Acta clinica Croatica最新文献

{"title":"COMPUTED TOMOGRAPHY SCORING SCALES AS EARLY OUTCOME PREDICTORS IN PATIENTS WITH TRAUMATIC BRAIN INJURY: WHICH ONE TO USE?","authors":"Jagoš Golubović, Petar Vuleković, Djula Djilvesi, Nenad Krajčinović, Igor Horvat, Bojan Jelača, Filip Pajičić, Nebojša Lasica, Srđan Stošić, Ante Rotim, Lukas Rasulić","doi":"10.20471/acc.2024.63.02.11","DOIUrl":"10.20471/acc.2024.63.02.11","url":null,"abstract":"<p><p>Computed tomography (CT) is an essential tool in diagnosing and treating traumatic brain injury (TBI). Marshall CT classification, Rotterdam and Helsinki CT scores were consecutively developed as prediction outcome scales by computing TBI CT abnormalities. None of them classifies the pathological CT findings in the same manner. We aimed to determine which one is most accurate and has the best grading discriminatory power in determining early outcome. All TBI patients treated at a single center in a one-year period having undergone a CT scan on admission were retrospectively included. After calculation of all three scores, comparison among scale performances, as well as their accuracy in predicting patient 6-month outcome by the Glasgow Outcome Scale (GOS) was made. We used the Receiver Operating Characteristic curves to analyze correlation between all scales and early outcome. We calculated the area under the curve (AUC) to determine the power of each system while paired samples T-test was used to determine correlation among the scales. Mann-Whitney U test was performed to determine difference in outcome groups. A total of 1006 patients were included in final analysis. The mean patient age at presentation was 55.6 (±20.1) years, overall mortality was 6.4%, mean GOS was 3.00 (±1.4), and mean Glasgow Coma Score (GCS) was 13.9 (±0.2). Mortality was higher among patients with lower scores (p<0.01 all). The AUCs indicated that all scoring systems had a similarly high discriminative power in predicting early unfavorable outcome (Marshall AUC 0.86 <i>vs</i>. Rotterdam AUC 0.82 <i>vs</i>. Helsinki AUC 0.84). High correlation was found between Marshall and Rotterdam grading, r = 0.78, and moderate correlation between the other two pairs (Marshall <i>vs</i>. Helsinki, r=0.62, and Rotterdam <i>vs</i>. Helsinki, r=0.51). Additionally, low GCS and high injury severity score (ISS) could be identified as strong predictors of early death and poor outcome. In conclusion, all classification systems demonstrated a similar, strong predictive power for early outcome, but even greater discrimination results could be obtained if GCS and ISS were incorporated in the calculation. Helsinki CT score was least predictable of all three, and had the lowest correlation with the other two. Although Marshall CT classification was the oldest and simplest, it had at least the same prediction power as the newer scoring scales and should remain in use. Therefore, for prognostic purposes, this study recommends using one individual scale in clinical application to get the best possible prediction for TBI.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"351-357"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ENDOSCOPIC TREATMENT OF INTRALUMINAL DUODENAL DIVERTICULUM: A CASE REPORT.","authors":"Ivan Budimir, Filip Babić, Vedran Tomašić, Petra Ćaćić, Ivana Bešlić, Pierre Henri Deprez","doi":"10.20471/acc.2024.63.02.19","DOIUrl":"10.20471/acc.2024.63.02.19","url":null,"abstract":"<p><p>Intraluminal duodenal diverticulum is a rare entity that may cause recurrent pancreatitis. We report a case of a 36-year-old female admitted with etiologically unclear, recurrent pancreatitis. Radiographic study and endoscopy revealed a sac-like structure of the second portion of the duodenum near the minor duodenal papilla. Endoscopic diverticulotomy was successfully performed. No complications were observed and the patient was discharged home a day later. After 62-month follow-up, the patient was active and without symptoms. To our knowledge, this is the first reported case of recurrent pancreatitis caused by intraluminal duodenal diverticulum near the minor duodenal papilla, treated with endoscopic diverticulotomy performed from the apex to the base of the diverticulum.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"418-421"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF BODY MASS INDEX ON FUNCTIONAL RECOVERY AFTER TOTAL KNEE REPLACEMENT.","authors":"Mirhada Mešanović, Mirela Vučković, Snježana Schuster","doi":"10.20471/acc.2024.63.02.9","DOIUrl":"10.20471/acc.2024.63.02.9","url":null,"abstract":"<p><p>The aim of this study was to determine whether body mass index and age had an impact on functional recovery two years after total knee replacement. The research was conducted at the Lovran Hospital of Orthopedics and Traumatology, School of Medicine, University of Rijeka, Croatia. Study sample included patients who underwent total knee replacement surgery with median parapatellar approach in 2019. Morphological measurements, knee range of motion and WOMAC questionnaire score were examined before and two years after surgery. Descriptive statistics was used for gender, age and body mass index, and inferential statistics was employed to check the correlation of recovery measured by changes in the WOMAC score and change in the range of motion results with age and body mass index. According to study results, male and female patients did not differ in body mass index (t=1.184; p>0.05). There was no statistically significant correlation of functional recovery of the patients with age (p=0.556), or between body mass index and differences in the range of motion (p=0.927) from flexion to extension. The study indicated that knee arthroplasty and thus the impact on functional recovery had an equally good effect regardless of age. In patients who had flexion contracture before surgery, the surgery improved motion amplitude.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"332-339"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COCAINE-INDUCED MIDLINE DESTRUCTIVE LESIONS.","authors":"Hanna Pašić, Branka Vidrih, Iva Šarac, Nina Rotim, Ana Hrkać Pustahija, Branko Malojčić, Ivana Karla Franić, Ivona Radmanović, Maja Živković, Stjepan Jurić, Jelena Šarić-Jurić, Marija Bošnjak Pašić","doi":"10.20471/acc.2024.63.02.21","DOIUrl":"10.20471/acc.2024.63.02.21","url":null,"abstract":"<p><p>Prolonged cocaine inhalation can cause destruction of nasal mucosa and ethmoid sinuses and palate perforation, thus inducing cocaine-induced midline destructive lesions (CIMDL) that affect only a limited number of predisposed patients. CIMDL are an autoimmune necrotizing inflammatory phenomenon associated with the presence of atypical antineutrophil cytoplasmic antibody (ANCA). Patients complain of epistaxis, nasal obstruction, hyposmia, sinus infections, and facial pain. Protocol for the CIMDL diagnosis includes medical history, clinical examination, magnetic resonance imaging, laboratory tests, immunology and serology tests, and chest x-ray. A 68-year-old man presented with a brain extension mimicking an ischemic-like lesion with surrounding edema. A diagnosis of CIMDL was made in the light of the patient's medical history, imaging studies, and laboratory testing including pANCA positivity which seems to promote disease phenotype.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"431-435"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE PREVALENCE OF ORTHOREXIA NERVOSA AMONG GYM PARTICIPANTS FROM CROATIA: AN OBSERVATIONAL STUDY.","authors":"Edita Ružman, Orjena Žaja, Jadranka Karuza, Ines Banjari","doi":"10.20471/acc.2024.63.02.6","DOIUrl":"10.20471/acc.2024.63.02.6","url":null,"abstract":"<p><p>Orthorexia nervosa (ON) is pathological obsession and preoccupation with 'healthy' and 'clean' eating, which is more pronounced in specific population groups such as fitness enthusiasts. The aim of this observational study was to determine the prevalence and characteristics of ON symptoms among gym attendees in Croatia based on ORTHO-15 questionnaire. A number of individual characteristics were considered too, from eating habits, anthropometry, personality traits, psychophysical state, to the presence of irritable bowel syndrome symptoms. Out of 126 participants who completed the questionnaire, 99 were analyzed (female 68.7% and male 31.3%, median age 24 years). Based on the traditional criterion (ORTHO-15 score <40), the prevalence of ON was 77.8% and 33.3% according to the modified criterion (ORTHO-15 <35). Women were two times more likely to have high ON tendency in comparison to men (39.7% <i>vs</i>. 19.4%, p=0.037). Participants with high ON tendency avoided a wide variety of foods, especially sugar, processed food and gluten, and did not skip meals. There were no significant differences in orthorexic tendencies according to nutritional status, personality traits, psychophysical state, or irritable bowel symptoms. For gym attendees in Croatia, being a woman and dietary restrictions were identified as independent risk factors for ON.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"306-315"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE EFFECT OF A SINGLE ORAL DOSE OF L-ARGININE ON QUADRICEPS STRENGTH IN SMOKERS AND NON-SMOKERS: A NON-RANDOMIZED CLINICAL TRIAL.","authors":"Goranka Radmilović, Sanja Popović-Grle, Valentina Matijević","doi":"10.20471/acc.2024.63.02.7","DOIUrl":"10.20471/acc.2024.63.02.7","url":null,"abstract":"<p><p>Smoking is a major risk factor for the development of chronic obstructive pulmonary disease (COPD), which is thought to be caused by smoking in even 8 out of 10 cases. One of the first clinical signs in patients with COPD is reduced physical ability, which is usually attributed to reduced lung function, although a significant role is played by a disorder of the musculoskeletal system. The aim of the study was to examine differences in fitness and locomotor status between smokers and non-smokers, as well as the effect of oral administration of L-arginine on the strength of the quadriceps depending on smoking status. The study included 164 subjects, 84 non-smokers and 81 smokers not diagnosed with COPD. All subjects completed CAT and IPAQ questionnaires, and performed spirometry, 6-minute walking test and quadriceps strength testing without therapy and after oral administration of 500 mg L-arginine. The results showed that the increase in quadriceps strength after oral administration of L-arginine was not dependent on smoking status but was more pronounced in smokers who started smoking at an earlier age and who smoked more cigarettes, as well as a generally higher physical activity of non-smokers. These results could become relevant for recognizing the development of skeletal musculature hypotonus and hypotrophy in smokers who are prone to develop COPD.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"316-325"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSESSMENT OF TOOTH COLOR DIFFERENCE IN DIGITAL PHOTOGRAPHS TAKEN WITH DIFFERENT SMARTPHONES.","authors":"Maja Žagar, Amar Piknjac, Mirko Soldo, Dubravka Knezović Zlatarić","doi":"10.20471/acc.2024.63.02.17","DOIUrl":"10.20471/acc.2024.63.02.17","url":null,"abstract":"<p><p>Digital photography has become an indispensable part of modern medicine and dentistry. In the initial stages, digital single lens reflex cameras were used in medicine and dentistry and were considered the golden standard. In recent years, smartphones have become available and enable adjusting of camera settings. The aim of the study was to examine color accuracy on digital photographs taken with a smartphone and the possibility of applying a simple protocol for shooting digital photographs in daily clinical work. The study was conducted on 45 subjects, and a total of 15 JPEG photographs using three smartphones were taken. Five photographs with different lighting modes were taken with each smartphone and the CIE L*a*b* values were measured. Difference in color (dE) was calculated. The results showed that different lighting conditions and different smartphones did affect color values in this study. The CIE L*a*b* values measured on digital photographs using different smartphones and different illuminations differed significantly (p<0.01). There was significant difference in color between digital photographs in different illuminations and measurements of the natural teeth (p<0.01). Digital photo protocol taken with a smartphone cannot be used as an accurate method for digital determination of tooth color in dentistry.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"403-412"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INTESTINAL OBSTRUCTION AS A RESULT OF PANCREATIC ECTOPY IN JEJUNUM: A CASE REPORT AND LITERATURE REVIEW.","authors":"Matilda Đolai, Milena Šunjević, Ana Dražin, Predrag Petrović, Slobodan Torbica, Sandra Trivunić Dajko","doi":"10.20471/acc.2024.63.02.18","DOIUrl":"10.20471/acc.2024.63.02.18","url":null,"abstract":"<p><p>Pancreatic heterotopia is a relatively rare condition that implies pancreatic tissue anatomically separated from the main gland, showing no vascular or ductal continuity. It is known to occur in many sites of gastrointestinal tract, with stomach being the most common one. This case is of great interest because ectopic pancreatic tissue in jejunal wall presented as bowel obstruction. The aim of this article is to provide a review of clinical, histopathologic and immunohistochemical features of ectopic pancreatic tissue in jejunum, emphasizing the possible diagnostic pitfalls in gastrointestinal tract, especially in its upper parts. Knowing the most common locations, imaging features and histopathologic criteria, the diagnosis of pancreatic heterotopia could be successfully set preoperatively. Associated complications are various and sometimes difficult to handle, so accurate and precise diagnosis, as well as surgical resection, is often needed.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"413-417"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CROATIAN GUIDELINES FOR SPECIFIC PREVENTIVE TREATMENT OF MIGRAINE WITH MONOCLONAL ANTIBODIES TARGETING CALCITONIN GENE-RELATED PEPTIDE (CGRP) (EPTINEZUMAB, FREMANEZUMAB, AND GALCANEZUMAB) OR THE CGRP RECEPTOR (ERENUMAB).","authors":"Davor Jančuljak, Damir Petravić, Darija Mahović Lakušić, Arijana Lovrenčić-Huzjan, Koraljka Bačić Baronica, Marijana Bosnar Puretić, Zlatko Hucika, Marina Titlić, Zvonimir Popović, Zoran Tomić, Maristela Stojić, Vanja Bašić Kes","doi":"10.20471/acc.2024.63.02.22","DOIUrl":"10.20471/acc.2024.63.02.22","url":null,"abstract":"<p><p>Calcitonin gene-related peptide (CGRP) plays a key role in the pathophysiology of migraine, acting on CGRP receptors in the trigeminovascular system, causing neurogenic inflammation and vasodilation, and promoting nociception. Four specific monoclonal antibodies targeting CGRP are available for prevention of episodic and chronic migraine in adults with at least four migraine days <i>per</i> month. The aim of these guidelines is to provide evidence-based recommendations for the use of monoclonal antibodies targeting CGRP in migraine prevention in Croatia. The questions were formulated using the Patients, Intervention, Comparison, Outcome (PICO) criteria, with evidence-based answers. To assess the quality of scientific evidence, a review of the literature available in PubMed was performed. Relevant studies were reviewed by the Expert Group of the Headache Section of the Croatian Neurological Society, and served as the basis for formulating the recommendations outlined in these guidelines. We found high quality evidence for good safety and efficacy of anti-CGRP monoclonal antibodies in the preventive treatment of episodic and chronic migraine. These medications may be considered as first-line prophylactic therapy depending on the patient's history, concomitant diseases, and disease burden. Further real-world studies are needed to elucidate other aspects of their application.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"436-450"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COMBINED ENDOVASCULAR REPAIR OF AORTA AND REMOVAL OF PENETRATING PEDICLE SCREW AFTER POSTERIOR INSTRUMENTATION: A CASE REPORT AND LITERATURE REVIEW.","authors":"Dean Girotto, Josip Burić, Hrvoje Šimić, Vjekoslav Tomulić, Tomislav Jakljević, Zvonimir Kvas","doi":"10.20471/acc.2024.63.02.20","DOIUrl":"10.20471/acc.2024.63.02.20","url":null,"abstract":"<p><p>Stabilization of spine using transpedicular screws is the most commonly used instrumentation technique among spinal surgeons. The 'free hand' technique is considered relatively safe and can be performed under x-ray control. Vascular injuries with misplaced screws are rare but potentially fatal complications. Injury of thoracoabdominal aorta by malpositioned screw demands a multidisciplinary approach. Injury of vessel wall might demand screw removal and vessel wall repair. Here we present a case of 72-year-old female patient who underwent long segment fixation of thoracolumbar spine. During follow up, computed tomography (CT) scan and afterwards aortography showed a lesion of the posterior aortic wall by malpositioned screw without signs of bleeding. After meticulous preparation, combined endovascular repair with stent-graft and removal of the penetrating screw were performed. Endovascular treatment was performed simultaneously with screw removal. During screw removal, the patient was in lateral decubital position. The patient was discharged on postoperative day 8. Follow up CT aortography 6 months later showed no leak or other changes in the aorta. We found combined endovascular vessel repair with simultaneous screw removal safe and sufficient for this kind of aortic injury. Although lateral decubital position bears limitations, it gives enough space for the operator. Performing intraoperative aortography provides good insight into stent position and possible bleeding after screw removal.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 2","pages":"422-430"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}