Search

COVID-19 je infektivna bolest koja se nakon pojave (prosinac 2019., Wuhan, Kina) tijekom sljedeća 3 mjeseca proširila na sve kontinente i izazvala pandemiju s kojom je čovječanstvo prvi put suočeno. S obzirom na to da bolesnici imaju pretežito respiratornu simptomatologiju često s razvojem intersticijske upale pluća te da se radi o visoko kontagioznoj bolesti, nameće se potreba brze, pouzdane i sigurne dijagnostike plućnih komplikacija ove bolesti. U COVID-19 bolesnika ciljani ultrazvuk pluća je superioran u odnosu na klasičnu Rtg snimku srca i pluća te se u dijagnostičkoj pouzdanosti približio MSCT-u toraksa. Razlog tomu je činjenica da su upalni infiltrati lokalizirani prvenstveno bazalno i periferno gdje su dostupni UZV pregledu. Najčešće zahvaćene regije su 5 i 6 obostrano, a u nalazu dominiraju multiple B linije u 2 i više regija u kombinaciji s pojedinačnim B linijama. U ožujku 2020. osnovan je Primarni respiracijsko-intenzivistički centar u KB Dubrava (PRIC KBD) s ciljem zbrinjavanja COVID-19 bolesnika s umjerenom do teškom kliničkom slikom i znacima respiracijske insuficijencije. Za dijagnostiku i praćenje bolesnika, uz Rtg snimku srca i pluća te MSCT toraksa, korišten je ciljani UZV pluća. Osim dobre korelacije s kliničkom slikom i stupnjem respiracijske insuficijencije, ciljani UZV pluća pokazao se korisnim zbog kratke izloženosti aerosolu tijekom pretrage, a bez potrebe za mobilizacijom bolesnika ili korištenjem mobilnog Rtg uređaja. Postao je suverena zamjena za stetoskop uz mogućnost pridržavanja svih mjera za prevenciju širenja aerosola: mobilni uređaj bez kabela, mogućnost dezinfekcije pa čak i korištenje samo jednog uređaja po bolesniku u intenzivističkom centru, čime je postao važna dijagnostička metoda kod COVID-19 pozitivnih bolesnika., COVID-19 is an infectious disease which surfaced in December 2019 (Wuhan, China) and swept across all the continents in a matter of 3 months, triggering a pandemic faced by humanity for the first time. Given the predominance of respiratory symptoms in patients, often accompanied by the development of interstitial pneumonia, and the fact that it is a highly contagious disease, it called for a prompt, reliable and safe diagnosis of pulmonary complications of the disease. In COVID-19 patients, focused lung ultrasound is superior to the classical heart or chest X-ray, and in terms of diagnostic reliability, is almost up to par to an MSCT of the thorax. This is due to the fact that inflammatory infiltrates are localized primarily basally and peripherally where they are accessible to ultrasound examinations. Regions 5 and 6 (both sides) are most commonly affected, and medical reports show a predominance of multiple B lines in 2 or more regions in combination with individual B lines. In March 2020, the Primary Respiratory Intensive Care Center at Clinical Hospital Dubrava (PRIC KBD) was founded to treat COVID-19 patients with a moderate to severe clinical picture and signs of respiratory failure. In addition to an X-ray of the heart and lungs and MSCT of the thorax, patients were diagnosed and monitored using focused lung ultrasound. Besides a good correlation with the clinical picture and degree of respiratory failure, focused lung ultrasound has shown to be favorable due to short aerosol exposure during screening, without the need to mobilize patients or use a mobile X-ray device. It has become an unrivalled replacement for the stethoscope, capable of adhering to all measures to prevent the spread of aerosols: a cordless mobile device, disinfectable, with even the ability to use only one device per patient in the intensive care unit, rendering it an important diagnostic tool in COVID-19 positive patients.

Dijagnoza bolesti nealkoholne masne jetre (engl. non-alcoholic fatty liver disease, NAFLD) počinje već na temelju kliničkih obilježja bolesnika. Tipičan rizični profil predstavlja bolesnik s prekomjernom tjelesnom težinom, pogotovo ako su tome pridruženi šećerna bolest tipa 2, arterijska hipertenzija i/ili hiperlipidemija, uz uvjet isključene rizične konzumacije alkohola. Postojanje masne jetre najčešće se utvrđuje ultrazvukom na kojem je jetra svjetlija (ehogenija) u odnosu na korteks bubrega. Ultrazvukom se ne može prepoznati blaže oblike steatoze kada je < 20 – 30 % hepatocita masno transformirano. Elastografskim metodama može se kvantificirati stupanj steatoze i stadij fibroze. Stadij fibroze je najznačajniji prognostički čimbenik, dok je značaj upalne aktivnosti dvojben, a stupanj steatoze ne utječe bitno na ishod bolesti jetre. Za neinvazivnu procjenu steatoze i fibroze koriste se i biokemijski testovi, od najjednostavnijih dobivenih iz rutinskih laboratorijskih nalaza do složenih koji uključuju cirkulirajuće makromolekule i komponente izvanstaničnoga matriksa. Neinvazivne metode su pouzdane za isključivanje ciroze, no imaju relativno skromnu pozitivnu prediktivnu vrijednost, jer često precjenjuju stadij fibroze i ne daju informaciju o aktivnosti upale. Objektivniju dijagnozu ovih histoloških komponenti i time pouzdanu prognostičku informaciju pruža biopsija jetre. Obradu bolesnika s NAFLD-om treba započeti na primarnoj razini zdravstvene zaštite jednostavnim biokemijskim testom (npr. FIB-4) kojim se isključuje značajna fibroza. U slučaju povišenih vrijednosti potreban je potvrdni test (najbolje elastografija). Ako taj nalaz isključi značajnu fibrozu, bolesnik ostaje u skrbi obiteljskoga liječnika, a u slučaju teške fibroze/ciroze bolesnik se nastavlja liječiti kod specijaliste. Na ovaj način za 80 % se smanjuje upućivanje bolesnika specijalisti, te za pet puta poboljšava otkrivanje značajne fibroze/ciroze., Diagnosing non-alcoholic fatty liver disease (NAFLD) begins with analysing patient’s clinical features. The typical risk profile includes an overweight patient with comorbidities such as type 2 diabetes mellitus, arterial hypertension and/or hyperlipidaemia, excluding harmful alcohol consumption. Ultrasonography is the most widely used diagnostic tool for detecting fatty liver, which has higher echogenicity, i.e. is lighter in colour, compared to renal cortex. However, ultrasound cannot detect mild steatosis where < 20 – 30% of hepatocytes have been infiltrated by fat. Elastographic methods are used for grading steatosis and staging fibrosis. Liver fibrosis stage is the most significant prognostic indicator. On the other hand, the relevance of inflammatory activity is questionable and the degree of steatosis has no significant impact on the outcome of the disease. Steatosis and fibrosis can be evaluated using non-invasive biochemical tests, ranging from simple routine laboratory tests to more complex tests that include circulating macromolecules and components of extracellular matrix. Non-invasive methods provide reliable results for the exclusion of cirrhosis; however, their positive predictive value is relatively modest, as they often over-estimate the fibrosis stage and provide no information on inflammatory activity. Liver biopsy provides a more objective diagnosis of the histological features and, as a result, a more reliable prognosis. The workup of NAFLD patients should start at the primary healthcare level, with simple biochemical tests such as FIB-4, which excludes significant fibrosis. Elevated results need to be additionally confirmed by another test, most preferably elastography. If this test excludes significant fibrosis, the patient remains under the care of a primary care physician, and if it detects severe fibrosis/cirrhosis, the patient is referred to specialist treatment. This pathway has resulted in an 80 % decrease in referrals to a specialist an

Dijagnoza bolesti nealkoholne masne jetre (engl. non-alcoholic fatty liver disease, NAFLD) počinje već na temelju kliničkih obilježja bolesnika. Tipičan rizični profil predstavlja bolesnik s prekomjernom tjelesnom težinom, pogotovo ako su tome pridruženi šećerna bolest tipa 2, arterijska hipertenzija i/ili hiperlipidemija, uz uvjet isključene rizične konzumacije alkohola. Postojanje masne jetre najčešće se utvrđuje ultrazvukom na kojem je jetra svjetlija (ehogenija) u odnosu na korteks bubrega. Ultrazvukom se ne može prepoznati blaže oblike steatoze kada je < 20 – 30 % hepatocita masno transformirano. Elastografskim metodama može se kvantificirati stupanj steatoze i stadij fibroze. Stadij fibroze je najznačajniji prognostički čimbenik, dok je značaj upalne aktivnosti dvojben, a stupanj steatoze ne utječe bitno na ishod bolesti jetre. Za neinvazivnu procjenu steatoze i fibroze koriste se i biokemijski testovi, od najjednostavnijih dobivenih iz rutinskih laboratorijskih nalaza do složenih koji uključuju cirkulirajuće makromolekule i komponente izvanstaničnoga matriksa. Neinvazivne metode su pouzdane za isključivanje ciroze, no imaju relativno skromnu pozitivnu prediktivnu vrijednost, jer često precjenjuju stadij fibroze i ne daju informaciju o aktivnosti upale. Objektivniju dijagnozu ovih histoloških komponenti i time pouzdanu prognostičku informaciju pruža biopsija jetre. Obradu bolesnika s NAFLD-om treba započeti na primarnoj razini zdravstvene zaštite jednostavnim biokemijskim testom (npr. FIB-4) kojim se isključuje značajna fibroza. U slučaju povišenih vrijednosti potreban je potvrdni test (najbolje elastografija). Ako taj nalaz isključi značajnu fibrozu, bolesnik ostaje u skrbi obiteljskoga liječnika, a u slučaju teške fibroze/ciroze bolesnik se nastavlja liječiti kod specijaliste. Na ovaj način za 80 % se smanjuje upućivanje bolesnika specijalisti, te za pet puta poboljšava otkrivanje značajne fibroze/ciroze., Diagnosing non-alcoholic fatty liver disease (NAFLD) begins with analysing patient’s clinical features. The typical risk profile includes an overweight patient with comorbidities such as type 2 diabetes mellitus, arterial hypertension and/or hyperlipidaemia, excluding harmful alcohol consumption. Ultrasonography is the most widely used diagnostic tool for detecting fatty liver, which has higher echogenicity, i.e. is lighter in colour, compared to renal cortex. However, ultrasound cannot detect mild steatosis where < 20 – 30% of hepatocytes have been infiltrated by fat. Elastographic methods are used for grading steatosis and staging fibrosis. Liver fibrosis stage is the most significant prognostic indicator. On the other hand, the relevance of inflammatory activity is questionable and the degree of steatosis has no significant impact on the outcome of the disease. Steatosis and fibrosis can be evaluated using non-invasive biochemical tests, ranging from simple routine laboratory tests to more complex tests that include circulating macromolecules and components of extracellular matrix. Non-invasive methods provide reliable results for the exclusion of cirrhosis; however, their positive predictive value is relatively modest, as they often over-estimate the fibrosis stage and provide no information on inflammatory activity. Liver biopsy provides a more objective diagnosis of the histological features and, as a result, a more reliable prognosis. The workup of NAFLD patients should start at the primary healthcare level, with simple biochemical tests such as FIB-4, which excludes significant fibrosis. Elevated results need to be additionally confirmed by another test, most preferably elastography. If this test excludes significant fibrosis, the patient remains under the care of a primary care physician, and if it detects severe fibrosis/cirrhosis, the patient is referred to specialist treatment. This pathway has resulted in an 80 % decrease in referrals to a specialist an

COVID-19 je infektivna bolest koja se nakon pojave (prosinac 2019., Wuhan, Kina) tijekom sljedeća 3 mjeseca proširila na sve kontinente i izazvala pandemiju s kojom je čovječanstvo prvi put suočeno. S obzirom na to da bolesnici imaju pretežito respiratornu simptomatologiju često s razvojem intersticijske upale pluća te da se radi o visoko kontagioznoj bolesti, nameće se potreba brze, pouzdane i sigurne dijagnostike plućnih komplikacija ove bolesti. U COVID-19 bolesnika ciljani ultrazvuk pluća je superioran u odnosu na klasičnu Rtg snimku srca i pluća te se u dijagnostičkoj pouzdanosti približio MSCT-u toraksa. Razlog tomu je činjenica da su upalni infiltrati lokalizirani prvenstveno bazalno i periferno gdje su dostupni UZV pregledu. Najčešće zahvaćene regije su 5 i 6 obostrano, a u nalazu dominiraju multiple B linije u 2 i više regija u kombinaciji s pojedinačnim B linijama. U ožujku 2020. osnovan je Primarni respiracijsko-intenzivistički centar u KB Dubrava (PRIC KBD) s ciljem zbrinjavanja COVID-19 bolesnika s umjerenom do teškom kliničkom slikom i znacima respiracijske insuficijencije. Za dijagnostiku i praćenje bolesnika, uz Rtg snimku srca i pluća te MSCT toraksa, korišten je ciljani UZV pluća. Osim dobre korelacije s kliničkom slikom i stupnjem respiracijske insuficijencije, ciljani UZV pluća pokazao se korisnim zbog kratke izloženosti aerosolu tijekom pretrage, a bez potrebe za mobilizacijom bolesnika ili korištenjem mobilnog Rtg uređaja. Postao je suverena zamjena za stetoskop uz mogućnost pridržavanja svih mjera za prevenciju širenja aerosola: mobilni uređaj bez kabela, mogućnost dezinfekcije pa čak i korištenje samo jednog uređaja po bolesniku u intenzivističkom centru, čime je postao važna dijagnostička metoda kod COVID-19 pozitivnih bolesnika., COVID-19 is an infectious disease which surfaced in December 2019 (Wuhan, China) and swept across all the continents in a matter of 3 months, triggering a pandemic faced by humanity for the first time. Given the predominance of respiratory symptoms in patients, often accompanied by the development of interstitial pneumonia, and the fact that it is a highly contagious disease, it called for a prompt, reliable and safe diagnosis of pulmonary complications of the disease. In COVID-19 patients, focused lung ultrasound is superior to the classical heart or chest X-ray, and in terms of diagnostic reliability, is almost up to par to an MSCT of the thorax. This is due to the fact that inflammatory infiltrates are localized primarily basally and peripherally where they are accessible to ultrasound examinations. Regions 5 and 6 (both sides) are most commonly affected, and medical reports show a predominance of multiple B lines in 2 or more regions in combination with individual B lines. In March 2020, the Primary Respiratory Intensive Care Center at Clinical Hospital Dubrava (PRIC KBD) was founded to treat COVID-19 patients with a moderate to severe clinical picture and signs of respiratory failure. In addition to an X-ray of the heart and lungs and MSCT of the thorax, patients were diagnosed and monitored using focused lung ultrasound. Besides a good correlation with the clinical picture and degree of respiratory failure, focused lung ultrasound has shown to be favorable due to short aerosol exposure during screening, without the need to mobilize patients or use a mobile X-ray device. It has become an unrivalled replacement for the stethoscope, capable of adhering to all measures to prevent the spread of aerosols: a cordless mobile device, disinfectable, with even the ability to use only one device per patient in the intensive care unit, rendering it an important diagnostic tool in COVID-19 positive patients.

Aim To assess the measures of disease frequency and determine the clinical features of primary biliary cholangitis (PBC) in two Croatian regions. Methods Databases of two tertiary hospitals, one located in the continental and one in the coastal region of Croatia, were retrospectively searched for PBC patients diagnosed from 2007 to 2018. Epidemiologic data analysis was restricted to patients from each hospital’s catchment area. We analyzed factors related to response to therapy and event-free survival (EFS), defined as absence of ascites, variceal bleeding, encephalopathy, hepatocellular carcinoma, liver transplantation (LT), or death. In addition, we determined clinical and demographic data of transplanted PBC patients.Results Out of 83 PBC patients, 86.7% were female, with a median age at diagnosis of 55 years. Average PBC incidence for the 11-year period was 0.79 and 0.89 per 100 000 population, whereas the point prevalence on December 31, 2017 was 11.5 and 12.5 in the continental and coastal region, respectively. Of 76 patients with complete medical records, 21% had an advanced disease stage, 31.6% had an associated autoimmune condition, and all received ursodeoxycholic acid. EFS rate at 5 years was 95.8%. In an age and sex-adjusted multivariate Cox regression model, the only factor significantly associated with inferior EFS was no response to therapy (HR = 18.4; P = 0.018). Of all Croatian patients who underwent LT, 3.8% had PBC, with the survival rate at 5 years after LT of 93.4%. Conclusion This study gives pioneer insights into the epidemiological and clinical data on PBC in Croatia, thus complementing the PBC map of Southeast Europe.

Aim To assess the measures of disease frequency and determine the clinical features of primary biliary cholangitis (PBC) in two Croatian regions. Methods Databases of two tertiary hospitals, one located in the continental and one in the coastal region of Croatia, were retrospectively searched for PBC patients diagnosed from 2007 to 2018. Epidemiologic data analysis was restricted to patients from each hospital’s catchment area. We analyzed factors related to response to therapy and event-free survival (EFS), defined as absence of ascites, variceal bleeding, encephalopathy, hepatocellular carcinoma, liver transplantation (LT), or death. In addition, we determined clinical and demographic data of transplanted PBC patients.Results Out of 83 PBC patients, 86.7% were female, with a median age at diagnosis of 55 years. Average PBC incidence for the 11-year period was 0.79 and 0.89 per 100 000 population, whereas the point prevalence on December 31, 2017 was 11.5 and 12.5 in the continental and coastal region, respectively. Of 76 patients with complete medical records, 21% had an advanced disease stage, 31.6% had an associated autoimmune condition, and all received ursodeoxycholic acid. EFS rate at 5 years was 95.8%. In an age and sex-adjusted multivariate Cox regression model, the only factor significantly associated with inferior EFS was no response to therapy (HR = 18.4; P = 0.018). Of all Croatian patients who underwent LT, 3.8% had PBC, with the survival rate at 5 years after LT of 93.4%. Conclusion This study gives pioneer insights into the epidemiological and clinical data on PBC in Croatia, thus complementing the PBC map of Southeast Europe.

Cilj istraživanja: Cilj je ovog rada prikazati klinička iskustva našeg centra s oboljelima od hereditarne hemoragijske teleangiektazije (HHT). Prikazali smo kliničku sliku svojih bolesnika, nove dijagnostičke i terapijske mogućnosti, kao i svjetske smjernice u dijagnostici bolesti. Ispitanici i metode: U ovu retrospektivnu studiju uključeno je 13-ero bolesnika liječenih u Klinici za unutarnje bolesti KB-a Dubrava u razdoblju od 2008. do 2017. godine. Rezultati: Bilo je 9 muškaraca i 4 žene u dobi između 45 i 80 godina (medijan 70 godina). Svih 13-ero bolesnika prezentiralo se sideropeničnom anemijom i rekurentnim epistaksama koje su ujedno bile i najraniji znak bolesti. Dvanaestero bolesnika imalo je mukokutane teleangiektazije, a njih devetero gastrointestinalna krvarenja. U jednog bolesnika dokazana je pulmonalna, a kod još jednoga hepatalna arteriovenska malformacija. Nakon medijana praćenja od 60 mjeseci devetero je bolesnika živo, a njih četvero preminulo je. Zaključci: Prava dijagnoza bolesti u većine naših bolesnika postavljena je tek u starijoj dobi iako su se simptomi javljali i puno prije. U Republici Hrvatskoj ne postoje točni podaci o broju oboljelih, kao ni smjernice za otkrivanje i liječenje komplikacija bolesti. Nužno je formiranje multidisciplinarnih timova radi unaprjeđenja dijagnostike, ranijeg otkrivanja komplikacija bolesti te sveobuhvatnijeg praćenja bolesnika., Aim: The aim of this study is to present our center’s clinical experience with hereditary haemorrhagic telangiectasia (HHT). Herein, we showed clinical presentations of our patients, new diagnostic and therapeutic options, as well as the international guidelines for HHT diagnosis. Patients and methods: In this retrospective study, we identified 13 patients that were treated at the Department of Medicine, Clinical Hospital Dubrava from 2008 to 2017. Results: There were nine men and four women aged between 45 and 80 years (median 70 years). All 13 patients presented with sideropenic anaemia and recurrent epistaxis that was the earliest sign of the disease. Twelve patients had mucocutaneous telangiectasia, and nine patients were presented with gastrointestinal bleeding. One patient was diagnosed with pulmonary arteriovenous malformation, and the other one with hepatic malformation. After a median follow-up of 60 months, nine patients are alive, and four patients died. Conclusion: Most of our patients were diagnosed in older age, although the symptoms appeared much earlier in life. There are no data on the number of patients with HHT in the Republic of Croatia. Also, guidelines for diagnosis and screening for complications are lacking. Therefore, it is necessary to form a multidisciplinary team for diagnostic improvement, early detection of complications, and more intensive monitoring of patients.

Aim To evaluate the impact of pharmacotherapeutic education on 30-day post-discharge medication adherence and adverse outcomes in patients with type 2 diabetes mellitus (T2DM). Methods The prospective, randomized, single-center study was conducted at the Medical Department of University Hospital Dubrava, Zagreb, between April and June 2018. One hundred and thirty adult patients with T2DM who were discharged to the community were randomly assigned to either the intervention or the control group. Both groups during the hospital stay received the usual diabetes education. The intervention group received additional individual pre-discharge pharmacotherapeutic education about the discharge prescriptions. Medication adherence and occurrence of adverse outcomes (adverse drug reactions, readmission, emergency department visits, and death) were assessed at the follow-up visit, 30 days after discharge.Results The number of adherent patients was significantly higher in the intervention group (57/64 [89.9%] vs 41/61 [67.2%]; χ2 test, P = 0.003]. There was no significant difference between the groups in the number of patients who experienced adverse outcomes (31/64 [48.4%] vs 36/61 [59.0%]; χ2 test, P = 0.236). However, higher frequencies of all adverse outcomes were consistently observed in the control group. Conclusion Pharmacotherapeutic education of patients with T2DM can significantly improve 30-day post-discharge medication adherence, without a significant reduction in adverse clinical outcomes.

The aim of the study was to explore predictive value of the ALBI, PALBI and MELD scores on survival in patients resected for hepatocellular carcinoma with compensated liver cirrhosis and no macrovascular infi ltration. In this retrospective study, longitudinal survival analysis was performed. We analyzed patient/tumor characteristics and MELD, ALBI and PALBI scores as liver function tests for predicting survival outcome. Survival was analyzed from the date of liver resection until death, liver transplantation, or end of follow-up. Patients were stratifi ed for age, cirrhosis etiology, presence of esophageal varices, hepatocellular carcinoma stage, microvascular invasion, histologic diff erentiation, and resection margins. We identifi ed 38 patients (alcoholic cirrhosis in 84.2% of patients) resected over an 8-year period. Median preoperative MELD score was 8, ALBI score -2.63, and PALBI score -2.38. During the follow-up period, 24 patients died. Estimated median survival time was 36 months. Microvascular invasion was observed in 33 patients. Higher ALBI score was associated with 23.1% higher relative risk of death. PALBI score was associated with 12.1% higher relative risk of death, whereas MELD score was not associated with the risk of death. In conclusion, ALBI score demonstrated signifi cant predictive capabilities for survival in patients with compensated cirrhosis resected for hepatocellular carcinoma., Cilj je bio istražiti prediktivnu vrijednost zbira ALBI, PALBI i MELD za preživljenje bolesnika s kompenziranom cirozom reseciranih zbog hepatocelularnog karcinoma bez makrovaskularne invazije. Provedena je retrospektivna longitudinalna analiza preživljenja. Testirane su karakteristike bolesnika/tumora kao i jetreni funkcijski testovi MELD, ALBI i PALBI za predviđanje preživljenja. Bolesnici su praćeni nakon resekcije jetre do smrti, transplantacije jetre odnosno do kraja vremena praćenja. Bolesnici su kategorizirani po dobi, etiologiji ciroze, prisutnosti varikoziteta jednjaka, stadiju karcinoma, mikrovaskularnoj invaziji, histološkom stadiju i resekcijskim rubovima. Identifi cirali smo 38 bolesnika (alkoholna ciroza kod 84,2% bolenika) reseciranih kroz razdoblje od 8 godina. Medijan prijeoperacijskog zbira MELD bio je 8, zbira ALBI -2,63 i zbira PALBI -2,38. Tijekom praćenja 24 bolesnika su umrla. Očekivani medijan preživljenja iznosio je 36 mjeseci. Mikrovaskularna invazija pronađena je u 33 bolesnika. Veći ALBI je bio povezan s 23,1%, a PALBI s 12,1% većim relativnim rizikom od smrtnog ishoda. MELD nije bio povezan sa smrtnim ishodom. Zbir ALBI je pokazao značajnu prediktivnu vrijednost preživljenja u skupini bolesnika s kompenziranom cirozom reseciranih zbog hepatocelularnog karcinoma.

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., Aim: To demonstrate the results of contrast-enhanced ultrasound (CEUS) for diagnostic characterization of liver tumors (LT) in a tertiary-care hospital. Patients and methods: Results of CEUS examinations of LT in successively included patients from January 1st 2015 to December 31st 2016 were retrospectively analyzed. Definite diagnosis was made through standardized clinical workup including MRI and/or MSCT, tissue sampling (biopsy or cytology) in cases when imaging was inconclusive, as well as pathohistological analysis of resected specimens in patients that underwent surgery. Results: In 90 patients (48 M, 42 F; age 57±15) 132 LT were analyzed (68 benign and 64 malignant), with average size of 30 (8-130) mm. CEUS demonstrated excellent diagnostic performance to differentiate between benign and malignant LT (sensitivity 98.44%, specifi city 83.82%, AUC 0.91), without adverse reactions. Conclusion: Our results demonstrate high diagnostic accuracy and safety of CEUS for characterization of LT.

Aim Primary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV). Methods Predictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV. Results In the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients. Conclusion This is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients.

Aim Primary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV). Methods Predictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV. Results In the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients. Conclusion This is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients.

Some 25 years ago endoscopic ultrasound (EUS) was introduced in clinical practice for better visualization of pancreas. At the time of introduction EUS was superior to other methods in detection of pancreatic masses allowing tissue diagnosis by later introduced EUS-guided fine needle aspiration (FNA). During the time EUS was improved, electronic probes replaced mechanical probes adding ability of color Doppler, power Doppler, contrast enhanced endosonography as well as EUS elastography analysis. Meanwhile, CT technology has also experienced significant improvements raising the question whether EUS has lost ground in diagnostics of solid pancreatic masses. The aim of this review was to discuss the current evidence of clinical impact of EUS and EUS-FNA in evaluation of solid pancreatic masses with special emphasis on differentiation between benign and malignant pancreatic lesions. According to the literature, the detection of small pancreatic tumors, preoperative localization of pancreatic endocrine tumors and tissue sampling by fine-needle aspiration of pancreatic masses in cases with therapeutic consequences are considered firm indications for EUS. Cytological tissue analysis remains undisputed in differentiation benign from malignant lesions, but the question when FNA is needed is discussed. Color Doppler, power Doppler, contrast enhanced endosonography and especially elastography are also discussed as tools that are bringing additional information in evaluation of pancreatic masses, however insufficient for definitive judgment of the lesion’s nature. Pancreatic cancer staging as indication for EUS is discussed controversially, inconsistent results and conflicting evidence in literature making adequate conclusion impossible. However, this indicates that at least the role of EUS is no longer undisputed in this matter. Resuming the role of EUS we can state that despite some controversies EUS is very valuable method in evaluation of solid pancreatic masses and with EU