Tracheal measurements in the intensive care unit (ICU) are important for the choice of endotracheal tube and may correlate with patient demographic characteristics and infections. The study included ...42 surgical patients, age 60 48-71 years, who underwent diagnostic chest computed tomography (CT) scans during treatment in the ICU, Osijek University Hospital, in 2019 and 2020. CT scans were analyzed using AW Server 3.2. Measurement analysis showed that the diameters of the tracheobronchial tree, the length of the trachea and left main bronchus were significantly larger in men compared to women (p<0.05 all). The smallest tracheal upper diameter was 15.25 IQR 11.8-18.8 mm vs. 17.95 13.55-20.05 mm in septic and nonseptic patients, respectively (p=0.028). A total of 26 patients who underwent CT scans developed nosocomial pneumonia. It was right-sided in 15, left-sided in 6 and bilateral in 5 patients, and correlated significantly with the left main bronchus length (rho=0.515, p=0.007). No correlation was observed between tracheobronchial measurements and length of ICU treatment, number of hours spent on mechanical ventilation, or survival. A larger study could provide better data on the importance of tracheobronchial tree measurements in ICU patients. Key words: Trachea; Bronchi; Pneumonia, bacterial; Intensive care unit; Tomography, x-ray computed; Comorbidity Izmjere traheje u jedinici intenzivnog lijecenja (JIL) vazne su zbog odabira velicine tubusa te mogu korelirati s demografskim obiljezjima bolesnika i infekcijama. U ovoj studiji su analizirana 42 kirurska bolesnika u dobi od 60 48-71 godina kojima je ucinjena dijagnosticka kompjutorizirana tomografja (CT) prsnog kosa za vrijeme lijecenja u JIL-u Klinickog bolnickog centra Osijek tijekom 2019. i 2020. godine. Snimci CT-a su analizirani programom AW Server 3.2. Analiza izmjera pokazala je da su promjeri traheobronhalnog stabla, duljina dusnika i lijevog glavnog bronha znacajno veci kod muskaraca nego kod zena (p<0,05 za sve). Najuzi gornji promjer dusnika bio je 15,25 IQR 11,8-18,8 naspram 17,95 13,55-20,05 mm u septickih i neseptickih bolesnika (p=0,028). Kod ukupno 26 bolesnika koji su podvrgnuti CT-u tijekom lijecenja u JIL-u dijagnosticirana je pneumonija. Bila je desnostrana u 15, lijevostrana u 6, a obostrana u 5 bolesnika i znacajno je korelirala s duljinom lijevog glavnog bronha (p=0,515, p=0,007). Nije uocena korelacija izmedu traheobronhalnih mjerenja i duljine lijecenja u JIL-u, duljine mehanicke ventilacije ili prezivljenja. Veca studija bi mogla pruziti bolje podatke o znacenju dimenzija traheobronhalnog stabla kod kriticno oboljelih pacijenata. Kljucne rijeci: Traheja; Bronhi; Pneumonija, bakterijska; Jedinica intenzivnog lijecenja; Tomografja, rendgenska kompjutorizirana; Komorbiditet
Background
Monte Carlo (MC) simulations or measurements in anthropomorphic phantoms are recommended for estimating fetal dose in pregnant patients in radiotherapy. Among the many existing phantoms, ...there is no commercially available physical phantom representing the entire pregnant woman.
Purpose
In this study, the development of a low‐cost, physical pregnant female phantom was demonstrated using commercially available materials. This phantom is based on the previously published computational phantom.
Methods
Three tissue substitution materials (soft tissue, lung and bone tissue substitution) were developed. To verify Tena's substitution tissue materials, their radiation properties were assessed and compared to ICRP and ICRU materials using MC simulations in MV radiotherapy beams. Validation of the physical phantom was performed by comparing fetal doses obtained by measurements in the phantom with fetal doses obtained by MC simulations in computational phantom, during an MV photon breast radiotherapy treatment.
Results
Materials used for building Tena phantom are matched to ICRU materials using physical density, radiation absorption properties and effective atomic number. MC simulations showed that percentage depth doses of Tena and ICRU material comply within 5% for soft and lung tissue, up to 25 cm depth. In the bone tissue, the discrepancy is higher, but again within 5% up to the depth of 5 cm. When the phantom was used for fetal dose measurements in MV photon breast radiotherapy, measured fetal doses complied with fetal doses calculated using MC simulation within 15%.
Conclusions
Physical anthropomorphic phantom of pregnant patient can be manufactured using commercial materials and with low expenses. The files needed for 3D printing are now freely available. This enables further studies and comparison of numerical and physical experiments in diagnostic radiology or radiotherapy.
Cilj: Prikazati slučaj pacijenta obrađenog zbog gubitka na tjelesnoj masi i anksioznosti kojemu je utvrđen tumor srži nadbubrežne žlijezde, a naknadnim uvidom u medicinsku dokumentaciju utvrđene su i ...višegodišnje povremene palpitacije, tahikardije i skokovi tlaka. Prikaz slučaja: Prikazan je šezdesetdvogodišnji pacijent koji se žalio na oslabljen apetit unatrag 3 mjeseca, gubitak na tjelesnoj masi 10 kg te anksioznost. Ultrazvukom abdomena utvrđena je, a kompjutoriziranom tomografijom (CT) abdomena potvrđena, oštro ograničena heterogena tvorba desne nadbubrežne žlijezde promjera 4,2 x 5 cm i denziteta 26 Hounsfieldovih jedinica. Iz medicinske dokumentacije saznaje se da je prethodnih 4 godina povremeno imao palpitacije i supraventrikularne tahikardije s vrijednostima krvnog tlaka do 190/100 mmHg. Endokrinološkom obradom utvrđene su povišene vrijednosti metanefrina i normetanefrina u plazmi (12 i 9 puta). Nakon operacije patohistološki je potvrđena dijagnoza feokromocitoma. Kontrolni nalazi metanefrina i normetanefrina bili su uredni. Planira se kontrola metanefrina i normetanefrina u plazmi jedanput godišnje. Zaključak: U ovom prikazu slučaja želi se istaknuti važnost postavljanja sumnje i pravovremenog utvrđivanja feokromocitoma te sprječavanja mogućih komplikacija. Ako postoji klinička sumnja na feokromocitom ili je tijekom obrade incidentaloma nadbubrežne žlijezde CT-om isključeno da se radi o adenomu, potrebno je učiniti biokemijsku obradu feokromocitoma. Ako se ne prepoznaju na vrijeme, ovi tumori zbog svoje hipersekrecije katekolamina imaju visok kardiovaskularni morbiditet i mortalitet.
Aim: This case report presents a patient with diagnosed adrenal medulla mass. The patient presented with weight-loss and anxiety. Additional examination of medical records has revealed occasional palpitations, tachycardia and fluctuating blood pressure. Case report: A 62-year-old male patient presented with arterial hypertension, type 2 diabetes, hypercholesterolemia, anxiety, appetite and weight loss of 10 kg in three months. Adominal ultrasound showed and abdominal computerised tomography (CT) scan confirmed a sharply defined heterogenous mass on the right adrenal gland of 4.2x5 cm in diameter, with a density of 26 Hounsfield units. Medical records showed that during the previous four years the patient occasionally suffered from palpitation and supraventricular tachycardia with blood pressure levels up to 190/100mmHg. The laboratory analysis showed elevated plasma levels of metanephrine and normetanephrine (12 and 9 times). Following the surgery, the histopathological examination confirmed the diagnosis of pheochromocytoma. The metanephrine and normetanephrine follow-up results were normal. Annual follow-up is recommended once a year. Conclusion: This case study shows the importance of suspicion of pheochromocytoma with its early detection and the prevention of possible complications. If there is a clinical suspicion of pheochromocytoma or if CT scan rules out adenoma, a biochemical evaluation for pheochromocytoma is mandatory. Unless recognized on time, these tumors have high cardiovascular morbidity and mortality due to their hypersecretion of catecholamines.
Background: Leiomyosarcoma (LMS) is a rare malignancy that originates from smooth muscle. The most common sites of metastases include the lungs, liver, kidney, and skin. Notably, metastases of LMS to ...the central nervous system/or spine are extremely rare. When a cervical spinal LMS lesion was encountered, the patient successfully underwent gross total tumor resection with negative margins. Case Description: A 63-year-old female had undergone an anterior cervical C5–C7 diskectomy and fusion 18 years ago and resection of a retroperitoneal LMS 3 years ago. She newly presented with right-sided numbness and pain of 2 months duration that correlated with a focal right-sided C5-level hemiparesis (i.e., 4/5 motor strength). When the cervical magnetic resonance demonstrated a right-sided C5 intralaminar mass with extension into the C5–C6 foramen, she underwent posterior tumor resection; pathologically, this proved to be an LMS metastasis. Respectively, 1- and six months postoperatively, follow-up magnetic resonance imaging scans showed no tumor recurrence; she tolerated adjuvant oncological treatment accompanied by physical therapy. However, in one postoperative year, the lesion recurred, and she is presently under consideration for additional surgical management. Conclusion: Gross total surgical resection is the first line of treatment for patients with metastatic LMS. Here, a patient with a C5 laminar/C5–C6 foraminal bony LMS metastasis underwent posterior tumor resection accompanied by adjuvant oncological treatment but exhibited disease recurrence within one postoperative year.
The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the ...SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (
= 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (
< 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38-0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.
A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with ...breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3−31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3−33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.
Streptococcus constellatus (SC) is a species of Streptococcus belonging to the Streptococcus anginosus group, along with Streptococcus anginosus and Streptococcus intermedius. Despite its commensal ...nature, underlying risk factors and medical conditions might lead to various anatomic site infections caused by this opportunistic pathogen. Although SC infections have mostly been associated with bacteremia, some case reports of abscess and empyema formation have been documented. Herein, we report a case of a middle-aged female patient who initially presented with radiculopathy symptoms. Subsequent neurologic imaging revealed a pyogenic abscess along paravertebral muscles, which was found to be caused by SC. The patient was successfully treated with abscess drainage from the lumbar zone and antibiotics, and the symptoms of radiculopathy have completely resolved.
Objectives of the study were to observe supraspinatus muscle thickness in patients with supraspinatus tendon pathology using ultrasound (US) and examining inter- and intra-rater reliability, and to ...compare muscle thickness with cross-sectional area (CSA) and occupation ratio measured by both US and magnetic resonance imaging (MRI). The investigation was designed as a prospective cohort study. Two groups of patients were included in the study: 43 patients with tendon rupture and 44 patients without tendon rupture as a control group. A written consent was obtained from all patients. In both groups, muscle thickness, CSA and occupation ratio were measured with US, and CSA and occupation ratio with MRI. Study results showed statistically significant between-group differences. The mean supraspinatus muscle thickness measured by US was 14.01 mm and 19.83 mm in patients with and without tendon rupture, respectively. CSA and occupation ratio measured by US and MRI also showed statistically significant between-group differences. Pearson correlation coefficient between supraspinatus thickness and occupation ratio and CSA measured by US and MRI showed strong to moderate correlation. US measurements showed moderate to strong intra- and inter-rater reliability. In conclusion, supraspinatus muscle thickness measurement by US is a reliable method for muscle atrophy evaluation and strongly correlates with other acknowledged methods.Ciljevi istrazivanja bili su mjerenje debljine misica supraspinatusa u bolesnika s patologijom tetive supraspinatusa pomocu ultrazvuka (UZV) i odredivanje reproducibilnosti metode izmedu ispitivaca i kod samih ispitivaca te usporedba mjerenja debljine misica s presjecnom povrsinom (CSA) i omjerom zauzeca fose supraspinatusa mjereno pomocu UZV i magnetskom rezonancijom (MR). Istrazivanje je provedeno kao prospektivna kohortna studija u koju su bile ukljucene dvije skupine ispitanika: 43 ispitanika s rupturom tetive supraspinatusa i 44 ispitanika bez takve patologije kao kontrolna skupina. Svaki ispitanik je potpisao pristanak za sudjelovanje u ispitivanju. Debljina misica, CSA i fosa supraspinatusa te omjer zauzeca izmjereni su u objema skupinama pomocu UZV, a CSA misica i fose supraspinatusa te omjer zauzeca pomocu MR. Rezultati su pokazali statisticki znacajnu razliku izmedu dviju skupina. U ispitanika s rupturom tetive prosjecna debljina misica supraspinatusa mjerena pomocu UZV bila je 14,01 mm, a u onih bez rupture 19,83 mm. CSA i omjer zauzeca izmjereni pomocu UZV i MR takoder su pokazali statisticki znacajnu razliku. Mjerenja pomocu UZV i MR pokazala su umjerenu do snaznu korelaciju. Reproducibilnost izmedu ispitivaca i kod pojedinog ispitivaca bila je visoka. U zakljucku, mjerenje debljine misica supraspinatusa pomocu UZV je pouzdana metoda za procjenu atrofije misica i snazno korelira s ostalim poznatim metodama.Key words: Rotator Cuff; Rotator Cuff Injuries; Ultrasonography; Magnetic Resonance Imaging; Tendon Injuries; Muscular AtrophyKljucne rijeci: rotatorna manseta; rotatorna manseta, ozljede; ultrazvuk; magnetska rezonancija, snimanje; tetive, ozljede; misicna atrofija
BACKGROUND: Women with breast cancer can experience changes in sexual functioning and body images that can seriously affect their quality of life.
AIM: The aim of this research was to study the ...quality of life and sexual functioning of women after a mastectomy and after a breast-conserving surgery and to compare post-operative quality of life.
SUBJECTS AND METHODS: This cross-sectional study included 204 participants, 101 patients after a mastectomy and 103 patients after a quadrantectomy. The research was conducted using the Croatian version of the questionnaire of the European Organization for Research and Treatment of Breast Cancer, the questionnaire with the breast cancer module EORTC QLQ - BR 23.
RESULTS: On the EORTC QLQ –BR23 scale, participants with mastectomy rated their sexual functioning (p < 0.001), sexual pleasure (p < 0.001), and systemic side effects (p = 0.04) lower comparing to women after breast-conserving surgery. The overall functionality scale was significantly lower (p = 0.03) for women who underwent mastectomy compared to those who underwent breast-conserving surgery. Participants under 51 years of age had worse body image 1 month after mastectomy (p = 0.006), while sexual functioning was better (p = 0.03) than in older age groups. In breast-conserving surgery group, 1 month after surgery, participants in the age group of 61 years and older assessed body image better (p = 0.04) than in the younger age group. Sexual functioning was rated better by women aged 51–60 years (p = 0.03).
CONCLUSION: Results of this study show that women after breast conserving surgery have better quality of life, better sexual functioning and less side effects of systemic therapy compared to women after mastectomy. The type of surgery, patient’s age and time passed after completion of treatment are important factors which influence sexual functioning and quality of life in breast cancer survivors.
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