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.
Bladder carcinoma incidence is on the rise making it the tenth most common and thirteenth deadliest carcinoma in the world. Transurethral resection of bladder tumor (TURBT) following a cystoscopy is ...the golden standard for diagnosis and treatment, despite it missing about 25% of muscle invasion of the bladder wall. This leads to understaging and increase of bladder carcinomas with unfavorable prognosis and elevating mortality. To avoid understaging a new and complementary method is needed. A new system called Vesical imaging reporting and data system (VI-RADS), based on multi-parametric magnetic resonance imaging (mpMRI) which suggests the probability of muscle invasion, could greatly improve diagnosis and treatment of bladder cancer.
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.
Incidencija karcinoma mjehura je u porastu te je danas deseti najčešći I trinaesti najsmrtonosniji karcinom na svijetu. Cistoskopska transureteralna resekcija tumora mjehura (TURBT) je zlatni ...standard u dijagnozi I liječenju, unatoč činjenici da ne detektira 25% slučajeva invazija mišića stjenke mjehura. To vodi do neadekvatnog staging-a tumora te povećanog broja karcinoma s nepovoljnom prognozom i povećanom smrtnošću. Kako bi se ovo izbjeglo nova i komplementarna metoda je potrebna. Novi sistem nazvan Vesical imaging reporting and data system (VI-RADS), koji se temelji na multi-parametrijskoj magnetskoj rezonanci (mpMRI) te procjenjuje vjerojatnost invazije mišića, mogao bi uvelike poboljšati dijagnozu i liječenje karcinoma mjehura.
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.
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.
INTRODUCTION Uhl’s anomaly is characterized by absence of the right ventricular myocardial layer. Although it appears to be of congenital origin, etiology is still uncertain. Patients usually present ...with congestive heart failure. Diagnosis is generally suggested by echocardiography. Medication treatment is only palliative, but surgical methods offer etiological cure.
Van Wyk-Grumbach syndrome (VWGS) is characterized by prolonged primary hypothyroidism, isosexual precocious pseudopuberty, delayed bone age with either enlarged multicystic ovaries in girls or ...enlarged testes in boys. Pathophysiology is most likely based on similarity of TSH and FSH glycoproteins and its binding to FSH receptors leading to precocious pseudopuberty. CASE REPORT A 8.5-year old girl was referred to endocrinologist due to hypothyroidism and obesity. She experienced fatigue, weakness, weight gain and growth retardation for 1.5 years prior to referral. At the examination she was short 110 cm(-3.7 SDS), obese 40.5 kg(+1.75 SDS) with bradycardia c/p 58/min; edematous, with dry skin, thin hair and hoarse voice. Breasts were Tanner II-III, with no pubic or axillary hair. Menarche occurred at the age of 8.3 years. Labs: TSH >100 mU/L(ref. 0.5-4.7), fT4 2.6 nmol/L(ref. 9-19), FSH 3.9 IU/L(ref. 0.4-3.5), anti-TG 18 IU/mL(ref. <4.1), anti-TPO 250 IU/mL(ref. <5), LH 0.1 IU/L(ref. 0.7-2.2), E 2 62 pmol/L(ref.<37), prolactin 43.3 μg/L(ref. 4.2-23.3). Estimated bone age was 6 years. Thyroid ultrasound revealed atrophic autoimmune thyroiditis. Pelvic ultrasound showed endometrial thickening with enlarged cystic ovaries. Subsequently, she was diagnosed with VWGS and L-thyroxine substitution was introduced. After 5 months on L-thyroxine she grew 7.5 cm, lost 7 kg and was clinically euthyroid. CONCLUSION Autoimmune thyroid disease is one of the most common endocrine disorders, characterized by gradual onset and relatively mild symptoms. VWGS represents its rare complication. Early recognition of VWGS and introduction of treatment is important in order to prevent unnecessary diagnostic and surgical procedures, and achieve excellent prognosis.
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