Kliničko-radiološke manifestacije azbestne bolesti ovisno o mineraloškim svojstvima azbesta

Dependence of the incidence of pulmonary/pleural asbestosis on the mineralogic characteristics of asbestos and sensitivity of chest roentgenogram and high-resolution computed tomography on analyzing this pathology are presented. This retrospective / prospective study was conducted in 109 patients, workers of Plobest Ltd Asbestos Industry in Ploče (group 1, predominantly inhaling chrysotile asbestos) and 216 workers of Salonit Ltd from Vranjic near Split and Split Shipyard (group 2, predominantly inhaling crocidolite asbestos) with the diagnosis of pulmonary/ pleural asbestosis. Statistical analysis was done by Kappa test, c2-test, and analysis of variance. Test results are shown in diagrams and table. Pulmonary asbestosis was confirmed in 38 (35%), pulmonary and pleural asbestosis in 49 (45%), and pleural asbestosis in 22 (20%) group 1 patients (exposed to chrysotile). In group 2 patients (exposed to crocidolite asbestos), pulmonary asbestosis was confirmed in only 9 (4%), pleural asbestosis in 117 (54%), and pleural and pulmonary asbestosis in 90 (42%) patients. In 35 (32.1%) group 1 patients with normal chest roentgenograms (International Labour Organization (ILO) perfusion categories 0/0 and 0/1), high-resolution computed tomography revealed initial or moderate stage of interstitial pulmonary fibrosis. Interpretation of chest roentgenograms showed good, almost excellent agreement between the results obtained by three observers on ILO profusion categories 0/0, 0/1 and 1/0, and "normal" agreement for profusion category 31/1. For pleural asbestosis, two readers had excellent agreement (Kappa test = 79%) in group 1 and good agreement in group 2. It was concluded that the incidence of pulmonary and pleural asbestosis was much higher in persons exposed to the inhalation of chrysotile and crocidolite, respectively. It is recommended that in radiologic diagnosis, high-resolution computed tomography should always be used in addition to ILO classification, particularly in the initial stages of the lung and pleural disease.Prikazana je zastupljenost plućne, odnosno pleuralne azbestoze ovisno o mineraloškim svojstvima azbesta, kao i osjetljivost rentgenograma prsiju i visokorezolucijske kompjutorizirane tomografije prsiju u analizi ovih promjena. Retrospektivno prospektivna studija obuhvatila je 109 ispitanika - radnika tvornice azbestnih proizvoda Plobest d.d. iz Ploča (1. skupina, inhalacija pretežito azbesta krizotila) te 216 zaposlenika tvornice Salonit d.o.o. iz Vranjica kod Splita i Brodograđevne industrije Split (2. skupina, inhalacija pretežito azbesta krocidolita), u kojih je utvrđena azbestoza pluća i/ili plućnih maramica. Statistička obrada podataka učinjena je Kappa testom, c2-testom i analizom varijance, a rezultati ispitivanja prikazani su u grafikonima i tablici. Azbestoza pluća je utvrđena u 38 (35%), azbestoza pluća i pleure u 49 (45%), a azbestoza pleure u 22 (20%) ispitanika 1. skupine (izloženi krizotilu). U 2. skupini ispitanika (veća zastupljenost izloženosti krocidolitnom azbestu) azbestoza pluća je utvrđena samo u 9 (4%) ispitanika, azbestoza pleure u 117 (54%), a azbestoza pleure i pluća u 90 (42%) ispitanika. U 1. skupini ispitanika u njih 35 (32,1% ukupnog broja ispitanika 1. skupine) s urednim nalazom rentgenograma prsiju (International Labour Organisation /ILO/ kategorije prožetosti 0/0 i 0/1) visokorezolucijska kompjutorizirana tomografija je otkrila početni ili umjereni stupanj intersticijske plućne fibroze. U interpretaciji rentgenograma prsiju utvrđena je dobra, gotovo odlična podudarnost trojice ispitivača za kategorije ILO prožetosti 0/0, 0/1 i 1/0, te dobra podudarnost za kategorije prožetosti 31/1. Za azbestozu plućnih maramica u 1. skupini utvrđena je odlična podudarnost dvojice ispitivača (Kappa test = 79%), a u 2. skupini dobra podudarnost. Azbestoza pluća je znatno žešća u osoba izloženih inhalaciji krizotila, a azbestoza plućnih maramica u onih izloženih inhalaciji krocidolita. U radiološkoj dijagnostici, uz ILO klasifikaciju, preporučuje se u algoritam pretraga obvezatno uvesti visokorezolucijsku kompjutoriziranu tomografiju, poglavito u početnim stadijima bolesti pluća i pleure

Desmoplastični tumor malih okruglih stanica – DSRCT – prikaz slučaja

Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm of adolescent males with predilection for involvement of the peritoneum. It is an aggressive neoplasm with a poor prognosis. Herein we present a case of a 23 year old man with DSRCT which, at the beginning, has been a diagnostic and clinical problem.Dezmoplastični okrugli malostanični tumor ( DSRCT) je rijedak maligni tumor koji se pojavljuje u mla|ih muškaraca i najčešće zahvaća peritonej. To je agresivan tumor s lošom prognozom. Ovdje ćemo prikazati slučaj 23-godišnjeg muškarca s dijagnosticiranim DSRCT, koji je u početku predstavljao dijagnostički i klinički problem

Kliničke upute za dijagnostiku, liječenje i praćenje bolesnika oboljelih od raka mokraćnog mjehura Hrvatskoga onkološkog društva i Hrvatskoga urološkog društva Hrvatskoga liječničkog zbora [Clinical guidelines for diagnosing, treatment and monitoring patients with bladder cancer - Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association]

Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia

CLINICAL GUIDELINES FOR DIAGNOSING, TREATMENT AND MONITORING PATIENTS WITH BLADDER CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN UROLOGY SOCIETY, CROATIAN MEDICAL ASSOCIATION

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj.Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia

CLINICAL GUIDELINES FOR DIAGNOSING, TREATMENT AND MONITORING PATIENTS WITH BLADDER CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN UROLOGY SOCIETY, CROATIAN MEDICAL ASSOCIATION

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj.Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia

Pre-Existing Interstitial Lung Abnormalities in Patients with Head and Neck Squamous Cell Carcinoma and Their Follow Up after Therapy

Interstitial lung abnormalities (ILAs) are incidentally found nondependent parenchymal abnormalities affecting more than 5% of any lung zone and are potentially related to interstitial lung disease and worsening post-treatment outcomes in malignancies and infectious diseases. The aim of this study was to determine the prevalence and type of ILA changes in patients with head and neck squamous cell carcinoma (HNSCC) and their change in the follow-up period. This retrospective single-center study included 113 patients with newly diagnosed HNSCC who underwent lung MSCT prior to treatment. ILAs were reported in 13.3% of patients on pretreatment MSCT. Patients with ILAs were significantly older (median 75 vs. 67 years). ILAs were most prevalent in lower zones (73.3%) (p = 0.0045). The most reported ILA subtype was subpleural non-fibrotic (60%) (p = 0.0354). Reticulations were the most frequently described pattern (93.3%) (p p = 0.0464). In conclusion, ILA’s incidence, distribution and presentation were similar to previous research conducted in other special cohorts. Our research suggests a possible association of more frequent radiation pneumonitis with ILA changes in patients with HNSCC, which should be further investigated

Diagnostic and Practical Value of Abbreviated Contrast Enhanced Magnetic Resonance Imaging in Breast Cancer Diagnostics

Background: Although MRI is the most efficient method of detecting breast cancer, its standard protocol is time-consuming and expensive. The objective of this study was to compare the diagnostic accuracy of the modified innovative abbreviated MRI protocol (AMRP) and the standard magnetic resonance protocol (SMRP) when detecting breast cancer. Methods: The research involved 477 patients referred for breast MRI due to suspected lesions. They were randomly assigned to the AMRP group (N = 232) or the SMRP group (N = 245). The AMRP comprised one native (contrast-free) and four post-contrast dynamic sequences of T1-weighted volume imaging for breast assessment (VIBRANT) and 3d MIP (maximum intensity projection) lasting for eight minutes. All the patients underwent a core biopsy of their lesions and histopathological analysis. Results: The groups were comparable regarding the pre-screening and post-diagnostic characteristics and were of average (±SD) age at breast cancer diagnosis of 53.6 ± 12.7 years. There was no significant difference between the two protocols in terms of specificity or sensitivity of breast cancer diagnosis. The sensitivity (95% Cis) of the AMRP was 99.05% (96.6–99.9%), and its specificity was 59.09% (36.4–79.3%), whereas the sensitivity of the SMRP was 98.12% (95.3–99.5%) and its specificity was 68.75% (50.0–83.9%). Most of the tumors comprised one solid lesion in one of the breasts (77.3%), followed by multicentric tumors (16%), bilateral tumors (4.3%), and multifocal tumors (1.7%). The average size of tumors was approximately 14 mm (ranging from 3 mm to 72 mm). Conclusion: Our innovative AMR protocol showed comparable specificity and sensitivity for the diagnosis of breast cancer when compared to SMRP, which is the “gold standard” for histopathological diagnosis. This can lead to great savings in terms of the time and cost of imaging and interpretation

Clinical guidelines for radiological diagnosis and monitoring of patients with breast cancer

Rak dojke najčešća je zloćudna novotvorina u žena u Republici Hrvatskoj. Osnovne radiološke pretrage u dijagnostici bolesti dojke jesu mamografija, ultrazvuk i magnetska rezonancija. U radu su prikazane radiološke smjernice za radiološku dijagnostičku i intervencijsku obradu bolesti dojke i praćenje bolesnica oboljelih od raka dojke u Republici Hrvatskoj. Razrađen je algoritam radiološke obrade kod simptomatskih bolesnica, trudnica i dojilja, bolesnica prosječnog i povećanog rizika za razvoj karcinoma dojke, te kod bolesnica s radiološkim nalazom upalnih promjena (mastitisa).Breast carcinoma is the most common neoplasm in the female population of Croatia. The main imaging breast diagnostic modalities are mammography, ultrasound, and magnetic resonance. This paper reviews radiological guidelines for breast diagnostic and interventional procedures, and monitoring of breast cancer patients in the Republic of Croatia. An algorithm for radiological assessment is presented for symptomatic patients, pregnant and lactating women, patients with average and increased risk of developing breast cancer, and patients with radiological findings of mastitis

Desmoplastični tumor malih okruglih stanica – DSRCT – prikaz slučaja

Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm of adolescent males with predilection for involvement of the peritoneum. It is an aggressive neoplasm with a poor prognosis. Herein we present a case of a 23 year old man with DSRCT which, at the beginning, has been a diagnostic and clinical problem.Dezmoplastični okrugli malostanični tumor ( DSRCT) je rijedak maligni tumor koji se pojavljuje u mla|ih muškaraca i najčešće zahvaća peritonej. To je agresivan tumor s lošom prognozom. Ovdje ćemo prikazati slučaj 23-godišnjeg muškarca s dijagnosticiranim DSRCT, koji je u početku predstavljao dijagnostički i klinički problem

Clinical guidelines for diagnosis, treatment and monitoring of patients with invasive breast cancer – Croatian Oncology Society (BC-3 COS)

Rak dojke je najčešći zloćudni tumor u žena koji se može probirom, redovitim kontrolama i zdravstvenim odgojem otkriti u ranim stadijima bolesti i uspješno liječiti. Metode liječenja uključuju kirurgiju, kemoterapiju, radioterapiju, endokrinu terapiju, imunoterapiju, ciljanu terapiju te simptomatsko-suportivnu terapiju, koja se primjenjuje ovisno o stadiju bolesti, biološkim obilježjima tumora i općem stanju, dobi i komorbidetima bolesnica. Plan liječenja definira multidisciplinarni tim. S obzirom na pojavnost ove bolesti, mogućnost ranog otkrivanja i mogućeg značajnog učinka terapijskih postupaka na tijek bolesti, potrebno je definirati i pravilno standardizirati pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu su iznesene smjernice s ciljem primjene standardiziranih postupaka u svakodnevnom radu s bolesnicama s rakom dojke u Republici Hrvatskoj.Breast cancer is the most common cancer in women, which can be diagnosed early through screening, early detection and through education. When diagnosed early, it can be successfully treated. Treatment modalities include surgery, chemotherapy, radiotherapy, endocrine therapy, immunotherapy, targeted therapy and supportive therapy applied depending on the stage of the disease, tumor and patient´s characteristics. Treatment should be defined by a multidisciplinary team. Due to the incidence of this disease, opportunity of early detection and possible significant influence of various treatment modalities on the course of the disease, it is important to define and implement a standardized approach for diagnosis , treatment and monitoring algorithm. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis,treatment and monitoring of breast cancer patients in the Republic of Croatia