Hematom vrata i medijastinuma kao primarna prezentacija karcinoma paratiroidne žlijezde

Uvod: Karcinom paratireoidne žlijezde je vrlo rijedak oblik karcinoma koji se rijetko primarno prezentira kao hematom vrata i medijastinuma. Svrha ovoga prikaza slučaja je da se naglasi važnost uzimanja u obzir spontanog krvarenja karcinoma paratireoidne žlijezde kao diferencijalne dijagnoze prilikom nastanka spontanog hematoma vrata i medijastinuma i da odgađanje operativnog zahvata u takvim slučajevima može dovesti do fatalnih komplikacija. Prikaz slučaja: Šezdesetčetverogodišnji muškarac javlja se u hitnu otorinolaringološku ambulantu zbog bolova u vratu, oticanja vrata i promuklosti. Prema anamnestičkim podacima nije bilo traume, te dan prije hitnog pregleda nije imao prisutnu oteklinu vrata i bolove. U kliničkom statusu bila je prisutna manja oteklina lijeve strane hipofarinksa, a lijeva strana larinksa bila je slabije pomična sa suficijentnom rimom, a na prednjoj i lijevoj strani vrata se palpirala difuzna, tvrda i bolna oteklina. Učinio se CT vrata i toraksa na kojem se opisala nepravilna heterodenzna tvorba dimenzija 10 x 5, 5 x 5,5 cm koja je odgovarala hemoragičnoj kolekciji i koja je komprimirala lijevo ACC i unutarnju jugularnu venu prema lateralno, potiskivala larinks, početni dio traheje i jednjaka kontralateralno, te se spuštala u gornji i stražnji medijastinum s posljedičnim medijastinitisom i ezofagitisom. Zbog pogoršanja općega stanja, povećanja otekline, kliničkog i CT nalaza, učinila se hitna eksploracija vrata. Intraoperativno je uočena cistična tvorba na lijevom režnju štitnjače koja je krvarila, te se učinila ljevostrana lobektomija štitnjače. Konačni patohistološki nalaz ukazao je na karcinom paratireoidne žlijezde veličine 2 cm koji je razoren opsežnim krvarenjem, a na osnovu kojega se multidisciplinirani tim odlučio na kirurško odstranjenje i drugog režnja štitnjače s paratireoidnim žlijezdama, uz nastavak redovnih kontrola po endokrinologu. Zaključak: Možemo zaključiti da kod bolesnika koji nije imao traumu, a ima prisutan hematom vrata i medijastinuma, treba razmotriti mogućnost krvarenja iz karcinoma paratireoidne žlijezde

Contralateral neck lymph node metastasis as a primary presentation of papillary thyroid microcarcinoma

Background: Papillary thyroid cancer usually follows a certain order of metastases to the lymph nodes of the neck. We present a case report of a patient with the primary presentation of the cancer in the form of a metastasis in the lateral neck compartment. Case report: A 22-year-old woman was referred for a painful nodule in region IV on the right side of the neck. Ultrasound showed a hypoechoic nodule measuring 0.5×0.4×0.6 cm in the left thyroid lobe and a hypoanechoic nodule measuring 2.5×2.0×3.1 cm in region IV on the right side of the neck. The FNAC finding of a nodule in region IV indicated the metastasis of papillary thyroid cancer, while the finding of the nodule in the left thyroid lobe did not indicate the presence of tumor cells. The multidisciplinary team decided to perform a total thyroidectomy with a selective neck dissection IIVI on the right side. The pathohistological analysis ultimately confirmed a papillary microcarcinoma (0.3 cm) in the left thyroid lobe, and a metastasis in the lymph node in region IV on the opposite side. Conclusion: Papillary cancer normally follows a certain sequence of metastases, and the central neck compartment is most often affected. In very rare cases, metastases can be seen in the lateral neck department without metastases in the central neck department (the so-called skipped metastases). From the presented case of the patient, a good preoperative evaluation and a discussion of the optimal surgical strategy by a multidisciplinary team is of utmost importance

Hematom vrata i medijastinuma kao primarna prezentacija karcinoma paratiroidne žlijezde

Uvod: Karcinom paratireoidne žlijezde je vrlo rijedak oblik karcinoma koji se rijetko primarno prezentira kao hematom vrata i medijastinuma. Svrha ovoga prikaza slučaja je da se naglasi važnost uzimanja u obzir spontanog krvarenja karcinoma paratireoidne žlijezde kao diferencijalne dijagnoze prilikom nastanka spontanog hematoma vrata i medijastinuma i da odgađanje operativnog zahvata u takvim slučajevima može dovesti do fatalnih komplikacija. Prikaz slučaja: Šezdesetčetverogodišnji muškarac javlja se u hitnu otorinolaringološku ambulantu zbog bolova u vratu, oticanja vrata i promuklosti. Prema anamnestičkim podacima nije bilo traume, te dan prije hitnog pregleda nije imao prisutnu oteklinu vrata i bolove. U kliničkom statusu bila je prisutna manja oteklina lijeve strane hipofarinksa, a lijeva strana larinksa bila je slabije pomična sa suficijentnom rimom, a na prednjoj i lijevoj strani vrata se palpirala difuzna, tvrda i bolna oteklina. Učinio se CT vrata i toraksa na kojem se opisala nepravilna heterodenzna tvorba dimenzija 10 x 5, 5 x 5,5 cm koja je odgovarala hemoragičnoj kolekciji i koja je komprimirala lijevo ACC i unutarnju jugularnu venu prema lateralno, potiskivala larinks, početni dio traheje i jednjaka kontralateralno, te se spuštala u gornji i stražnji medijastinum s posljedičnim medijastinitisom i ezofagitisom. Zbog pogoršanja općega stanja, povećanja otekline, kliničkog i CT nalaza, učinila se hitna eksploracija vrata. Intraoperativno je uočena cistična tvorba na lijevom režnju štitnjače koja je krvarila, te se učinila ljevostrana lobektomija štitnjače. Konačni patohistološki nalaz ukazao je na karcinom paratireoidne žlijezde veličine 2 cm koji je razoren opsežnim krvarenjem, a na osnovu kojega se multidisciplinirani tim odlučio na kirurško odstranjenje i drugog režnja štitnjače s paratireoidnim žlijezdama, uz nastavak redovnih kontrola po endokrinologu. Zaključak: Možemo zaključiti da kod bolesnika koji nije imao traumu, a ima prisutan hematom vrata i medijastinuma, treba razmotriti mogućnost krvarenja iz karcinoma paratireoidne žlijezde

Contralateral neck lymph node metastasis as a primary presentation of papillary thyroid microcarcinoma

Background: Papillary thyroid cancer usually follows a certain order of metastases to the lymph nodes of the neck. We present a case report of a patient with the primary presentation of the cancer in the form of a metastasis in the lateral neck compartment. Case report: A 22-year-old woman was referred for a painful nodule in region IV on the right side of the neck. Ultrasound showed a hypoechoic nodule measuring 0.5×0.4×0.6 cm in the left thyroid lobe and a hypoanechoic nodule measuring 2.5×2.0×3.1 cm in region IV on the right side of the neck. The FNAC finding of a nodule in region IV indicated the metastasis of papillary thyroid cancer, while the finding of the nodule in the left thyroid lobe did not indicate the presence of tumor cells. The multidisciplinary team decided to perform a total thyroidectomy with a selective neck dissection IIVI on the right side. The pathohistological analysis ultimately confirmed a papillary microcarcinoma (0.3 cm) in the left thyroid lobe, and a metastasis in the lymph node in region IV on the opposite side. Conclusion: Papillary cancer normally follows a certain sequence of metastases, and the central neck compartment is most often affected. In very rare cases, metastases can be seen in the lateral neck department without metastases in the central neck department (the so-called skipped metastases). From the presented case of the patient, a good preoperative evaluation and a discussion of the optimal surgical strategy by a multidisciplinary team is of utmost importance

Basic Characteristics of Ideal Societies in the Works of Some Classic and Contemporary Social Utopians

Cilj rada je iznijeti pregled najvažnijih ideja o utopijama, potom analizirati i usporediti njihove najvažnije značajke, odnosno ukazati na što pojedini autori stavljaju naglasak u svojim idejama te naposljetku izraditi jednu komparativnu shemu iz uočenoga. Želi se također razmotriti što je to od ideje utopije ostalo danas. Prvo se poglavlje usredotočuje na antičke utopije, poglavito na Platona kao začetnika utopijske misli. Sljedeće poglavlje prati renesansne autore koji su pisali o idealnom društvu, počevši od Thomasa Morea, tvorca riječi utopija do Campanelle i Grada Sunca te naposljetku Bacona i Nove Atlantide. Potom slijedi poglavlje o idejama socijalnih utopista Saint-Simona, Owena te Fouriera. U posljednjem poglavlju razmatraju se i neke ideje suvremenih autora, poput Rawlsa i Bregmana. Na kraju je u zaključku prikazana shema koja na sinoptički način prikazuje temeljne elemente i najvažnije značajke utopija svakog od razmatranih autora te njihove sličnosti i razlike.The aim of this paper is to review the most important ideas about utopias, analyze and compare their most important features that authors emphasize in their ideas, and at the end create a comparative scheme from the observed. We also want to consider what has remained of the idea of utopia today. The first chapter focuses on ancient utopias, primarily Plato as the originator of utopian thought. The next chapter follows the Renaissance authors who wrote about the ideal society, starting with Thomas More, the creator of the word utopia, Campanella\u27s City of the Sun, and ending with Bacon\u27s New Atlantis. Then follows the chapter on the ideas of social utopians Saint-Simone, Owen and Fourier. In the last chapter, some ideas of contemporary authors John Rawls and Rutger Bregman are considered. Finally, in the conclusion, a scheme is presented that shows the basic elements and most important features of the utopias of each of the considered authors, as well as their similarities and differences

Quality of life after FESS combined with diode laser in patients with chronic rhinosinusitis with nasal polyposis

Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is one of the most severe forms of chronic rhinosinusitis. The Sino-Nasal-Outcome Test 22 (SNOT-22) is most commonly used to assess the quality of life of these patients. One of the new treatment options for patients with CSRwNP is endoscopic diode laser polypectomy (DLPE) in local anesthesia. This study aims to compare the quality of life of patients with CSRwNP who underwent FESS and those who underwent DLPE before and after surgery. Patients and Methods: The study included a total of 59 patients with CRSwNP who had undergone FESS or DLPE under local anesthesia. The quality of life before and after surgery was examined using SNOT-22. Results: A total of 59 patients were included in the study, with a greater predominance of men than women (37:22). Endoscopic DLPE was performed in 25 (42.4%) of patients. The overall SNOT-22 score was a significantly lower one and three months postoperatively in both groups of patients (p<0.001). There was no significant difference in the overall SNOT-22 score three months postoperatively between patients who had undergone FESS and those who had undergone DLPE. Conclusions: Endoscopic DLPE shows the same success in improving the quality of life as FESS and can be performed under local anesthesia, which it is ideal for people with multiple comorbidities

Quality of life after FESS combined with diode laser in patients with chronic rhinosinusitis with nasal polyposis

Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is one of the most severe forms of chronic rhinosinusitis. The Sino-Nasal-Outcome Test 22 (SNOT-22) is most commonly used to assess the quality of life of these patients. One of the new treatment options for patients with CSRwNP is endoscopic diode laser polypectomy (DLPE) in local anesthesia. This study aims to compare the quality of life of patients with CSRwNP who underwent FESS and those who underwent DLPE before and after surgery. Patients and Methods: The study included a total of 59 patients with CRSwNP who had undergone FESS or DLPE under local anesthesia. The quality of life before and after surgery was examined using SNOT-22. Results: A total of 59 patients were included in the study, with a greater predominance of men than women (37:22). Endoscopic DLPE was performed in 25 (42.4%) of patients. The overall SNOT-22 score was a significantly lower one and three months postoperatively in both groups of patients (p<0.001). There was no significant difference in the overall SNOT-22 score three months postoperatively between patients who had undergone FESS and those who had undergone DLPE. Conclusions: Endoscopic DLPE shows the same success in improving the quality of life as FESS and can be performed under local anesthesia, which it is ideal for people with multiple comorbidities

Povezanost indeksa tjelesne mase i patohistoloških značajki karcinoma štitnjače

Available studies report conflicting results on the association of body mass index (BMI) and pathohistological features of thyroid cancer. This study aimed to investigate the relationship between BMI and the pathohistological features of different thyroid cancer types. We analyzed the following data from 95 patients with thyroid cancer: age, gender, BMI, pathohistological characteristics of cancer (tumor size, multifocality, lymphovascular invasion, extrathyroidal invasion) and the presence of regional metastases. The BMI of all patients with thyroid cancer was 27.1 ± 4.2. Significantly more patients with obesity class I had cancer size less than 2 cm (p = 0.02). There is a significant association between BMI and extrathyroid invasion (p = 0.03; OR, 1.18), but not with lymphovascular invasion, tumor size, and multifocality. We can conclude that although obesity is a risk factor for the development of thyroid cancer, higher BMI is only partially associated with more aggressive pathohistological features of thyroid cancer.Dostupne studije pokazuju oprečne rezultate povezanosti indeksa tjelesne mase (ITM) s patohistološkim značajkama raka štitnjače. Cilj ove studije bio je istražiti odnos između ITM-a i patohistoloških značajki različitih tipova karcinoma štitnjače. Analizirali smo sljedeće podatke od 95 bolesnika s karcinomom štitnjače: dob, spol, ITM, patohistološke karakteristike karcinoma (veličina tumora, multifokalnost, limfovaskularna invazija, ekstratireoidna invazija) i prisutnost regionalnih metastaza. ITM svih bolesnika s karcinomom štitnjače bio je 27,1 ± 4,2. Značajno više pacijenata s klasom pretilosti I imalo je veličinu raka manju od 2 cm (p=0,02). Postoji značajna povezanost ITM-a i ekstratireoidne invazije (p=0.03; OR, 1,18), ali ne i s limfovaskularnom invazijom, veličinom tumora i multifokalnosti. Možemo zaključiti da iako je pretilost čimbenik rizika za razvoj raka štitnjače, viši ITM je samo djelomično povezan s agresivnijim patohistološkim značajkama raka štitnjače

Incidence of smokers among female handball players in eastern Croatia

Cilj ovoga istraživanja je bio utvrditi učestalost pušenja među rukometašicama na području istočne Hrvatske, te procijeniti njihove pušačke navike i utvrditi njihovo mišljenje o utjecaju pušenja na njihovu fizičku spremu. U ovom su presječnom istraživanju ispitane registrirane rukometašice klubova koji su igrali 3. hrvatsku rukometnu ligu Istok za žene u razdoblju od početka veljače do kraja svibnja 2015. godine. Istraživanje je provedeno anonimnim anketnim upitnikom na dobrovoljnoj osnovi, te je ispitanicama dano usmeno i pismeno objašnjenje osnovnih podataka o istraživanju. Glavne pretpostavke za hipotezu ovoga rada su bile da rukometašice klubova 3. hrvatske rukometne lige Istok ne puše, te da su dobro upoznate sa štetnim učincima pušenja. Od ukupno 100 ispitanica 27 (27%) ih puši, a od toga broja njih 13 (48,1%) ih redovito puši, a njih 14 (51,9%) puši ponekad. Od ispitanica koje redovito puše najveći broj (22,2%) puše 5 – 10 cigareta dnevno. Srednja vrijednost duljine pušenja ispitanica iznosi 4 godine. Veći broj ispitanica (59,3%) puši cigarete s manje ili do 0,6 mg nikotina. Najveći broj ispitanica trenira rukomet više od 10 godina, najčešće treniraju 3-4 puta tjedno. Ukupno 66 ispitanica je jako dobro upoznato sa štetnim učincima pušenja. Najveći broj ispitanica koje puše smatra da im pušenje ne utječe na fizičku spremu. Veći broj ispitanica puši prije i nakon treninga/utakmice. Ovom studijom je dokazano da manji broj rukometašica ispitane lige puši. Iste su jako dobro upoznate sa štetnim učinkom pušenja i smatraju kako pušenje nema utjecaja na njihovu fizičku spremu.The main goal of this research was to determine the incidence of smokers in Eastern Croatia among female handball players, and to appraise smoking habits and establish certain opinions among female handball players of smoking effects on their physical fitness. This cross-sectional study poll covered registered handball players from 3rd Croatian Handball League East for women from the beginning of January till the end of May 2015. The research was conducted with anonymous questionnaires. The study group was given oral and written basic information about the research and all participants were volunteers. The leading hypothesis was that handball players of the 3rd Croatian Handball League East for women do not smoke and that the same participants are familiarized with the bad side effects of smoking. From a total of 100 participants 27 (27%) participants smoked. From a total number of smokers 13 (48.1%) participants smoked regularly and 14 (51.9%) smoked sometimes. Participants who smoked regularly usually smoked 5-10 cigarettes daily. The mean length of smoking age was 4 years. A greater number of participants (59.3%) smoked lighter cigarettes with 0.6 mg of nicotine or less. Most of the participants had been playing handball for more than 10 years and had trainings more than 3-4 times a week. A total of 66 participants was very well familiarized with the bad side effects of smoking. A greater number of smoking participants considered smoking to have no effect on their physical fitness. Most of the participants smoked before and after training/match. This study has proved that the smaller number of female handball players of 3rd Croatian Handball League were smokers. All female handball players were very well familiarized with the side effects of smoking and considered smoking to have no effect on their physical fitness

Metastaze u nosnoj šupljini, paranazalnim sinusima i nazofarinksu - prikazi sluučajeva

Uvod: Metastaze u nosnu šupljinu, paranazalne sinuse i nazofarinks su rijetke, ali ako su prisutne tada je najčešće sijelo maksilarni sinus. Prateći simptomi metastaze u navedenim sijelima mogu imitirati druga benigna i češća stanja, a prava etiologija se može predvidjeti i propustiti tijekom duljeg razdoblja. Prikaz slučaja: Prikazujemo dva slučaja s prisutnim tumorskim tvorbama u nosnoj šupljini, paranazalnim sinusima i nazofarinksu s različitom kliničkom slikom i konačnim ishodom. Prvi je slučaj šesnaestogodišnjeg bolesnika sa suspektnom metastazom ekstraosealnog Ewingovog sarkoma lijeve potkoljenice u nazofarinks i desni maksilarni sinus. Sumnja je postavljena nakon snimanja PET/CT-a, a bolesnik nije imao tegobe od strane nosa i paranazalnih šupljina. Patohistološka analiza bioptata ukazala je na upalne promjene bez tumorskih stanica. Drugi je slučaj pedesetsedmogodišnje bolesnice koja se žalila na otežano disanje i učestale epistakse iz lijeve nosnice. Kliničkim pregledom i radiološkom obradom bila je vidljiva tumorska tvorba u lijevom nosnom kavumu, a patohistološka analiza bioptata ukazala je na metastazu karcinoma bubrega. Zaključak: Metastaze u nosnu šupljinu, paranazalne sinuse i nazofarinks vrlo su rijetke. Mogući je širok spektar pratećih simptoma, a njihova odsutnost ne isključuje mogućnost prisutnosti metastaze. Svaki patološki nalaz utvrđen kliničkim pregledom ili radiološkom obradom, te prisutnost tegoba od strane nosa i paranazalnih sinusa kod bolesnika s malignom bolešću zahtjeva pregled i obradu otorinolaringologa