Isolated nodular amyloidosis of the breast associated with monoclonal gamapathy (IgG) - Case report

Amiloidoza je bolest nakupljanja netopivih proteina amiloida u ekstracelularnom prostoru. Nakupljeni proteini su imunoglobulinski spojevi koje proizvode plazma stanice i B-limfociti stimulirani antigenom. Razlikujmo tri sistemska oblika amiloidoze: primarna (AL), sekundarna (AA) i obiteljska. Lokalizirana amilodoza javlja se u gušterači kod dijabetičara tipa 2, te kod bolesnika na kroničnoj dijalizi. Amiloidoza dojke je rijedak entitet i obično se javlja kod starijih žena. Pojavljuje se kao nakupljanje ili amiloidni tumor ili u sklopu sistemskih bolesti, a često se mamografski dijagnosticira kao karcinom. Prikazat ćemo slučaj 70-godišnje bolesnice s monoklonalnom IgG gamapatijom, te pridruženom hidronefrozom i akutnom bubrežnom insuficijencijom kod koje je ultrazvučni nalaz ukazivao na zloćudni tumor dojke, a mamografski nalaz prikazao je lobulirano, neoštro ograničeno područje, bez vidljivih mikrokalcifikata.Amyloidosis is an abnormal deposition of insoluble amyloid proteins in extracellular spaces. Protein deposits are components of immunoglobulins produced by plasma cells and B–lymphocytes in response to antigenic stimulation. Three different forms of systemic amyloidosis can be distinguished, those are primary (AL), secondary (AA) and family form. Localized amyloidosis occurs in the pancreas in type 2 diabetic patients and in patients on chronic hemodialysis. Amyloidosis of the breast is a rare entity, mostly involving elderly women, and may be misdiagnosed as carcinoma on mammography. A 70 years old woman presented with monoclonal IgG gamapathy, hydronephrosis, acute renal insufficiency and suspicious lesion in the breast on ultrasound. Mammography revealed a lobulated, ill demarcated area without visible microcalcifications

Isolated nodular amyloidosis of the breast associated with monoclonal gamapathy (IgG) - Case report

Amiloidoza je bolest nakupljanja netopivih proteina amiloida u ekstracelularnom prostoru. Nakupljeni proteini su imunoglobulinski spojevi koje proizvode plazma stanice i B-limfociti stimulirani antigenom. Razlikujmo tri sistemska oblika amiloidoze: primarna (AL), sekundarna (AA) i obiteljska. Lokalizirana amilodoza javlja se u gušterači kod dijabetičara tipa 2, te kod bolesnika na kroničnoj dijalizi. Amiloidoza dojke je rijedak entitet i obično se javlja kod starijih žena. Pojavljuje se kao nakupljanje ili amiloidni tumor ili u sklopu sistemskih bolesti, a često se mamografski dijagnosticira kao karcinom. Prikazat ćemo slučaj 70-godišnje bolesnice s monoklonalnom IgG gamapatijom, te pridruženom hidronefrozom i akutnom bubrežnom insuficijencijom kod koje je ultrazvučni nalaz ukazivao na zloćudni tumor dojke, a mamografski nalaz prikazao je lobulirano, neoštro ograničeno područje, bez vidljivih mikrokalcifikata.Amyloidosis is an abnormal deposition of insoluble amyloid proteins in extracellular spaces. Protein deposits are components of immunoglobulins produced by plasma cells and B–lymphocytes in response to antigenic stimulation. Three different forms of systemic amyloidosis can be distinguished, those are primary (AL), secondary (AA) and family form. Localized amyloidosis occurs in the pancreas in type 2 diabetic patients and in patients on chronic hemodialysis. Amyloidosis of the breast is a rare entity, mostly involving elderly women, and may be misdiagnosed as carcinoma on mammography. A 70 years old woman presented with monoclonal IgG gamapathy, hydronephrosis, acute renal insufficiency and suspicious lesion in the breast on ultrasound. Mammography revealed a lobulated, ill demarcated area without visible microcalcifications

Solitary Rectal Ulcer Syndrome: A Case Report

Pojedinačni ili multipli ulkusi mogu se pojaviti u bilo kojemu dijelu kolona i/ili u rektumu. Diferencijalna dijagnoza rektalnoga ulkusa uključuje: upalne bolesti crijeva, crijevne infekcije, urogenitalne bolesti, ulceracije uzrokovane lijekovima (na primjer, nesteroidnim protuupalnim lijekovima – NSAID-om), sindrom solitarnoga rektalnog ulkusa, sterkoralni ulkus, ishemički kolitis te rektalne neoplazme. Prikazan je slučaj 50-ogodišnje pacijentice kojoj je dijagnosticiran sindrom solitarnoga rektalnog ulkusa i koja se kontrolira posljednje četiri godine. S obzirom na anamnestičke podatke, endoskopski i patohistološki nalaz, uz kronični i benigni tijek bolesti, a bez znakova za postojanje drugih organskih bolesti, postavljena je dijagnoza sindroma solitarnoga rektalnog ulkusa. Dodatno je naveden terapijski postupak koji je uključivao konzervativno i medikamentozno liječenje te biofeedback vježbe uz literaturni prikaz predloženoga algoritma liječenja toga sindroma.Single or multiple ulcers may appear in any part of the colon and/or rectum. The differential diagnosis of a rectal ulcer includes: inflammatory bowel disease, intestinal infections, genitourinary infections, drug-induced ulcers (e.g. nonsteroidal anti-inflammatory drugs - NSAID), solitary rectal ulcer syndrome, stercoral ulcer, ischemic colitis and rectal neoplasm. The article presents a case of a 50-year-old patient who has been diagnosed with solitary rectal ulcer syndrome and has been observed for four years. On the basis of the medical case history, endoscopic and histological findings, the chronic and benign course of the disease, and no evidence of other organic diseases, the patient was diagnosed with solitary rectal ulcer syndrome. In addition, this article contains a description of the therapeutic procedure that included conservative and medical therapy together with biofeedback, and gives an overview of the literature dealing with the suggested treatment algorithm of this syndrome

Solitary Rectal Ulcer Syndrome: A Case Report

Pojedinačni ili multipli ulkusi mogu se pojaviti u bilo kojemu dijelu kolona i/ili u rektumu. Diferencijalna dijagnoza rektalnoga ulkusa uključuje: upalne bolesti crijeva, crijevne infekcije, urogenitalne bolesti, ulceracije uzrokovane lijekovima (na primjer, nesteroidnim protuupalnim lijekovima – NSAID-om), sindrom solitarnoga rektalnog ulkusa, sterkoralni ulkus, ishemički kolitis te rektalne neoplazme. Prikazan je slučaj 50-ogodišnje pacijentice kojoj je dijagnosticiran sindrom solitarnoga rektalnog ulkusa i koja se kontrolira posljednje četiri godine. S obzirom na anamnestičke podatke, endoskopski i patohistološki nalaz, uz kronični i benigni tijek bolesti, a bez znakova za postojanje drugih organskih bolesti, postavljena je dijagnoza sindroma solitarnoga rektalnog ulkusa. Dodatno je naveden terapijski postupak koji je uključivao konzervativno i medikamentozno liječenje te biofeedback vježbe uz literaturni prikaz predloženoga algoritma liječenja toga sindroma.Single or multiple ulcers may appear in any part of the colon and/or rectum. The differential diagnosis of a rectal ulcer includes: inflammatory bowel disease, intestinal infections, genitourinary infections, drug-induced ulcers (e.g. nonsteroidal anti-inflammatory drugs - NSAID), solitary rectal ulcer syndrome, stercoral ulcer, ischemic colitis and rectal neoplasm. The article presents a case of a 50-year-old patient who has been diagnosed with solitary rectal ulcer syndrome and has been observed for four years. On the basis of the medical case history, endoscopic and histological findings, the chronic and benign course of the disease, and no evidence of other organic diseases, the patient was diagnosed with solitary rectal ulcer syndrome. In addition, this article contains a description of the therapeutic procedure that included conservative and medical therapy together with biofeedback, and gives an overview of the literature dealing with the suggested treatment algorithm of this syndrome

Hrvatske smjernice za farmakološko liječenje šećerne bolesti tipa 2 [Croatian guidelines for the pharmacotherapy of type 2 diabetes]

Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES

Uvod: Hrvatsko društvo za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora izradilo je 2011. godine prve nacionalne smjernice o prehrani, edukaciji i samokontroli te farmakološkom liječenju šećerne bolesti tipa 2. Sukladno povećanom broju dostupnih lijekova te novim spoznajama o učinkovitosti i sigurnosti primjene već uključenih lijekova, pokazala se potreba za obnovom postojećih smjernica za farmakološko liječenje šećerne bolesti tipa 2 u Republici ­Hrvatskoj. Sudionici: Kao koautori Smjernica navedeni su svi članovi Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora, kao i ostalih uključenih stručnih društava, koji su svojim komentarima i prijedlozima pridonijeli izradi Smjernica. Dokazi: Ove su Smjernice utemeljene na dokazima, prema sustavu GRADE (engl. Grading of Recommendations, Assessment, Development and Evaluation) koji uz razinu dokaza opisuje i snagu preporuke. Zaključci: Individualan pristup temeljen na fiziološkim principima regulacije glikemije nuždan je u liječenju osoba sa šećernom bolesti. Ciljeve liječenja i odabir medikamentne terapije treba prilagoditi oboljeloj osobi, uzimajući u obzir životnu dob, trajanje bolesti, očekivano trajanje života, rizik od hipoglikemije, komorbiditete, razvijene vaskularne i ostale komplikacije, kao i ostale čimbenike. Zbog svega navedenoga od nacionalnog je interesa imati praktične, racionalne i provedive smjernice za farmakološko liječenje šećerne bolesti tipa 2.Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of ­diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the ­pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes’ patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglycemia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES

Uvod: Hrvatsko društvo za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora izradilo je 2011. godine prve nacionalne smjernice o prehrani, edukaciji i samokontroli te farmakološkom liječenju šećerne bolesti tipa 2. Sukladno povećanom broju dostupnih lijekova te novim spoznajama o učinkovitosti i sigurnosti primjene već uključenih lijekova, pokazala se potreba za obnovom postojećih smjernica za farmakološko liječenje šećerne bolesti tipa 2 u Republici ­Hrvatskoj. Sudionici: Kao koautori Smjernica navedeni su svi članovi Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora, kao i ostalih uključenih stručnih društava, koji su svojim komentarima i prijedlozima pridonijeli izradi Smjernica. Dokazi: Ove su Smjernice utemeljene na dokazima, prema sustavu GRADE (engl. Grading of Recommendations, Assessment, Development and Evaluation) koji uz razinu dokaza opisuje i snagu preporuke. Zaključci: Individualan pristup temeljen na fiziološkim principima regulacije glikemije nuždan je u liječenju osoba sa šećernom bolesti. Ciljeve liječenja i odabir medikamentne terapije treba prilagoditi oboljeloj osobi, uzimajući u obzir životnu dob, trajanje bolesti, očekivano trajanje života, rizik od hipoglikemije, komorbiditete, razvijene vaskularne i ostale komplikacije, kao i ostale čimbenike. Zbog svega navedenoga od nacionalnog je interesa imati praktične, racionalne i provedive smjernice za farmakološko liječenje šećerne bolesti tipa 2.Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of ­diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the ­pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes’ patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglycemia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES

Uvod: Hrvatsko društvo za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora izradilo je 2011. godine prve nacionalne smjernice o prehrani, edukaciji i samokontroli te farmakološkom liječenju šećerne bolesti tipa 2. Sukladno povećanom broju dostupnih lijekova te novim spoznajama o učinkovitosti i sigurnosti primjene već uključenih lijekova, pokazala se potreba za obnovom postojećih smjernica za farmakološko liječenje šećerne bolesti tipa 2 u Republici ­Hrvatskoj. Sudionici: Kao koautori Smjernica navedeni su svi članovi Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora, kao i ostalih uključenih stručnih društava, koji su svojim komentarima i prijedlozima pridonijeli izradi Smjernica. Dokazi: Ove su Smjernice utemeljene na dokazima, prema sustavu GRADE (engl. Grading of Recommendations, Assessment, Development and Evaluation) koji uz razinu dokaza opisuje i snagu preporuke. Zaključci: Individualan pristup temeljen na fiziološkim principima regulacije glikemije nuždan je u liječenju osoba sa šećernom bolesti. Ciljeve liječenja i odabir medikamentne terapije treba prilagoditi oboljeloj osobi, uzimajući u obzir životnu dob, trajanje bolesti, očekivano trajanje života, rizik od hipoglikemije, komorbiditete, razvijene vaskularne i ostale komplikacije, kao i ostale čimbenike. Zbog svega navedenoga od nacionalnog je interesa imati praktične, racionalne i provedive smjernice za farmakološko liječenje šećerne bolesti tipa 2.Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of ­diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the ­pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes’ patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglycemia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes