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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.

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.

Dijagnoza varikoziteta jednjaka (VJ) postavlja se endoskopskim pregledom što je neugodna metoda koja nosi određeni rizik od komplikacija. Zbog toga se istražuju neinvazivne metode za karakterizaciju VJ. Cilj našeg istraživanja bio je analizirati vrijednost omjera broja trombocita i veličine slezene (OTS) za neinvazivnu karakterizaciju VJ u bolesnika s alkoholnom cirozom jetre (ACJ). U istraživanje je bilo uključeno 117 bolesnika s ACJ (20 žena i 97 muškaraca, prosječne dobi 60,7 godina). Svim bolesnicima učinjen je endoskopski pregled jednjaka, a varikoziteti su kvalifi cirani kao mali (5 mm). U svih je bolesnika ultrazvukom izmjeren dulji promjer slezene, te je iz uzorka krvi određen broj trombocita. Izračunat je OTS, te su dobivene vrijednosti komparirane s prisustvom, veličinom i rizikom od krvarenja iz VJ što je defi nirano endoskopski. Nije nađena značajna razlika u vrijednostima OTS između bolesnika bez VJ i s VJ (1,341±0,725 prema 1,053±0,636; p=0,06). Vrijednost OTS značajno se razlikuje u bolesnika s malim od onih s velikim VJ (1,103±0,689 prema 0,876±0,314; p, Diagnosis of esophageal varices (EV) is based upon endoscopic examination, which is a rather unpleasant method that carries a certain risk of complications. For that reason, efforts have been made to develop noninvasive methods for characterization of EV. The aim of this study was to explore the value of platelet count to spleen size ratio (PSR) for noninvasive prediction and characterization of EV in patients with alcoholic liver cirrhosis (ALC). One hundred and seventeen patients (20 females and 97 males, mean age 60.7) with ALC were included in our research. All patients underwent endoscopic examination upon which the EV were classifi ed as small (5 mm), or absent. Spleen size (bipolar diameter in mm) was assessed by ultrasound. Platelet count to spleen diameter ratio was calculated and the values obtained were compared to the presence, size and risk of bleeding from EV as defi ned by endoscopy. No signifi cant difference in PSR could be found between patients without and with EV (1.341±0.725 vs. 1.053±0.636, respectively; p=0.06). The PSR was signifi cantly different between the patients with small and large EV (1.103±0.689 vs. 0.876±0.314; p

Najbolji pokazatelj težine oštećenja jetre i prognoze bolesti u kroničnom virusnom hepatitisu je uznapredovalost jetrene fibroze. Ona se može utvrditi biopsijom jetre ali i neinvazivnim fizikalnim ili biološkim metodama. Biopsiju jetre koristimo za etiološku dijagnozu bolesti jetre, utvrđivanje težine bolesti (stadija fibroze) i za definiranje prognoze. U kroničnom virusnom hepatitisu navedene informacije pomažu i u procjeni omjera koristi i rizika te modaliteta antivirusne terapije. Serološkim testovima i elastografijom moguće je razlikovati značajnu fibrozu (F ≥2) od početne fibroze (AUROC 0,77-0,83 za serologiju i 0,84 za elastografiju) i cirozu od necirotičnih stadija fibroze (AUROC 0,77-0,86 za serologiju i 0,9-0,94 prosječne vrijednosti AUROC u meta-analizama za elastografiju). U pojedinačnoj izvedbi metoda izbora za razlikovanje ciroze od necirotičnih stadija jetrene fibroze je elastografija. Kombinacijom seroloških testova i elastografije moguće je u slučaju podudarnih vrijednosti s točnosti od 93-95 % utvrditi postojanje ciroze i izbjeći biopsije u 77-80 % bolesnika. U slučaju da se vrijednosti testova ne podudaraju ili ukazuju na intermedijarne stadije fibroze treba učiniti biopsiju jetre, jer su u tom kontekstu neinvazivni testovi manje pouzdani. Istraživanja su pokazala kako nalaz tranzijentne elastografije ima visoku prediktivnu vrijednost za razvoj dekompenzacije ciroze i nastanak portohipertenzivnih komplikacija te diskriminira bolesnike u odnosu na prognozu 5-godišnjeg preživljenja., The best indicator of the severity of liver damage and prognosis in chronic viral hepatitis is extension of liver fibrosis. Extension of liver fibrosis can be assessed by liver biopsy and non-invasive physical or biological methods. Biopsy is used to define ethiology, severity (stage of fibrosis) and prognosis of liver disease. These informations are also usefull when estimating the risk-benefit and deciding on the modalities of antiviral therapy. Serological tests and elastography may distinguish significant fibrosis (F ≥2) from baseline fibrosis (AUROC 0.77-0.83 for serology and 0.84 for elastography) and cirrhosis from noncirrhotic stages (AUROC 0.77-0.86 for serology and 0.9-0.94 for elastography). Individual method of choice with best performance to distinguish cirrhosis from noncirrhotic stages of liver is elastography. Combination of serological tests and transient elastography has 93-95% accuracy to predict liver cirrhosis, and in case of concordant values of both tests biopsy could be avoided in 77-80% of patients. In case of discordant values or those in favour of intermediate stages of fibrosis liver biopsy should be performed because in these situations non-invasive tests are less reliable. According to several studies liver stiffness as assessed by transient elastography has high predictive value for the development of decom-pensated cirrhosis and portal hypertensive complications and may also discriminate the patients with respect to the predicted 5-year survival.

Hrvatske konsenzus konferencije o virusnim hepatitisima održane su 2005. i 2009. g. (1). S obzirom na brojne nove spoznaje o epidemiologiji, dijagnostici i liječenju virusnih hepatitisa (poglavito kroničnog hepatitisa C genotipa 1) u protekle četiri godine, 28. veljače 2013. g. održana je nova Hrvatska konsensus konferencija o virusnim hepatitisima u Zagrebu. Sažeti tekst ove Hrvatske konsenzus konferencije o virusnim hepatitisima sadrži prikaz novih spoznaja o epidemiologiji virusnih hepatitisa, serološkoj i mo¬lekularnoj dijagnostici virusnih hepatitisa, određivanju polimorfizma promotora gena za IL-28, procjeni stadija fibroze, algoritmu dijagnostičkog praćenja bolesnika, liječenju kroničnog hepatitisa C (genotipovi 1-6) i hepatitisa B, liječenju specijalnih populacija (djeca, bolesnici na dijalizi, bolesnici liječeni transplantacijom, osobe s HIV/HCV koinfekcijom) i nuspojavama liječenja., Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fi¬brosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treat¬ment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects.