial pathology.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80296299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Janković, A. Savić, J. Zvekic-Svorcan, Marina Maksimovic-Simovic, K. Boskovic
Introduction. Elucidation of the pathogenetic mechanisms of osteoporosis has led to the development of new and effective drugs from the group of biological agents. Case report. In April 2018, a 64-year-old female patient was presented to the hospital due to low back pain. She was diagnosed with postmenopausal osteoporosis based on bone density scan score and a compression fracture of the L1 vertebral body revealed by X-ray. She was treated with a weekly bisphosphonate and supplementation with vitamin D and calcium. After one year, monthly bisphosphonate was introduced in therapy because of an inadequate response. In April 2020, the patient was treated for COVID-19 according to protocol, and during the treatment, bisphosphonate therapy was discontinued. After five months, she suffered a fracture of her left forearm. Due to the persistence of low mineral bone density, which was complicated by a new fracture, denosumab 60 mg subcutaneously once every six months was initiated with additional vitamin D and calcium supplementation. At six months follow-up, an increase in mineral bone density was verified, and after 12 months, the dual-energy x-ray absorptiometry score was within the osteopenia range. Laboratory findings showed a decrease in bone turnover markers. Conclusion. One-year administration of denosumab led to a significant increase in bone mineral density measured at the lumbar spine and neck of the femur, as well as changes in the levels of biochemical markers of bone synthesis and resorption, and reduced the risk of new fractures.
{"title":"Biological therapy for osteoporosis - solving clinical problems - a case report","authors":"T. Janković, A. Savić, J. Zvekic-Svorcan, Marina Maksimovic-Simovic, K. Boskovic","doi":"10.2298/mpns22s2022j","DOIUrl":"https://doi.org/10.2298/mpns22s2022j","url":null,"abstract":"Introduction. Elucidation of the pathogenetic mechanisms of osteoporosis has led to the development of new and effective drugs from the group of biological agents. Case report. In April 2018, a 64-year-old female patient was presented to the hospital due to low back pain. She was diagnosed with postmenopausal osteoporosis based on bone density scan score and a compression fracture of the L1 vertebral body revealed by X-ray. She was treated with a weekly bisphosphonate and supplementation with vitamin D and calcium. After one year, monthly bisphosphonate was introduced in therapy because of an inadequate response. In April 2020, the patient was treated for COVID-19 according to protocol, and during the treatment, bisphosphonate therapy was discontinued. After five months, she suffered a fracture of her left forearm. Due to the persistence of low mineral bone density, which was complicated by a new fracture, denosumab 60 mg subcutaneously once every six months was initiated with additional vitamin D and calcium supplementation. At six months follow-up, an increase in mineral bone density was verified, and after 12 months, the dual-energy x-ray absorptiometry score was within the osteopenia range. Laboratory findings showed a decrease in bone turnover markers. Conclusion. One-year administration of denosumab led to a significant increase in bone mineral density measured at the lumbar spine and neck of the femur, as well as changes in the levels of biochemical markers of bone synthesis and resorption, and reduced the risk of new fractures.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80319386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. The myelodysplastic syndromes are a group of clonal haematopoietic stem cell disorders characterized by cytopenia, dysplasia, ineffective hematopiesis, recurrent genetic abnormalities, and increased risk of developing acute myeloid leukemia. In this paper, we present the review and recommendations for treatment of high risk myelodysplastic syndromes on behalf of the Serbian myelodysplastic syndromes group. Material and Methods. A literature review was conducted using the following bibliographic databases: Google Scholar, MEDLINE and Kobson. The recommendations treatment of high risk myelodysplastic syndromes are based on expert opinion based on review of literature and contemporary recommendations for treatment of high risk for myelodysplastic syndromes. Recommendations. Higher-risk myelodysplastic syndromes should be defined in patients risk group with > 3.5 IPSS-R score. Allo- HSCT is recommended in fit higher-risk patients with IPSS-R > 3.5 as well as in fit lower-risk patients with poor risk features according to EBMT/ELN International expert panel and myelodysplastic syndromes right group. Acute myeloid leukemia like or hypomethylation treatment before Allo-HSCT is indicated in patients with myelodysplastic syndromes with ? 10% of blasts. Azacitidine is recommended in intermediate-2 and high risk IPSS patients who are not eligible for transplantation with minimal number of six cycles to define response. Acute myeloid leukemia like treatment is recommended in fit higher-risk for patients with myelodysplastic syndromes with excess of blasts, good performance status, without substantial comorbidities, and with no poor/very poor cytogenetics/genetics. Conclusion. The treatment of fit higher-risk patients should be based on allo-SCT. In patients who are not candidates for transplant hypomethylation treatment is indicated as well as acute myeloid leukemia like treatment in selected patients.
{"title":"Treatment of higher-risk myelodysplastic syndrome","authors":"A. Savic, D. Marisavljević, A. Bogdanović","doi":"10.2298/mpns22s1038s","DOIUrl":"https://doi.org/10.2298/mpns22s1038s","url":null,"abstract":"Introduction. The myelodysplastic syndromes are a group of clonal haematopoietic stem cell disorders characterized by cytopenia, dysplasia, ineffective hematopiesis, recurrent genetic abnormalities, and increased risk of developing acute myeloid leukemia. In this paper, we present the review and recommendations for treatment of high risk myelodysplastic syndromes on behalf of the Serbian myelodysplastic syndromes group. Material and Methods. A literature review was conducted using the following bibliographic databases: Google Scholar, MEDLINE and Kobson. The recommendations treatment of high risk myelodysplastic syndromes are based on expert opinion based on review of literature and contemporary recommendations for treatment of high risk for myelodysplastic syndromes. Recommendations. Higher-risk myelodysplastic syndromes should be defined in patients risk group with > 3.5 IPSS-R score. Allo- HSCT is recommended in fit higher-risk patients with IPSS-R > 3.5 as well as in fit lower-risk patients with poor risk features according to EBMT/ELN International expert panel and myelodysplastic syndromes right group. Acute myeloid leukemia like or hypomethylation treatment before Allo-HSCT is indicated in patients with myelodysplastic syndromes with ? 10% of blasts. Azacitidine is recommended in intermediate-2 and high risk IPSS patients who are not eligible for transplantation with minimal number of six cycles to define response. Acute myeloid leukemia like treatment is recommended in fit higher-risk for patients with myelodysplastic syndromes with excess of blasts, good performance status, without substantial comorbidities, and with no poor/very poor cytogenetics/genetics. Conclusion. The treatment of fit higher-risk patients should be based on allo-SCT. In patients who are not candidates for transplant hypomethylation treatment is indicated as well as acute myeloid leukemia like treatment in selected patients.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83179158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. D-dimer is formed during plasmin-mediated proteolysis of cross-linked fibrin; hence it serves as a biomarker of activated coagulation and fibrinolysis. Clinical significance. Measurement of D-dimer is most commonly used to exclude venous thromboembolism, and in the diagnosis of disseminated intravascular coagulation. For the diagnosis of venous thromboembolism D-dimer is part of the validated algorithm, which includes an assessment of clinical pre-test probability to guide further investigation. Due to very high negative predictive values, average levels of D-dimer are sufficient for ruling out venous thromboembolism in patients with low-medium pre-test clinical probability. However, in patients with high pre-test probability, the measurement of D-dimer is of limited value. Similarly, normal values of D-dimer reliably exclude disseminated intravascular coagulation. On the other hand, elevated values of D-dimer have low specificity for this condition and should be evaluated in a validated scoring system developed for the diagnosis of disseminated intravascular coagulation. Recently, measurement of D-dimer has been increasingly applied to assess the risk of venous thrombosis recurrence in women and to decide on the duration of anticoagulant therapy after the first unprovoked venous thrombosis. Elevated D-dimer level is an essential characteristic of COVID-19 - associated coagulopathy. The degree of coagulopathy and D-dimer levels correlate with the clinical severity of the disease and higher mortality, most likely reflecting increased activation of the coagulation system in the microcirculation of various organs, primarily the lungs. Conclusion. D-dimer is one of the most often used hemostasis test, validated so far for diagnosis of venous thromboembolism and disseminated intravascular coagulation.
{"title":"D-dimer - origin and clinical significance","authors":"P. Miljić, J. Bodrozic","doi":"10.2298/mpns22s1143m","DOIUrl":"https://doi.org/10.2298/mpns22s1143m","url":null,"abstract":"Introduction. D-dimer is formed during plasmin-mediated proteolysis of cross-linked fibrin; hence it serves as a biomarker of activated coagulation and fibrinolysis. Clinical significance. Measurement of D-dimer is most commonly used to exclude venous thromboembolism, and in the diagnosis of disseminated intravascular coagulation. For the diagnosis of venous thromboembolism D-dimer is part of the validated algorithm, which includes an assessment of clinical pre-test probability to guide further investigation. Due to very high negative predictive values, average levels of D-dimer are sufficient for ruling out venous thromboembolism in patients with low-medium pre-test clinical probability. However, in patients with high pre-test probability, the measurement of D-dimer is of limited value. Similarly, normal values of D-dimer reliably exclude disseminated intravascular coagulation. On the other hand, elevated values of D-dimer have low specificity for this condition and should be evaluated in a validated scoring system developed for the diagnosis of disseminated intravascular coagulation. Recently, measurement of D-dimer has been increasingly applied to assess the risk of venous thrombosis recurrence in women and to decide on the duration of anticoagulant therapy after the first unprovoked venous thrombosis. Elevated D-dimer level is an essential characteristic of COVID-19 - associated coagulopathy. The degree of coagulopathy and D-dimer levels correlate with the clinical severity of the disease and higher mortality, most likely reflecting increased activation of the coagulation system in the microcirculation of various organs, primarily the lungs. Conclusion. D-dimer is one of the most often used hemostasis test, validated so far for diagnosis of venous thromboembolism and disseminated intravascular coagulation.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89202298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanja Bjelan, M. Okanović, A. Vejnović, Nemanja Stanković, P. Savic
Introduction. Shared psychotic disorder, or folie ? deux, is a rare entity characterized by the transmission of psychotic symptoms from one patient (the inducer) to another (the induced). Delusional disorder is a type of mental illness (International Classification of Diseases, Tenth Revision, Clinical Modification, diagnosis code F24; it was moved from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, to Other Specified Schizophrenia Spectrum and Other Psychotic Disorders). Only one person (the inducer) suffers from a real psychotic disorder, and the other/s is/ are induced, and most often recover/s after separation from the inducer. Case Report. Based on the medical records and available literature on this condition, we present a case of a mother and son with this disorder, where the son with a paranoid psychosis transfers it to his mother. They lived alone in the same household for years, socially isolated from the others. Conclusion. In general, the research has shown that there are no uniform opinions among authors regarding the incidence of the disorder in males and females, at younger and older age, as well as in relationships between partners, siblings, and between parents and children. Most agree that longterm social isolation is among the most common risk factors, as well as dominance and strong power of suggestion in one partner, and passivity and tendency to suggestion in the other.
{"title":"Folie à deux - a case report","authors":"Sanja Bjelan, M. Okanović, A. Vejnović, Nemanja Stanković, P. Savic","doi":"10.2298/mpns2204123b","DOIUrl":"https://doi.org/10.2298/mpns2204123b","url":null,"abstract":"Introduction. Shared psychotic disorder, or folie ? deux, is a rare entity characterized by the transmission of psychotic symptoms from one patient (the inducer) to another (the induced). Delusional disorder is a type of mental illness (International Classification of Diseases, Tenth Revision, Clinical Modification, diagnosis code F24; it was moved from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, to Other Specified Schizophrenia Spectrum and Other Psychotic Disorders). Only one person (the inducer) suffers from a real psychotic disorder, and the other/s is/ are induced, and most often recover/s after separation from the inducer. Case Report. Based on the medical records and available literature on this condition, we present a case of a mother and son with this disorder, where the son with a paranoid psychosis transfers it to his mother. They lived alone in the same household for years, socially isolated from the others. Conclusion. In general, the research has shown that there are no uniform opinions among authors regarding the incidence of the disorder in males and females, at younger and older age, as well as in relationships between partners, siblings, and between parents and children. Most agree that longterm social isolation is among the most common risk factors, as well as dominance and strong power of suggestion in one partner, and passivity and tendency to suggestion in the other.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89430759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ivana Stanisic, M. Živojinov, A. Ilic, Željka Vrekić, D. Ivanov
Introduction. Calcifying fibrous tumor is a rare benign neoplasm of soft tissue origin. The tumor is commonly found in young adults. In most cases it is an incidental finding, because patients do not have obvious symptoms. This tumor may appear in different anatomical locations mimicking other stromal lesions. The diagnosis is made based on pathohistological characteristics and an appropriate immunohistochemical profile. The treatment is surgical, and the prognosis is good. Case Report. A 19-year-old female patient was admitted for abdominal surgery presenting with abdominal pain and pressure. Abdominal ultrasonography and multislice computed tomography of the abdomen showed a tumor mass in the right hemiabdomen. The patient underwent surgical treatment and the tumor was completely removed. Macroscopic analysis showed that the tumor was encapsulated and had a smooth surface. Microscopically, the tumor consisted of bundles of partially hyalinized collagen fibers with calcifications in the form of psammoma bodies that were permeated with mononuclear inflammatory infiltrates. Conclusion. Given the higher incidence of other mesenchymal tumors in the abdomen, due to its rare occurrence, calcifying fibrous tumor presents a diagnostic challenge.
{"title":"Calcifying fibrous tumor in the abdomen: A case report","authors":"Ivana Stanisic, M. Živojinov, A. Ilic, Željka Vrekić, D. Ivanov","doi":"10.2298/mpns2212371s","DOIUrl":"https://doi.org/10.2298/mpns2212371s","url":null,"abstract":"Introduction. Calcifying fibrous tumor is a rare benign neoplasm of soft tissue origin. The tumor is commonly found in young adults. In most cases it is an incidental finding, because patients do not have obvious symptoms. This tumor may appear in different anatomical locations mimicking other stromal lesions. The diagnosis is made based on pathohistological characteristics and an appropriate immunohistochemical profile. The treatment is surgical, and the prognosis is good. Case Report. A 19-year-old female patient was admitted for abdominal surgery presenting with abdominal pain and pressure. Abdominal ultrasonography and multislice computed tomography of the abdomen showed a tumor mass in the right hemiabdomen. The patient underwent surgical treatment and the tumor was completely removed. Macroscopic analysis showed that the tumor was encapsulated and had a smooth surface. Microscopically, the tumor consisted of bundles of partially hyalinized collagen fibers with calcifications in the form of psammoma bodies that were permeated with mononuclear inflammatory infiltrates. Conclusion. Given the higher incidence of other mesenchymal tumors in the abdomen, due to its rare occurrence, calcifying fibrous tumor presents a diagnostic challenge.","PeriodicalId":87940,"journal":{"name":"Calcutta medical review","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87457390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：