Uloga ultrazvučne elastografije u dijagnostici patoloških stanja testisa i skrotuma

Several years ago, elastography emerged as a potentially very useful ultrasound technique that is currently used in diagnostic workup of the breast, liver and some other organ systems, whereas for other ones it is still mainly in the phase of research. The aim of the study was to compare elasticity index (EI) of testicles using strain elastography in healthy subjects and those with pathologic changes of testicles/scrotum. A total of 117 patients were included in the study. Measurements were performed on a Logiq E9 ultrasound system using strain elastography. In healthy subjects, the mean EI value was 1.34±0.35 for right testis and 1.49±0.47 for left testis. Increased mean EI values were found in the following six conditions: patients with varicocele, infertile patients, solitary testis after orchidectomy of the other testicle because of tumor, patients with testicular tumors, patients after orchidopexy of undescended testicle, and patients with congenitally smaller testicle. There is a paucity of literature data on the use of elastography in testes, as well as on normal elastography values in testicular tissue. Strain elastography was demonstrated to be a valuable method to acquire additional information in patients with pathologic changes in testicles/scrotum. These data provide reference values for further research in a larger sample of subjects.Prije nekoliko godina pojavila se elastografija kao potencijalno vrlo korisna ultrazvučna metoda koja je danas u svakodnevnoj upotrebi u dijagnostici dojke, jetre i drugih organskih sustava, dok je za druge organe još u fazi istraživanja i evaluacije. Cilj istraživanja bio je usporediti indeks elastičnosti (EI) testisa u zdravih ispitanika i bolesnika s patološkim promjenama testisa i skrotuma. Istraživanje je provedeno kod ukupno 117 ispitanika od kojih je bilo 40 zdravih i 77 ispitanika s patološkim promjenama testisa i skrotuma. Mjerenja su provedena na ultrazvučnom aparatu Logiq E9 primjenom programa za sonoelastografska mjerenja. Kod zdravih ispitanika vrijednosti EI bile su 1,34±0,35 za desni testis i 1,49±0,47 za lijevi testis. Prema vrijednosti EI, pojačana tvrdoća tkiva testisa uočena je kod sljedećih stanja: varikokele, neplodnosti, ostatnog testisa kod stanja nakon orhidektomije drugog testisa, tumora testisa, stanja nakon orhidopeksije nespuštenog testisa i kongenitalno manjeg testisa. Malo je podataka u literaturi o elastografiji testisa, kao i o normalnim elastografskim vrijednostima tkiva testisa. Elastografija testisa se u našem ispitivanju pokazala korisnom metodom za dobivanje dodatnih dijagnostičkih informacija kod bolesnika s patološkim promjenama testisa i skrotuma, no potrebna su daljnja istraživanja s većim skupinama bolesnika

OVERVIEW OF SYMPTOMS OF ONGOING SYMPTOMATIC AND POST-COVID-19 PATIENTS WHO WERE REFFERED TO PULMONARY REHABILITATION - FIRST SINGLE-CENTRE EXPERIENCE IN CROATIA

Background: Coronavirus-2 pandemic has changed the functioning of health systems worldwide. It is not yet fully known which symptoms of the disease are most commonly presented in patients referred for pulmonary rehabilitation. Our aim was to investigate the profile of patients referred for pulmonary rehabilitation; what symptoms they had during the acute phase of the disease and what symptoms were still present at the start of pulmonary rehabilitation. Subjects and methods: Study included ongoing symptomatic and post-COVID patients who attended standard, in person pulmonary rehabilitation program. Patients had COVID-19 disease at least four weeks before attending pulmonary rehabilitation. Patients completed questionnaires of self-reported somatic deficits during acute and post-COVID-19 stage as well as questionnaires regarding their psychological symptoms. Pulmonary function test, expiratory and inspiratory muscle strenght, hand grip strenght and six-minute walk test was performed prior and after pulmonary rehabilitation. Results: Study included 63 patients (32 male, 31 female), with mean age of 52.9 years. During acute COVID-19, majority of patients complained of fatigue, cough, dyspnea, myalgia and headache. More than 85% of patients reported pulmonary deficits during ongoing symptomatic and post-COVID-19 stage. Emotional distress and anxiety levels were significantly elevated in acute stage, while depression, anger and the need for help was not significantly elevated. All reported symptoms were significantly reduced in post-COVID-19 stage. There was statistically significant difference in six-minute walk distance, inspiratory and expiratory muscle strenght and hand grip strenght between first and final testing. Conclusions: Results of our study are similar with previous studies, the most common symptoms during acute phase were fatigue, cough and dyspnea and fatigue and respiratory problems during ongoing symptomatic and post-COVID stage. Emotional distress diminishes signifiacantly in post-COVID stage. Further larger studies are needed to clarify which acute disease symptoms are predominant in patients referred to pulmonary rehabilitation and cause prolongued discomfort

Imunoterapija u tretmanu ne-sitnostaničnog raka pluća

Lung cancer is leading cause of death among malignant disease Worldwide and it is responsible for more than 1, 5 million deaths each year. Lung cancer is divided in two major groups: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Despite significant improvements, for vast majority of patients chemotherapy still remains the treatment of choice in the first line setting. Progress over the last decade has led to the recognition of immunoevasion as of the leading hallmarks of cancer development. Clinical development was focused on immune checkpoint inhibitors, cytotoxic T-lymphocyte–associated antigen 4 (CTLA4) and programmed death (PD1/PD-L1) pathway. Programmed death 1 protein is another T-cell coinhibitory receptor with a structure similar to that of CTLA-4 but with a distinct biologic function and ligand specificity and it is stimulated with PD-L1. PD-1 or PD-L1 blockade with drugs like nivolumab, pembrolizumab or atezolizumab resulted in superior efficacy comparing to standard chemotherapy in first-line setting. In patient with high PD-L1 expression (50% or more) pemborlizumab should be treatment of choice in first-line setting. PD-L1 expression is at the moment only available biomarker who can predict response to immune checkpoint inhibitors.Karcinom pluća vodeći je uzrok smrti od malignih bolesti te je odgovoran za više od 1,5 milijuna smrti. U većine bolesnika osnovu liječenja karcinoma pluća čini kemoterapija temeljena na platini. Unazad desetak godina, brojna se istraživanje provode o ulozi imunološkog sutava u karcinogenezi. Tumori uspjevaju izbjeći nadzor imunološkog sustava te tako rasti i metastazirati. Koncpet aktivacije imunološkog sutava iznimno je zanimljiv te se pokazalo da blokatori kontrolnih točaka pokazauju dobro učinkovitost u liječenju solidnih tumora poput melanoma ili bubrega. U zadnjih pet godina, inhibitori kontrolnih točaka nivolumab, pembrolizumab i atezoilizumab pokazali su se kao iznimno učinkoviti lijekovi u liječenju bolesnika s karcinomom pluća ranije liječenih klasičnom kemoterapijom. Pembrolizumab se također pokazao kao iznimno učinkovit u liječenju bolesnika sa visokom PD-L1 ekspresijom (PD-L1≥50%) u prvoj liniji liječenja. Ono što je nužno je pronaći biomarker koji bi ukazivao koji će bolesnici regirati na liječenje imunoterapijom. Danas znamo da što je viša ekspresija PD-L1 bolji je odgovor na imunoterapiju, ali i negativni bolesnici mogu odgovoriti na liječenje. Imunoterapija inhibitorima kontrolnih točaka danas je standard u drugoj liniji liječenja karcinoma pluća malih stanica, te je pembrolizumab najbolja opcija za liječenje visoko pozitivnih PD-L1 bolesnika u prvoj liniji liječenja

Risk factors and severity of functional impairment in long COVID: a single-center experience in Croatia

Aim To determine the frequency of common symptoms in long COVID and their effect on the quality of life, and to determine the factors contributing to a more severe long COVID. Methods The study enrolled 266 patients who were either referred to long-COVID outpatient clinic or were inpatients undergoing rehabilitation. The data were collected between December 2020 and May 2021. We evaluated the symptoms experienced during acute and long COVID and comorbidities. Functional status was assessed with Post Covid Functional Status (PCFS). Results The final sample consisted of 261 patients. After acute COVID-19 period (>4 weeks), almost 80% of patients had impaired functional status. Only 21.5% reported no functional impairment (0 on PCFS scale). A higher PCFS score was associated with female sex (P<0.001) and oxygen therapy requirement during acute disease (P=0.001). However, it was not associated with having a pre-existing lung disease (P=0.749). Disease severity did not pose a risk for developing a more severe long COVID. Conclusion Women were at greater risk for developing greater functional impairment in long COVID, although we have no explanation why. Malignant disease and hypertension also presented a risk factor for greater functional impairment. More studies are warranted to determine if patients with certain lung disease are more susceptible to long COVID

Radiološke dijagnostičke metode kod transplantacije bubrega

Radiological diagnostic methods have a significant role in the preoperative and postoperative care of patients after kidney transplantation. Improvement and innovations in technology, but also the growing experience of the radiologists who deal with kidney transplant patients as part of the transplant team lead to earlier detection of complications in the postoperative period, which are the leading cause of transplant failure. In this article, we describe, through diagnostic imaging examples, detailed evaluation of all possible complications that can occur after kidney transplantation, with evaluation of different possible diagnostic methods that can be used in the preoperative assessment and postoperative follow up and care of the transplanted patient. The goal of this article is to demonstrate and summarize in detail the possible complications of renal transplantation and how to best diagnostically approach them, with special reference to ultrasound which is the main imaging method for this group of conditions.Radiološke dijagnostičke metode imaju značajnu ulogu u prijeoperacijskom i poslijeoperacijskom razdoblju kod bolesnika s transplantiranim bubregom. Sve bolje tehnološke mogućnosti i inovacije, ali i sve veće iskustvo radiologa koji se kao sastavni dio transplantacijskog tima bave transplantiranim bolesnicima dovode do ranog prepoznavnja poslijetransplantacijskih komplikacija, najznačajnijeg uzroka propadanja transplantiranog organa. U ovom članku predstavljamo kroz primjere detaljan prikaz svih mogućih komplikacija te analizu mogućnosti različitih dijagnostičkih metoda koje se primjenjuju u pripremi za transplantaciju i poslijetransplantacijskoj obradi i praćenju transplantiranog bolesnika. Cilj ovoga članka je detaljno prikazati i sistematizirati moguće komplikacije te kako im dijagnostički pristupiti, s naglaskom na ultrazvuk koji ima glavnu ulogu u dijagnostici ovih stanja

Multimodality Imaging of Cardiac Myxomas

Cardiac myxomas are the most common benign cardiac neoplasms. Echocardiography is the first-line imaging modality used to analyze cardiac masses, allowing the detection of tumor location, size, and mobility. However, additional imaging techniques are required to confirm the diagnosis, evaluate tissue characteristics of the mass, and assess potential invasion of surrounding structures. Second-line imaging includes cardiac magnetic resonance imaging (MRI) and/or computed tomography (CT) depending on availability and the patient’s characteristics and preferences. The advantages of CT include its wide availability and fast scanning, which allows good image quality even in patients who have difficulty cooperating. MRI has excellent soft-tissue resolution and is the gold standard technique for noninvasive tissue characterization. In some cases, evaluation of the tumor metabolism using 18F-fluorodeoxyglucose positron emission tomography with CT may be useful, mainly if the differential diagnosis includes primary or metastatic cardiac malignancies. A cardiac myxoma can be identified by its characteristic location within the atria, typically in the left atrium attached to the interatrial septum. The main differential diagnoses include physiological structures in the atria like crista terminalis in the right atrium and the coumadin ridge in the left atrium, intracardiac thrombi, as well as other benign and malignant cardiac tumors. In this review paper, we describe the characteristics of cardiac myxomas identified using multimodality imaging and provide tips on how to differentiate myxomas from other cardiac masses