Bone densitometry – the gold standard for diagnosis of osteoporosis

Dijagnostičke slikovne metode namijenjene detekciji osteoporoze kreću se od vizualne analize koštane strukture na standardnim rendgenskim snimkama do kvantitativnih slikovnih tehnika koje omogućuju preciznije mjerenje mineralne gustoće kosti (BMD), kao što je kvantitativna kompjuterizirana tomografija (QCT). Prema smjernicama za dijagnostiku i liječenje denzitometrija i nadalje predstavlja “zlatni standard” za dijagnozu osteoporoze i predviđanje rizika za prijelom. U radu su prikazane današnje mogućnosti i najnovije spoznaje u primjeni denzitometrije skeleta.Diagnostic imaging methods aimed to detect osteoporosis range from the visual analysis of bone structure on plain skeletal radiographs to quantitative imaging techniques that enable accurate measurement of bone mineral density (BMD), such as quantitative computed tomography (QCT). According to the guidelines for diagnosis and treatment, dual X-ray absorptiometry (DXA) still represents the “gold standard” for diagnosis of osteoporosis and fracture risk prediction. This paper illustrates the current possibilities and recent advances the in application of bone densitometry

Prevalence and antimicrobial resistance of extended-spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumoniae strains isolated in a university hospital in Split, Croatia

The prevalence of Escherichia coli and Klebsiella pneumoniae that produce extended-spectrum β-lactamases (ESBL) was investigated in patients of a university hospital in Split, Croatia. Patients were grouped according to age (pediatric vs. adult), antibiotic type, and hospital ward. From Jan. 2001 to Dec. 2002, the susceptibility of E. coli and K. pneumoniae isolates to antimicrobials was tested. ESBL production was assayed using the double-disk synergy test. ESBL-producing E. coli and K. pneumoniae were detected in all sites of infection sampled. The percentages of ESBL-positive isolates were higher in the pediatric wards than in the adult wards. The antibiotics most commonly prescribed to patients in all hospital wards belonged to the third-generation cephalosporin group. Among ESBL producers, E. coli isolates were more resistant to aminoglycosides, but less resistant to ciprofloxacin and cotrimoxazole. Resistance of E. coli and K. pneumoniae to ciprofloxacin was exclusively found in isolates from adult patients. None of the isolates, regardless of ESBL production, was resistant to carbapenemes. In addition, the prevalence and antimicrobial resistance of ESBL-producing E. coli and K. pneumoniae isolates differed between pediatric and adult patients. [Int Microbiol 2005; 8(2):119-124

Bone densitometry – the gold standard for diagnosis of osteoporosis

Dijagnostičke slikovne metode namijenjene detekciji osteoporoze kreću se od vizualne analize koštane strukture na standardnim rendgenskim snimkama do kvantitativnih slikovnih tehnika koje omogućuju preciznije mjerenje mineralne gustoće kosti (BMD), kao što je kvantitativna kompjuterizirana tomografija (QCT). Prema smjernicama za dijagnostiku i liječenje denzitometrija i nadalje predstavlja “zlatni standard” za dijagnozu osteoporoze i predviđanje rizika za prijelom. U radu su prikazane današnje mogućnosti i najnovije spoznaje u primjeni denzitometrije skeleta.Diagnostic imaging methods aimed to detect osteoporosis range from the visual analysis of bone structure on plain skeletal radiographs to quantitative imaging techniques that enable accurate measurement of bone mineral density (BMD), such as quantitative computed tomography (QCT). According to the guidelines for diagnosis and treatment, dual X-ray absorptiometry (DXA) still represents the “gold standard” for diagnosis of osteoporosis and fracture risk prediction. This paper illustrates the current possibilities and recent advances the in application of bone densitometry

Neobično mjesto presadnice papilarnog karcinoma štitnjače u nadbubrežnu žlijezdu: prikaz slučaja

Papillary thyroid carcinoma (PTC) is considered one of the most favorable tumors, indolent, with rare distant dissemination. Lungs and bones are the most common metastatic sites. Unusual sites of PTC distant metastases are extremely rare. Brain, liver, skin, kidney, pancreas, and adrenal gland PTC metastases have been sporadically reported in the literature. An 86-year-old female patient underwent total thyroidectomy and neck dissection due to PTC. Postoperative whole body iodine-131 scintigraphy with I-131 SPECT/CT of the abdomen revealed radioiodne avid left adrenal gland metastasis together with high postoperative serum thyroglobulin (Tg) value of more than 5000 µg/L and high serum Tg antibodies. Considering the above-mentioned findings, patient‘s age and multiple comorbidities, radioiodine therapy was applied. PTC metastases to the adrenal gland are extremely rare, and to our knowledge, only nine cases have been reported in the literature. This case report complements rare examples of unusual PTC metastases.Papilarni karcinom štitnjače svrstava se u maligne tumore s najpovoljnijom prognozom, polaganog je rasta, a presadnice na udaljenim mjestima su rijetke. Najčešća mjesta udaljene diseminacije papilarnog karcinoma štitnjače su pluća i kosti. Rijetka mjesta udaljene diseminacije opisana u literaturi su mozak, jetra, koža, gušterača i nadbubrežna žlijezda. Bolesnica u dobi od 86 godina operirana je zbog papilarnog karcinoma štitnjače. Nakon operativnog odstranjenja štitnjače s tumorom i disekcije vrata učinjena je poslijeoperacijska onkološka obrada uključujući scintigrafiju cijelog tijela jodom-131 uz SPECT/CT abdomena. U području lijeve nadbubrežne žlijezde zabilježena je intenzivna nakupina joda-131 koja je odgova-rala presadnici papilarnog karcinoma štitnjače. Serumska vrijednost tumorskog biljega tireoglobulina bila je izrazito poviše-na i iznosila je više od 5000 µg/L uz pozitivna antitireoglobulinska protutijela. Uzevši u obzir nalaze poslijeoperacijske onkološke obrade, dob i opće loše stanje bolesnice provedeno je liječenje jodom-131. Presadnice papilarnog karcinoma štitnjače u nadbubrežnu žlijezdu su iznimno rijetke i dosad je u literaturi opisano samo 9 slučajeva. Ovaj prikaz bolesnice upotpunjuje dosadašnje rijetke slučajeve neobičnih mjesta udaljene diseminacije papilarnog karcinoma štitnjače

Primarni hiperparatireoidizam i serumski kalcij u bolesnica s rakom dojke tijekom procjene niske koštane mase - iskustvo jednog centra

The bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD.Smjernice o koštanom zdravlju za bolesnice s rakom dojke (RD) preporučuju ispitivanje mineralne gustoće kostiju (bone mineral density, BMD). U bolesnica s niskom vrijednosti BMD-a i povišenom razinom kalcija u serumu (RKS) dodatno se procjenjuje primarni hiperparatireoidizam (PHPT). Cilj je bio utvrditi učestalost PHPT-a u liječenih bolesnica s RD i sniženom vrijednosti BMD-a te analizirati povezanost RKS s histopatološkim značajkama tumora i onkološkim liječenjem. Retrospektivna studija obuhvatila je postmenopauzalne bolesnice s RD koje su pregledane u Ambulanti za osteoporozu između 2013. i 2020. godine. Klinički podaci i podaci o BMD prikupljeni su iz medicinske dokumentacije. Bolesnice s biokemijskom sumnjom na PHPT podvrgnute su standardnim postupcima snimanja paratireoidnih žlijezda. U devet od 137 (6,6%) bolesnica dijagnosticiran je PHPT; 8/9 bolesnica podvrgnuto je paratireoidektomiji, a jednoj je bolesnici savjetovano praćenje. U ostalih 128 bolesnica bez PHPT-a više RKS pokazale su trend pozitivne povezanosti s višim gradusom tumora, zahvaćenošću aksilarnih limfnih čvorova i primljenom imunoterapijom, iako nije postignuta statistička značajnost. Utvrdili smo veću učestalost PHPT-a u liječenih bolesnica s RD u odnosu na opću populaciju. Više RKS pokazuju trend pozitivne korelacije s nekim agresivnijim histopatološkim značajkama tumora i imunoterapijom. Rezultati ove studije upućuju na to da bi se kod liječenih bolesnica s RD i s niskom vrijednosti BMD-a trebala rutinski provoditi procjena RKS kako bi se isključio PHPT

99mTc-MIBI SPECT/CT scintigrafija i ultrazvuk prednje vratne regije u dijagnostici bolesti paratireoidnih žlijezda kod bolesnika s nodoznim promjenama štitnjače

Parathyroid scintigraphy with 99mTc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.Scintigrafija paratireoidnih žlijezda 99mTc-MIBI-jem je slikovna metoda nuklearne medicine, a provodi se kod bolesnika sa sumnjom na hiperparatireoidizam (HPT). Cilj istraživanja bio je procijeniti važnost upotrebe ove metode kod bolesnika koji uza sumnju na HPT imaju i nodozne promjene štitnjače. Retrospektivna analiza obuhvatila je razdoblje od 8 godina (2006.-2013.). U studiju je bio uključen 91 bolesnik s klinički ili laboratorijski sumnjivim HPT. Od 67 scintigrafski pozitivnih bolesnika, patološki promijenjena paratireoidna žlijezda dokazana je u njih 47 (70%). U preostalih 20 (30%) bolesnika patološki promijenjena paratireoidna žlijezda nije dokazana. Od 9 bolesnika s negativnim nalazom scintigrafije, a UZV suspektnom povećanom paratireoidnom žlijezdom, patološki promijenjena paratireoidna žlijezda nije dokazana u njih 8 (89%), a dokazana je u jednog (11%) bolesnika. Od 15 scintigrafski dvojbenih bolesnika, njih 8 (54%) je imalo pozitivan nalaz UZV i citološke punkcije uz određivanje PTH u punktatu. U 7 (46%) bolesnika nalaz punkcije i PTH u punktatu bio je negativan. Istraživanje potvrđuje da scintigrafija ima visoku osjetljivost za otkrivanje bolesnika s patološki promijenjenim paratireoidnim žlijezdama (98%). Zbog niske specifičnosti (28%) scintigrafiju treba nadopuniti punkcijom uz određivanje PTH u punktatu u bolesnika sa suspektnim HPT

Amiodaron i funkcija štitnjače [Amiodarone and the thyroid function]

Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH

AMIODARONE AND THE THYROID FUNCTION

Amiodaron je derivat benzofurana koji sadržava do 40% joda. Primjenjuje se za liječenje i prevenciju supraventrikularnih i ventrikularnih tahiaritmija opasnih po život. Učinak na štitnjaču očituje se od poremećaja funkcionalnih testova štitnjače do klinički izražene hipotireoze potaknute amiodaronom (AIH) i tirotoksikoze (AIT). Bolesnici s AIH liječe se supstitucijskom terapijom L-tiroksinom, a terapija amiodaronom može se nastaviti. Moramo razlikovati dva oblika AIT-a: hipertireoza potaknuta amiodaronom (AIT I) i tiroiditis (AIT II). AIT I liječi se tirostaticima, a metode definitivnog liječenja jesu jod-131 ili totalna tiroidektomija. Oblik II AIT-a liječi se glukokortikoidima. Bolesnici s AIT-om moraju prekinuti terapiju amiodaronom. Dronedaron je manje učinkovit antiaritmik koji je strukturno i farmakološki sličan amiodaronu, ali ne sadržavaju jod, a toksične nuspojave su rjeđe. Dronedaron se može rabiti za liječenje bolesnika s povećanim rizikom od razvoja AIT-a ili AIH.Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH

AMIODARONE AND THE THYROID FUNCTION

Amiodaron je derivat benzofurana koji sadržava do 40% joda. Primjenjuje se za liječenje i prevenciju supraventrikularnih i ventrikularnih tahiaritmija opasnih po život. Učinak na štitnjaču očituje se od poremećaja funkcionalnih testova štitnjače do klinički izražene hipotireoze potaknute amiodaronom (AIH) i tirotoksikoze (AIT). Bolesnici s AIH liječe se supstitucijskom terapijom L-tiroksinom, a terapija amiodaronom može se nastaviti. Moramo razlikovati dva oblika AIT-a: hipertireoza potaknuta amiodaronom (AIT I) i tiroiditis (AIT II). AIT I liječi se tirostaticima, a metode definitivnog liječenja jesu jod-131 ili totalna tiroidektomija. Oblik II AIT-a liječi se glukokortikoidima. Bolesnici s AIT-om moraju prekinuti terapiju amiodaronom. Dronedaron je manje učinkovit antiaritmik koji je strukturno i farmakološki sličan amiodaronu, ali ne sadržavaju jod, a toksične nuspojave su rjeđe. Dronedaron se može rabiti za liječenje bolesnika s povećanim rizikom od razvoja AIT-a ili AIH.Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH