Lokoregionalna terapija u liječenju hepatocelularnog karcinoma – prikaz slučaja

A hepatocellular carcinoma (HCC) is a primary liver malignancy, often arising in the setting of chronic liver disease. Incidence of this carcinoma is increasing at a great rate. Disease often manifests asymptomatically and to make the final diagnosis is often challenging. Screening of patients at risk is based on ultrasound (US) examinations, which in the setting of suspicion lesion findings often converts to multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) procedures for advanced disease evaluation. The selection of treatment modality depends on tumor size and location, extrahepatic spread and subsequent liver disease. For years the first line of treatment was liver resection and transplantation. Locoregional therapy is a novel approach to diverse stages of HCC with good response and higher overall survival rates, especially in early stages. Transarterial chemoembolization (TACE) is the method of choice in patients with multifocal HCC and maintained liver function, unsuitable for surgical treatment. We present a patient with HCC in the setting of hepatitis C virus (HCV) infection, treated with combined methods of locoregional therapy.Hepatocelularni karcinom (HCC) je primarna maligna bolest jetre. Uslijed porasta broja oboljelih od kroničnog hepatitisa koji u konačnici dovodi do stadija ciroze jetre, incidencija ovog karcinoma je u porastu. U svom početnom stadiju bolest je najčešće asimptomatska, a postavljanje konačne dijagnoze je zahtjevno i s odgodom. Probir visoko rizične populacije zasniva se na ultrazvučnoj dijagnostici koja se, u slučaju pronalaska sumnjive lezije, nadopunjuje multifaznim CT i MR pregledom radi daljnje evaluacije bolesti. Odabir terapijske metode ovisi o veličini i lokaciji tumora, ekstraheptalnom širenju i priležećoj bolesti jetre. Prema svim dosadašnjim smjernicama, liječenje je uključivalo kiruršku resekciju i transplantaciju jetre. U pacijenata s određenim stadijem bolesti danas je metoda odabira lokoregionalna terapija. Tehnike ablacije pogodne su za pacijente u vrlo ranoj fazi bolesti. Transarterijska embolizacija (TACE) je metoda odabira kod pacijenata s multifokalnim HCC-om održane jetrene funkcije, nepodobnih za operaciju. Primjena lokoregionalne terapije s kombinacijom ostalih tehnika pridonosi boljoj rezoluciji bolesti s boljim ishodima preživljenja. U prikazanom slučaju, pratimo pacijenticu s HCCom u podlozi hepatitis C virusne (HCV) infekcije kod koje se, odlukom multidisciplinarnog tima, odlučilo na lokoregionalnu terapiju naizmjeničnom kombinacijom mikrovalne ablacije i TACE kod recidivirajućeg HCC-a

Videotorakoskopska biopsija pluća i pleure u dijagnostici kroničnih izljeva prsišta

Chronic pleural effusion requires pleural and lung biopsy in more than 60% of patients. Open lung biopsy was formerly considered as the most reliable diagnostic method, whereas now the procedure is mostly performed via video-assisted thoracoscopy. During the last ten-year period (1995­-2005), 96 patients aged 31-72 (mean age 53) years were operated on at University Department of Thoracic Surgery, Jordanovac University Hospital for Lung Diseases by video-assisted thoracoscopy in general anesthesia. All biopsies were done by clamp sampling from parietal or visceral pleura, and in 31 patients lung tissue was sampled by endostapler wedge resection. Conversion to mini-thoracotomy was needed in only 12 patients, due to massive adhesions. Tissue samples were referred for histopathologic analysis. After the procedure, the patients had a thoracic drain connected to negative pressure. Histopathologic diagnosis was made in almost all patients, yielding a 97% success rate. In 16 patients, drain airflow had to be prolonged to more than 5 days, while the mean drainage duration was 4 days and mean hospital stay 8 days. Talc pleurodesis was performed in most patients with malignant effusion to stop effusion accumulation. Video-assisted thoracoscopic biopsy allows for adequate pleural and lung sampling with a high rate of accuracy. Postoperative mortality and morbidity are lower in comparison with open lung biopsy. It is concluded that video-assisted thoracoscopic biopsy is an efficient and safe method in the diagnosis of chronic pleural effusion.Dugotrajni izljevi pleuralne šupljine zahtijevaju biopsiju pleure i pluća kod više od 60% bolesnika. Ranije se otvorena biopsija pluća smatrala najpouzdanijom dijagnostičkom metodom, dok se danas taj zahvat najčešće izvodi videotorakoskopskim putem. U zadnjih deset godina, od 1995. do 2005. godine, u Klinici za torakalnu kirurgiju "Jordanovac" operirano je videotorakoskopskim načinom 96 bolesnika u općoj anesteziji. Prosječna životna dob bila je 53 godine, s rasponom od 31-72 godina. Sve biopsije su rađene uzimanjem uzoraka hvataljkom s parijetalne ili visceralne pleure, a kod 31 bolesnika uzet je i komadić plućevine klinastom resekcijom uz pomoć endostaplera. Samo kod 12 bolesnika učinjena je konverzija u minitorakotomiju zbog opsežnih priraslica. Svi uzorci su upućeni na patohistološku analizu. Nakon zahvata svaki bolesnik je imao torakalni dren koji je spojen na negativni tlak. Histopatološka dijagnoza postavljena je kod gotovo svih bolesnika, tako da je uspješnost zahvata bila 97%. Kod 16 bolesnika postojao je produženi protok zraka na dren kroz više od pet dana, dok je prosječno vrijeme drenaže iznosilo 4 dana, a prosječni boravak u bolnici 8 dana. Kod većine bolesnika s malignim izljevom rađena je pleurodeza talkom kako bi prestalo nakupljanje izljeva. Videotorakoskopska biopsija omogućava uzimanje kvalitetnog uzorka pleure i plućevine (bioptata) uz visok postotak točnosti. Poslijeoperacijska smrtnost i pobol bili su niži nego kod otvorene biopsije pluća. Zaključak je da je videotorakoskopska biopsija pluća učinkovita i sigurna metoda u dijagnostici kroničnog pleuralnog izljeva

The effect of massage before activities on neuromuscular activation

Masaža se oduvijek koristi u procesu pripreme sportaša. Koristi se prije i poslije aktivnosti. Koristi se kao metoda pasivnog zagrijavanja, a spoznaje o učinku masaže koja se provodi neposredno prije aktivnosti, na motoričku izvedbu kontradiktorne su. Cilj ovoga rada je utvrditi utjecaj različitih vrsta masaža (klasične i aktivacijske) na živčano mišićnu funkciju tjelesno aktivnih osoba. Testirala se eksplozivna jakost, agilnost, te brzina trčanja na 5, 10 i 20 m. Primjenom t-testa za zavisne uzorke, utvrđeno je negativno djelovanje masaže na živčano-mišićnu funkciju zdravih, tjelesno aktivnih osoba. Specifično, primjena klasične masaže dovela je do znatnog pogoršanja eksplozivne jakosti tipa skočnosti i agilnosti dok nije utjecala na brzinu trčanja. Primjena aktivacijske masaže dovela je do znatnog pogoršanja eksplozivne jakosti tipa skočnosti, i brzine trčanja na 5, 10 i 20 metara, bez znatnog utjecaja na agilnost. Usporedbom dvaju masaža utvrđen je znatno veći negativan utjecaj klasične masaže na agilnost, u odnosu na aktivacijsku masažu.Massage has always been used in the process of physical conditioning, before and after training. It is used as a method of passive warm-up, however the knowledge about the effect of massage, which is performed immediately before the activity, on motor performance is contradictory. The aim of this paper is to determine the influence of different types of massages (classical and activation) on the neuromuscular function of physically active individuals. Explosive strength, agility, and running speed at 5, 10 and 20 m were tested. T-test for dependent samples, found a negative effect of massage on the neuromuscular function of healthy, physically active persons. Specifically, the application of classical massage led to a significant reduction in explosive strength and agility, with no change in running speed. The application of activation massage led to a significant reduction of explosive strength (measured by means of jumping and running tasks), without a significant impact on agility. By comparing the two massages, a significantly greater negative impact of classical massage on agility was found, compared to activation massage

Our Experience in the Management of Congenital Chest Wall Deformities

Deformiteti stijenke prsnog koša su relativno rijetke bolesti nepoznate etiologije koje se javljaju u djetinjstvu i adolescenciji. Primjetna je obiteljska pojavnost deformiteta uz vrlo rijetko spontano izlječenje. Kirurško liječenje predstavlja jedinu mogućnost ispravljanja deformiteta bilo klasičnim operacijskim načinom ili minimalno invazivnom metodom liječenja (endoskopskim putem). Među kirurzima nema ujednačenog stava o tome u kojem je životom razdoblju najbolje učiniti ispravljanje deformiteta, jer su rezultati vrlo dobri bez obzira na primijenjenu metodu liječenja. U ovom radu prikazani su rezultati liječenja kod 105 bolesnika operiranih klasičnim načinom između 1985. i 2005. godine u Klinici za torakalnu kirurgiju Kliničke bolnice za plućne bolesti „Jordanovac“.Chest wall deformities are relatively rare diseases of unknown etiology, which occur in childhood and adolescence. Pectus deformities show familial occurrence with very rare spontaneous resolution. Operative treatment is one of the possible therapeutic options for deformity correction by classic operative procedure or by minimally invasive method of treatment (endoscopic). There is no consensus among surgeons about the age at which correction of the chest wall deformity should best be performed because therapeutic results are very good irrespective of the method of treatment employed. Therapeutic results in 105 patients operated on by the classic method during the 1985-2005 period at University Department of Thoracic Surgery, Jordanovac University Hospital for Lung Diseases in Zagreb, Croatia, are reported

Can contrast enhanced ultrasound replace computed tomography angiography in endoleak surveillance in post-EVAR patients? – a literature review

Cilj: Kompjutorizirana tomografska angiografija (CTA) zlatni je standard za otkrivanje endoleaka nakon endovaskularnog liječenja aorte (EVAR). Cilj je ovog rada utvrditi može li kontrastni ultrazvuk (CEUS) zamijeniti CTA u dijagnostici endoleaka nakon EVAR-a. Materijali i metode: Pregled literature na engleskom jeziku proveden je u bazama podataka: PubMed/MEDLINE, ScienceDirect, Google Scholar. Ključne riječi bile su: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studije koje su odgovarale kriterijima uključivanja recenzirane su u cijelosti te je odabrano 39 studija. Rezultati: Pacijenti su u analiziranim studijama najvećim dijelom bili muškarci (86 %). Medijan dobi iznosio je 74 godine. Endoleak nakon EVAR-a promatran je u infrarenalnih (79 %), jukstarenalnih (17 %) i suprarenalnih aneurizama (4 %). Stopa endoleaka kretala se između 3 i 52 %. Najčešći endoleak bio je po tipu II te se u 15 % slučajeva javljao unutar prvih šest mjeseci, odnosno u manje od 10 % slučajeva unutar dvije godine nakon EVAR-a. Za sve tipove endoleaka CEUS je pokazao uravnoteženu osjetljivost, specifičnost i područje ispod krivulje od 94 %, 88 % i 96 %. U odnosu na CTA, CEUS ima veću osjetljivost (94/83 %), ali lošiju specifičnost (94,8/99 %). Specifično za tip II endoleaka, CEUS je imao veću stopu detekcije (36,88/20,88 %). Visoka osjetljivost (97 %) i specifičnost (100 %) obilježje su CEUS-a u prikazu endoleaka tipa I i III, bez prednosti u odnosu na CTA. Zaključci: CEUS je slikovna metoda ravnopravna CTA u probiru pacijenata za endoleak nakon EVAR-a. CEUS ne može u potpunosti nadomjestiti CTA, no sigurna je i efikasna alternativa za korištenje u pacijenata bez CTA komplikacija nakon jednogodišnjeg kontrolnog intervala.Aim: Computed tomography angiography (CTA) is the mainstay in endoleak detection after endovascular aneurysm repair (EVAR). The objective of this review is to determine if contrast enhanced ultrasound (CEUS) is able to replace CTA in monitoring endoleaks in patients after EVAR. Materials and methods: The literature search of Englishlanguage articles was conducted in PubMed/MEDLINE, ScienceDirect, Google Scholar. The used keywords included: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studies appearing to meet inclusion criteria were reviewed in full and 39 studies were included. Results: In analysed studies, patients were predominantly men (86%) and median age was 74 years. Endoleak after EVAR was followed in infrarenal (79%), juxtarenal (17%) and suprarenal aneurysms (4%). Endoleak detection rate was 3-52%. Type II endoleaks were the most frequently encountered – in 15% of cases during the first six months and in less than 10% of cases during the first two years after EVAR. In diagnosing all endoleaks, CEUS demonstrated sensitivity, specificity, and AUC of 94%, 88%, 96%, respectively. Compared to CTA, CEUS possesses higher sensitivity (94/83%), but lesser specificity (94.8/99%). Particularly in type II endoleak evaluation, CEUS provided higher detection rates (36.88/20.88%). Regarding type I and type III endoleaks, CEUS demonstrated high sensitivity (97%) and specificity (100%), but without superiority over CTA. Conclusions: CEUS is an imaging technique equivalent to CTA in screening for post-EVAR endoleaks. CTA cannot be entirely replaced by CEUS; however, it is safe and effective alternative method to use after one year of negative CTA exams

Embolisation of pulmonary arteriovenous malformations : case series

Purpose: Pulmonary arteriovenous malformations (PAVM) are the direct communications between the pulmonary arteries and veins. These malformations can cause serious complications, and most of these patients should be treated. Herein we present our experience in the treatment of 18 cases of PAVM, treated with endovascular embolisation. Material and methods: Eighteen patients with PAVMs underwent endovascular embolisation during a five-year period. Eight were male and 10 were female, with ages ranging from 16 to 65 years. Standard steel coils and vascular plug were used for embolisation. Results: Embolisation was successful in 17 of 18 patients. Coiling was used in 10 patients, vascular plug in five, and both materials in two patients. All symptomatic patients with successful embolisation lost all their symptoms after treatment. Control angiography after embolisation showed a closure of AV shunt without migration of embolic material in all patients. Post-embolisation syndrome developed in four patients and late onset of pleural pain in three patients. There was no connection between pleural reaction and type of PAVM and embolic material. Conclusions: Endovascular PAVM treatment is a minimally invasive, highly successful method with a low rate of only transitory complications

The effect of massage before activities on neuromuscular activation

Masaža se oduvijek koristi u procesu pripreme sportaša. Koristi se prije i poslije aktivnosti. Koristi se kao metoda pasivnog zagrijavanja, a spoznaje o učinku masaže koja se provodi neposredno prije aktivnosti, na motoričku izvedbu kontradiktorne su. Cilj ovoga rada je utvrditi utjecaj različitih vrsta masaža (klasične i aktivacijske) na živčano mišićnu funkciju tjelesno aktivnih osoba. Testirala se eksplozivna jakost, agilnost, te brzina trčanja na 5, 10 i 20 m. Primjenom t-testa za zavisne uzorke, utvrđeno je negativno djelovanje masaže na živčano-mišićnu funkciju zdravih, tjelesno aktivnih osoba. Specifično, primjena klasične masaže dovela je do znatnog pogoršanja eksplozivne jakosti tipa skočnosti i agilnosti dok nije utjecala na brzinu trčanja. Primjena aktivacijske masaže dovela je do znatnog pogoršanja eksplozivne jakosti tipa skočnosti, i brzine trčanja na 5, 10 i 20 metara, bez znatnog utjecaja na agilnost. Usporedbom dvaju masaža utvrđen je znatno veći negativan utjecaj klasične masaže na agilnost, u odnosu na aktivacijsku masažu.Massage has always been used in the process of physical conditioning, before and after training. It is used as a method of passive warm-up, however the knowledge about the effect of massage, which is performed immediately before the activity, on motor performance is contradictory. The aim of this paper is to determine the influence of different types of massages (classical and activation) on the neuromuscular function of physically active individuals. Explosive strength, agility, and running speed at 5, 10 and 20 m were tested. T-test for dependent samples, found a negative effect of massage on the neuromuscular function of healthy, physically active persons. Specifically, the application of classical massage led to a significant reduction in explosive strength and agility, with no change in running speed. The application of activation massage led to a significant reduction of explosive strength (measured by means of jumping and running tasks), without a significant impact on agility. By comparing the two massages, a significantly greater negative impact of classical massage on agility was found, compared to activation massage

Magnetna rezonanca dojki – gdje smo 2021?

Magnetic resonance imaging (MRI) is a sensitive and safe radiological method for breast and axillar lymph node imaging. MRI is widely used for diagnostics and follow-up of breast cancer candidates for neoadjuvant chemotherapy. MRI is used to assess tumor response to chemotherapy in these patients and help plan the type of surgical procedure needed after the therapy. Also, preoperative MRI changes the surgical approach in 11-16% of the cases and depicts the occult tumor in the contralateral breast in 3-4% of patients whose primary treatment is surgery. Several studies in recent years, some on more than a thousand patients, have shown usefulness of breast MRI for planning surgical approaches reducing the number of patients with positive resection margins, thus reducing the number of patients who need reoperation. In future, we should aim to include MRI of the breast as a diagnostic tool in more, if not all, patients diagnosed with breast cancer.Magnetna rezonanca (MR) dojki je dobra i sigurna radiološka metoda oslikavanja dojki i aksila. Opće je prihvaćen u dijagnostici i praćenju pacijentica koje su kandidati za neodjuvantnu kemoterapiju raka dojke. MR se kod ovih pacijentica koristi za procjenu odgovora tumora na liječenje, te za planiranje opsega kirurškog zahvata nakon provedenog neoadjuvantnog liječenja. MR dojki kod pacijentica koje su kandidatkinje za primarno kirurško liječenje mijenja kirurški pristup u oko 11 do 16% slučajeva, dok u oko 3-4 % slučajeva otkriva i dotad nedijagnosticirani proces kontralateralne dojke. Recentnija istraživanja proteklih nekoliko godina, od kojih neka i na više tisuća pacijentica ipak pokazuju značajnu korisnost MR-e dojki u planiranju opsega operativnog zahvata i kod svih pacijentica s ranim rakom dojke koje su kandidatkinje za kirurško liječenje, sa smanjenjem stope pozitivnih resekcijskih rubova na operaciji, te smanjenjem broja potrebnih reoperacija. U budućnosti bi bilo korisno uvesti pregled MR-om za veći broj, ako ne i za sve pacijentice s dijagnosticiranim rakom dojke prije početka liječenja

ERRATA CORRIGE - Significance of interventional radiology in liver transplantation

The KEYWORDS of this article on page 87 as listed are first-line treatment, metastatic urothelial bladder cancer, maintenance immunotherapy. Keywords have been corrected to: transplantation, chemoembolization, radioembolization, ablation

Značaj intervencijske radiologije u transplantaciji jetre

Liver transplantation is a method that allows treating of various liver pathological conditions. Interventional radiology (IR) focuses on oncology patients, primarily those with hepatocellular carcinoma. The importance of interventional radiology techniques is in preventing the progression of current liver disease in those patients awaiting liver transplantation and downstaging in patients with unresectable liver tumors to the stage where transplantation is possible. Chemoembolization (TACE), i.e., conventional transarterial chemoembolization (cTACE) or with drug particles (DEBTACE), radioembolization (SIRT), BLAND embolization, radiofrequency ablation (RFA), and microwave ablation (MWA) are the most widely used IR methods in the treatment of liver cancer. cTACE is a form of TACE in which a high dose of cytostatic is injected into the feeding vessel and the tumor’s microenvironment, and then the blood vessels that feed the tumor are embolized. DEB-TACE is a form of TACE in which a cytostatic bind to bead particles that gradually release the drug within the liver tumor itself after injection. BLAND embolization is an IR method of TACE based on ischemia of tumor tissue by IR procedure of embolization and occlusion of the feeding vessel that supplies the tumor, without the use of chemotherapeutics. Transarterial radioembolization is a method that uses endovascular techniques to bring radiospheres containing a radioactive substance near the tumor. Radiofrequency ablation (RFA) is an IR percutaneous method of treatment in which an RF needle inserted into a liver tumor releases heat that causes coagulation necrosis of tumor cells. MWA is an IR percutaneous method of treatment that uses molecules with an internal dipole moment, which move kinetic energy and then heat inside the tumor via a percutaneously inserted MWA needle into the tumor.Transplantacija jetre je metoda koja omogućuje liječenje brojnih jetrenih patoloških stanja. Intervencijska radiologija (IR) najveći značaj pruža liječenju onkoloških pacijenata, najčešće onima s hepatocelularnim karcinomom. Odlike interventnih radioloških tehnika ogledaju se ponajprije u prevenciji progresije trenutne jetrene bolesti te smanjenju stupnja proširenosti tumorske bolesti. U najčešće korištene IR metode u liječenju jetrenih tumora svrstavaju se transarterijska kemoembolizacija (TACE), tj. konvencionalna transarterijska kemoembolizacija (cTACE) ili TACE česticama koje sadržavaju citostatik (DEB-TACE), radioembolizacija, BLAND embolizacija, radiofrekvencijska ablacija (RFA) te mikrovalna ablacija (MWA). cTACE metoda konvencionalni je oblik TACE metode temeljen na lokalnoj aplikaciji citostatika u mikrookoliš tumora te embolizaciji krvnih žila koje opskrbljuju tumor. DEB-TACE metoda zasniva se na lokalnoj aplikaciji čestica ispunjenih citostatikom koje omogućavaju konstantno otpuštanje lijeka u tumorski mikrookoliš. BLAND embolizacijom emboliziraju se krvne žile koje opskrbljuju tumor što rezultira tumorskom ishemijom. Transarterijska radioembolizacija metoda je kojom se radiosferama apliciraju radioaktivne supstance u tumorski mikrookoliš. RFA tehnika zasnovana je na aplikaciji toplinske energije kroz radiofrekvencijsku iglu uvedenu u jetreni tumor što rezultira koagulacijskom nekrozom tumora. MWA je metoda zasnovana na perkutanoj aplikaciji molekula sa unutarnjim dipolom koje u kombinaciji sa vanjskim promjenjivim poljem uzrokuju produkciju topline što rezultira nekrozom tumora