Endoskopsko liječenje sindroma škljocavog kuka vanjskog tipa: kirurška tehnika i prikaz dvaju slučajeva

Snapping hip or coxa saltans is a condition characterized by an audible and/or palpable snapping during hip movement and can be associated with pain around the hip. There are various causes of this condition and can be divided into two types: extra-articular and intra-articular. The most common type is the external extra-articular, where the snapping is due to thickened posterior part of the iliotibial band or anterior part of the gluteus maximus muscle sliding over the greater trochanter during hip movement. Two patients with external snapping hip are presented, who were treated with our original endoscopic iliotibial band release and greater trochanteric bursectomy. There were no surgical complications and the patients did not experience snapping or pain in the hip during 24-month follow-up period. Results of various open techniques and one endoscopic technique in the treatment of external snapping hip are also reported.Škljocavi kuk ili coxa saltans je stanje u kojem dolazi do čujnog i/ili palpabilnog škljocanja prilikom pokreta u kuku, tijekom čega se mogu javljati i bolovi. Prema uzrocima škljocavi kuk se dijeli na ekstra-artikularni i intra-artikularni. Najčešći tip je vanjski ekstra-artikularni, gdje do škljocanja dolazi zbog preskakanja zadebljanog stražnjeg dijela traktusa iliotibijalisa ili prednjeg dijela mišića gluteusa maksimusa preko velikog trohantera tijekom pokreta u kuku. U ovom radu prikazujemo dvoje bolesnika s vanjskim tipom škljocavog kuka koji su podvrgnuti endoskopskom opuštanju traktusa iliotibijalisa i uklanjanju burze nad velikim trohanterom našom vlastitom metodom. Oba zahvata su prošla bez komplikacija te bolesnici nisu imali bolove ili škljocanje u kuku u vremenu praćenja od dvije godine. Ujedno prikazujemo rezultate mnogobrojnih otvorenih tehnika i jedne endoskopske tehnike u liječenju škljocavog kuka

INCIDENTALNI NALAZ ČVORA NA VRATU KOŽNOG MALIGNOG MELANOMA NAKON 34 GODINE LATENCIJE

The authors report a case of a 64-year-old man who had nodal recurrence of melanoma 34 years after the primary diagnosis of a cutaneous melanoma on his back. Neck ultrasound confirmed an oval anechogenic/hypoechogenic lobular lesion (1.6x1.7 cm) in the right supraclavicular fossa. Fine-needle aspiration revealed sparse population of the poorly preserved malignant cells and bare malignant nuclei with prominent nucleoli. Extirpation of the lymph node was done and the histopathologic diagnosis confirmed metastatic melanoma. The man was referred to positron emission tomography/ computed tomography, dermatologist, ophthalmologist and gastroenterologist for further management to exclude other potential sites of new primary melanoma. It is one of the longest disease-free latency periods between the primary melanoma diagnosis and recurrence reported to date. This article suggests melanoma to be a disease with a potentially lifelong risk of recurrence, however, late recurrences are very rare. The clinicians and patients must be vigilant and aware of the risk of late recurrences.Prikazujemo slučaj 64-godišnjeg muškarca koji je imao metastazu melanoma u limfnom čvoru 34 godine nakon postavljene dijagnoze kožnog melanoma na leđima. Na ultrazvuku je ponađena ovalna anehogena/hipoehogena lobularna lezija (1,6x1,7 cm) u desnoj supraklavikularnoj regiji. Citološka punkcija je ukazivala na slabo diferencirane maligne stanice. Učinjena je ekstirpacija limfnog čvora i patohistološki nalaz je potvrdio metastatski melanom. Daljnjom obradom (pozitronska emisijska tomografi ja, pregled dermatologa, oftalmologa i i gastroenterologa) nije pronađeno novo sijelo primarnog melanoma. To je jedno od najdužih razdoblja između primarnog melanoma i povratka bolesti opisano do danas. Ovaj prikaz pokazuje da se metastaze melanoma mogu javiti tijekom cijelog života. Liječnici i bolesnici moraju biti svjesni rizika kasnih metastaza

The Epidemiology of Non-Traumatic Prehospital Sudden Death in Split-Dalmatia County

The aim of this study was to determine epidemiology of non-traumatic prehospital sudden adult deaths in Split- -Dalmatia County from 2000. to 2005. The following information were collected from autopsy reports in the archives of University Hospital Split: gender of deceased, birth date, date of death, location of death, immediate cause of death, previously diagnosed diseases that might lead to terminal outcome. There were 160 non-traumatic prehospital sudden adult deaths in the observed period, with 104 (65%) male and 56 (35%) female autopsies performed. Diseases of cardio- vascular system were the main cause of death, responsible for 95 (59.37%) sudden deaths, followed by diseases of respira- tory system (14.37%) and central nervous system (8.12%). The most frequent cause of non-traumatic sudden death was myocardial infarction, found in 50 cases. July and September were the months of the most frequent occurrence of sudden death. In this study it was confirmed that sudden death incidence increases with age, with almost half of all deaths occurring in people between ages of 61–80. The result that a fifth of all sudden deaths occurred in people aged 51–60 is troubling and potentially preventable. The most frequent location of death was deceased’s place of residence (N=29), followed by the ambulance vehicle (N=17). In conclusion, this is the first publication describing the incidence of pre- hospital sudden non-traumatic adult death in Split-Dalmatia County. Causes of sudden death and its incidence are in accordance with World Health Organization’s information on general causes of death in Croatia and Western Europe

Učestalost RET mutacije u papilarnom karcinomu štitnjače i korelacija s kliničko-patološkim karakteristikama

The purpose of this study was to analyze the possible prognostic value of RET mutation in papillary thyroid carcinoma and its incidence in the past few decades in our population, due to the increasing incidence of papillary thyroid carcinoma. The present study included 180 patients operated for papillary thyroid carcinoma. The clinical and histopathologic characteristics were analyzed. Paraffin sections of the selected histologic slides were cut again and immunohistochemically stained by the Clone 3F8 P (HIER) from Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK) monoclonal antibody to RET oncoprotein. Univariate analysis indicated sex (p=0.01), histologic subtype (p=0.075) and capsular invasion (p=0.010) to be statistically significant predictors of lymph node metastases, whereas age (p=0.796), tumor size (p=0.556) and intraglandular dissemination (p=0.131) showed no such correlation. The presence of RET mutation (p=0.704) was not a statistically significant predictor of the tumor metastasizing potential. RET mutation (p=0.500) showed no statistically significant correlation with papillary thyroid carcinoma classifed into prognostic groups according to clinicopathologic features either. RET mutation was detected in 30% of 180 papillary thyroid carcinomas. This is the first large study demonstrating that RET mutation incidence in papillary thyroid carcinoma in Croatian population is consistent with the classic distribution of sporadic cases, despite the increased prevalence of papillary thyroid carcinoma in the past few decades.Cilj ovoga rada bio je ispitati moguće prognostičko značenje RET mutacije u papilarnom karcinomu štitnjače i učestalost mutacije u odnosu na porast učestalosti papilarnog karcinoma štitnjače u posljednjih nekoliko desetljeća. U istraživanje je bilo uključeno 180 bolesnika operiranih zbog papilarnog karcinoma štitnjače. Analizirane su kliničke i patohistološke osobitosti. Histološki rezovi iz parafinskih blokova odabranih uzoraka imunohistokemijski su obojani monoklonskim protutijelom na RET onkoprotein Clone 3F8 P (HIER) proizvođača Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK). Univarijatnom analizom utvrđena je statistički značajna povezanost spola (p=0,01), histološkog podtipa (p=0,075) i kapsularne invazije (p=0,010) kao prediktora pojave metastaza u limfne čvorove vrata, dok takva povezanost nije zabilježena za dob (p=0,796), veličinu tumora (p=0,556) i intraglandularnu diseminaciju tumora (p=0,131). Prisutnost RET mutacije nije bila statistički značajan prediktor metastatskog potencijala tumora (p=0,704). Također, RET mutacija nije bila statistički značajno povezana s prognostičkim skupinama papilarnog karcinoma koje su sastavljene na temelju kliničko-patološkh osobitosti (p=0,500). RET mutacija bila je prisutna u 30% od 180 papilarnih karcinoma štitnjače. Ovo je prvo veće istraživanje kojim je dokazano da je RET mutacija u papilarnom karcinomu štitnjače u Hrvatskoj u skladu s učestalošću pojave spontane mutacije, iako se bilježi porast učestalosti papilarnog karcinoma štitnjače tijekom posljednjih desetljeća

Genetic Drivers of Kidney Defects in the DiGeorge Syndrome

Background The DiGeorge syndrome, the most common of the microdeletion syndromes, affects multiple organs, including the heart, the nervous system, and the kidney. It is caused by deletions on chromosome 22q11.2; the genetic driver of the kidney defects is unknown. Methods We conducted a genomewide search for structural variants in two cohorts: 2080 patients with congenital kidney and urinary tract anomalies and 22,094 controls. We performed exome and targeted resequencing in samples obtained from 586 additional patients with congenital kidney anomalies. We also carried out functional studies using zebrafish and mice. Results We identified heterozygous deletions of 22q11.2 in 1.1% of the patients with congenital kidney anomalies and in 0.01% of population controls (odds ratio, 81.5; P=4.5×10(-14)). We localized the main drivers of renal disease in the DiGeorge syndrome to a 370-kb region containing nine genes. In zebrafish embryos, an induced loss of function in snap29, aifm3, and crkl resulted in renal defects; the loss of crkl alone was sufficient to induce defects. Five of 586 patients with congenital urinary anomalies had newly identified, heterozygous protein-altering variants, including a premature termination codon, in CRKL. The inactivation of Crkl in the mouse model induced developmental defects similar to those observed in patients with congenital urinary anomalies. Conclusions We identified a recurrent 370-kb deletion at the 22q11.2 locus as a driver of kidney defects in the DiGeorge syndrome and in sporadic congenital kidney and urinary tract anomalies. Of the nine genes at this locus, SNAP29, AIFM3, and CRKL appear to be critical to the phenotype, with haploinsufficiency of CRKL emerging as the main genetic driver. (Funded by the National Institutes of Health and others.)

The Expression Pattern of Bcl-2 and Bax in the Tumor and Stromal Cells in Colorectal Carcinoma

Background and objectives: The epithelial and stromal tissues both play a role in the progression of colorectal cancer (CRC). The aim of this study was to assess the expression of anti-apoptotic Bcl-2 and pro-apoptotic Bax in the epithelium as well as the lamina propria of normal colonic controls, low-grade tumor samples and high-grade tumor samples. Materials and Methods: A total of 60 samples consisting of both normal colonic and carcinoma samples was collected from the Department of Pathology, Cytology and Forensic Medicine, University Hospital Center, Split from January 2020 to December 2021. The expression of Bcl-2 and Bax markers was semi-quantitatively and quantitatively evaluated by recording immunofluorescence stain intensity and by counting stained cells in the lamina propria and epithelium. Analysis of positive cells was performed using the Mann–Whitney test. Results: In all samples, Bcl-2 was significantly more expressed in the lamina propria when compared with the epithelium. Bax was significantly more expressed in the epithelium of normal and low-grade cancer samples when compared with their respective laminae propriae. The percentage of Bcl-2-positive cells in lamina propria is about two times lower in high-grade CRC and about three times lower in low-grade CRC in comparison with healthy controls. Contrary to this, the percentage of Bax-positive cells was greater in the epithelium of low-grade CRC in comparison with healthy control and high-grade CRC. Conclusions: Our study provides a new insight into Bcl-2 and Bax expression pattern in CRC. Evaluation of Bcl-2 expression in the lamina propria and Bax expression in the epithelium could provide important information for colorectal cancer prognosis as well as potential treatment strategies

Endoskopsko liječenje sindroma škljocavog kuka vanjskog tipa: kirurška tehnika i prikaz dvaju slučajeva

Snapping hip or coxa saltans is a condition characterized by an audible and/or palpable snapping during hip movement and can be associated with pain around the hip. There are various causes of this condition and can be divided into two types: extra-articular and intra-articular. The most common type is the external extra-articular, where the snapping is due to thickened posterior part of the iliotibial band or anterior part of the gluteus maximus muscle sliding over the greater trochanter during hip movement. Two patients with external snapping hip are presented, who were treated with our original endoscopic iliotibial band release and greater trochanteric bursectomy. There were no surgical complications and the patients did not experience snapping or pain in the hip during 24-month follow-up period. Results of various open techniques and one endoscopic technique in the treatment of external snapping hip are also reported.Škljocavi kuk ili coxa saltans je stanje u kojem dolazi do čujnog i/ili palpabilnog škljocanja prilikom pokreta u kuku, tijekom čega se mogu javljati i bolovi. Prema uzrocima škljocavi kuk se dijeli na ekstra-artikularni i intra-artikularni. Najčešći tip je vanjski ekstra-artikularni, gdje do škljocanja dolazi zbog preskakanja zadebljanog stražnjeg dijela traktusa iliotibijalisa ili prednjeg dijela mišića gluteusa maksimusa preko velikog trohantera tijekom pokreta u kuku. U ovom radu prikazujemo dvoje bolesnika s vanjskim tipom škljocavog kuka koji su podvrgnuti endoskopskom opuštanju traktusa iliotibijalisa i uklanjanju burze nad velikim trohanterom našom vlastitom metodom. Oba zahvata su prošla bez komplikacija te bolesnici nisu imali bolove ili škljocanje u kuku u vremenu praćenja od dvije godine. Ujedno prikazujemo rezultate mnogobrojnih otvorenih tehnika i jedne endoskopske tehnike u liječenju škljocavog kuka

Cyclin D1 and p27 Expression as Prognostic Factor in Papillary Carcinoma of Thyroid: Association with Clinicopathological Parameters

Aim To determine the prognostic value of cell cycle regulators cyclin D1 and p27 for papillary thyroid carcinomas. Methods Analysis included 180 patients with papillary thyroid carcinoma who underwent surgery at Split University Hospital Center between 1999 and 2001. Clinical data were obtained from clinical charts and histopathology reports. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue by antibody p27 and cyclin D1. Quantification was based on the intensity and distribution of nuclear staining. Results Univariate analysis showed that sex (P = 0.019) and capsular invasion (P = 0.010) were significant predictors of lymph node metastases, whereas age (P = 0.96), histopathological variant (P = 0.075), size (P = 0.556) and multifocality (P = 0.131) were not. Univariate analysis also showed that overexpression of cyclin D1 (P < 0.001) and underexpression of p27 (P < 0.001) predicted lymph node metastases in papillary thyroid carcinomas. There was a significant correlation between cyclin D1 (P = 0.024) and p27 (P = 0.029) expression in two prognostic groups of low and high risk. Low risk group was cyclin D1 negative and p27 positive, while high risk group was cyclin D1 positive and p27 negative. Multivariate analysis confirmed that sex (P = 0.041), capsular invasion (P = 0.027), and p27 (P < 0.001) were strong independent predictors of lymph node metastases in the high-risk group. Conclusions Immunohistochemical analysis of p27 expression may be a valuable tool for identifying risk of lymph node metastases and more aggressive behavior of papillary thyroid carcinoma

Immunohistochemically Detected High Expression of Matrix Metalloproteinase-2 as Predictor of Poor Prognosis in Duke’s B Colon Cancer

Aim To demonstrate immunohistochemical expression of matrix metalloproteinase- 2 (MMP-2) protein in Duke’s B colon cancer and determine its correlation with age, sex, grade, presence of vascular invasion, and patients’ overall survival. Method The study took place from January 1995 to December 1997. We determined the expression of MMP-2 in 152 formalin-fixed, paraffin embedded specimens of Duke’s B colon carcinomas by immunohistochemical analysis using MMP-2 monoclonal antibody. Immunohistochemical expresssion was scored semiquantitatively. Carcinomas were graded as low or high grade. Survival time was analyzed with Kaplan-Meier method, and the log-rank test was used to assess the differences between groups. Cox proportional hazard regression model was used for multivariate survival analysis. Result Univariate analysis showed that positive staining for MMP-2, high histological grade, vascular invasion, male sex, and age >60 years were associated with shorter survival in patients with Duke’s B colon cancer (P range from 0.023 to <0.001). Multivariate analysis showed that only MMP-2 overexpression (P < 0.001; hazard ratio [HR] = 3.64) and vascular invasion (P < 0.001; HR = 4.27) were associated with shorter overall survival. Conclusion Expression of MMP-2 is an important independent indicator of shorter survival in patients with Duke’s B colon cancer and should be taken into consideration in decision-making on the use of adjuvant systemic therapy in patients with Duke’s B colon cancer

Activation of cGAS-STING Pathway Is Associated with MSI-H Stage IV Colorectal Cancer

Colorectal cancer is the second most common cause of cancer-related mortality in adults. Understanding colorectal tumorigenesis at both the cellular and molecular levels is crucial for developing effective treatment options. Forty-one biopsy samples from patients with metastatic CRC (mCRC) were collected at Split University Hospital in Croatia. A total of 41 patients (21 with microsatellite unstable tumours and 20 with microsatellite stable tumours) were randomly included in the study. Immunolabelling of cGAS and STING in metastatic CRC was performed and further complemented by histological classification, tumour grade, and KRAS, NRAS, and BRAF mutational status of mCRC. In bivariate analysis, elevated expression of cGAS and STING was positively associated with MSI-H colon cancer (Fisher’s exact test, both p = 0.0203). Combined expression analysis of cGAS and STING showed a significantly higher percentage of patients with mCRC MSI-H with a fully or partially activated cGAS-STING signalling pathway (chi-square test, p = 0.0050). After adjusting for age, sex, and STING expression, increased cGAS expression remained significantly associated with MSI-H colon cancer in a multiple logistic regression model (β = 1.588, SE = ±0.799, p = 0.047). The cGAS-STING signalling axis represents a compelling new target for optimization of immune checkpoint inhibitor therapeutic approaches in patients with MSI-H stage IV CRC