Usefulness of pulsed Doppler of lymph nodes in diagnosis of cervical lymphadenitis

Svrha ovog rada bila je istražiti vrijednost Dopplera u razlikovanju uzroka uvećanja limfnih čvorova vrata i vrijednost sniženja vaskularnog otpora kao specifičnog znaka limfadenitisa. Dopplerska analiza spektara s mjerenjem indeksa otpora (RI), indeksa pulzatilnosti (PI), vršne sistoličke brzine (PSV) i krajnje dijastoličke brzine (EDV) učinjena je u 98 bolesnika s metastatskim, limfomskim, upalnim ili normalnim limfnim čvorovima. Rezultati su uspoređeni s nalazom citologije i histologije ili s kliničkom prezentacijom i praćenjem bolesnika. Značajne razlike RI i PI nađene su između svih skupina osim između limfomskih i normalnih limfnih čvorova. Specifičnost od 100% za metastaze je nađena za granične vrijednosti RI > 0,80 i PI > 1,80. Pozitivna prediktivna vrijednost od 100% za akutni limfadenitis je dokazana za granične vrijednosti RI 9 cm/s ima 100% negativnu prediktivnu vrijednost, a EDV 0.80 and PI > 1.80. Positive predictive value of 100% for acute lymphadenitis was shown for cutoff values RI 9 cm/s has 100% negative predictive value and EDV < 1 cm/s has 100% specificity and positive predictive value for metastases. Although differences in RI, PI, PSV and EDV between different nodal diseases were found, only extreme cutoff values are helpful in differential diagnosis. The finding of very low vascular resistance is valuable in prediction of inflammatory etiology of lymphadenopathy

Ponovljena prezentacija Gravesove bolesti kao manifestacije sindroma imune rekonstitucije u bolesnice zaražene HIV-om koja uzima antiretrovirusne lijekove

An HIV-infected patient who experienced immune reconstitution after highly active antiretroviral therapy (HAART) (increase in CD4 T-cell count from 84/mm3 to 310/mm3) presented with severe Graves’ disease twice, after commencing and recommencing HAART. At the first episode of Graves’ disease, 21 months after the introduction of HAART, the symptoms of thyroid dysfunction vanished without any specific treatment, but were associated with termination of taking HAART. At the second episode, 5 years after recommencing HAART, the patient continued taking HAART and commenced antithyroid therapy with thiamazole. Graves’ disease developed after a long period, while the patient was in good condition and when complications resulting from HAART were not expected. No features of any autoimmune disease were diagnosed before HAART initiation.Bolesnica zaražena HIV-om u koje se razvio sindrom imune rekonstitucije nakon antiretrovirusnog liječenja (ARL) (porast broja stanica CD4 s 84/mm3 na 310/mm3) prezentirala se u dva navrata s Gravesovom bolešću, na početku liječenja ARL-om i nakon stanke u liječenju. Tijekom prve epizode 21 mjesec nakon uvođenja ARL-a simptomi tiroidne disfunkcije nestali su bez specifičnog liječenja, ali su bili povezani s prestankom uzimanja ARL-a. Tijekom druge epizode 5 godina nakon ponovnog uzimanja ARL-a bolesnica je nastavila uzimati ARL i započela s antitiroidnim lijekom tiamazolom.Gravesova bolest se ponovno javila nakon dugog razdoblja kad je bolesnica bila u dobrom općem stanju i kad se komplikacije vezane uz ARL više nisu očekivale. Prije uzimanja ARL-a bolesnica nije pokazivala nikakve znakove autoimune bolesti

Ponovljena prezentacija Gravesove bolesti kao manifestacije sindroma imune rekonstitucije u bolesnice zaražene HIV-om koja uzima antiretrovirusne lijekove

An HIV-infected patient who experienced immune reconstitution after highly active antiretroviral therapy (HAART) (increase in CD4 T-cell count from 84/mm3 to 310/mm3) presented with severe Graves’ disease twice, after commencing and recommencing HAART. At the first episode of Graves’ disease, 21 months after the introduction of HAART, the symptoms of thyroid dysfunction vanished without any specific treatment, but were associated with termination of taking HAART. At the second episode, 5 years after recommencing HAART, the patient continued taking HAART and commenced antithyroid therapy with thiamazole. Graves’ disease developed after a long period, while the patient was in good condition and when complications resulting from HAART were not expected. No features of any autoimmune disease were diagnosed before HAART initiation.Bolesnica zaražena HIV-om u koje se razvio sindrom imune rekonstitucije nakon antiretrovirusnog liječenja (ARL) (porast broja stanica CD4 s 84/mm3 na 310/mm3) prezentirala se u dva navrata s Gravesovom bolešću, na početku liječenja ARL-om i nakon stanke u liječenju. Tijekom prve epizode 21 mjesec nakon uvođenja ARL-a simptomi tiroidne disfunkcije nestali su bez specifičnog liječenja, ali su bili povezani s prestankom uzimanja ARL-a. Tijekom druge epizode 5 godina nakon ponovnog uzimanja ARL-a bolesnica je nastavila uzimati ARL i započela s antitiroidnim lijekom tiamazolom.Gravesova bolest se ponovno javila nakon dugog razdoblja kad je bolesnica bila u dobrom općem stanju i kad se komplikacije vezane uz ARL više nisu očekivale. Prije uzimanja ARL-a bolesnica nije pokazivala nikakve znakove autoimune bolesti

Radiološka snimanja u trudnoći

There are many false assumptions, both in the general population and among physicians, regarding the influence of radiation on pregnant patients and the fetus during diagnostic procedures, in spite of scientific facts based on studies. These false assumptions are mostly based on the idea that every diagnostic procedure using ionizing radiation is a cause for serious concern and that artificial abortion as a possible solution might be considered. We analyzed data from counseling of pregnant patients exposed to ionizing radiation during diagnostic procedures in the Merkur University Hospital during a 4-year period. In this period, 26 patients presented for counseling after exposure to diagnostic ionizing radiation during pregnancy. Results showed most of these patients to have been exposed to radiation between the 2nd and 3rd week of gestation (36%), between the 4th and 5th week 32%, before the 2nd week 24%, and after the 6th week of gestation less than 8%. To provide reasonable estimate of fetal doses, Report No. 174 from the National Council on Radiation Protection and Measurements (NCRP) was used. Data from the Report include estimate of the fetal dose from direct and indirect exposures. Th e mean doses were up to 0.01 cGy in 46.2%, 0.01-0.15 cGy in 19.2%, 0.2-1 cGy in 26.9% and 1 cGy or more in 7.7% of patients. None of the counseled patients had medical indication for abortion, even though in a small percentage of patients abortion was a personal subjective decision. Considering that there are no Croatian guidelines for counseling patients exposed to ionizing radiation during pregnancy, it is recommended to use the International Commission on Radiological Protection guidelines in the management of pregnant patients exposed to ionizing radiation.Usprkos znanstvenim spoznajama temeljenim na dugogodišnjim studijama utjecaja zračenja u dijagnostičke svrhe na trudnicu i plod o toj temi vladaju zablude kako u općoj populaciji tako i među liječnicima. Te se zablude odnose uglavnom na razmišljanje o svakoj dijagnostičkoj pretrazi koja rabi ionizirajuće zračenje kao o razlogu za ozbiljnu zabrinutost i razmatranje artificijelog pobačaja kao mogućeg rješenja. Analizirali smo podatke savjetovanja trudnica ozračenih u dijagnostičke svrhe u KB Merkur kroz razdoblje od 4 godine. U tom razdoblju savjetovalo se 26 trudnica ozračenih u dijagnostičke svrhe u našoj ustanovi. Rezultati su pokazali da je najveći broj trudnica, njih 36%, ozračen između 2. i 3. tjedna gestacije, između 4. i 5. tjedna 32%, do 2. tjedna 24%, a iznad 6. tjedna gestacije njih manje od 8%. Za izračun fetalnih doza korišten je Izvještaj 174 Nacionalnog vijeća za zaštitu od zračenja i mjerenja zračenja. Podaci iz izvještaja omogućuju procjenu doze izračun koje uzima u obzir izravnu i neizravnu izloženost za sve postupke. Prosječne doze bile su: do 0,01 cGy kod 46,2%; 0,01-0,15 cGy kod 19,2%; 0,2-1 cGy kod 26,9%; 1 cGy i više kod 7,7% trudnica. Niti jedna savjetovana trudnica nije imala medicinsku indikaciju za pobačaj, makar je u malom postotku slučajeva pobačaj bio osobna subjektivna odluka. S obzirom na to da ne postoje hrvatske smjernice za savjetovanje trudnica ozračenih u dijagnostičke svrhe preporuka je koristiti smjernice ICRP vezane za medicinske indikacije pobačaja kod određenih doza zračenja

The Possibilities and Limitations of Direct Digital Radiography, Ultrasound and Computed Tomography in Diagnosing Pleural Mesotelioma

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

The role of Carotid Intima-Media Thickness (CIMT) Measurement and Echo-tracking in the Assessment of Preclinical Carotid Artery Atherosclerosis in HIV-infected Patients

Kardiovaskularne bolesti se sve češće pojavljuju kao značajan uzrok morbiditeta i mortaliteta u HIV-om zaraženih bolesnika koji uzimaju antiretrovirusne lijekove (ARL). Ta se pojava različito objašnjava, kao posljedica toksičnosti ARL-a, imunodeficijencije i/ili upale uzrokovane HIV-om. Mjerenje debljine intime-medije (IMT) karotidnih arterija B-mod ultrazvukom je važan čimbenik u procjeni ranog stadija ateroskleroze. Pretklinička ateroskleroza karotidnih arterija može se mjeriti brojem i površinom aterosklerotskih plakova i određivanjem arterijske krutosti. Beta indeks krutosti je jedan od često korištenih kliničkih markera ateroskleroze. Echo-tracking je nova ultrazvučna tehnologija koja koristi radio-frekvencijski signal za dobivanje visoke rezolucije od 0,01 mm uz transmisiju i prijem putem linearne ultrazvučne sonde visoke frekvencije od 10 MHz. Ta tehnologija ne troši puno vremena i koristi se u procjeni arterijske krutosti. Na Odjelu za radiologiju i ultrazvuk Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu, u suradnji s HIV/AIDS centrom, započeli smo s kontinuiranim mjerenjem karotidnog IMT-a i površine i broja aterosklerotskih plakova u HIV-om zaraženih bolesnika od srpnja 2009. Također smo echo-trackingom pregledali skupinu HIV-om zaraženih bolesnika visokorizičnih za razvoj kardiovaskularnih i cerebrovaskularnih oboljenja. U našem ćemo prospektivnom istraživanju procjenjivati zamjenske markere ateroskleroze koji mogu uspješno identificirati i opisati HIV-om zaraženu populaciju s visokim rizikom razvoja kardiovaskularnih bolesti i utvrditi terapijske postupke.Cardiovascular (CV) disease has progressively emerged as a significant cause of morbidity and mortality among HIV-infected patients treated with combination antiretroviral therapy (cART). This has been variably attributed to cART toxicity, immunodeficiency and/or HIV-associated inflammation. Carotid intima-media thickness (CIMT) measurement by B-mod ultrasound is an important tool for evaluation of early stages of atherosclerosis. Subclinical atherosclerosis of carotid arteries can also be detected by measuring the number and area of present plaques and arterial stiffness assessment. Beta stiffness index is one of the most commonly used clinical markers of atherosclerosis. Echo-tracking is a new ultrasound technology that uses a radio frequency signal to provide high accuracy of 0.01 mm resolution at 10 MHz transmision/reception. Echo-tracking is a non-time consuming tool for diagnostic routine evaluation of arterial stiffness parameters. From July 2009, in collaboration with the HIV/AIDS Center, we started with a continuous CIMT and plaque area measurements in HIV-infected patients at the Department of Radiology and Ultrasound of the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ in Zagreb. We also used the echo-tracking to examine a group of HIV-infected patients who are at high-risk for CV diseases. In our prospective research we shall try to assess surrogate markers for atherosclerosis that can efficiently identify and describe HIV-infected population at high risk for CV disease development and investigate therapeutic regimens

Radiological manifestations of musculo-skeletal complications in HIV-infected patients

Bolesnici s infekcijom virusom humane imunodeficijencije (HIV) podložni su različitim komplikacijama koje mogu zahvatiti mišićno-koštani sustav. Infekcija (celulitis, nekrotizirajući fascitis, piomiozitis, osteomijelitis, septički artritis) predstavljaju najčešćee komplikacije. Upalna stanja mogu biti uzrokovana samom HIV-infekcijom, ali i potaknuta prilagodbom imunološkog sustava. Mišićni simptomi mogu nastati zbog rabdomiolize, miozitisa ili nuspojava antiretrovirusnog liječenja (ARL). Non-Hodgkinov limfom i Kaposiev sarkom su dvije najčešće neoplazme u ovoj populaciji bolesnika. Starenjem osoba zaraženih HIV-om zapaža se osteopenija, osteoporoza i patološki prijelomi, češće nego u HIV-negativnih osoba. Posebno važan je sindrom osteonekroze koja se rijetko pojavljuje i čiji uzrok nije posve spoznat. Radiologija ima značajnu ulogu u ranoj dijagnostici i planiranju terapijskog postupka. Važno je da radiolog bude upoznat s različitim oblicima mišićno-koštanih oboljenja u bolesnika s HIV-infekcijom tako da može postaviti odgovarajuću diferencijalnu dijagnozu.Patients with human immunodeficiency virus (HIV) infection are susceptible to a variety of complications that can affect musculosceletal system. Infection (cellulitis, necrotizing fasciitis, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory conditions are either caused by the HIV infection itself or triggered by adaptive changes in the immune system. Muscular symptoms may result from rhabdomyolysis, myositis or from sideeffects of highly active anti-retroviral therapy (HAART). Non-Hodgkin lymphoma and Kaposi sarcoma are two most common neoplasms in this patient population. During the aging proces of HIV-infected patients osteopenia, osteoporosis and patologic fractures are observed, more frequently than in non-HIV infected patients. Radiology plays an important role in the early diagnosis and treatment planning. Especially important is the syndrom of osteonecrosis that is not very frequent and whose cause is not well known yet. It is important for the radiologist to be familiar with the different types of musculoskeletal diseases in HIV-infected patients so that an appropriate differential diagnosis can be established

Ultrasound diagnostics of urogenital infectious diseases

Dostupnost, potvrđena neškodljivost i povoljan omjer cijene i efikasnosti ultrazvuka utvrdili su njegovu ulogu u dijagnostici u uogenitalnih infektivnih bolesti. Imperativ je da svi liječnici koji su uključeni u dijagnostiku urogenitalnih bolesti razumiju ultrazvučne manifestacije navedenih bolesti, zato jer rana dijagnostika i terapija predstavljaju temelj izbjegavanja dugotrajnog morbiditeta i mortaliteta. Ako su prednosti i ograničenja ultrazvuka ispravno shvaćene, liječnik će moći dobiti najbržu i najjeftiniju dijagnozu s minimalnim uključivanjem daljnjeg, invazivnog oslikavanja. Pojava novih ultrazvučnih tehnika omogućila je da ultrazvuk dostigne središnju ulogu u dijagnozi i karakterizaciji urogenitalnih infekcija.The growing ubiquity, well-established safety, and cost-effectiveness of ultrasound imaging have determined its role in the diagnosis of urogenital infectious diseases. It is imperative that all practitioners involved in the diagnostics of urogenital diseases understand the ultrasonographic manifestations of these diseases, as early diagnosis and treatment are the cornerstones of avoidance of long-term morbidity and mortality. If the strengths and limitations of ultrasonography are understood properly, a practitioner will be able to achieve the quickest and safest diagnosis with the minimal amount of further invasive imaging. The advent of new ultrasonographic techniques may allow it to serve a more central role in the diagnosis and characterization of urogenital infections

Radiological manifestations of musculo-skeletal complications in HIV-infected patients

Bolesnici s infekcijom virusom humane imunodeficijencije (HIV) podložni su različitim komplikacijama koje mogu zahvatiti mišićno-koštani sustav. Infekcija (celulitis, nekrotizirajući fascitis, piomiozitis, osteomijelitis, septički artritis) predstavljaju najčešćee komplikacije. Upalna stanja mogu biti uzrokovana samom HIV-infekcijom, ali i potaknuta prilagodbom imunološkog sustava. Mišićni simptomi mogu nastati zbog rabdomiolize, miozitisa ili nuspojava antiretrovirusnog liječenja (ARL). Non-Hodgkinov limfom i Kaposiev sarkom su dvije najčešće neoplazme u ovoj populaciji bolesnika. Starenjem osoba zaraženih HIV-om zapaža se osteopenija, osteoporoza i patološki prijelomi, češće nego u HIV-negativnih osoba. Posebno važan je sindrom osteonekroze koja se rijetko pojavljuje i čiji uzrok nije posve spoznat. Radiologija ima značajnu ulogu u ranoj dijagnostici i planiranju terapijskog postupka. Važno je da radiolog bude upoznat s različitim oblicima mišićno-koštanih oboljenja u bolesnika s HIV-infekcijom tako da može postaviti odgovarajuću diferencijalnu dijagnozu.Patients with human immunodeficiency virus (HIV) infection are susceptible to a variety of complications that can affect musculosceletal system. Infection (cellulitis, necrotizing fasciitis, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory conditions are either caused by the HIV infection itself or triggered by adaptive changes in the immune system. Muscular symptoms may result from rhabdomyolysis, myositis or from sideeffects of highly active anti-retroviral therapy (HAART). Non-Hodgkin lymphoma and Kaposi sarcoma are two most common neoplasms in this patient population. During the aging proces of HIV-infected patients osteopenia, osteoporosis and patologic fractures are observed, more frequently than in non-HIV infected patients. Radiology plays an important role in the early diagnosis and treatment planning. Especially important is the syndrom of osteonecrosis that is not very frequent and whose cause is not well known yet. It is important for the radiologist to be familiar with the different types of musculoskeletal diseases in HIV-infected patients so that an appropriate differential diagnosis can be established

Patient Doses Received During Interventional Cardiology Procedures at the University Hospital Osijek

Posljednjih godina znatno se povećava broj zahvata intervencijske kardiologije. Iako od velike koristi za bolesnika, koronarne su intervencije zahvati koji uključuju izloženost visokim dozama zračenja. Mjerenje doza koje su bolesnici primili pri radiološkim zahvatima u Republici Hrvatskoj propisano je zakonom, ali se ono, u pravilu, ne primjenjuje. U KBC-u Osijek uveden je priručnik za kontrolu kvalitete u koronarnim intervencijama. Priručnik, osim provjera tehničkih karakteristika uređaja, propisuje i stalno mjerenje apsorbiranih doza bolesnicima u intervencijskoj kardiologiji te njihovu analizu. Rezultati prvih istraživanja pokazuju da su se mjerene doze snizile tijekom vremena i u skladu su s literaturom, ali i dalje postoji mogućnost dodatne optimizacije opreme i načina rada. Pri visokim dozama zračenja koje bolesnici primaju tijekom koronarnih intervencija postoji mogućnost ozljeda kože uzrokovanih zračenjem koje često ostanu neprepoznate. Zbog toga se bolesnici koji su ozračeni dozama pri kojima postoji rizik od ozljede upozoravaju te pozivaju na kontrolne preglede. Do sada nije zabilježena nijedna ozljeda kože, ali je postupak uveden kao redovit. Ovaj je rad jedan u nizu koraka koji je potrebno učiniti da bi se bolesnici što bolje zaštitili od nepoželjnih učinaka zračenja.Apart from its benefi ts, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. Measuring patient doses in radiological procedures is required by law in Croatia, but rarely implemented. The Osijek University Hospital implements its own radiation protection quality guidelines. Among other, the guidelines require constant measuring of patient doses in IC and their periodic analysis. Doses measured until now are within the acceptable limits compared to literature. With time the doses were reduced signifi cantly, but there is room to downsize them still further. IC procedures can generate skin doses over 2 Gy, which is considered the threshold for erythema. Depending on the dose received, IC patients at the Osijek University Hospital are informed about the risk and examined for skin injuries. Until now we have found none, but this practice remains to be routine