Primjena traneksamične kiseline u dermatologiji

Tranexamic acid is a synthetic derivative of the amino acid lysine, an antifibrinolytic that is primarily used to reduce bleeding in surgery, trauma, and dental procedures. Its anti-inflammatory and anti-angiogenic properties, as well as its ability to suppress melanogenesis have enabled it to be used in dermatology in the treatment of skin conditions such as melasma, acne, post-inflammatory hyperpigmentation, rosacea and angioedema. Tranexamic acid can be used by various routes of administration including oral, topical and intradermal injection, and in combination with other treatment methods. This review article presents evidence for the effectiveness of tranexamic acid in the treatment of various skin disorders.Traneksamična kiselina sintetski je derivat aminokiseline lizina, antifibrinolitika koji se prvenstveno rabi za smanjenje krvarenja u kirurškim zahvatima, traumi i stomatološkim zahvatima. Njegova protuupalna i antiangiogena svojstva, kao i njegova sposobnost suzbijanja melanogeneze omogućili su mu upotrebu u dermatologiji u liječenju kožnih stanja kao što su melazma, akne, poslijeupalna hiperpigmentacija, rozacea i angioedem. Traneksamičnu kiselinu moguće je primijeniti na različite načine: oralno, lokalno i intradermalno te u kombinaciji s drugim metodama liječenja. Ovaj pregledni članak prikazuje dokaze o učinkovitosti traneksamične kiseline u liječenju različitih kožnih poremećaja

Idiopatski asinkroni obostrani segmentalni infarkt testisa - prikaz slučaja

We present an unusual case of sudden onset of pain in the left testis in a patient with a previous medical history of right orchiectomy due to hemorrhagic infarction. A partial orchiectomy was performed with complete removal of the lesion and reconstruction of the testicular parenchyma. Histopathological assessment confirmed segmental testicular infarction without the presence of malignancy. The patient subsequently received anticoagulant therapy.Prikazujemo neobičan slučaj iznenadne pojave boli u lijevom testisu kod bolesnika u kojeg je prethodno učinjena desnostrana orhidektomija zbog hemoragijskog infarkta. Izvršena je djelomična orhidektomija s potpunim uklanjanjem lezije i rekonstrukcijom parenhima testisa. Histopatološkom obradom potvrđen je segmentalni infarkt testisa bez prisutnosti zloćudne bolesti. U bolesnika je nakon toga primjenjena protuzgrušavajuća terapija

Učinak botulinum toksina tip A u bolesnika s esencijalnim blefarospazmom

The aim of this study was to determine the effect of botulinum toxin type A and satisfaction in patients with essential blepharospasm. The study included 12 subjects suffering from essential blepharospasm who received therapy with botulinum toxin type A injections. Respondents were given a Blepharospasm Disability Index (BSDI) survey before and three weeks after the procedure with questions related to quality of life. They were also given a Jankovic Rating Scale with questions related to the severity and frequency of symptoms. The overall level of difficulties was reduced, meaning the quality of life increased after the application of botulinum toxin, and the study found that the increase was statistically significant (p = 0.003). The severity of symptoms after the application of botulinum toxin was reduced, which meant that there was a decrease in the severity of the difficulties, and the study found a statistically significant difference (p=0.003). The frequency of symptoms was reduced after botulinum toxin administration, and the study revealed a statistically significant difference (p = 0.012). From the results of this study, we can determine that the use of botulinum toxin type A increases the quality of life and that the severity and frequency of symptoms are statistically significantly reduced.Cilj je bio utvrditi učinak botulinum toksina tip A i zadovoljstvo u bolesnika s esencijalnim blefarospazmom. U istraživanje je uključeno 12 ispitanika u dobi od 49 do 86 godina s esencijalnim blefarospazmom kojima je primijenjena terapija injekcijama botulinum toksina tip A. Ispitanicima je prije te tri tjedna nakon postupka dana anketa Blepharospasm Disability Index (BSDI) u kojoj su bila pitanja vezana za kvalitetu života. Dana im je i ljestvica Jankovic Rating Scale s pitanjima koja se odnose na težinu i učestalost simptoma. Ukupna razina poteškoća je smanjena, što znači da se kvaliteta života povećala nakon primjene botulinum toksina, a studija je pokazala da je povećanje statistički značajno (p = 0,003). Ozbiljnost simptoma nakon primjene botulinum toksina smanjena je, što znači da je došlo do smanjenja težine poteškoća, a istraživanje je utvrdilo statistički značajnu razliku (p=0,003). Učestalost simptoma smanjena je nakon primjene botulinum toksina, a studija je pokazala statistički značajnu razliku (p = 0,012). Iz rezultata ovog istraživanja možemo utvrditi da primjenom botulinum toksina tipa A dolazi do povećanja kvalitete života, te da se ozbiljnost i učestalost simptoma statistički značajno smanjuju

CAN A REDUCED DOSE OF CYTARABINE BE AS EFFECTIVE AS FULL DOSE IN THE TREATMENT OF PRIMARY DIFFUSE B-CELL LYMPHOMA IN MATRix PROTOCOL?

Primarni limfom središnjeg živčanog sustava rijetki je agresivan non-Hodgkinov limfom. Suvremeni pristup liječenju bolesnika podobnih za intenzivnu imuno-kemoterapiju uključuje faze indukcije i konsolidacije. IELSG32, randomizirano ispitivanje Međunarodne grupe za istraživanje ekstranodalnih limfoma (engl. International Extranodal Lymphoma Study Group) pokazalo je kako u indukcijskoj fazi kombinacija visokih doza metotreksata, citarabina, tiotepe i rituksimaba praćena konsolidacijom autolognom transplantacijom krvotvornih matičnih stanica znatno poboljšava ishode tih bolesnika. Retrospektivno je analizirano sedmero bolesnika s novo dijagnosticiranim primarnim limfomom mozga liječenih od listopada 2018. do veljače 2022. godine koji su primili MATRix protokol kemoterapije s reduciranom dozom citarabina. Primijenjena doza iznosila je 2000 mg/m2 svakih 12 sati trećeg dana ciklusa. Četvrtog dana ciklusa citarabin je izostavljen kod svih bolesnika. Pet bolesnika postiglo je kompletnu remisiju, a jedan parcijalnu remisiju. Kod većine bolesnika na indukcijsku fazu nastavljena je konsolidacija transplantacijom krvotvornih matičnih stanica. Kod jednog bolesnika zabilježena je progresija bolesti tri mjeseca nakon autologne transplantacije krvotvornim matičnim stanicama. Terapijske nuspojave su usporedive i slične s rezultatima IELSG32, s naglaskom da su se hematološke toksičnosti gradusa 4 javljale u malim brojevima. S obzirom na prikazane kliničke slučajeve postavlja se pitanje bi li niža doza citarabina u MATRix protokolu mogla biti jednako učinkovita kao i puna doza u postizanju remisije bolesti primarnog B-velikostaničnog limfoma mozga.Primary diffuse B-cell brain lymphoma is a rare, aggressive non-Hodgkin’s lymphoma. The modern approach to treatment involves two phases, induction and consolidation. IELSG32, a randomized trial by the International Extranodal Lymphoma Study Group, showed that in the induction phase, the combination of high doses of methotrexate, cytarabine, thiotepa, and rituximab followed by consolidation therapy with autologous hematopoietic stem cell transplantation signifi cantly improved outcomes in these patients. We aim here to present characteristics and outcomes of seven patients with newly diagnosed primary central nervous system lymphoma who were treated between November 2018 and February 2022. All of them received the MATRix reduced-dose cytarabine chemotherapy protocol. The dose of cytarabine was 2000 mg/ m2 every 12 hours on the third day of the cycle. On the fourth day of the cycle, cytarabine was completely omitted in all patients. Five patients achieved complete remission and one patient achieved partial remission after completion of the induction therapy at a reduced dose, followed by autologous hematopoietic stem cell transplantation in most patients. One patient had progression of the disease three months after autologous hematopoietic stem cell transplantation. Therapeutic toxicities were similar to IELSG32 results with emphasis on the fact that hematologic toxicities of grade 4 occurred in a low percentage. The above raises a question whether a reduced dose of cytarabine in MATRix protocol be as effective as full dose in achieving disease remission

CAN A REDUCED DOSE OF CYTARABINE BE AS EFFECTIVE AS FULL DOSE IN THE TREATMENT OF PRIMARY DIFFUSE B-CELL LYMPHOMA IN MATRix PROTOCOL?

Primarni limfom središnjeg živčanog sustava rijetki je agresivan non-Hodgkinov limfom. Suvremeni pristup liječenju bolesnika podobnih za intenzivnu imuno-kemoterapiju uključuje faze indukcije i konsolidacije. IELSG32, randomizirano ispitivanje Međunarodne grupe za istraživanje ekstranodalnih limfoma (engl. International Extranodal Lymphoma Study Group) pokazalo je kako u indukcijskoj fazi kombinacija visokih doza metotreksata, citarabina, tiotepe i rituksimaba praćena konsolidacijom autolognom transplantacijom krvotvornih matičnih stanica znatno poboljšava ishode tih bolesnika. Retrospektivno je analizirano sedmero bolesnika s novo dijagnosticiranim primarnim limfomom mozga liječenih od listopada 2018. do veljače 2022. godine koji su primili MATRix protokol kemoterapije s reduciranom dozom citarabina. Primijenjena doza iznosila je 2000 mg/m2 svakih 12 sati trećeg dana ciklusa. Četvrtog dana ciklusa citarabin je izostavljen kod svih bolesnika. Pet bolesnika postiglo je kompletnu remisiju, a jedan parcijalnu remisiju. Kod većine bolesnika na indukcijsku fazu nastavljena je konsolidacija transplantacijom krvotvornih matičnih stanica. Kod jednog bolesnika zabilježena je progresija bolesti tri mjeseca nakon autologne transplantacije krvotvornim matičnim stanicama. Terapijske nuspojave su usporedive i slične s rezultatima IELSG32, s naglaskom da su se hematološke toksičnosti gradusa 4 javljale u malim brojevima. S obzirom na prikazane kliničke slučajeve postavlja se pitanje bi li niža doza citarabina u MATRix protokolu mogla biti jednako učinkovita kao i puna doza u postizanju remisije bolesti primarnog B-velikostaničnog limfoma mozga.Primary diffuse B-cell brain lymphoma is a rare, aggressive non-Hodgkin’s lymphoma. The modern approach to treatment involves two phases, induction and consolidation. IELSG32, a randomized trial by the International Extranodal Lymphoma Study Group, showed that in the induction phase, the combination of high doses of methotrexate, cytarabine, thiotepa, and rituximab followed by consolidation therapy with autologous hematopoietic stem cell transplantation signifi cantly improved outcomes in these patients. We aim here to present characteristics and outcomes of seven patients with newly diagnosed primary central nervous system lymphoma who were treated between November 2018 and February 2022. All of them received the MATRix reduced-dose cytarabine chemotherapy protocol. The dose of cytarabine was 2000 mg/ m2 every 12 hours on the third day of the cycle. On the fourth day of the cycle, cytarabine was completely omitted in all patients. Five patients achieved complete remission and one patient achieved partial remission after completion of the induction therapy at a reduced dose, followed by autologous hematopoietic stem cell transplantation in most patients. One patient had progression of the disease three months after autologous hematopoietic stem cell transplantation. Therapeutic toxicities were similar to IELSG32 results with emphasis on the fact that hematologic toxicities of grade 4 occurred in a low percentage. The above raises a question whether a reduced dose of cytarabine in MATRix protocol be as effective as full dose in achieving disease remission

THE EFFECT OF BOTULINUM TOXIN TYPE A IN PATIENTS WITH ESSENTIAL BLEPHAROSPASM

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi učinak botulinum toksina tipa A i zadovoljstvo kod pacijenata s esencijalnim blefarospazmom. Ispitanici i metode: U ovo prospektivno eksperimentalno istraživanje uključeno je 12 ispitanika koji boluju od esencijalnog blefarospazma te im je primijenjena terapija injekcijama botulinum toksina tipa-A. Istraživanje se provodilo u Klinici za očne bolesti Kliničkog bolničkog centra Split u razdoblju od prosinca 2019. do lipnja 2021. godine. U studiju je uključeno 11 žena i 1 muškarac u dobi od 49 do 86 godina. Ispitanicima je prije te dva do tri tjedna nakon zahvata dana anketa u kojoj se pitanja odnose na kvalitetu života i uključuju poteškoće pri čitanju, vožnji, gledanju televizije, izvođenju svakodnevnih aktivnosti, šetanju i kupovini u dućanu. Također im je dana ljestvica „Jankovic Rating Scale“ u kojoj se pitanja odnose na ozbiljnost i učestalost simptoma. U terapiji se koristio botulinum toksin tipa- A (Botox) koji smo razrijedili s 4 ml fiziološke otopine, tako da je u inzulinskoj brizgalici s integriranom iglom, od jednog mililitra 25 jedinica lijeka. Svi pacijenti su dobili po 25 jedinica po strani, u pet točaka (5 jedinica po točki) subkutano i to na dva mjesta na gornjoj vjeđi, zatim u središnjem području m. orbicularis oculi na donjoj vjeđi te u dvije točke u lateralnom dijelu mišića. Rezultati: Ukupna razina poteškoća snižena je (3,0 (2,2-3,2) vs. 1,6 (0,6-1,8)), odnosno kvaliteta života je narasla nakon primjene botulinum toksina, te je ispitivanjem utvrđeno da je porast statistički značajan (P=0,003). Ozbiljnost simptoma nakon primjene botulinum toksina snižena je (3,5 (3,0-4,0) vs. 2,0(1,0-2,0), što znači da je došlo do smanjenja ozbiljnosti poteškoća, te je ispitivanjem utvrđeno postojanje statistički značajne razlike (P=0,003). Učestalost simptoma je nakon primjene botulinum toksina snižena (3,0 (3,0-3,0) vs. 1,0 (1,0-2,5)), te je ispitivanjem utvrđeno postojanje statistički značajne razlike (P=0,012). Zaključak: Iz rezultata ovog istraživanja možemo utvrditi da primjenom botulinum toksina tipa-A dolazi do povećanja kvalitete života, te da se ozbiljnost i učestalost simptoma statistički značajno smanjuju.Objectives: The aim of this study was to determine the effect of botulinum toxin type A and satisfaction in patients with essential blepharospasm. Subjects and methods: This prospective experimental study included 12 subjects suffering from essential blepharospasm who received therapy with botulinum toxin type-A injections. The research was conducted at the Department of Ophthalmology of University Medical Center Split between December 2019 and June 2021. The study included 11 women and 1 man aged 49 to 86 years. Respondents were given a survey before and two to three weeks after the procedure in which were questions related to quality of life including difficulties in reading, driving, watching television, doing everyday activities, walking and shopping in the store. They were also given a "Jankovic Rating Scale" with questions related to the severity and frequency of symptoms. Botulinum toxin type-A (Botox) was used in the therapy and was diluted with 4 ml of physiological solution, so that in an insulin syringe with an integrated needle, there are 25 units of the drug from one milliliter. All patients received 25 units per side, at five points (5 units per point) subcutaneously in two places on the upper eyelid, then in the central area of the m. orbicularis oculi on the lower eyelid and at two points in the lateral part of the muscle. Results: The overall level of difficulties was reduced (3,0 (2,2-3,2) vs. 1,6 (0,6-1,8)), meaning the quality of life increased after the application of botulinum toxin, and the study found that the increase was statistically significant (P = 0.003). The severity of symptoms after the application of botulinum toxin was reduced (3,5 (3,0-4,0) vs. 2,0(1,0-2,0), which means that there was a decrease in the severity of the difficulties, and the study found a statistically significant difference (P=0,003). The frequency of symptoms was reduced after botulinum toxin administration (3,0 (3,0-3,0) vs. 1,0 (1,0-2,5)), and the study revealed a statistically significant difference (P = 0.012). Conclusions: From the results of this study, we can determine that the use of botulinum toxin type-A increases the quality of life, and that the severity and frequency of symptoms are statistically significantly reduced