Pleural, peritoneal and pericardial effusions – a biochemical approach

The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented

Gene polymorphisms in dopamine (COMT and DAT1) and serotonin (MAOA and 5-HTT) systems and dimensions of symptoms in patients with schizophrenia

Shizofrenija je teška psihička bolest koja zahvaća 1% opće populacije. Dijagnoza se postavlja prema kliničkoj slici i prisutnim simptomima. Premda sama biološka osnova nije razjašnjena, danas je najprihvaćenija dopaminska hipoteza prema kojoj dopamin ima centralnu ulogu u nastanku shizofrenije. Dopaminske puteve u mozgu velikim dijelom prati serotoninski put za koji je utvrđeno da ima inhibitorni učinak na dopaminski sustav. Djelovanje dopamina regulira dopaminski transporter i katekol-o-metil transferaza, a djelovanje serotonina regulira serotoninski transporter i monoamino-oksidaza A, koja osim što sudjeluje u metabolizmu serotonina, sudjeluje i u metabolizmu dopamina. Hipoteza ovog istraživanja je da bi funkcionalni polimorfizmi dopaminskog transportera (DAT-VNTR), katekolo- metil transferaze (COMT Val158Met), serotoninskog transportera (5-HTTLPR) i monoamino-oksidaze A (MAOA-uVNTR) mogli biti povezani sa pojavom simptoma shizofrenije. Ciljevi ovog istraživanja su: Ispitati povezanost pojedinih polimorfizama i kombinacija genotipova sa shizofrenijom. U skupini ispitanika sa shizofrenijom ispitati povezanost polimorfizama sa simptomima bolesti. Uspostaviti regresijski model za predviđanje shizofrenije. U istraživanje je uključeno 314 zdravih ispitanika i 306 ispitanika sa dijagnozom shizofrenije. Za ispravnu klasifikaciju zdravih ispitanika korišten je MINI upitnik i fizikalni pregled. Dijagnoza shizofrenije postavljena je prema DSM IV standardu, a simptomi shizofrenije ocijenjeni su PANSS i Calgary skalom. Genotipizacija ispitivanih polimorfizama rađena je PCR reakcijom uz elektroforetsko razdvajanje dobivenih fragmenata odnosno PCR-RFLP metodom za genotipizaciju COMT Val158Met polimorfizma. Usporedbom zdravih i ispitanika sa shizofrenijom utvrđeno je sljedeće: na ukupnom uzorku utvrđena je statistički značajna razlika u distribuciji DAT-VNTR polimorfizma. U podskupini žena utvrđena je statistički značajna razlika u distribuciji COMT Val158Met polimorfizma a u podskupini muškaraca utvrđena je povezanost MAOA-uVNTR polimorfizma sa shizofrenijom. U skupini ispitanika sa shizofrenijom utvrđena je povezanost COMT Val158Met polimorfizma sa obiteljskim hereditetom. Utvrđen je logistički model za predviđanje shizofrenije.Schizophrenia is severe psychiatric disorder which affects 1% of general population. Diagnosis of schizophrenia is based on presence of clinical symptoms but its exact pathophysiology is still unknown. However, according to extensive research the most accepted is dopamine hypothesis by which dopamine plays central role in development of schizophrenia. Dopamine pathways in brain are followed by serotonin pathway which has inhibitory effect on dopamine. Dopamine action is regulated by dopamine transporter and catechol-o-methyltranspherase, while serotonin action is regulated by serotonin transporter and monoamine-oxidase A which is also included in dopamine metabolism. Hypothesis of this research is that polymorphisms of dopamine transporter (DAT-VNTR), catechol-omethyltranspherase (COMT Val158Met), serotonin transporter (5-HTTLPR) and monoamine oxidase A (MAOA-uVNTR) might be associated with symptoms of schizophrenia. The aims of this research were: To test association of polymorphisms and genotype combinations with schizophrenia. In group of patients with schizophrenia, test association of polymorphisms with schizophrenia symptoms. To establish regression model for prediction of schizophrenia. 314 healthy volunteers and 306 patients with schizophrenia were included in this research. Healthy volunteers were included based on MINI psychiatric questioner and physical exam. Schizophrenia was diagnosed based on DSM IV standard and symptoms of schizophrenia were assessed by PANSS and Calgary scale. For detection of polymorphisms we used PCR followed by electrophoresis with exception of COMT Val158Met polymorphism for which we used PCR-RFLP method. Comparing healthy volunteers and patients with schizophrenia, the following was established: In overall sample there was statistically significant difference in distribution of DAT-VNTR polymorphisms. In female population we found statistically significant difference in distribution of COMT Val158Met polymorphism. In male population we found statistically significant distribution of MAOA-uVNTR polymorphism. In group of patients with schizophrenia we found association of COMT Val158Met polymorphism with family heritage of schizophrenia. Logistic regression model was established for predicting schizophrenia

Pojavnost kolorektalnog karcinoma i ABO sustav krvnih grupa

The distribution of the AB0 blood group system (A, B, 0 or AB) and Rhesus type (Rh-positive or Rh negative Rh+ or Rh-) was studied retrospectively in 981 patients with colorectal cancer. The distribution of ABO and Rh blood groups among the observed patients was similar to the distribution among the normal population in Croatia. No specific relationship has been established between the blood group type and colorectal cancer. There were significant differences in the proportions of the various ABO blood groups in Rh-positive and Rh-negative patients (chi-square = 15.18; p = 0.0017), with the A/O ratio of 1.15 and 0.75 in Rh-positive and Rh-negative patients, respectively. Further analysis confirmed that these significant differences were due to the O Rh-negative blood group. No significant difference could be found in the ABO distributions with regard to tumor stage.U ovoj studiji retrospektivno je proučavana raširenost ABO i Rh krvnih grupa u 981 bolesnika oboljelih od kolorektalnog karcinoma. Raširenost ABO i Rh krvnih grupa u bolesnika bila je slična raširenosti krvnih grupa u zdravoj populaciji u Hrvatskoj. Nije utvrđena posebna povezanost između krvnih grupa i kolorektalnog karcinoma. Značajne razlike pronađene su u udjelima različitih ABO krvnih skupina u Rh pozitivnih i Rh-negativnih bolesnika (hi-kvadrat = 15,18, p = 0,0017) s A/O omjerom 1,15 u Rh+ i 0,75 u Rh- bolesnika. Daljnja analiza potvrdila je da je uzrok značajnim razlikama O Rh-negativna krvna grupa. Nije se mogla utvrditi povezanost između krvnih grupa i stadija bolesti

Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part II – Synovial fluid

Joint diseases are conditions with an often progressive and generally painful nature affecting the patient’s quality of life and, in some cases, requiring a prompt diagnosis in order to start the treatment urgently. Synovial fluid (SF) laboratory testing is an important part of a diagnostic evaluation of patients with joint diseases. Laboratory testing of SF can provide valuable information in establishing the diagnosis, be a part of a patient’s follow-up and treatment with the purpose of improving the patient’s health and quality of life. Synovial fluid laboratory testing is rarely performed in Croatian medical biochemistry laboratories. Consequently, procedures for SF laboratory testing are poorly harmonized. This document is the second in the series of recommendations prepared by the members of the Working group for extravascular body fluid samples of the Croatian Society of Medical Biochemistry and Laboratory Medicine. It addresses preanalytical, analytical, and postanalytical issues and the clinical significance of tests used in SF laboratory testing with the aim of improving the value of SF laboratory testing in the diagnosis of joint diseases and assisting in the achievement of national harmonization. It is intended for laboratory professionals and all medical personnel involved in synovial fluid collection and testing

Duboka venska tromboza gornjih ekstremiteta kod onkoloških bolesnika – prikaz slučaja

Upper extremity deep venous thrombosis (UEDVT) makes approximately 4% to 20% of all venous thromboembolism (VTE). Cancer is the most relevant acquired thrombotic risk factor of VTE, because of its myriad of prothrombotic molecules released by neoplastic cells. In our case report we presented deep venous thrombosis (DVT) of the upper limb that is not associated with central venous catheter (CVC) or receiving chemotherapy or hormonal therapy. A 55-year old female patient was admitted to our Department of Transfusion Medicine because of the swelling and pain in the left arm. One month earlier she underwent left segmentectomy and axillary dissection because of the breast cancer. Physical examination revealed left arm swelling and pressure pain. D-dimers were 770 μg/L (normal range 170-500 μg/L). Duplex ultrasound revealed thrombogenic mass in the left brachial vein, without total obstruction. She was treated with low molecular mass heparin (LMWH) and warfarin. This uncommon presentation of hypercoagulable state in cancer patient points out one more time the importance of prophylactic use of anticoagulants in any hospitalized cancer patient receiving anticancer therapy. In University Hospital for Tumors we recommend anticoagulation prophylaxis for all cancer patients undergoing surgery. We use low doses of LMWH eight hours after surgery and once daily until discharge.Na duboku vensku trombozu gornjih ekstremiteta (DVTGE) otpada 4% - 20% svih slučajeva venskog tromboembolizma (VTE). Maligna bolest je značajniji stečeni rizični factor za razvoj VTE zbog protrombotskih tvari koje otpuštaju neoplastične stanice. U ovom radu prikazali smo slučaj bolesnice koja je razvila duboku vensku trombozu (DVT) ruke koja nije povezana sa središnjim venskim kateterom, aplikacijom kemoterapije ili hormonske terapije. 55 - godišnja bolesnica primljena je na Zavod za transfuzijsku medicinu zbog otekline i boli u lijevoj ruci . Mjesec prije bila je podvrgnuta kirurškom zahvatu zbog karcinoma dojke, učinjena je segmentektomija s disekcijom aksile. Fizikalnim pregledom nađe se otok lijeve ruke. Vrijednost D- dimera kod prijema bila je 770 g / L (normalni raspon 170-550 g / L). Obojanom ultrazvučnom obradom nađu se trombogene mase u lijevoj brahijalnoj veni, bez potpune opstrukcije. U terapiju je uveden niskomolekularni heparin (LMWH), a potom varfarin. Ovakva rijeđa posljedica hiperkoagulabilnog stanja kod onkoloških bolesnika još je jedna potvrda važnosti procjene rizika i profilaktičke upotrebe antikoagulantne terapije.U Klinici za tumore preporuča se antikoagulantna terapija kod svih bolesnika podvrgnutih kirurškom liječenju. Koristi se LMWH osma sati nakon operacije, a potom jednom dnevno do otpusta

Vrijednosti D-dimera u bolesnika s metastatskim karcinomom jetre prije i poslije kirurškog zahvata

Vein thrombosis is a common complication in patients with cancer. Tumor cells produce or have expressed on their surface many procoagulant factors such as tissue factor and cancer procoagulant. Besides procoagulant activity of the tumor cells, surgical procedure, chemotherapy treatment, immobility and disease stage are additional factors for thrombosis development. Laboratory test used in diagnosis of thrombosis is D-dimer level measurement. Because of its high negative predictive value it has been used to exclude deep vein thrombosis in patients presented with deep vein thrombosis symptoms. Since its levels could be increased in patients with cancer, using this test in cancer population should be taken with caution. The aim of this study was to asses D-dimer levels in a specific group of patients with metastatic liver cancer before and after surgery, and determine the difference between these two measurements. The study included 43 patients of both sexes, average age 68 (46 – 80) years, with metastatic liver carcinoma. Concentrations of D-dimer after surgery were higher than before surgery accounting for 2851 (617 – 3650) μg/L and 364 (229-615) μg/L, respectively, P < 0.001. The lowest difference between measurements was 51 μg/L and the highest one was 10644 μg/L. We confirmed the trend in D-dimer levels before and after surgery reported in the literature and showed that these values can vary in a wide range.Venska tromboza česta je komplikacija u bolesnika s karcinomom. Tumorske stanice proizvode ili su im na površini izraženi brojni prokoagulcijski faktori poput tkivnog faktora i tumorskog prokoagulanta. Uz prokoagualcijsku aktivnost tumorskih stanica, kirurški zahvat, kemoterapija, nepokretnost i stadij bolesti dodatni su faktori koji utječu na nastanak tromboze. Mjerenje koncentracije D-dimera laboratorijska je pretraga koja se provodi u dijagnostici venske tromboze. Zbog svoje visoke negativne prediktivne vrijednosti, primjenjuje se kako bi se isključilo postojanje duboke venske tromboze u bolesnika s tim simptomima. S obzirom na to da vrijednosti D-dimera mogu biti povećane u bolesnika s karcinomom, rezultate ove pretrage u toj populaciji bolesnika valja oprezno razmotriti. Cilj ovog ispitivanja bio je procijeniti vrijednosti D-dimera u odre|enoj skupini bolesnika s metastatskim karcinomom jetre prije i poslije operacije te utvrditi razliku između ta dva mjerenja. Ispitivanje je obuhvatilo 43 bolesnika oba spola, prosječne dobi od 68 (46-80) godina, s metastatskim karcinomom jetre. Koncentracija D-dimera nakon operacije bila je veća nego prije operacije, tj. nakon operacije iznosila je 2851 (617 – 3650) μg/L, a prije operacije 364 (229-615) μg/L, P < 0,001. Najmanja razlika izme|u dva mjerenja iznosila je 51 μg/L, a najveća 10644 μg/L. Potvrdili smo kretanje koncentracije D-dimera prije i poslije kirurškog zahvata kao što je opisano u literaturi te pokazali da vrijednosti mogu varirati u velikom rasponu

Povezanost ABO krvne grupe, Rh faktora i raka dojke u bolesnika liječenih u Klinici za tumore

The study is a retrospective review of 407 female patients with primary breast cancer and 320 female patients with benign breast changes who were surgically treated in the University Hospital for Tumors during calendar year 2009. We investigated a possible link between the ABO blood group and breast cancer. All patients had their blood group (ABO antigen and RhD) determined, as a part of preoperative treatment, at the Department for Transfusion Medicine of the University Hospital for Tumors. Erythrocyte antigens were determined using the plate and microcard technique. The mean age of all patients was 62.1 years (range 30 – 95 yrs). No statistically significant differences were found between patients who have cancer and those who have not in the frequency of certain blood groups (χ = 2.525, df = 3, p = 0.471). Also, there was no statistically significant difference between patients with cancer and those without cancer in the frequency of Rh (χ = 2.343, df = 1, p = 0.076). We found a statistically significant but slight correlation between Rh factor and HER2/neu (p=0.038), r=0.106. According to the correlation coefficient, the correlation between these two variables is none or slight. The causal relationship between the two parameters remains unknown and should be tested in a larger study.Ispitivanje je retrospektivno obuhvatilo 407 bolesnica s primarnim rakom dojke i 320 bolesnica s dobroćudnim promjenama u dojci koje su kirurški liječene u Klinici za tumore u 2009. godini. Proučavali smo moguću povezanost između ABO krvne grupe i raka dojke. Krvna grupa (ABO antigen i RhD) utvrđena je svim bolesnicama u okviru prijeoperacijske obrade u Službi za transfuzijsku medicinu Klinike za tumore. Antigeni na površini eritrocita određivani su na pločama i u mikrokarticama. Prosječna dob bolesnica iznosila je 62;1 godina (raspon 30 – 95 godina). S obzirom na učestalost određenih krvnih grupa nisu utvrđene statistički značajne razlike između bolesnica koje imaju rak i onih koje ga nemaju (χ = 2;525; df = 3; p = 0;471). Statistički značajnih razlika u učestalosti Rh faktora između bolesnica s rakom i onih koje ga nemaju; također; nije bilo (χ = 2;343; df = 1; p = 0;076). Otkrivena je statistički znakovita; iako slaba korelaciju između Rh faktora i HER2/neu (p=0;038); r=0;106. Prema koeficijentu korelacije između te dvije varijable korelacije ili nema ili je slaba. Uzročna povezanost između ta dva parametra i dalje je nepoznata i treba je ispitati na većem uzorku

Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part I – Serous fluids

Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document

Duboka venska tromboza gornjih ekstremiteta kod onkoloških bolesnika – prikaz slučaja

Upper extremity deep venous thrombosis (UEDVT) makes approximately 4% to 20% of all venous thromboembolism (VTE). Cancer is the most relevant acquired thrombotic risk factor of VTE, because of its myriad of prothrombotic molecules released by neoplastic cells. In our case report we presented deep venous thrombosis (DVT) of the upper limb that is not associated with central venous catheter (CVC) or receiving chemotherapy or hormonal therapy. A 55-year old female patient was admitted to our Department of Transfusion Medicine because of the swelling and pain in the left arm. One month earlier she underwent left segmentectomy and axillary dissection because of the breast cancer. Physical examination revealed left arm swelling and pressure pain. D-dimers were 770 μg/L (normal range 170-500 μg/L). Duplex ultrasound revealed thrombogenic mass in the left brachial vein, without total obstruction. She was treated with low molecular mass heparin (LMWH) and warfarin. This uncommon presentation of hypercoagulable state in cancer patient points out one more time the importance of prophylactic use of anticoagulants in any hospitalized cancer patient receiving anticancer therapy. In University Hospital for Tumors we recommend anticoagulation prophylaxis for all cancer patients undergoing surgery. We use low doses of LMWH eight hours after surgery and once daily until discharge.Na duboku vensku trombozu gornjih ekstremiteta (DVTGE) otpada 4% - 20% svih slučajeva venskog tromboembolizma (VTE). Maligna bolest je značajniji stečeni rizični factor za razvoj VTE zbog protrombotskih tvari koje otpuštaju neoplastične stanice. U ovom radu prikazali smo slučaj bolesnice koja je razvila duboku vensku trombozu (DVT) ruke koja nije povezana sa središnjim venskim kateterom, aplikacijom kemoterapije ili hormonske terapije. 55 - godišnja bolesnica primljena je na Zavod za transfuzijsku medicinu zbog otekline i boli u lijevoj ruci . Mjesec prije bila je podvrgnuta kirurškom zahvatu zbog karcinoma dojke, učinjena je segmentektomija s disekcijom aksile. Fizikalnim pregledom nađe se otok lijeve ruke. Vrijednost D- dimera kod prijema bila je 770 g / L (normalni raspon 170-550 g / L). Obojanom ultrazvučnom obradom nađu se trombogene mase u lijevoj brahijalnoj veni, bez potpune opstrukcije. U terapiju je uveden niskomolekularni heparin (LMWH), a potom varfarin. Ovakva rijeđa posljedica hiperkoagulabilnog stanja kod onkoloških bolesnika još je jedna potvrda važnosti procjene rizika i profilaktičke upotrebe antikoagulantne terapije.U Klinici za tumore preporuča se antikoagulantna terapija kod svih bolesnika podvrgnutih kirurškom liječenju. Koristi se LMWH osma sati nakon operacije, a potom jednom dnevno do otpusta

Koncentracija feritina u serumu kod bolesnika sa solidinim tumorima

Ferritin is a positive acute phase reactant. It is produced and secreted by various cells such as hepatocytes, macrophages and cancer cells. This was a retrospective study which included 46 patients with solid tumors who were tested for ferritin level in plasma. The measured value of the ferritin concentration in plasma of patients was in the range from 5.98 to 850.78 μg/L, and the average measured value was 174.62 μg/L. For the control group, we also included 46 subjects. The measured value of ferritin in the control group was in the range from 5.94 to 351.54 μg/Ll, and the average measured value was 63.17 μg/L. There is a statistically significant difference between the two groups. Our data shows that the highest level of ferritin was measured in patient with breast cancer. By many studies done until now it is shown that iron metabolism is dysregulated in cancer, and that changes occur in both intracellular and extracellular ferritin.Feritin je reaktant akutne faze. Proizvode ga i luče različite stanice, jetrene, makrofagi i neoplastične stanice. U ovoj retrospektivnoj studiji obrađeni su podaci 46 bolesnika sa solidnim tumorima kojima je određena koncentracija feritina u serumu. Koncentracija feritina kod bolesnika kretela se u rasponu od 5,98 do 850,78 g / L, a prosječna izmjerena vrijednost je 174,62 g / L. Kontrolan skupina je 46 zdravih osoba. Izmjerena vrijednost feritina u kontrolnoj skupini kretala se u rasponu 5,94 do 351,54 g / Ll, a prosječna izmjerena vrijednost je 63.17 g / L. Postoji statistički značajna razlika između dvije skupine. Naši podaci pokazuju da je najviša razina feritina izmjerena kod bolesnice s rakom dojke. Mnoge studije učinjene do sada pokazale su da postoji poremećaj metabolizma željeza kod malignih stanja, te da dolazi do promjena i unutarstaničnog i izvanstaničnog feritina