The case of vascular reconstruction of the superior mesenteric and portal vein confluence using a left renal vein (LRV) graft has been researched in this paper. The patient was a 66-year-old female ...who presented with features of biliary obstruction. A contrast-enhanced computed tomography scan revealed bile duct dilatation and a common bile duct tumor mass. Four years ago, she underwent stomach resection with subsequent Billroth II gastrojejunostomy due to gastric cancer. After surgical resection, on histopathological and immunohistochemistry examination, a recurrence of previously resected poorly cohesive gastric cancer was found.
Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This article presents a case of a 35-year-old patient presenting with acute pancreatitis who subsequently developed a ...splenic vein thrombosis and splenic rupture requiring a laparotomy and splenectomy. This rare but life-threatening complication requires prompt recognition and management in patients with pancreatitis who develop sudden hemodynamic instability.
Abstract Background The standard first-line systemic treatment for patients with non-oncogene addicted advanced nonsquamous non-small cell lung cancer (NSCLC) is immunotherapy with immune checkpoint ...inhibitors (ICI) and/or chemotherapy (ChT). Therapy after failing ICI +/− ChT remains an open question, and docetaxel plus nintedanib represent a valid second line option. Patients and methods A multicenter retrospective trial of real-life treatment patterns and outcomes of patients with advanced lung adenocarcinoma treated with docetaxel plus nintedanib after the failure of ICI and/or ChT was performed. Patients from 2 Slovenian and 1 Croatian oncological center treated between June 2014 and August 2022 were enrolled. We assessed objective response (ORR), disease control rate (DCR), median progression free survival (PFS), median overall survival (OS), and safety profile of treatment. Results There were 96 patients included in the analysis, with ORR of 18.8%, DCR of 57.3%, median PFS of 3.0 months (95% CI: 3.0–5.0 months), and a median OS of 8.0 months (95% CI: 7.0–10.0 months). The majority of patients (n = 47,49%) received docetaxel plus nintedanib as third-line therapy. The ORR for this subset of patients was 19.1%, with a DCR of 57.4%. The highest response rate was observed in patients who received second-line docetaxel plus nintedanib after first-line combination of ChT-ICI therapy (n = 24), with an ORR of 29.2% and DCR of 66.7% and median PFS of 4.0 months (95% CI: 3.0–8.0 months). Fifty-three patients (55.2%) experienced adverse events (AEs), most frequently gastrointestinal; diarrhea (n = 29, 30.2%), and increased liver enzyme levels (n = 17, 17.7%). Conclusions The combination of docetaxel and nintedanib can be considered an effective therapy option with an acceptable toxicity profile for patients with advanced NSCLC after the failure of ICI +/− ChT.
Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, ...respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered
a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed.
Intramural duodenal hematoma (IDH) is a rare entity which is generally associated with trauma. Spontaneous (nontraumatic) intramural duodenal hematoma is associated with bleeding disorders, ...anticoagulation therapy, alcoholism, pancreatitis, tumors and duodenal ulcers. We report two cases of spontaneous intramural duodenal hematoma in middle-aged men who subsequently developed pancreatitis. The underlying pathophysiology is still unclear. In the cases described, it is not clear whether the intramural duodenal hematoma contributed to the development of pancreatitis or chronic pancreatitis has contributed to the development of IDH.
e21188
Background: Inflammatory cells have important effects on tumor development. Systemicinflammation markers can be used as prognostic factors. Numerous studiesshown that high pretreatment ...neutrophil-to-lymphocyte ratio (NLR) and/or platelet-to-lymphocyte ratio (PLR) levels are potential prognostic predictors for poor progression-free survival (PFS) and overall survival (OS) in NSCLC patients receiving immunotherapy. Methods: We performed a cohort study of patients with metastatic or recurrent NSCLC treated with nivolumab monotherapy in second‐line or further‐line treatment in Clinical hospital centre Zagreb. Pre-treatment NLR and PLR were calculated by division of neutrophils and platelets by lymphocytes measured in peripheral blood. Patients were categorized in two sub-groups according to their NLR and PLR values. In previous meta-analyses it was suggested that significant cut-off value of NLR is NLR < 5 and ≥5 and PLR < 160 and ≥160. We analysed PFS and OS. Results: Overall 105 patients diagnosed with NSCLC were treated with nivolumab. The patients were enrolled from March 2017 until October 2017 and were observed them for disease progression and death until June 1st 2020. Most of the patients were male (71; 67.6%) with median age 60.3 years (36-77). Our patients were selected on the basis of good performance status, so most of them had ECOG PS 0 and 1 (103; 98.1%). Therapy was applied mostly in the second and third line (67; 64%), but even up to seventh line (2; 1.9%). Median duration of therapy was 34.5 weeks (2-149), while median number of doses was 17 (1-69).The median PFS was 7.2 months (95% CI 4.53-9.86). Regardless of previous treatment the mOS was 16.1 months (95% CI 11.26-20.93).We observed median value of NLR 4.08 (IQR 2.44-5.84) and PLR 200 (IQR 127.49-284.72). Patients with low PLR had better overall survival compared to patients with low PLR (mOS 20.5 months vs 11.9 months; 95%CI 14.07-26.92 vs 7.35-16.44; p = 0.039). The same was not as clear in mPFS, tendency of better mPFS was toward low PLR, but it did not reach statistical difference (low PLR mPFS 9.1 months vs high PLR mPFS 6.1 months; p = 0.49).Patients with low NLR had significantly better overall survival compared to patients with high NLR (mOS low NLR 18.2 vs high NLR 10.1 months; 95%CI 13.07-23.32 vs 6.04-14.15; p = 0.014). Again, the statistical significance was not reached for progression-free survival (mPFS low NLR 8.3 months vs high NLR 5.8 months; 95%CI 4.81-11.78 vs 2.91-8.68; p = 0.214). Conclusions: Here, we demonstrated that the presence of indicators of systemic inflammation suchas high NLR and high PLR are associated with poor overall survival, but not withprogression-free survival in pre‐treated NSCLC patients who received nivolumabtreatment. The limitation of our study is the lack of a randomizedcontrol and small sample size. The main strength of our study is that it is real-worldeveryday clinical setting.
Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, ...respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered via a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed. Key words: Coronavirus disease 2019; Respiratory failure; Continuous positive airway pressure; Noninvasive mechanical ventilation; Noninvasive respiratory support Bolest uzrokovana novim koronavirusom 2019 (COVID-19) prezentira se sirokim rasponom simptoma, od asimptomatske bolesti do teske i progresivne intersticijske upale pluca. Kao dio intersticijske pneumonije respiracijska insufficijencija tipicno je obiljezena hipoksijom i najcesci je uzrok hospitalizacije. Kada terapija kisikom ne uspije, kontinuirani pozitivni tlak u disnim putovima (CPAP) ili neinvazivna mehanicka ventilacija (NIV) mjere su respiracijske potpore prvog izbora. Neinvazivna respiracijska potpora (NIRS) primjenjuje se kako bi se ustedjeli resursi jedinica intenzivnog lijecenja i izbjegle komplikacije povezane s invazivnom mehanickom ventilacijom. Uporaba CPAP-a ili NIV-a u lijecenju akutne hipoksemicne respiracijske insufficijencije kod COVID-19 smanjuje potrebu za intubacijom i smrtnost. Prednost NIRS-a je da se moze provoditi na odjelima. NIV se moze primijeniti preko maske ili kacige. Kaciga bolje prianja u odnosu na masku i stoga je smanjen gubitak zraka, isporuka pozitivnog tlaka na kraju izdisaja je tocnija, a rizik od nozokomijalnog prijenosa infekcija je manji. Bolesnici na NIRS-u moraju se pazljivo nadzirati kako se ne bi previdjelo daljnje respiracijsko pogorsanje i kako bi se mogle provesti dodatne mjere skrbi ukljucujuci pravodobnu intubaciju i invazivnu mehanicku ventilaciju. Kljucne rijeci: Bolest uzrokovana novim koronavirusom 2019; Respiracijska insufficijencija; Kontinuirani pozitivni tlak u disnim putovima; Neinvazivna mehanicka ventilacija; Neinvazivna respiracijska potpora
Plućni embolizam (PE) i pneumonija dijele zajedničke rizične faktore, uzajamno se potenciraju i slično radiološki manifestiraju. Klinička slika pneumonije može u potpunosti maskirati prateću PE što ...uz porast D-dimera uslijed upalnog zbivanja znatno otežava probir pacijenata koje je potrebno podvrgnuti slikovnim metodama dijagnostike. Još uvijek nije pronađeno neko karakteristično obilježje (niti granična vrijednost D-dimera) koje bi direktno sugeriralo prisutnost PE u osobe s pneumonijom. Prateća PE najčešće se javlja u starijih i bolesnika s komorbiditetima, a bol u prsima, dispneja i sinkopa češće su nego kod pneumonije bez PE. Pojavnost PE u bolesnika s pneumonijom uzrokovanom novim koronavirusom (COVID-19) značajno je veća nego u pneumonija uzrokovanih drugim uzročnicima i povezuje se s rizičnim faktorima poput muškog spola, višim razinama C-reaktivnog proteina te odgodom hospitalizacije. Primjena profilaktičke doze antikoagulantne terapije može reducirati učestalost PE u bolesnika s COVID-19 pneumonijom.
COVID-19 i pneumonija Pavliša, Gordana; Ljubičić, Lidija; Turk, Lana ...
Medicus (Zagreb, Croatia : 1992),
09/2020, Letnik:
29, Številka:
2 COVID-19
Journal Article
Recenzirano
Odprti dostop
Bolest uzrokovana novim koronavirusom 2019 (COVID-19) postala je prijetnja cijeloj svjetskoj populaciji. Njena česta komplikacija je upala pluća. Najčešći simptomi bolesti su povišena tjelesna ...temperatura, suhi kašalj, umor, iskašljavanje, zaduha. Rjeđi simptomi su glavobolja, suho grlo, probavne tegobe, simptomi gornjega dišnog puta, promjene u osjetu njuha i okusa. Starija dob i komorbiditeti kao što je visoki krvni tlak, šećerna bolest, kronične plućne bolesti, kardiovaskularne bolesti, srčane bolesti, pretilost predstavljaju značajni rizični faktor za bolesnike inficirane koronavirusom SARS-CoV-2. Uobičajeni laboratorijski nalazi uključuju limfopeniju, povišenu razinu C-reaktivnog proteina, feritina, aminotransferaza, laktat dehidrogenaze. Bolesnici koji razviju tešku kliničku sliku obično imaju brojne laboratorijske poremećaje što sugerira da SARS-CoV-2 infekcija može uzrokovati ozljedu stanične imunosti, aktivaciju koagulacije, oštećenje miokarda, jetre i bubrega. Najčešće komplikacije su akutni respiratorni distres sindrom, šok, aritmije, akutna ozljeda miokarda, akutno oštećenje bubrežne funkcije. Kompjuterizirana tomografija (CT) može biti korisna kao komplementarna metoda polimeraznoj lančanoj reakciji u realnom vremenu za dijagnozu COVID-19 pneumonije. Njezine glavne CT karakteristike su infiltrati tipa mliječnog stakla periferne i subpleuralne distribucije. Ova područja uzorka mliječnog stakla mogu se miješati s područjima žarišne konsolidacije i/ili se na njih superponiraju zadebljale intralobularne septe, što daje uzorak ludog popločenja.
In most patients with acute respiratory distress syndrome (ARDS), invasive mechanical ventilation is an inevitable treatment measure. It should be applied respecting the principles of protective ...ventilation to minimize lung injury induced by mechanical ventilation. Ventilation of ARDS patients in prone position improves respiratory mechanics and oxygenation; consequently, it facilitates ventilation and reduces the risk of lung damage associated with the use of mechanical ventilation. Nevertheless, the prone position is still rarely used. We present a patient with ARDS in whom prone positioning resulted in a rapid and significant improvement in ventilation, which was directly recorded by the adaptive mode of mechanical ventilation. A 41-year-old woman was admitted to ICU with rightsided pneumonia, sepsis and type 1 respiratory failure. Empiric antibiotic therapy was administered immediately, along with all supportive therapy. During the next 48 hours, her condition progressed to ARDS and hypercapnic respiratory failure. This led us to initiate invasive mechanical ventilation using adaptive support ventilation (ASV). Achieved tidal volumes of 244 ml (3.9ml/kg of Ideal Body Weight)were insufficient despite optimized ventilator settings. The patient was placed in a completely prone position. Soon after the prone positioning, improvement of ventilation parameters were observed. Using the same ventilation settings, with even lower generated pressure support, tidal volumes increased to 451 ml (7ml/kg of Ideal Body Weight). In the further clinical course, the patient’s condition gradually improved until complete recovery. The presented course of treatment shows how prone positioning can significantly improve respiratory mechanics and facilitate the achievement of adequate mechanical ventilation, which has been clearly demonstrated using the adaptive ventilation modality.
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