Value of second-look ultrasound of suspicious breast lesion detected on MRI

Cilj. Svrha ovog rada jest utvrditi kliničku vrijednost dodatnoga ultrazvučnog (UZV) pregleda u evaluaciji sumnjivih lezija dojke inicijalno otkrivenih na pregledu magnetskom rezonancijom (MR) u pacijentica s invazivnim karcinomom dojke. Ispitanici i metode. Ovo retrospektivno istraživanje provedeno je analizom radioloških nalaza 277 bolesnica s karcinomom dojke kojima je u sklopu preoperativne obrade učinjen pregled MR-om na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju Kliničkoga bolničkog centra Zagreb. Na pregledu MR-om otkrivene su nove lezije koje su dodatno analizirane na ciljanom, dodatnom UZV pregledu. Učinjena je biopsija širokom iglom ili citološka punkcija UZV-om otkrivenih sumnjivih lezija kako bi se učinila patohistološka, odnosno citološka analiza. Uspoređena je korelacija MR i UZV nalaza s obzirom na tip i veličinu lezije. Rezultati. Preoperativnim MR pregledom otkrivene su 33 nove lezije. Dodatnim UZV pregledom verificirano je 25 lezija (75,8%), od kojih je 10 lezija (40,0%) pokazivalo benigne karakteristike. Zbog suspektnih obilježja kod 15 lezija (60,0%) učinjena je patohistološka ili citološka analiza. Među lezijama koje su ultrazvučno verificirane ukupno je otkriveno devet (36,0%) karcinoma i 16 lezija (64,0%) benignih karakteristika. Nije zabilježen niti jedan slučaj karcinoma tijekom dvogodišnjeg praćenja lezija benignih karakteristika. Postotak korelacije UZV i MR nalaza značajno je veći za lezije koje su se na MR-u prikazale kao tvorbe u usporedbi s korelacijom za zone imbibicije (p<0,05). Za fokus imbibicije nije zabilježena niti jedna korelacija. Veličina tvorbi i zona imbibicije ne utječe na uspjeh korelacije. Zaključak. Sumnjive lezije otkrivene MR-om mogu se analizirati dodatnim UZV pregledom, odnosno postotak korelacije UZV i MR nalaza je visok, pri čemu tvorbe pokazuju viši postotak korelacije od zona imbibicije. Za tvorbe i zone imbibicije veličina nema utjecaja na uspjeh korelacije. Dodatni UZV koristan je dodatak dijagnostičkoj obradi pacijentica s MR-om otkrivenom lezijom u dojci te se njegovom uporabom mogu izbjeći nepotrebne biopsije.Aim. The purpose of this study is to determine the clinical utility of an additional ultrasound examination in the evaluation of suspicious breast lesions detected initially on magnetic resonance imaging (MRI) in the patients with invasive breast cancer. Patients and Methods. This retrospective study was conducted by analysing the radiology reports of 277 patients with breast cancer who underwent MRI as a part of the preoperative workup at the University Hospital Centre Zagreb, Department of Radiology. MRI scan detected new lesions were subsequently evaluated by ultrasound examination. Percutaneous biopsy or fine needle aspiration (FNA) was performed on suspicious lesions to obtain pathohistological or cytological confirmation. Correlation of MRI and ultrasound findings was compared with respect to the lesion type and size. Results. A total of 33 new lesions were detected on preoperative MRI. Ultrasound correlation was made in 25 lesions (75.8%). Ten lesions (40.0%) had benign characteristics. Fifteen lesions (60.0%) underwent biopsy or FNA. In total, nine lesions (36.0%) were confirmed as malignant and 16 (64.0%) had benign characteristics. There was no recorded case of carcinoma in the group of lesions with benign appearance that were followed up for two years. Correlation rate of MRI and ultrasound findings was significantly higher in mass lesions (p<0.05). No correlation was found for foci. The size of other lesions did not affect correlation rate. Conclusion. Suspicious lesions detected on MRI can be successfully analysed on additional ultrasound examination. Correlation rate of MRI and ultrasound findings is high, with mass lesions exhibiting a higher percentage of correlation than non-mass lesions. The size of those lesions does not affect correlation rate. Additional ultrasound is useful in diagnostic workup of patients with MRI-detected breast lesion and can reduce the number of unnecessary biopsies

Utjecaj psa vodiča na regulaciju glikemije u slijepih/slabovidnih osoba sa šećernom bolešću

The aim was to assess glycemia regulation in a blind diabetic patient after getting a guide dog. Glycosylated hemoglobin (HbA1c) results of a blind patient before and after getting the guide dog were retrospectively collected. The paired t-test results yielded a two-tailed P value of 0.0925, a difference considered not statistically significant; the 95% confidence interval of this difference varied from -0.2494 to 1.889. An improvement of glycemia regulation was observed with the guide dog compared to previous glycemia regulation, however, the difference was not statistically significant. The moderate improvement could probably be attributed to the mobility of the blind person having a guide dog. Standard quality of life tests should be included in the evaluation of diabetic blind persons, especially the impact of a guide dog on glycemic control or other chronic complications of diabetes.Cilj je bio procijeniti regulaciju glikemije kod slijepe osobe sa šećernom bolešću nakon što je ta osoba dobila psa vodiča. Retrospektivno su se prikupljali rezultati HbA1c u slijepe osobe prije i nakon dobivanja psa vodiča. Primjenom rezultata parnog t-testa dobivena je dvosmjerna vrijednost P od 0,0925. Razlika nije bila statistički značajna, dok se 95% interval pouzdanosti te razlike kretao od -0,2494 do 1,889. Zabilježeno je poboljšanje regulacije glikemije uz psa vodiča u usporedbi s vrijednostima prije dobivanja psa vodiča, ali razlika nije bila statistički značajna. Smatramo da bi to umjereno poboljšanje moglo biti povezano s pokretljivošću slijepe osobe uz psa vodiča. U procjenu slijepe osobe sa šećernom bolešću treba uključiti standardne testove za kvalitetu života, osobito utjecaj psa na regulaciju glikemije ili na druge kronične komplikacije šećerne bolesti

Ileoileal Intussusception In A Patient With Peutz-Jeghers Syndrome

Invaginacija je rijedak uzrok akutne intestinalne opstrukcije u odraslih i u njih uzrokuje oko 1 % svih intestinalnih opstrukcija. Odrasli pacijenti čine otprilike 5 % svih slučajeva invaginacije. Dijagnozu je teško utvrditi zbog nespecifične prirode simptoma. Predstavlja se slučaj ileoilealne invaginacije uzrokovane polipom u pacijenta odrasle dobi s Peutz-Jeghersovim sindromom. Dijagnoza je postavljena na temelju MR enterografije i kolonoskopije.Intussusception is a rare cause of acute intestinal obstruction in adults and causes approximately 1% of all adult intestinal obstructions. Adult patients account for only 5% of all cases of intussusception. Diagnosing is usually difficult because of non-specific nature of the symptoms. This report presents a case of ileoileal intussusception caused by a polyp in an adult patient with Peutz-Jeghers syndrome. The case was diagnosed with magnetic resonance enterography (MRE) and colonoscopy

MRI of the Knee Joint – Our Experience

Prvi pregledi koljena magnetskom rezonancijom u ovome dijelu Europe obavljeni su u Zagrebu, u Općoj bolnici „Sveti Duh” na Zavodu za radiologiju 1989. godine, već dvije godine nakon Minkova izdanja knjige „MRI koljenskoga zgloba”. U osamnaest godina kontinuiranoga rada na permanentnome rezonatoru Hitachi MRP 20, 0.2 T, u potpunosti je odgovoreno mnogobrojnim specifičnim zahtjevima i pitanjima kliničara iz svih područja radiologije, sukladno tome i pitanjima iz domene mišićnokoštane radiologije. Iako je samo nekoliko autora u počecima sugeriralo da se dijagnostički vrijedne snimke mogu napraviti i na rezonatorima niskoga polja, naši su pregledi kliničarima pokazali iznimno vrijedne dijagnostičke informacije. U ovome stručnom članku prikazuje se anatomiju koljenskoga zgloba na način na koji ga analiziramo na rezonatoru Philips Achieva 1.5T, instaliranome u veljači 2008. godine u Zavodu za radiologiju Kliničke bolnice „Sveti Duh”. Prilikom procjene patologije koljenskoga zgloba, kolegijalna suradnja uspostavljena je sa Zavodom za radiologiju Kliničkoga bolničkog centra Osijek, u svrhu najboljeg odabira relevantnih sekvenci za optimalni odgovor kliničaru. Mjesečno se napravi od 80 do 100 pregleda mišićnokoštanoga sustava, od čega i dalje prevladavaju pregledi koljenskoga zgloba. Prikazujemo najčešću patologiju u dnevnoj kliničkoj praksi pacijenata koji pristupaju pregledima po preporuci specijalista ortopedije ili fizikalne medicine. Treba istaknuti da su danas i liječnici opće medicine dobro obaviješteni i svjesni vrijednosti pregleda koljenskoga zgloba magnetskom rezonancijom, kao i sigurnosti kliničara u prijeoperativnoj pripremi. Stoga više nije rijedak slučaj da kliničari sami naručuju svoje bolesnike elektronski ili u konzultaciji s radiologom.The first MRI knee examinations in this part of Europe were carried out in Zagreb, Croatia, at the General Hospital “Sveti Duh” Radiology Department in 1989, only two years after the appearance of the educational book “MRI of the Knee” by Mink. For 18 years, the Hitachi MRP 20, 0.2T, permanent magnet machine had worked uneventfully covering specific needs of the clinicians in all fields of radiology, as well as for the musculoskeletal system. Even though only few papers indicated that diagnostically appropriate images can be obtained with low field resonators, our examinations yielded sufficient diagnostic information. This article presents the MRI knee anatomy analyzed on a Philips Achieva 1.5T machine installed in February 2008 at our Department, in “Sveti Duh” University Hospital. During the knee pathology evaluation, collegial cooperation was established with Department of Radiology at University Hospital Osijek, with the purpose of selecting the relevant sequences for an optimal answer to the clinician. Eighty to one hundred musculoskeletal examinations are being performed monthly, 80% of which are knee MRI examinations. We present the most common pathology in daily clinical practice of patients who are examined by recommendation of specialists of orthopaedics or physical medicine. It should be pointed out that now even the general practice doctors are well informed and aware of the value of MRI knee examination, as well as of the safety of the clinician in preoperative preparation. Therefore it is not rare for clinicians to arrange for their patients’ appointments via internet or in consultation with the radiologist

Diagnostic performance of digital breast tomosynthesis in female patients with nipple discharge

Background: Nipple discharge is one of the most common symptoms related to the breast, but it is a presenting feature of breast cancer in 5%-12% of women. ----- Aims: The purpose of this study was to determine the diagnostic performance of digital breast tomosynthesis (DBT) in the evaluation of patients with nipple discharge and to compare it with mammography (MMG), ultrasound (US), and magnetic resonance imaging (MRI). ------ Methods and results: This retrospective study included 53 patients with nipple discharge. All patients underwent DBT, and results were compared to MMG, breast US, and MRI. Radiological findings for each method were categorized according to BI-RADS classification: categories 1-2 were considered negative and categories 3-5 positive. If a tissue specimen was obtained, the final diagnosis was established based on the results of histopathological analysis; otherwise, a clinical follow-up was required for at least 2 years to confirm benign radiological findings. Measures of diagnostic accuracy of DBT, MMG, US, and MRI were calculated and compared. ----- Results: Final histopathological analysis revealed six malignant breast lesions, all of which were detected in patients with pathologic nipple discharge. DBT and MRI exhibited high sensitivity (100%) and high negative predictive value (100%) for the detection of breast cancer in patients with nipple discharge. DBT showed higher specificity compared to MRI (82.9% vs. 61.9%). Sensitivity and specificity of MMG were 83.3% and 76.6%, respectively. Breast US was determined to have a sensitivity of 66.7% and specificity of 57.5%. ----- Conclusion: DBT exhibited higher specificity than MRI at the same level of sensitivity and negative predictive value. Therefore, the use of DBT should be considered as an alternative to MRI in the assessment of patients with nipple discharge

Comparison between Continuous Ambulatory Arterial Blood Pressure Monitoring and Standard Blood Pressure Measurements among Patients of Younger and Older Age Group

The purpose of the study was to evaluate whether there is a difference between blood pressure measured in a physician’s office and the average 24hr continuous blood pressure monitored by hypertensive patients at home. If there is a difference between these two situations then is it possibly the result of a blood pressure response by the patient to the physician which is known as »white coat effect« or »white coat hypertension«. We studied 80 hypertensive outpatients which were divided into two groups of 40 patients each – a younger patient group, with a mean age of 22.8 ± 1.8 years, and an older patient group with a mean age of 50.3 ± 5.7 years. They were selected because they had been diagnosed as essentially hypertension grade 1, according to 2007 ESH/ESC Guidelines, or the USA Joint National Committee Guidelines (JNC 7) (i.e., arterial blood pressure > 140/90 mm Hg and <160/100 mmHg) and 35 were not having any antihypertensive treatment. All participants in the study went through a two-week »wash-out« period without medication. At the beginning of the study blood pressure was measured using the Riva-Rocci-Korotkoff method (mercury sphygmomanometer) after 5 minutes of rest and with the patient in the sitting position. The average of the two last measurements by sphygmomanometer was used in the analysis. The subsequent measurement was made by continuous ambulatory blood pressure monitoring (SpaceLabs 90207 device). Continuous ambulatory blood pressure monitoring revealed that 17 patients of the younger age group (42.5%) who were diagnosed hypertonic, according to mercury sphygmomanometeric measurement, were in fact normotonic. In the older age group only 7 (17.5%) of participants were normotonic during 24hr blood pressure monitoring. The proportion of miss-diagnosed normotonic younger patients was directly related to elevated clinic blood pressure, which could be referred to as office hypertension or isolated clinic hypertension (white coat hypertension). This was statistically significant (c2=5.95; p=0.015). Hypertension diagnosed in younger patients based only on occasional doctor’s office mesuraments, using a mercury sphygmomanometer, could be miss-interpreted and treated as the start of arterial hypertension. This could sometimes have unwanted results due to the side effects of precipitate antihypertensive medication as well as the unnecessary cost of testing, cost of treatment, prevalence of white-coat hypertension at baseline, and the varying incidence of new hypertension after the initial screening. The results indicate a potential savings of 3–14% in the cost of care for hypertension, and a 10–23% reduction in treatment days when ambulatory blood pressure monitoring is incorporated into the diagnostic process11. Therefore CABPM should be used as a legitimate method in the diagnosing of »white coat hypertension«, particularly in young patients. The identification of »white coat hypertensive«’ patients should be followed by a search for metabolic risk or organ damage using the latest guidelines, and medication should start after an organ damage or cardiovascular risk assesement2,5,6

Pentadecapeptide BPC 157 as Therapy for Inferior Caval Vein Embolization: Recovery of Sodium Laurate-Post-Embolization Syndrome in Rats

After inferior caval vein embolization therapy, post-embolization syndrome (sodium laurate 10 mg/kg, 0.1 mL into rat inferior caval vein, assessment at 15, 30, 60 min, prime lung lesions, thromboemboli occluding lung vessels), as a severe occlusion/occlusion-like syndrome, might be resolved as a whole by stable gastric pentadecapeptide BPC 157 therapy. At 5 min after laurate injection, stable gastric pentadecapeptide BPC 157 was implemented as therapy (10 µg/kg, 10 ng/kg intraperitoneally or intragastrically). As before, confronted with the occlusion of major vessel(s) or similar noxious procedures, such as rapidly acting Virchow triad circumstances, the particular effect of the therapy (i.e., collateral pathways activation, “bypassing vascular key”, i.e., direct blood flow delivery via activation of azygos vein) assisted in the recovery of the vessel/s and counteracted multiorgan failure due to occlusion/occlusion-like syndrome as a whole in the laurate-injected rats. Along with prime lung lesions and thromboemboli occluding lung vessels, post-embolization syndrome rapidly occurred peripherally and centrally as a shared multiorgan and vessel failure, brain, heart, lung, liver, kidney, and gastrointestinal tract lesions, venous hypertension (intracranial (superior sagittal sinus), portal, and caval), aortal hypotension, progressing thrombosis in veins and arteries and stasis, congested and/or failed major veins, and severe ECG disturbances. Whatever the cause, these were all counteracted, eliminated, or attenuated by the application of BPC 157 therapy. As recovery with BPC 157 therapy commonly and rapidly occurred, reversing the collapsed azygos vein to the rescuing collateral pathway might initiate rapid direct blood delivery and start blood flow reorganization. In conclusion, we suggest BPC 157 therapy to resolve further vascular and embolization injuries