Prevalence of Hospitalized Patients with Sarcoidosis in Croatia

The aim of this study was to investigate the prevalence of hospitalized patients of sarcoidosis in the Republic of Croatia, its distribution in relation to sex and age as well as its geographical distribution. The data on sarcoidosis patients hospitalized in Croatia in the last six years, from 1997 to 2002, were analyzed retrospectively. The prevalence of sarcoidosis patients hospitalised in the Republic of Croatia is 4.1/100,000. The prevalence among women is 4.7 and among men 3.5 per 100,000 persons, with a ratio of 1.4:1. The disease more frequently occurs in the regions with a continental climate than in the Mediterranean zone. The ratio of sarcoidosis patients in the continental zone to the Mediterranean zone is 1.5:1. It occurs predominantly among the adults. Over the investigated period, in our country we have not registered any case of sarcoidosis among children. It occurs more frequently at a younger age and therefore 44.5% of the patients with sarcoidosis were between 20 and 39 years of age, 40.1% were between 40 and 59 years of age and 15.3% were more than 60 years old

Korelacija scintigrafije pluća Ga-67 s RTG pluća i testovima plućne funkcije u oboljelih od sarkoidoze

In order to assess the usefulness of Ga-67 scintigraphy in the evaluation of sarcoidosis activity, 44 patients including 14, 20 and 10 patients with radiologic stage I, II and III, respectively, were examined. Control group consisted of 22 subjects with healthy lungs who underwent Ga-67 scintigraphy for extrathoracic disease. An objective method of quantitative computer analysis was used on scintigram interpretation. Results were expressed as mean impulse count per pixel of the given area in the left and right hilar region, left and right lung, and in the area of focal accumulation if present. In sarcoidosis patients, the mean impulse count was statistically significantly higher in all regions than in the control group (p<0.0001 for left hilum, right hilum and right lung; and p<0.001 for left lung). The mean impulse count showed correlation with pathologic finding. Pathologic accumulation of Ga-67 in the hilar region was evident in 37 (84.1%) patients, and in the region of pulmonary parenchyma in 31 (70.5%) patients, and showed statistically significant correlation with radiologic staging of sarcoidosis (p<0.01). However, scintigraphy supplemented radiologic staging by providing additional information on the disease extent. In 35.7% of patients with X-ray stage I sarcoidosis, scintigraphy revealed pathologic accumulation of Ga-67 also in pulmonary parenchyma, whereas in as many as 70% of patients with X-ray stage III sarcoidosis the pathologic accumulation of Ga-67pointed to the disease activity in the lymph nodes of the hilum. Only three (6.7%) patients were free from any form of pathologic Ga-67 accumulation. The patients with pathologic Ga-67 accumulation in the lung parenchyma (n=31) had a more severe form of the disease with lower values of pulmonary function tests, i.e. forced vital capacity (FVC), forced expiratory volume in first second (FEV 1), diffusion capacity for carbon monoxide (DLCO) and arterial blood partial oxygen pressure (pO 2). Forced vital capacity as an indicator of ventilation restrictive impairments was statistically significantly lower in the group of patients with pathologic accumulation of Ga-67 in pulmonary parenchyma as compared with the group of patients without it (p<0.01). The decrease in diffusion capacity correlated statistically significantly with the increase in the pathologic accumulation of Ga-67 in pulmonary parenchyma (p<0.01). Thus, lung Ga-67scintigraphy was found to be a highly sensitive marker of the extent and activity of sarcoidosis, however, due to the low specificity of the method its use in good clinical practice should be reserved for diagnostically and therapeutically vague cases, with due consideration of the irradiation dose and cost.Radi procjene značenja scintigrafije pluća s Ga-67 u oboljelih od sarkoidoze ispitana su 44 bolesnika, i to 14 u I., 20 u II. i 10 u III. radiološkom stadiju bolesti. Kontrolnu skupinu činile su 22 osobe sa zdravim plućima u kojih je scintigrafija s Ga-67 rađena zbog ekstratorakalne bolesti. Pri tumačenju scintigrama rabljena je objektivna metoda kvantitativne kompjutorske analize gdje se rezultat izražava kao prosječan broj impulsa po kvadrantu zadane regije u području lijevog i desnog hilusa, lijevog i desnog pluća, te u području žarišnog nakupljanja ako je ono izraženo. U oboljelih od sarkoidoze prosječan broj impulsa za svaku regiju bio je statistički značajno viši od onoga u kontrolnoj skupini (p<0,0001 za lijevi hilus, desni hilus i desno pluće, te p<0,001 za lijevo pluće). Prosječan broj impulsa pratio je radiološki nalaz. Patološko nakupljanje Ga-67 u području hilusa bilo je očito u 37(84,1%) bolesnika, a u području plućnog parenhima u 31 (70,5%) bolesnika, uza statistički značajnu korelaciju s radiološkim stadijem sarkoidoze (p<0,01). Međutim, scintigrafija je dopunila radiološko određivanje stadija bolesti pruživši dodatne informacije o proširenosti bolesti. Tako je kod 35,7% bolesnika u I. rtg stadiju bolesti patološko nakupljanje Ga-67 bilo očito i u plućnom parenhimu, dok je u čak 70% bolesnika s III. rtg stadijem patološko nakupljanje Ga-67 upućivalo na aktivnost procesa i u limfnim čvorovima hilusa. Samo troje (6,7%) bolesnika nije imalo patološko nakupljanje Ga-67 u bilo kojem obliku. Bolesnici s patološkim nakupljanjem Ga-67 u plućnom parenhimu (n=31) imali su teži oblik bolesti s nižim vrijednostima testova plućnih funkcija, tj. forsiranog vitalnog kapaciteta, forsiranog ekspiracijskog volumena u prvoj sekundi, difuzijskog kapaciteta za ugljični monoksid i parcijalnog tlaka kisika u arterijskoj krvi. Forsirani vitalni kapacitet kao pokazatelj restriktivnih smetnja ventilacije bio je statistički značajno niži u skupini bolesnika s patološkim nakupljanjem Ga-67 u plućnom parenhimu u usporedbi sa skupinom bez patološkog nakupljanja (p<0,01). Pad difuzijskog kapaciteta je statistički značajno korelirao s porastom patološkog nakupljanja Ga-67 u plućnom parenhimu (p<0,01). Dakle, scintigrafija pluća s Ga-67 vrlo je osjetljiv biljeg proširenosti i aktivnosti kod sarkoidoze, međutim, ima nisku specifičnost, pa ovu metodu u dobroj kliničkoj praksi treba rabiti u dijagnostički i terapijski dvojbenim slučajevima, vodeći pritom računa o dozi ozračivanja i cijeni

XVIIIth Conference of the Croatian Association of Criminal Sciences

U radu se prikazuje tijek XVIII.redovitog savjetovanja Hrvatskog udruženja za kaznene znanosti i praksu na temu reformi hrvatskog kaznenopravnog sustava održanog u Opatiji u prosincu 2005

XVIIIth Conference of the Croatian Association of Criminal Sciences

U radu se prikazuje tijek XVIII.redovitog savjetovanja Hrvatskog udruženja za kaznene znanosti i praksu na temu reformi hrvatskog kaznenopravnog sustava održanog u Opatiji u prosincu 2005

The Role of Transbronchial Lung Biopsy in the Diagnosis of Solitary Pulmonary Nodule

Transbronchial lung biopsy (TBLB) is a well-recognized diagnostic technique in diffuse interstitial lung diseases, but it is not considered to be the first choice in investigation of solitary pulmonary nodules (SPN). The main idea of this study was to increase the sensitivity of bronchoscopy using multiple techniques, especially TBLB, thus to avoid more aggressive diagnostic procedures. The objective of this prospective study was to evaluate the efficacy and safety of TBLB in the diagnosis of SPN, in comparison with other bronchoscopic techniques. Fifty patients with chest x-ray finding consistent with SPN underwent bronchoscopy with bronchial washing, brushing, bronchoalveolar lavage (BAL) and TBLB were included in this study. Thirty-one patients suffered from malignant tumors, while 19 patients had nonmalignant lesions. TBLB achieved overall diagnostic sensitivity of 62%, BAL of 29%, bronchial brushing of 16% and washing of 6%. Combining all techniques together, bronchoscopy had overall sensitivity of 86%. Concerning malignant lesions, TBLB had a sensitivity of 65%, specificity of 100%, and accuracy of 82%. TBLB had a significantly better yield for lesions with a diameter 25 mm than for lesions of <25 mm (sensitivity of 82% and 53% respectively, p<0.05). Diagnostic yield improved significantly with the increasing number of specimens (less than 3 specimens: sensitivity 59%, 3 or more specimens: sensitivity 87%, p<0.05). Complications of TBLB occurred in 2 (4%) patients: 1 incomplete pneumothorax and 1 hemorrhage. According to the results, we conclude that TBLB is an accurate and safe technique for the diagnosis of pulmonary solitary nodule with a diameter equal or greater than 25 mm