30 research outputs found
Bone densitometry ā the gold standard for diagnosis of osteoporosis
DijagnostiÄke slikovne metode namijenjene detekciji osteoporoze kreÄu se od vizualne analize koÅ”tane strukture na standardnim rendgenskim snimkama do kvantitativnih slikovnih tehnika koje omoguÄuju preciznije mjerenje mineralne gustoÄe kosti (BMD), kao Å”to je kvantitativna kompjuterizirana tomografija (QCT). Prema smjernicama za dijagnostiku i lijeÄenje denzitometrija i nadalje predstavlja āzlatni standardā za dijagnozu osteoporoze i predviÄanje rizika za prijelom. U radu su prikazane danaÅ”nje moguÄnosti i najnovije spoznaje u primjeni denzitometrije skeleta.Diagnostic imaging methods aimed to detect osteoporosis range from the visual analysis of bone structure on plain skeletal radiographs to quantitative imaging techniques that enable accurate measurement of bone mineral density (BMD), such as quantitative computed tomography (QCT). According to the guidelines for diagnosis and treatment, dual X-ray absorptiometry (DXA) still represents the āgold standardā for diagnosis of osteoporosis and fracture risk prediction. This paper illustrates the current possibilities and recent advances the in application of bone densitometry
Prevalence and antimicrobial resistance of extended-spectrum Ī²-lactamases-producing Escherichia coli and Klebsiella pneumoniae strains isolated in a university hospital in Split, Croatia
The prevalence of Escherichia coli and Klebsiella pneumoniae that produce extended-spectrum Ī²-lactamases (ESBL) was investigated in patients of a university hospital in Split, Croatia. Patients were grouped according to age (pediatric vs. adult), antibiotic type, and hospital ward. From Jan. 2001 to Dec. 2002, the susceptibility of E. coli and K. pneumoniae isolates to antimicrobials was tested. ESBL production was assayed using the double-disk synergy test. ESBL-producing E. coli and K. pneumoniae were detected in all sites of infection sampled. The percentages of ESBL-positive isolates were higher in the pediatric wards than in the adult wards. The antibiotics most commonly prescribed to patients in all hospital wards belonged to the third-generation cephalosporin group. Among ESBL producers, E. coli isolates were more resistant to aminoglycosides, but less resistant to ciprofloxacin and cotrimoxazole. Resistance of E. coli and K. pneumoniae to ciprofloxacin was exclusively found in isolates from adult patients. None of the isolates, regardless of ESBL production, was resistant to carbapenemes. In addition, the prevalence and antimicrobial resistance of ESBL-producing E. coli and K. pneumoniae isolates differed between pediatric and adult patients. [Int Microbiol 2005; 8(2):119-124
Bone densitometry ā the gold standard for diagnosis of osteoporosis
DijagnostiÄke slikovne metode namijenjene detekciji osteoporoze kreÄu se od vizualne analize koÅ”tane strukture na standardnim rendgenskim snimkama do kvantitativnih slikovnih tehnika koje omoguÄuju preciznije mjerenje mineralne gustoÄe kosti (BMD), kao Å”to je kvantitativna kompjuterizirana tomografija (QCT). Prema smjernicama za dijagnostiku i lijeÄenje denzitometrija i nadalje predstavlja āzlatni standardā za dijagnozu osteoporoze i predviÄanje rizika za prijelom. U radu su prikazane danaÅ”nje moguÄnosti i najnovije spoznaje u primjeni denzitometrije skeleta.Diagnostic imaging methods aimed to detect osteoporosis range from the visual analysis of bone structure on plain skeletal radiographs to quantitative imaging techniques that enable accurate measurement of bone mineral density (BMD), such as quantitative computed tomography (QCT). According to the guidelines for diagnosis and treatment, dual X-ray absorptiometry (DXA) still represents the āgold standardā for diagnosis of osteoporosis and fracture risk prediction. This paper illustrates the current possibilities and recent advances the in application of bone densitometry
NeobiÄno mjesto presadnice papilarnog karcinoma Å”titnjaÄe u nadbubrežnu žlijezdu: prikaz sluÄaja
Papillary thyroid carcinoma (PTC) is considered one of the most favorable tumors, indolent, with rare distant dissemination. Lungs and bones are the most common metastatic sites. Unusual sites of PTC distant metastases are extremely rare. Brain, liver, skin, kidney, pancreas, and adrenal gland PTC metastases have been sporadically reported in the literature. An 86-year-old female patient underwent total thyroidectomy and neck dissection due to PTC. Postoperative whole body iodine-131 scintigraphy with I-131 SPECT/CT of the abdomen revealed radioiodne avid left adrenal gland metastasis together with high postoperative serum thyroglobulin (Tg) value of more than 5000 Āµg/L and high serum Tg antibodies. Considering the above-mentioned findings, patientās age and multiple comorbidities, radioiodine therapy was applied. PTC metastases to the adrenal gland are extremely rare, and to our knowledge, only nine cases have been reported in the literature. This case report complements rare examples of unusual PTC metastases.Papilarni karcinom Å”titnjaÄe svrstava se u maligne tumore s najpovoljnijom prognozom, polaganog je rasta, a presadnice na udaljenim mjestima su rijetke. NajÄeÅ”Äa mjesta udaljene diseminacije papilarnog karcinoma Å”titnjaÄe su pluÄa i kosti. Rijetka mjesta udaljene diseminacije opisana u literaturi su mozak, jetra, koža, guÅ”teraÄa i nadbubrežna žlijezda. Bolesnica u dobi od 86 godina operirana je zbog papilarnog karcinoma Å”titnjaÄe. Nakon operativnog odstranjenja Å”titnjaÄe s tumorom i disekcije vrata uÄinjena je poslijeoperacijska onkoloÅ”ka obrada ukljuÄujuÄi scintigrafiju cijelog tijela jodom-131 uz SPECT/CT abdomena. U podruÄju lijeve nadbubrežne žlijezde zabilježena je intenzivna nakupina joda-131 koja je odgova-rala presadnici papilarnog karcinoma Å”titnjaÄe. Serumska vrijednost tumorskog biljega tireoglobulina bila je izrazito poviÅ”e-na i iznosila je viÅ”e od 5000 Āµg/L uz pozitivna antitireoglobulinska protutijela. UzevÅ”i u obzir nalaze poslijeoperacijske onkoloÅ”ke obrade, dob i opÄe loÅ”e stanje bolesnice provedeno je lijeÄenje jodom-131. Presadnice papilarnog karcinoma Å”titnjaÄe u nadbubrežnu žlijezdu su iznimno rijetke i dosad je u literaturi opisano samo 9 sluÄajeva. Ovaj prikaz bolesnice upotpunjuje dosadaÅ”nje rijetke sluÄajeve neobiÄnih mjesta udaljene diseminacije papilarnog karcinoma Å”titnjaÄe
Primarni hiperparatireoidizam i serumski kalcij u bolesnica s rakom dojke tijekom procjene niske koŔtane mase - iskustvo jednog centra
The bone health guidelines for breast cancer (BC) patients recommend bone mineral
density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are
further evaluated for primary hyperparathyroidism (PHPT). We aimed to determine the prevalence
of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic
tumor features and cancer treatment. This retrospective study included postmenopausal
BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were
collected from patient medical records. Patients with biochemical suspicion of PHPT underwent
standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with
PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among
the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher
tumor grade and axillary lymph node involvement, and received immunotherapy, although without
statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to
the general population. Higher SCLs show a trend of positive correlation with some more aggressive
histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment
of SCLs should be routinely performed to rule out PHPT in treated BC patients with low
BMD.Smjernice o koÅ”tanom zdravlju za bolesnice s rakom dojke (RD) preporuÄuju ispitivanje mineralne gustoÄe kostiju (bone
mineral density, BMD). U bolesnica s niskom vrijednosti BMD-a i poviŔenom razinom kalcija u serumu (RKS) dodatno se
procjenjuje primarni hiperparatireoidizam (PHPT). Cilj je bio utvrditi uÄestalost PHPT-a u lijeÄenih bolesnica s RD i sniženom
vrijednosti BMD-a te analizirati povezanost RKS s histopatoloÅ”kim znaÄajkama tumora i onkoloÅ”kim lijeÄenjem.
Retrospektivna studija obuhvatila je postmenopauzalne bolesnice s RD koje su pregledane u Ambulanti za osteoporozu izmeÄu
2013. i 2020. godine. KliniÄki podaci i podaci o BMD prikupljeni su iz medicinske dokumentacije. Bolesnice s biokemijskom
sumnjom na PHPT podvrgnute su standardnim postupcima snimanja paratireoidnih žlijezda. U devet od 137
(6,6%) bolesnica dijagnosticiran je PHPT; 8/9 bolesnica podvrgnuto je paratireoidektomiji, a jednoj je bolesnici savjetovano
praÄenje. U ostalih 128 bolesnica bez PHPT-a viÅ”e RKS pokazale su trend pozitivne povezanosti s viÅ”im gradusom tumora,
zahvaÄenoÅ”Äu aksilarnih limfnih Ävorova i primljenom imunoterapijom, iako nije postignuta statistiÄka znaÄajnost. Utvrdili
smo veÄu uÄestalost PHPT-a u lijeÄenih bolesnica s RD u odnosu na opÄu populaciju. ViÅ”e RKS pokazuju trend pozitivne
korelacije s nekim agresivnijim histopatoloÅ”kim znaÄajkama tumora i imunoterapijom. Rezultati ove studije upuÄuju na to da
bi se kod lijeÄenih bolesnica s RD i s niskom vrijednosti BMD-a trebala rutinski provoditi procjena RKS kako bi se iskljuÄio
PHPT
99mTc-MIBI SPECT/CT scintigrafija i ultrazvuk prednje vratne regije u dijagnostici bolesti paratireoidnih žlijezda kod bolesnika s nodoznim promjenama Å”titnjaÄe
Parathyroid scintigraphy with 99mTc-MIBI is an imaging technique used in nuclear
medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of
this study was to evaluate the role of this technique in patients who, along with suspected HPT, also
have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included
91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid
glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in
parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with
negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by
ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas
one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had
positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid
hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings
and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting
patients with pathologic changes in the parathyroid glands. In patients with suspected HPT,
scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low
specificity of 28%.Scintigrafija paratireoidnih žlijezda 99mTc-MIBI-jem je slikovna metoda nuklearne medicine, a provodi se kod bolesnika
sa sumnjom na hiperparatireoidizam (HPT). Cilj istraživanja bio je procijeniti važnost upotrebe ove metode kod bolesnika
koji uza sumnju na HPT imaju i nodozne promjene Å”titnjaÄe. Retrospektivna analiza obuhvatila je razdoblje od 8 godina
(2006.-2013.). U studiju je bio ukljuÄen 91 bolesnik s kliniÄki ili laboratorijski sumnjivim HPT. Od 67 scintigrafski pozitivnih
bolesnika, patoloŔki promijenjena paratireoidna žlijezda dokazana je u njih 47 (70%). U preostalih 20 (30%) bolesnika
patoloŔki promijenjena paratireoidna žlijezda nije dokazana. Od 9 bolesnika s negativnim nalazom scintigrafije, a UZV
suspektnom poveÄanom paratireoidnom žlijezdom, patoloÅ”ki promijenjena paratireoidna žlijezda nije dokazana u njih 8
(89%), a dokazana je u jednog (11%) bolesnika. Od 15 scintigrafski dvojbenih bolesnika, njih 8 (54%) je imalo pozitivan
nalaz UZV i citoloÅ”ke punkcije uz odreÄivanje PTH u punktatu. U 7 (46%) bolesnika nalaz punkcije i PTH u punktatu bio
je negativan. Istraživanje potvrÄuje da scintigrafija ima visoku osjetljivost za otkrivanje bolesnika s patoloÅ”ki promijenjenim
paratireoidnim žlijezdama (98%). Zbog niske specifiÄnosti (28%) scintigrafiju treba nadopuniti punkcijom uz odreÄivanje
PTH u punktatu u bolesnika sa suspektnim HPT
AMIODARONE AND THE THYROID FUNCTION
Amiodaron je derivat benzofurana koji sadržava do 40% joda. Primjenjuje se za lijeÄenje i prevenciju supraventrikularnih i ventrikularnih tahiaritmija opasnih po život. UÄinak na Å”titnjaÄu oÄituje se od poremeÄaja funkcionalnih testova Å”titnjaÄe do kliniÄki izražene hipotireoze potaknute amiodaronom (AIH) i tirotoksikoze (AIT). Bolesnici s AIH lijeÄe se supstitucijskom terapijom L-tiroksinom, a terapija amiodaronom može se nastaviti. Moramo razlikovati dva oblika AIT-a: hipertireoza potaknuta amiodaronom (AIT I) i tiroiditis (AIT II). AIT I lijeÄi se tirostaticima, a metode definitivnog lijeÄenja jesu jod-131 ili totalna tiroidektomija. Oblik II AIT-a lijeÄi se glukokortikoidima. Bolesnici s AIT-om moraju prekinuti terapiju amiodaronom. Dronedaron je manje uÄinkovit antiaritmik koji je strukturno i farmakoloÅ”ki sliÄan amiodaronu, ali ne sadržavaju jod, a toksiÄne nuspojave su rjeÄe. Dronedaron se može rabiti za lijeÄenje bolesnika s poveÄanim rizikom od razvoja AIT-a ili AIH.Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH
AMIODARONE AND THE THYROID FUNCTION
Amiodaron je derivat benzofurana koji sadržava do 40% joda. Primjenjuje se za lijeÄenje i prevenciju supraventrikularnih i ventrikularnih tahiaritmija opasnih po život. UÄinak na Å”titnjaÄu oÄituje se od poremeÄaja funkcionalnih testova Å”titnjaÄe do kliniÄki izražene hipotireoze potaknute amiodaronom (AIH) i tirotoksikoze (AIT). Bolesnici s AIH lijeÄe se supstitucijskom terapijom L-tiroksinom, a terapija amiodaronom može se nastaviti. Moramo razlikovati dva oblika AIT-a: hipertireoza potaknuta amiodaronom (AIT I) i tiroiditis (AIT II). AIT I lijeÄi se tirostaticima, a metode definitivnog lijeÄenja jesu jod-131 ili totalna tiroidektomija. Oblik II AIT-a lijeÄi se glukokortikoidima. Bolesnici s AIT-om moraju prekinuti terapiju amiodaronom. Dronedaron je manje uÄinkovit antiaritmik koji je strukturno i farmakoloÅ”ki sliÄan amiodaronu, ali ne sadržavaju jod, a toksiÄne nuspojave su rjeÄe. Dronedaron se može rabiti za lijeÄenje bolesnika s poveÄanim rizikom od razvoja AIT-a ili AIH.Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH
Amiodaron i funkcija Å”titnjaÄe [Amiodarone and the thyroid function]
Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH