CT-GUIDED TRANSTHORACIC CORE NEEDLE BIOPSY OF PULMONARY LESIONS: DIAGNOSTIC YIELD AND COMPLICATIONS

Cilj: procijeniti dijagnostičku točnost CT-om vođene biopsije, prikazati učestalost komplikacija te odrediti utjecaj pojedinih čimbenika (spol i dob bolesnika, veličinu, dubinu i lokalizaciju lezije, kut penetriranja pleure, debljinu igle i trajanje biopsije) na veličinu i učestalost pojavnosti pneumotoraksa. Materijali: retrospektivno su prikupljeni i obrađeni podatci o 124 bolesnika podvrgnutih TTB-u u razdoblju između siječnja 2017. i siječnja 2019. godine. Kod svih bolesnika izmjerili smo prethodno navedene parametre i statističkom obradom utvrdili utjecaj pojedinih faktora na veličinu i pojavnost pneumotoraksa. Rezultati: pneumotoraks se javio kod 21,8% ili 27 bolesnika. Nije postojala indikacija za postavljanje torakalnog drena ni kod jednog bolesnika. Statističkom analizom utvrđen je značajan utjecaj dubine lezije na učestalost pojave i veličinu pneumotoraksa, dokazano je da manji kut penetriranja pleure dovodi do većeg pneumotoraksa. Također biopsija manjih lezija povezana je s duljim vremenskim trajanjem postupka. Apsolutna točnost iznosi 97,6%, osjetljivost je 97,4%, specifičnost 100%, kao i pozitivna prediktivna vrijednost, dok negativna prediktivna vrijednost iznosi 75%. Zaključak: zaključci našeg istraživanja usporedivi su s rezultatima recentne literature po pitanju incidencije pneumotoraksa i dijagnostičke točnosti. Transtorakalna iglena biopsija vođena CT-om preporučena je dijagnostička metoda za dijagnostiku perifernih i paracentralnih plućnih lezija.Aim: to evaluate the diagnostic accuracy of CT-guided transthoracic biopsy, to show the frequency of complications and to determine the effect of certain factors (patient’s gender and age, size, depth and location of lesion, pleura penetration angle, needle size and duration of biopsy) on the size and frequency of pneumothorax. Materials: data on 124 patients who underwent TTB between January 2017 and January 2019 were retrospectively collected and processed. In all patients, we measured the above-mentioned parameters, statistically determined the influence of individual factors on the size and frequency of pneumothorax. Results: pneumothorax appeared in 21.8% or 27 patients. There was no indication of the placement of the thoracic drain in either patient. Statistical analysis determined the significant correlation between lesion depth and the frequency and size of pneumothorax, it showed that smaller pleura penetration angle leads to larger pneumothorax. Also, a biopsy of smaller lesions is associated with prolonged duration of the procedure. Diagnostic accuracy is 97.6%, sensitivity 97.4%, specificity 100%, positive predictive value 100%, and negative predictive value is 75%. Conclusion: the findings of our research are comparable to the results of recent literature on the incidence of pneumothorax and diagnostic accuracy. CT-guided transthoracic needle biopsy is a recommended diagnostic method for peripheral and paracentral pulmonary lesions

CT-GUIDED TRANSTHORACIC CORE NEEDLE BIOPSY OF PULMONARY LESIONS: DIAGNOSTIC YIELD AND COMPLICATIONS

Cilj: procijeniti dijagnostičku točnost CT-om vođene biopsije, prikazati učestalost komplikacija te odrediti utjecaj pojedinih čimbenika (spol i dob bolesnika, veličinu, dubinu i lokalizaciju lezije, kut penetriranja pleure, debljinu igle i trajanje biopsije) na veličinu i učestalost pojavnosti pneumotoraksa. Materijali: retrospektivno su prikupljeni i obrađeni podatci o 124 bolesnika podvrgnutih TTB-u u razdoblju između siječnja 2017. i siječnja 2019. godine. Kod svih bolesnika izmjerili smo prethodno navedene parametre i statističkom obradom utvrdili utjecaj pojedinih faktora na veličinu i pojavnost pneumotoraksa. Rezultati: pneumotoraks se javio kod 21,8% ili 27 bolesnika. Nije postojala indikacija za postavljanje torakalnog drena ni kod jednog bolesnika. Statističkom analizom utvrđen je značajan utjecaj dubine lezije na učestalost pojave i veličinu pneumotoraksa, dokazano je da manji kut penetriranja pleure dovodi do većeg pneumotoraksa. Također biopsija manjih lezija povezana je s duljim vremenskim trajanjem postupka. Apsolutna točnost iznosi 97,6%, osjetljivost je 97,4%, specifičnost 100%, kao i pozitivna prediktivna vrijednost, dok negativna prediktivna vrijednost iznosi 75%. Zaključak: zaključci našeg istraživanja usporedivi su s rezultatima recentne literature po pitanju incidencije pneumotoraksa i dijagnostičke točnosti. Transtorakalna iglena biopsija vođena CT-om preporučena je dijagnostička metoda za dijagnostiku perifernih i paracentralnih plućnih lezija.Aim: to evaluate the diagnostic accuracy of CT-guided transthoracic biopsy, to show the frequency of complications and to determine the effect of certain factors (patient’s gender and age, size, depth and location of lesion, pleura penetration angle, needle size and duration of biopsy) on the size and frequency of pneumothorax. Materials: data on 124 patients who underwent TTB between January 2017 and January 2019 were retrospectively collected and processed. In all patients, we measured the above-mentioned parameters, statistically determined the influence of individual factors on the size and frequency of pneumothorax. Results: pneumothorax appeared in 21.8% or 27 patients. There was no indication of the placement of the thoracic drain in either patient. Statistical analysis determined the significant correlation between lesion depth and the frequency and size of pneumothorax, it showed that smaller pleura penetration angle leads to larger pneumothorax. Also, a biopsy of smaller lesions is associated with prolonged duration of the procedure. Diagnostic accuracy is 97.6%, sensitivity 97.4%, specificity 100%, positive predictive value 100%, and negative predictive value is 75%. Conclusion: the findings of our research are comparable to the results of recent literature on the incidence of pneumothorax and diagnostic accuracy. CT-guided transthoracic needle biopsy is a recommended diagnostic method for peripheral and paracentral pulmonary lesions

Incidence of squamous cell carcinoma in patients with lung cancer diagnosed by computed tomography and pathohistologically in 2022 at CHC Rijeka

Cilj: utvrditi histološke tipove raka pluća među bolesnicima kojima je kompujeriziranom tomografijom toraksa i patohistološki dijagnosticiran rak pluća te odrediti prevalenciju planocelularnog karcinoma. Nadalje, utvrditi spolnu i dobnu zastupljenost te udio pušača i nepušača među ispitanicima s dijagnosticiranim planocelularnim karcinom u odnosu na bolesnike oboljele od adenokarcinoma. Metode: ova retrospektivna studija uključuje sve bolesnike kod kojih je u 2022.g. u KBC-u Rijeka, dijagnosticiran rak pluća. Svi podaci potrebni za provođenje ovog istraživanja (dob i spol bolesnika, patohistološki nalaz, dijagnostička metodu pomoću koje je pribavljen materijal za patohistološku analizu te pušački status), dobiveni su pretraživanjem bolničkih baza podataka (IBIS i ISSA). Rezultati: u ovom istraživanju utvrđeno je sveukupno 147 novodijagnosticiranih primarnih karcinoma pluća. Udio bolesnika muškog spola s primarnim karcinoma pluća iznosio je 65,3%, a ženskog 34,7%. Najzastupljeniji histološki tip raka pluća bio je adenokarcinom, potvrđen kod 40,8% bolesnika, a potom planocelularni karcinom, dijagnosticiran kod 22,4% bolesnika. Pripadnika muškog spola među ispitanicima s adenokarcinomom bilo je 63,3%, a među ispitanicima s planocelularnim karcinomom 75,5%. U grupi oboljelih od adenokarcinomom bilo je 80% aktivnih ili bivših pušača cigareta, a među ispitanicima s dijagnosticiranim planocelularnim karcinomom 94 %. Udio pušača kod muškaraca oboljelih od adenokarcinoma iznosio je 92,2%, a kod planocelularnog 92%. U skupini žena oboljelih od adenokarcinoma bilo je 59,1% pušača, a u skupini oboljelih od planocelularnog karcinoma 100%. Zaključci: planocelularni karcinom je drugi po učestalosti u bolesnika kod kojih je u 2022.g. u KBC-u Rijeka dijagnosticiran karcinom pluća nemalih stanica, nakon adenokarcinoma, s udjelom od 22,4%. Među bolesnicima oboljelim od planocelularnog karcinoma znatno veći je bio udio pripadnika muškog spola (75,8% naprema 24,2%), kao i udio pušača (94% naprema 80%) nego u onih oboljelih od adenokarcinoma.Aim: The aim of this research was to determine the histological types of lung cancer among patients diagnosed with primary lung cancer by CT and pathohistologically, and to determine the prevalence of squamous cell carcinoma. Furthermore, to determine gender and age distribution and the proportion of smokers and non-smokers among respondents with diagnosed squamous cell carcinoma in relation to patients with adenocarcinoma. Methods: This retrospective study included patients in whom the lung cancer was diagnosed in 2022 at the Clinical Hospital Center (CHC) Rijeka. All data necessary for the conduct of this study (age and gender, pathohistological findings, the diagnostic method by which the material for pathohistological analysis was obtained and smoking status) were obtained from hospital databases (IBIS and ISSA). Results: A total of 147 diagnosed primary lung cancers were detected in this study. Lung cancer showed a male predominance with 65,3% while the proportion of female patients was 34,7%. The most common histological type of lung cancer was adenocarcinoma, confirmed in 40,8% of patients, followed by squamous cell carcinoma, which was diagnosed in 22,4% of patients. The male gender was more prevalent in patients with adenocarcinoma and squamous cell carcinoma, with the incidence of 63,3% and 75,5%. Analysis of the smoking status showed that 80% of patients with adenocarcinoma and 94% of patients with squamous cell carcinoma were smokers. The incidence of smokers among men diagnosed with adenocarcinoma and squamous cell carcinoma was approximately equal (92.2% vs. 92%). The proportion of smokers among women with adenocarcinoma was 59.1% while all women with squamous cell carcinoma were smokers. Conclusion: Squamous cell carcinoma was the second most common histological type in patients diagnosed with lung cancer in 2022 at CHC Rijeka, after adenocarcinoma, with the incidence of 22.4%. Squamous cell carcinoma showed a significantly higher incidence in male patients (75,8% vs. 24,2%). Furthermore, the proportion of smokers was higher among the patients diagnosed with squamous cell carcinoma compared to those diagnosed with adenocarcinoma (94% versus 80%)

Incidence of pulmonary thromboembolism in patients who underwent CT pulmonary angiography in the first quarter of 2023 at CHC Rijeka

Cilj: Plućna tromboembolija (PTE) je hitno medicinsko stanje kod kojeg dolazi do okluzije jedne ili više grana plućnih arterija tromboembolusom. CT plućna angiografija (CTPA) je brza, neinvazivna radiološka metoda kojom se postavlja dijagnoza PTE. Glavni cilj ovog rada je odrediti incidenciju pozitivnih PTE nalaza kod 524 pacijenta podvrgnutih CTPA te odrediti učestalost zahvaćenih grana plućnih arterija. Nadalje, jedan od ciljeva je i odrediti incidenciju usputnih nalaza (plućni nodusi, tumor pluća, pneumonija, infarkt pluća, pleuralni izljev). Ispitanici i metode: U ovom retrospektivnom istraživanju prikupljeni su podaci 524 bolesnika koji su zbog sumnje na PTE podvrgnuti CTPA pregledu na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju, na lokalitetu Sušak, u Kliničkom bolničkom centru (KBC) Rijeka, u razdoblju od siječnja do travnja 2023. godine. Svi potrebni podaci navedeni u nalazu radiologa prikupljeni su iz integriranog bolničkog informacijskog sustava (IBIS) i pripadajuće aplikacije (ISSA). Rezultati: Od ukupno 524 bolesnika podvrgnutih CTPA, PTE je dokazana kod 97 ili 18,51% pacijenata. U našem istraživanju bio je podjednak broj ispitanika muškog i ženskog spola (260 ili 49,62% naprema 264 ili 50,39%). Nešto je veća incidencija PTE bila kod muškaraca (52 ili 53,61%) nego kod žena (45 ili 46,39%). Najveći broj bolesnika (262 ili 50,00%) pripadao je dobnom razredu između 61. i 80. godine života. Usputni nalazi opisani na CTPA, prema redoslijedu učestalosti su bili: pneumonije (37,15%), pleuralni izljevi (34,86%), plućni nodusi (16,79%), tumori pluća (6,87%) i plućni infarkti (4,33%). Zaključak: CT plućna angiografija predstavlja zlatni standard za detekciju plućne tromboembolije. Pregledom dostupne literature, incidencija PTE je komparabilna s rezultatima našeg istraživanja. U našoj, kao i u većini recentnih studija, PTE je najčešće detektirana u segmentalnim i subsegmentalnim granama plućnih arterija, dok se incidencija usputnih nalaza detektiranih na CTPA ne podudara s rezultatima drugih istraživanja.Aim: Pulmonary thromboembolism (PTE) is an urgent medical condition in which one or more branches of the pulmonary arteries are occluded by an embolus. CT pulmonary angiography (CTPA) is a rapid, non-invasive radiological method used to diagnose PTE. The main goal of this research was to determine the incidence of positive PTE findings in 524 patients who underwent CTPA, and to determine the frequency of affected branches of the pulmonary arteries. Furthermore, one of the goals was to determine the frequency of incidental findings (lung nodules, lung tumor, pneumonia, lung infarction, pleural effusion). Methods: In this retrospective study, data was collected on 524 patients, who due to suspicion of PTE, underwent CTPA at the Clinical Department for Diagnostic and Interventional Radiology, at the Clinical Hospital Center (CHC) Rijeka, in the period from January to April 2023. All the necessary data specified in the radiologist’s report was collected from the hospital database (IBIS) and the associated application (ISSA). Results: Out of a total of 524 patients who underwent CTPA, PTE was diagnosed in 97 patients or 18,51%. In our research, there was an approximately equal number of male and female subjects (260 or 49,62% versus 264 or 50,39%). The incidence of PTE was slightly higher in men (52 or 53,61%) than in women (45 or 46,39%). Most of the patients (262 or 50,00%) belonged to the age group between 61 and 80 years. Incidental findings described on CTPA, in order of frequency, were pneumonia (37,15%), pleural effusions (34,86%), pulmonary nodules (16,79%), lung tumors (6,87%), and pulmonary infarcts (4,33%). Conclusion: CT pulmonary angiography is the gold standard for the detection of pulmonary thromboembolism. By reviewing the available literature, the incidence of PTE is comparable to the results of our study. In ours, as well as in most recent studies, PTE was most often detected in the segmental and subsegmental branches of the pulmonary arteries, while the frequency of incidental findings detected on CTPA does not match with the results of other studies

CT-GUIDED TRANSTHORACIC CORE NEEDLE BIOPSY OF PULMONARY LESIONS: DIAGNOSTIC YIELD AND COMPLICATIONS

Cilj: procijeniti dijagnostičku točnost CT-om vođene biopsije, prikazati učestalost komplikacija te odrediti utjecaj pojedinih čimbenika (spol i dob bolesnika, veličinu, dubinu i lokalizaciju lezije, kut penetriranja pleure, debljinu igle i trajanje biopsije) na veličinu i učestalost pojavnosti pneumotoraksa. Materijali: retrospektivno su prikupljeni i obrađeni podatci o 124 bolesnika podvrgnutih TTB-u u razdoblju između siječnja 2017. i siječnja 2019. godine. Kod svih bolesnika izmjerili smo prethodno navedene parametre i statističkom obradom utvrdili utjecaj pojedinih faktora na veličinu i pojavnost pneumotoraksa. Rezultati: pneumotoraks se javio kod 21,8% ili 27 bolesnika. Nije postojala indikacija za postavljanje torakalnog drena ni kod jednog bolesnika. Statističkom analizom utvrđen je značajan utjecaj dubine lezije na učestalost pojave i veličinu pneumotoraksa, dokazano je da manji kut penetriranja pleure dovodi do većeg pneumotoraksa. Također biopsija manjih lezija povezana je s duljim vremenskim trajanjem postupka. Apsolutna točnost iznosi 97,6%, osjetljivost je 97,4%, specifičnost 100%, kao i pozitivna prediktivna vrijednost, dok negativna prediktivna vrijednost iznosi 75%. Zaključak: zaključci našeg istraživanja usporedivi su s rezultatima recentne literature po pitanju incidencije pneumotoraksa i dijagnostičke točnosti. Transtorakalna iglena biopsija vođena CT-om preporučena je dijagnostička metoda za dijagnostiku perifernih i paracentralnih plućnih lezija.Aim: to evaluate the diagnostic accuracy of CT-guided transthoracic biopsy, to show the frequency of complications and to determine the effect of certain factors (patient’s gender and age, size, depth and location of lesion, pleura penetration angle, needle size and duration of biopsy) on the size and frequency of pneumothorax. Materials: data on 124 patients who underwent TTB between January 2017 and January 2019 were retrospectively collected and processed. In all patients, we measured the above-mentioned parameters, statistically determined the influence of individual factors on the size and frequency of pneumothorax. Results: pneumothorax appeared in 21.8% or 27 patients. There was no indication of the placement of the thoracic drain in either patient. Statistical analysis determined the significant correlation between lesion depth and the frequency and size of pneumothorax, it showed that smaller pleura penetration angle leads to larger pneumothorax. Also, a biopsy of smaller lesions is associated with prolonged duration of the procedure. Diagnostic accuracy is 97.6%, sensitivity 97.4%, specificity 100%, positive predictive value 100%, and negative predictive value is 75%. Conclusion: the findings of our research are comparable to the results of recent literature on the incidence of pneumothorax and diagnostic accuracy. CT-guided transthoracic needle biopsy is a recommended diagnostic method for peripheral and paracentral pulmonary lesions

Mediation in Labour Disputes

Cilj rada je analizirati medijaciju u radnim odnosima u hrvatskom pravnom sustavu. Rad objašnjava mirenje općenito, njegove prednosti te sam postupak mirenja. Nakon toga, kratko su opisani radni sporovi i različiti načini na koje se oni rješavaju. Nastavak rada donosi povijesni razvoj medijacije u radnim sporovima općenito te razvoj međunarodnih i domaćih izvora prava. Potom su objašnjeni kolektivni i individualni radni sporovi i njihove posebnosti. Na kraju se u radu nastoji iznijeti analiza trenutnog stanja medijacije u radnim sporovima i zaključna riječ.This paper aims to analyze mediation in labor relations in the Croatian legal system. The paper explains conciliation in general, its advantages, and the conciliation process itself. Then, labor disputes and various ways in which they are resolved are briefly described. The paper also gives an overview of the historical development of mediation in labor disputes in general and the development of international and domestic sources of law. Then, collective and individual labor disputes and their peculiarities are explained. The final part offers an analysis of the current state of mediation in labor disputes and a concluding remark

Mediation in Labour Disputes

Cilj rada je analizirati medijaciju u radnim odnosima u hrvatskom pravnom sustavu. Rad objašnjava mirenje općenito, njegove prednosti te sam postupak mirenja. Nakon toga, kratko su opisani radni sporovi i različiti načini na koje se oni rješavaju. Nastavak rada donosi povijesni razvoj medijacije u radnim sporovima općenito te razvoj međunarodnih i domaćih izvora prava. Potom su objašnjeni kolektivni i individualni radni sporovi i njihove posebnosti. Na kraju se u radu nastoji iznijeti analiza trenutnog stanja medijacije u radnim sporovima i zaključna riječ.This paper aims to analyze mediation in labor relations in the Croatian legal system. The paper explains conciliation in general, its advantages, and the conciliation process itself. Then, labor disputes and various ways in which they are resolved are briefly described. The paper also gives an overview of the historical development of mediation in labor disputes in general and the development of international and domestic sources of law. Then, collective and individual labor disputes and their peculiarities are explained. The final part offers an analysis of the current state of mediation in labor disputes and a concluding remark

COMPUTED TOMOGRAPHY-GUIDED BIOPSY OF PULMONARY LESIONS: DIAGNOSTIC YIELD AND COMPLICATION RATE

Aim: The purpose of this study is to assess the diagnostic accuracy of computed tomography-guided transthoracic biopsy (TTB), and to determine the type and incidence of complications. Methods: This was a retrospective analysis of 124 CT-guided TTB of the pulmonary lesions at the Department of Radiology at the Rijeka Clinical Hospital Center. All patients were followed for 6-12 months after the biopsy to verify the accuracy of pathohistological diagnosis and were divided into four groups: true and false-positive and true and false-negative groups. The sensitivity, specifi city, diagnostic accuracy, positive and negative predictive values were calculated. Results: Out of the total number of biopsies, 71.8% of the procedures were performed on men and 28.2% on women. The largest group of patients (44.4%) were between the age of 66 and 75. Pneumothorax was reported in 27 procedures (21,8%), and pulmonary hemorrhage occurred in 9 biopsies (7.1%). No patient had any symptoms of complications, and no case required chest tube placement. The diagnostic accuracy, sensitivity, specifi city, positive and negative predictive values were 97.6%, 97.4%, 100%, 100%, 75%, respectively. Conclusion: CT-transthoracic needle biopsy is a gold standard for peripheral and paracentric lung lesions diagnostics. This study shows an acceptable rate of complications a the null rate of chest tube placement or severe complications. Also, we presented the diagnostic signifi cance of this method in the two years at the Rijeka Clinical Hospital Center. As with any diagnostic procedures, further technological and technical development is vital

COMPUTED TOMOGRAPHY-GUIDED BIOPSY OF PULMONARY LESIONS: DIAGNOSTIC YIELD AND COMPLICATION RATE

Aim: The purpose of this study is to assess the diagnostic accuracy of computed tomography-guided transthoracic biopsy (TTB), and to determine the type and incidence of complications. Methods: This was a retrospective analysis of 124 CT-guided TTB of the pulmonary lesions at the Department of Radiology at the Rijeka Clinical Hospital Center. All patients were followed for 6-12 months after the biopsy to verify the accuracy of pathohistological diagnosis and were divided into four groups: true and false-positive and true and false-negative groups. The sensitivity, specifi city, diagnostic accuracy, positive and negative predictive values were calculated. Results: Out of the total number of biopsies, 71.8% of the procedures were performed on men and 28.2% on women. The largest group of patients (44.4%) were between the age of 66 and 75. Pneumothorax was reported in 27 procedures (21,8%), and pulmonary hemorrhage occurred in 9 biopsies (7.1%). No patient had any symptoms of complications, and no case required chest tube placement. The diagnostic accuracy, sensitivity, specifi city, positive and negative predictive values were 97.6%, 97.4%, 100%, 100%, 75%, respectively. Conclusion: CT-transthoracic needle biopsy is a gold standard for peripheral and paracentric lung lesions diagnostics. This study shows an acceptable rate of complications a the null rate of chest tube placement or severe complications. Also, we presented the diagnostic signifi cance of this method in the two years at the Rijeka Clinical Hospital Center. As with any diagnostic procedures, further technological and technical development is vital

CT-guided transthoracic core needle biopsies of focal pleural lesions smaller than 10 mm: a retrospective study

Background: CT-guided transthoracic core needle biopsy (TCNB) is a minimally invasive diagnostic procedure and a useful radiological method for diagnosing pleural lesions smaller than 10 mm in the presence of loculated pleural effusion. The purpose of this study was to retrospectively assess the diagnostic accuracy of CT-guided TCNB of small pleural lesions and determine the incidence of complications. Methods: This retrospective study included a total of 56 patients (45 men and 11 women; mean [± SD] age, 71.84 ± 10.11 years) with small costal pleural lesions (thickness of < 10 mm) who underwent TCNB performed at the Department of Radiology from January 2015 to July 2021. One of the inclusion criteria for this study was a loculated pleural effusion greater than 20 mm, with a nondiagnostic cytological analysis. Sensitivity, specificity and positive as well as negative predictive values (PPV, NPV) were calculated. Results: The sensitivity of CT-guided TCNB for the diagnosis of small pleural lesions in this study was 84.6% (33 of 39), specificity 100% (17 of 17), PPV 100% (33 of 33), and NPV 73.9% (17 of 23), while diagnostic accuracy was 89.3% (50 of 56). The overall diagnostic contribution of TCNB in our study is comparable with the results of other recent reports. Loculated pleural effusion was considered a protective factor since no complications were noted. Conclusion: CT-guided transthoracic core needle biopsy (TCNB) is an accurate diagnostic method for small suspected pleural lesions with a near-zero complication rate in the presence of loculated pleural effusion