Ultrazvuk dijafragme dijagnostička je metoda kojom se može utvrditi dijafragmalna disfunkcija ili paraliza. Dijafragmalna disfunkcija može uzrokovati otežano disanje i intoleranciju napora. Rijetko ...se utvrđuje u kliničkoj praksi te prava incidencija nije poznata. Javlja se u nekih neuromišićnih bolesti poput multiple skleroze, amiotrofične lateralne skleroze, poliomijelitisa, lezije
N. phrenicusa
te u nekih bolesti vezivnog tkiva, plućnim bolestima ili idiopatski. Za razliku od ranije upotrebljavanih metoda procjene dijafragmalne funkcije poput elektromiografije, mjerenja transdijafragmalnog tlaka i fluoroskopije, ultrazvuk je neinvazivna i jednostavna pretraga koja ne izlaže bolesnike ionizirajućem zračenju. Cilj je ovog rada opisati pregled dijafragme ultrazvučnom metodom te primjenu ultrazvuka u kliničkoj praksi uz pregled literature.
Ultrasound of the diaphragm is a diagnostic method that can determine diaphragmatic dysfunction or paralysis. Diaphragmatic dysfunction can cause dyspnea and exercise intolerance. It is rarely diagnosed in clinical practice and the true incidence is unknown. It can occur in some neuromuscular diseases such as multiple sclerosis, amyotrophic lateral sclerosis, poliomyelitis, phrenic nerve lesions, and in some connective tissue diseases, lung diseases or it can be idiopathic. Unlike previously used diagnostic methods of assessing diaphragmatic function such as electromyography, transdiaphragmatic pressure measurement and fluoroscopy, ultrasound is a fast, non-invasive and simple examination, which does not expose patients to ionizing radiation. The aim of this review is to describe the examination of the diaphragm using the ultrasound method and its application in clinical practice along with a review of the literature.
U ovome radu prikazujemo bolesnicu u kliničkoj slici akutnog abdomena koja se razvila zbog rupture apscesa jetre s posljedicom plinske embolije u sustavu portalne vene te doprinos i mogućnosti ...radiološke dijagnostike u hitnoj bolničkoj obradi. U etiopatogenetskoj podlozi kolangitisa i razvoja apscesa jetre utvrđena je kronična bilijarna litijaza s intermitentnim opstrukcijama u hepatoduodenalnoj cirkulaciji žuči. Anatomske karakteristike sustava portalne vene i njegovih anastomoza sa sistemskom cirkulacijom predstavljaju supstrat za razvoj ozbiljnih posljedica plinske embolije na drugim organskim sustavima, primjerice, u obliku infarkta bubrega i infarkta slezene, što je radiološkim dijagnostičkim metodama dokazano u ovome slučaju.
The diaphragm is the most important muscle in respiration. Nevertheless, its function is rarely evaluated. Patients with systemic sclerosis (SSc) could be at risk of diaphragmatic dysfunction because ...of multiple factors. These patients often develop interstitial lung disease (SSc-ILD) and earlier studies have indicated that patients with different ILDs have decreased diaphragmatic mobility on ultrasound (US). This study aimed to evaluate diaphragmatic function in SSc patients using US with regard to the ILD, evaluated with the Warrick score on high-resolution computed tomography (HRCT), and to investigate associations between ultrasonic parameters and dyspnea, lung function, and other important clinical parameters. In this cross-sectional study, we analyzed diaphragm mobility, thickness, lung function, HRCT findings, Modified Medical Research Council (mMRC) dyspnea scale, modified Rodnan skin score (mRSS), autoantibodies, and esophageal diameters on HRCT in patients with SSc. Fifty patients were enrolled in the study. Patients with SSc-ILD had lower diaphragmatic mobility in deep breathing than patients without ILD. The results demonstrated negative correlations between diaphragmatic mobility and mMRC, mRSS, anti-Scl-70 antibodies, esophageal diameters on HRCT, and a positive correlation with lung function. Patients with SSc who experience dyspnea should be evaluated for diaphragmatic dysfunction for accurate symptom phenotyping and personalized pulmonary rehabilitation treatment.
Cancer-induced cachexia is associated with poor prognosis in patients with non-Hodgkin lymphoma, but it is unknown how and to what extent curable lymphoma treatments affect the musculoskeletal ...system.
We retrospectively analyzed 104 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients with unfavorable disease features treated with the R-DA-EPOCH regimen. Psoas muscle area (PMA) measured at L3 vertebra level was compared between staging (pre-therapy) and revision (end of treatment) computerized tomography (CT) scans.
Small but significant decline in PMA was observed during the immunochemotherapy period (average loss 5%;
=0.016) with 57.7% of patients experiencing muscle loss. Higher body surface area (OR=17.98 for each m
;
=0.034), number of cycles with dose reduction (OR=2.86 for each cycle;
=0.039) and worse response to therapy (OR=3.09 for each response category;
=0.052) were recognized as independent contributors to the PMA loss in multivariate analysis. One quarter of patients had more pronounced PMA loss (≥21%), which was associated with significantly worse overall and progression-free survival. Both ≥21% PMA loss and non-achieving response to therapy remained independently associated with inferior OS (PMA loss HR=2.98;
=0.016 and achieving response HR=0.04;
<0.001) and PFS (PMA loss HR=3.16;
=0.005 and achieving response HR=0.08;
=0.001) in multivariate analyses.
Muscle loss occurs in approximately half of newly diagnosed DLBCL patients with unfavorable disease features during R-DA-EPOCH immunochemotherapy. If pronounced, this is associated with worse clinical outcomes irrespectively of achieved response to therapy. Muscle loss seems to be mostly affected by the efficacy and tolerability of the regimen.
Summary
We retrospectively investigated clinical and prognostic significance of psoas muscle index (PMI) calculated as total psoas muscle area at L3 vertebra level obtained from baseline computed ...tomography (CT) scans in 49 newly diagnosed classical Hodgkinʼs lymphoma (cHL) patients prior to specific treatment. Median PMI was 572.5 mm
2
/m
2
and was significantly higher in males (
P
< 0.001), patients with higher body mass index (BMI,
P
< 0.001), absence of extranodal disease (
P
= 0.037), higher absolute lymphocyte count (
P
= 0.037), higher hemoglobin (
P
= 0.010) and lower lactate dehydrogenase (LDH,
P
= 0.050). There were no significant associations with age, disease subtype, presence of constitutional symptoms, Ann Arbor disease stage, presence of advanced disease or international prognostic score. Patients with lower PMI had significantly worse PFS (hazard ratio HR 4.91;
P
= 0.009). This phenomenon persisted in the multivariate model (HR = 5.09;
P
= 0.042) adjusted for International Prognostic Score (IPS) and chemotherapy type.
We retrospectively analyzed perirenal and subcutaneous fat thickness and their dynamics from baseline to end-of-treatment computerized-tomography scans in a cohort of 118 newly diagnosed diffuse ...large B-cell lymphoma (DLBCL) patients with unfavorable features treated with R-DA-EPOCH regimen. Higher revised-international-prognostic-index (R-IPI) score was significantly associated with higher baseline perirenal and lower subcutaneous fat thickness. Up to 51% patients experienced perirenal and 40% subcutaneous fat-tissue loss during immunochemotherapy period. R-DA-EPOCH feasibility, toxicity and obtained response to therapy did not significantly differ regarding baseline perirenal and subcutaneous fat measurements whereas higher number of febrile-neutropenia cycles was associated with more pronounced subcutaneous fat loss. In multivariate-analyses subcutaneous fat loss of ≥6% (hazard-ratio (HR) =4.58, p < 0.001) and achieving response to therapy (HR = 0.03, p < 0.001) predicted overall-survival, and baseline subcutaneous fat thickness ≤24 mm (HR = 3.14, p = 0.023), baseline minimal perirenal fat thickness ≤8 mm (HR = 2.44, p = 0.042) and achieving response to therapy (HR = 0.04, p < 0.001) predicted progression-free-survival independently of each other.
Cilj: Prikazati rezultate primjene kontrastnog ultrazvuka (engl. contrast-enhanced ultrasound – CEUS) u tercijarnom centru radi dijagnostičke karakterizacije jetrenih tumora. Bolesnici i metode: ...Retrospektivno su analizirani rezultati CEUS-a pri definiranju vrste jetrenih tumora u sukcesivno uključenoj kohorti bolesnika (od 1. siječnja 2015. do 31. prosinca 2016. godine). Definitivna dijagnoza vrste tumora postavljena je na temelju standardizirane kliničke obrade, što je uključivalo pregled magnetskom rezonancijom i/ili višeslojnim CT-om, tkivno uzorkovanje (biopsija ili citološka punkcija) u slučajevima kada nalaz nije bio jasan te patohistološku analizu reseciranog materijala operiranih bolesnika. Rezultati: U 90 bolesnika (48 M, 42 Ž, 57 ± 15 godina) analizirana su
132 jetrena tumora (68 benignih i 64 maligna), prosječne veličine 30 (8 – 130) mm. Nalaz CEUS-a imao je visoku točnost (senzitivnost 98,44%, specifičnost 83,82%, površina ispod krivulje ROC 0,91) za razlikovanje benignih tumora od malignih. Zaključak: Rezultati našeg Centra potvrđuju visoku dijagnostičku točnost i neškodljivost CEUS-a u karakterizaciji jetrenih tumora.
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