Superior vena cava (SVC) syndrome develops because of intravascular thrombosis or extrinsic compression of the SVC. Current literature shows that 90%- 97% of SVC syndrome cases are due to malignant mediastinal disease, and a small proportion of the cases develop because of benign conditions. The classic symptoms include dyspnea, cough, headache, facial and arm swelling. We present a rare case of SVC syndrome caused by retrosternal goiter in a 77-year-old woman. After confirming the diagnosis, total thyroidectomy was performed, resulting in complete remission of compressive symptoms. Multidisciplinary management is necessary to avoid complications in the treatment of high-risk patients with SVC syndrome.
Sphingolipids are a complex group of lipids that are becoming increasingly important in many aspects of disease and cell physiology. They are composed of a long-chain sphingoid base backbone, a long-chain fatty acid linked by an amide bond, and one or more polar head groups the structures of which are characterized by different sphingolipid subtypes such as ceramide, sphingomyelin, and glycosphingolipids. The metabolism of these lipids plays an integral role in scaling body functions. They take involvement in the membrane domains and signaling, inflammation, cell proliferation, death, migration, and central nervous system development. Due to their discovery as potent messenger and signaling molecules, sphingolipids have lately attracted interest and are now thought to be potential therapeutic targets for a number of diseases. Here, we provide a thorough overview of sphingolipid metabolism and numerous biological functions inside the cell. Additionally, we draw attention to the sphingolipid involvement in a number of diseases, such as cancer, cystic fibrosis, and inflammatory disease, Alzheimer’s disease, Parkinson’s disease, and diseases related to lysosomal storage.
The sequence of deterioration in different cognitive domains, depending on the severity of Alzheimer's disease (AD), is still largely unknown. The aim of this study was to use the Mini-Mental State Examination (MMSE) scale to divide subjects into six groups of disease severity and compare the deterioration in cognitive domains (orientation in time and place, working memory, concentration, recall, language, and visuospatial orientation) between the groups. A total of 624 par-ticipants with a median age of 76 years (interquartile range (IQR) 70-80 years) were included in the study. A significant difference in age was observed between participants with severe cognitive impairment compared to other participants. No difference in sex structure was observed between the groups. The highest fluctuation, even in persons without cognitive impairment, was observed in the recall and concentration domains, followed by visuospatial orientation. The first deteriorated domains with progression of the disease were concentration and visuospatial orientation. Deterioration then continued in orientation in time and place, language, and working memory. The results can be used to predict the development of the disease, as well as for the adequate planning and testing of therapeutic approaches for AD.
Intravenous sedation for endoscopic retrograde cholangiopancreatography (ERCP) in patients aged 65 years or older is associated with respiratory instability. During ERCP, oxygen therapy is commonly delivered using a conventional nasal cannula (CNC) or a high flow nasal cannula (HFNC). Respiratory instability may require minor airway interventions (MAI), including chin lift, secretion suctioning, the insertion of an oropharyngeal airway, or escalation from CNC to HFNC. This randomized controlled trial aimed to compare the incidence of MAI in patients receiving HFNC versus CNC during ERCP. In this single center, prospective, randomized, controlled trial, 115 patients aged 65 years or older undergoing ERCP under intravenous sedation were randomized to HFNC (n = 58) or CNC (n = 57). The primary outcome was the incidence of MAI in each group. MAI occurred in 30 patients (26.1%) overall and significantly less frequently in the HFNC group (7 of 58, 12.1%) than in the CNC group (23 of 57, 40.4%) (P < 0.001; relative risk (RR) 0.30, 95% confidence interval (CI) 0.14-0.64). Chin lift was the most frequent MAI. No associations between MAI and age, sex, or the American Society of Anesthesiologists (ASA) physical status were observed. HFNC significantly reduces the incidence of MAI compared with conventional nasal cannula oxygen therapy.
This study aimed to evaluate the impact of low-level laser therapy (LLLT) and topical vitamin B12 treatment on patients with burning mouth syndrome (BMS). A total of 123 patients were enrolled and assigned randomly into three groups: LLLT, B12, or no-treatment. Patients completed the EuroQol Five-Dimension Health-Related Quality-of-Life (EQ-5D-5L HRQoL) questionnaire and a visual analog scale (VAS) both before and after treatment. The data were analyzed using R 4.4.2 statistical software to compare pre- and post-treatment differences. Significant differences in the post-treatment period were observed between the three groups for pain/discomfort, anxiety/depression, and VAS scores. Both the B12 and LLLT groups had significantly higher post-treatment scores compared to those in the no-treatment group. Although the differences between the B12 and LLLT groups were not statistically significant, the LLLT group had consistently higher scores. Significant improvements were observed in the LLLT group (P < 0.001). Similarly, pain/discomfort (P < 0.001) and anxiety/depression (P < 0.001) improved significantly after treatment (P < 0.05) in the B12 group. LLLT and topical vitamin B12 therapy both improved the overall systemic health status of patients with BMS, with LLLT being more effective than topical vitamin B12 treatment.
Acromegaly is a rare pituitary disorder with significant morbidity. This consensus statement aims to provide evidence-based diagnostic and management recommendations adapted to the Croatian setting. A multidisciplinary panel systematically reviewed international guidelines and evidence, applying the GRADE approach to assess certainty and strength of recommendations. Recommendations cover diagnosis, imaging, surgery, pharmacotherapy (first- and second-generation somatostatin receptor ligands, pegvisomant, dopamine agonists, combination therapy), radiotherapy, follow-up, and comorbidity management. A graded summary table provides practical guidance. These consensus recommendations offer standardized, evidence-based guidance for the diagnosis and management of acromegaly, aiming to improve patient outcomes and harmonize care across Croatia.
Headache disorders are one of the most prevalent and disabling conditions worldwide. Headache is classified as primary or secondary according to its underlying pathophysiology. The most common primary headaches are migraines and tension-type headaches (TTH). Their diagnosis is based mostly on clinical presentation, but sometimes this can be challenging. In order to improve the differential diagnostics of these conditions, we evaluated the role of electroencephalography (EEG) in diagnostic workup. EEG records electrical activity of the brain cortex. It is mostly used to diagnose epilepsy, but EEG abnormalities are found in many headache patients as well. In this review, we provide an overview of EEG-based headache-related research. We compare their results in the hope of better understanding the neural changes in migraine and TTH. According to our findings, EEG might be helpful in the search for potential headache biomarkers, but further studies are necessary.
Hyponatremia is frequently encountered in clinical practice. Euvolemic hyponatremia (syndrome of inadequate antidiuresis, SIAD) represents diagnostic and management challenges regarding etiology unraveling, gradual acute substitution, and later causal treatment. Here we present a case of severe SIAD caused by segmental pulmonary thromboembolism and manifested as acute psychosis. COVID-19 complicated the course of the disease acquired in hospital settings. By simultaneous treatment of pulmonary thromboembolism, gradual substitution of hyponatremia, and treatment of COVID-19, the patient completely recovered biochemically and mentally. Even experienced clinicians are confused about diverse clinical manifestation of SIAD. Attentive correction of hyponatremia and treatment of its etiology are the mainstays of SIAD management.
The aim of this retrospective observational study was to determine the incidence of chest injuries associated with manual chest compressions during cardiopulmonary resuscitation and the factors influencing their occurrence. Clinical and autopsy data were analyzed through a retrospective review of 71 autopsy reports of adult patients (58 men and 13 women) who did not survive out-of-hospital cardiac arrest. The study included cases from four municipalities in the Obalno-kra & scaron;ka region (Ankaran, Koper, Piran and Izola) of Slovenia, during the period from January 1, 2016 to December 31, 2020. The results showed that 42 patients (59.2%) sustained rib cage fractures following unsuccessful cardiopulmonary resuscitation. Most fractures were located between the second and sixth ribs, with the third, fourth and fifth ribs being the most frequently affected. Sternal fractures were identified in 43.6% of cases. Rib cage injuries increased with age (rho = 0.299, P = 0.013) and were more prevalent in cardiac arrests due to drowning (P = 0.012) and those occurring in public places (P = 0.006). However, given the relatively small sample size, further research is required to confirm the factors influencing the occurrence of chest injuries.
Diabetic nephropathy (DN) is the primary cause of chronic kidney disease in individuals with diabetes. Increasing evidence implicates hyperglycemia-induced mitochondrial dysfunction and overproduction of mitochondrial reactive oxygen species (mtROS) as significant contributors to diabetic kidney disease (DKD). This review aimed to elucidate the role of mitochondrial oxidative stress in the progression of DKD and to assess emerging therapeutic strategies targeting mitochondria. A comprehensive analysis of both experimental and clinical studies was conducted, focusing on the mitochondrial mechanisms underlying DKD and therapeutic approaches, including conventional renoprotective agents and mitochondria-targeted interventions. Hyperglycemia enhances electron transport chain activity, leading to excessive mtROS generation and activation of inflammatory, fibrotic, and apoptotic signaling pathways. Current therapies, such as SGLT2 inhibitors, RAAS blockade, and systemic antioxidants, provide partial protection, but do not directly address mitochondrial oxidative stress. Emerging strategies, including mitochondria- targeted antioxidants, Nrf2 activators, mitophagy inducers, and nanoparticle-based delivery systems, have shown promising renoprotective effects in preclinical and early clinical studies. Targeting mitochondrial dysfunction represents a promising therapeutic paradigm for DKD. Future research should prioritize the development of precise mitochondrial delivery systems, sensitive mitochondrial biomarkers, and rational combination therapies to enhance clinical translation and patient outcomes.
As a part of the multimodal treatment of myasthenia gravis patients, thymec-tomy is an established method with positive effects in some patients. The traditional surgical approach, sternotomy, was modified over the years from total to partial sternotomy, but despite this offers a suboptimal aesthetic result with a scar in the decolletage region in mostly female patients. At the Jor-danovac Department of Thoracic Surgery, a minimally invasive video-assisted method has been performed since 2016 in the treatment of patients with my-asthenia gravis who, in collaboration with a neurologist, are estimated to be able to benefit from thymectomy. We present the results of a new method at the Jordanovac Department of Thoracic Surgery in the multimodal treatment of patients with myasthenia gra-vis. In the first 4 years, we operated on 50 patients with extremely low perioper-ative complications, short hospitalization time, and low need for postoperative analgesic therapy. In the first year, we operated on 14 patients. Access was generally right-sided through three or four thoracic ports. In case of suspected thymoma, access depended on tumor localization. In the second year, we operated on 8 pa-tients, in the third 9, and in the fourth 19 patients. The thoracic drainage was removed on the 1 st post-operative day in all patients. Hospitalization duration was 2-4 days. Video assisted thymectomy is the standard in the treatment of patients with myasthenia gravis and patients with thymoma up to 5 cm in diameter. The out-comes significantly outperform those of a sternotomy and maintain equivalent oncological efficacy.
Intravesical Bacillus Calmette-Gu & eacute;rin (BCG) immunotherapy after transurethral resection of non-muscle-invasive bladder cancer has been proven to reduce the recurrence and progression of the disease. Unfortunately, the treatment is associated with adverse effects that can induce other chronic health problems, such as Reiter's syndrome. In this case report, we present a 74-year-old patient from Croatia who developed Reiter's syndrome after intravesical BCG instillations. Clinical diagnosis was based on symmetric knee arthritis following bilateral conjunctivitis and urethritis. Symptoms of arthritis did not improve with nonsteroidal anti-inflammatory drugs and steroid injections to the knees. Consequently, an immunologist was consulted and Reiter's syndrome was confirmed. Oral glucocorticoids were administered, followed by full recovery of the patient's symptoms. Even though Reiter's syndrome is uncommon, it is a significant complication resulting from BCG immunotherapy. It should be immediately recognized and appropriately treated.
Our aim was to analyze and compare the diagnostic efficacy of systematic and targeted + systematic prostate biopsies in patients with prostate-specific antigen (PSA) levels of 4-10 ng/mL. A retrospective study was conducted at University Hospital Centre Zagreb by analyzing biopsy data from 2018 to 2023. A total of 2,466 patients met the inclusion criteria, undergoing either a systematic (n = 1,900) or a combined targeted + systematic biopsy (n = 566). Targeted biopsies were performed for patients with a Prostate Imaging-Reporting and Data System (PIRADS) score >= 3 on multiparametric magnetic resonance imaging (mpMRI). Cancer detection rates and Gleason score (GS) distributions were evaluated. Prostate cancer (PC) was diagnosed in 41% of the study cohort. The detection rate was higher in the targeted + systematic biopsy group (54.7%) than in the systematic biopsy group (38.2%). Among biopsy-naive patients, targeted + systematic biopsy yielded a detection rate of 72.7%, significantly higher than systematic biopsy alone (42.1%). Clinically significant PC (ISUP >= 2) was detected in 35.2% of all cases, with targeted biopsies identifying a higher proportion of clinically significant tumors. Operator bias was observed, as systematic cores in targeted biopsy patients often contained malignant cells. The combination of targeted and systematic biopsies demonstrated the highest detection rate of clinically significant prostate cancer, particularly in biopsy-naive patients. Given the increasing use of mpMRI, this approach should be considered the method of choice for patients with elevated PSA levels. Future studies should assess the financial feasibility of widespread mpMRI implementation in prostate cancer diagnostics.
Nutritional habits are key environmental factors in multiple sclerosis (MS). This study aimed to investigate the association between adherence to the Mediterranean diet and disability, and quality of life in MS. A total of 103 people with MS were included. Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Scale (MEDAS), disability with the Expanded Disability Status Scale (EDSS), and quality of life with the Multiple Sclerosis International Quality of Life Scale (MusiQoL). Secondary outcome measure was walking ability (12-item MS Walking Scale (MSWS-12)). The mean age of study subjects was 36.26 +/- 9.92 years. There was a negative correlation between MEDAS and EDSS (p=0.025, r=-0.221) and positive correlation between MEDAS and MusiQoL total score (p=0.044, r=0.199). Higher MEDAS scores were significantly associated with lower EDSS scores (R-2=0.362, 95% CI=-0.419 to -0.036, p=0.020) and better walking ability (lower MSWS-12 scores) (R-2=0.350, 95% CI=-0.399 to -0.028, p=0.024). Additionally, a positive association was observed between MEDAS and MusiQoL (R-2=0.122, 95% CI=0.067-0.501, p=0.011). In conclusion, Mediterranean diet may play a significant role in reducing disability and improving quality of life.
The aim of this study was to investigate the efficacy of ferric carboxymaltose (FCM) in the correction of iron deficiency anemia and to determine the frequency and level of hypophosphatemia as a side effect. The data on 28 patients treated in Sestre milosrdnice University Hospital Center with one or two applications of FCM in a single dose of 1000 mg, depending on the severity of anemia, was retrospectively analyzed. The inclusion criteria were hemoglobin < 110 g/L, iron saturation < 20%, ferritin <30 & micro;g/L and phosphate >0.79mmol/L. Parameters analyzed before and two weeks after FCM application were complete blood count (CBC), ferritin, and calcium and phosphate values, while vitamin D and creatinine levels were determined only once before application. After parenteral iron supplementation, the expected correction of hemoglobin values and iron deficiency occurred. The difference in phosphate values before and after FCM application was statistically significant. The onset of asymptomatic mild to moderate hypophosphatemia was reported in 67.86% patients. In this study, baseline hemoglobin and phosphate values were predictive factors of the degree of hypophosphatemia after FCM administration.
Anal cancer is a relatively uncommon malignancy, accounting for approximately 2.5% of all gastrointestinal cancers. This retrospective study included patients diagnosed and treated with anal cancer between February 1, 2015 and February 1, 2025 at Sestre milosrdnice University Hospital Center in Zagreb, Croatia. A total of 42 patients met the inclusion criteria. All 42 patients had histologically confirmed squamous cell carcinoma. At the time of diagnosis, 35 patients (83.33%) had localized or locoregionally advanced disease (stage I-III), 6 patients (14.29%) had metastatic (stage IV) disease, and 1 patient had an unknown disease stage. Most patients (31; 83.78%) received radical-dose (chemo)radiotherapy at some point during their disease. In patients with primary chemoradiotherapy as initial treatment, the complete response rate was 56.52% (13 patients). At the cut-off date (February 1, 2025), 31 patients (73.81%) were alive. Median follow-up was 24.82 months. For the whole study cohort, neither 2-year nor 5-year overall survival was reached. The findings of our single-center study demonstrate that definitive chemoradiotherapy is an effective treatment for anal cancer, with high rates of local control and overall survival.
The age of women in childbirth is increasing globally. Older pregnant and childbearing women and their children are considered to be at a higher risk of complications. This study aimed to determine whether older women giving birth for the first time had more complications during pregnancy, delivery, and postpartum period. A secondary analysis of national perinatal data from 2013 to 2019 was made. We compared complications in different age groups (20-24, 25-29, 30-34, 35-39, and >40 years). Statistically significant differences were estimated using chi 2-test and Fisher test. Older first-time mothers (>= 40 years) had a higher incidence of gestational diabetes (20.7%), preeclampsia (4.1%), and placental abnormalities than others. Cesarean section was also more common (21.1%). There were more preterm births (13.8%) and small-for-gestational-age babies (12.6%) in the group of first-time mothers aged over 40. Statistically significant differences were also found in Apgar scores at the first (p=0.00; chi 2=89.560) and fifth minute (p<0.001; chi 2=53.262). In physical terms, late motherhood does not offer advantages. We cannot influence the trend of postponed motherhood, but as health professionals, we have an obligation to provide women with all the information they need to make informed reproductive decisions.
Breast milk plays a pivotal role in maternal-infant immune communication. We examined cytokine dynamics in 45 asymptomatic breastfeeding mothers: 29 nursing infants with acute infection and 16 nursing healthy infants. All infants were born at full term, with high Apgar scores, and the mothers had no clinical or laboratory signs of inflammation. Milk samples were collected 3-5 days after the onset of infant illness and 4-6 weeks later during convalescence. Cytokine concentrations (IFN-gamma, IL-1R, IL-17A, IL-4, IL-6, and TNF-alpha) were measured in the aqueous phase of breast milk using Human HS ProcartaPlexTM Mix&Match assay. Only IL-6, IL-1R, and TNF were consistently detectable. In the mothers of ill infants, pro-inflammatory cytokines, particularly IL-6, were markedly suppressed during acute infection and correlated with elevated infant C-reactive protein levels. Cytokine recovery during convalescence was heterogeneous: IL-6 rebounded in younger mothers and in infants with milder leukocytosis, but recovery was blunted in older mothers and in cases of pronounced infant inflammation. TNF restoration was more frequent in early lactation, suggesting an influence of lactation stage. These findings reveal that breast milk cytokine responses are dynamically regulated by both infant inflammatory status and maternal characteristics, highlighting an adaptive mechanism of immune communication during lactation.
The aim of this study was to examine the influence of individual factors on adherence to treatment in patients with peripheral arterial disease (PAD). The study included 82 patients diagnosed with PAD (Fontaine IIa, IIb) and treated at the Clinic for Vascular Surgery of the University Clinical Center Nis, during the period from January 1, 2020 to December 31, 2020. We found a significant correlation between the degree of adherence to treatment and health-related quality of life in patients with PAD. Patients with a medium and high degree of adherence had a significantly higher quality of life compared to the respondents with a low degree of adherence. The chi-square test of independence showed a significant correlation between obesity (P = 0.007) and the number of medications in therapy (P < 0.001) with adherence to therapy in patients with PAD. Adherence was statistically significantly influenced by obesity and the number of medications in therapy, while sex, age, smoking, diabetes, dyslipidemia, the number of risk factors, and type of therapeutic modality did not show this association.
Our aim was to report the case of a patient treated for multiple synchronous primary carcinomas affecting the kidney, urinary bladder, prostate, and lungs. A 69-year-old man presented with macrohematuria, without any other symptoms. An initial ultrasound examination and cystoscopy revealed a bladder tumor. During a computer tomography scan, a left kidney and lung tumor were incidentally found. The patient underwent transurethral bladder tumor resection, nephrectomy, pulmonic lobectomy, and finally radical cystectomy due to additional evidence of invasive bladder cancer. The pathology report after the last surgery also revealed prostatic cancer. The pathological processing was extended by immunohistochemical analysis. This report showed a rare synchronous appearance of four independent carcinomas in one patient, who was surgically treated. To our knowledge, this is the first case presenting this combination of tumors.
