Introduction: Intrathyroidal lymphoepithelial cyst (TLEC) is an uncommon benign lesion of the thyroid gland, with less than 50 cases described in literature, often associated with chronic thyroiditis or other thyroid abnormalities. Two proposed hypotheses regarding its pathogenesis are branchial cleft origin and squamous metaplasia. Immunohistochemical analyses of the cyst epithelium serve as a valuable instrument for distinguishing the cell’s origin, however, the exact pathogenesis of TLEC is still uncertain. In our case, we demonstrate that lymphoepithelial cysts can develop within the thyroid gland’s healthy parenchyma, devoid of chronic inflammatory changes. Case presentation: We present the case of a 45-year-old woman with a growing mass in the left lateral neck and signs of compression, dysphagia, dyspnea, and fatigue. Ultrasonography and computerized tomography revealed a large solitary cyst measuring 22 x 25 x 36 mm within the left thyroid lobe, with no other abnormalities noted in the thyroid structure. Left thyroid lobectomy was performed with an outstanding outcome and no observed complication. Histologically, the diagnosis of the intrathyroidal lymphoepithelial cyst was made with no signs of Hashimoto’s thyroiditis or other thyroid pathology. After the definitive diagnosis, a detailed literature search was done by PubMed and Google Scholar to investigate such a rare disease. Conclusion: Our case highlights the complexity of TLEC diagnosis. The immunohistochemical analysis suggesting a potential branchial cleft origin challenges the conventional association with chronic inflammation. Furthermore, our comprehensive literature review revealed a lack of well-conducted scientific research regarding its pathogenesis, highlighting the need for standardized protocols for immunohistochemical staining in suspected cases.
Uvod: Simptomatsko škljocanje s medijalne strane lakta uvijek je posljedica interakcije struktura koje se nalaze izvan zgloba, a jedan od uzroka može biti preskok medijalnog dijela mišića tricepsa preko medijalnog epikondila. Do tog preskoka dolazi pri fleksiji lakta većoj od 100°. Iako je u početku bezbolno, s vremenom se može javiti bol i simptomi sindroma kubitalnog kanala. Najčešći uzrok nastanka sindroma škljocanja mišića tricepsa jest hipertrofija tricepsa, potom neke anatomske varijacije, poput četvrtog trbuha mišića tricepsa, hipoplazije medijalnog epikondila humerusa te varus deformacije lakta, a opisuje se i njegova pojava nakon učinjene antepozicije ulnarnog živca. Prikaz bolesnika: U ovom radu prikazana su dva bolesnika s različitom etiologijom nastanka sindroma. Kod jedne bolesnice došlo je do razvoja bolnog škljocanja i ponovne pojave sindroma kubitalnog kanala nakon učinjene antepozicije ulnarnog živca, dok je kod drugog bolesnika, nakon dugotrajnog bezbolnog škljocanja, uz pojavu boli, došlo i do postupnog pogoršanja neuroloških simptoma. U oba slučaja intraoperacijski je potvrđena dislokacija medijalnog dijela mišića tricepsa preko medijalnog epikondila pri fleksiji lakta većoj od 100° i posljedična kompresija ulnarnog živca. Kirurško liječenje rezultiralo je u oba bolesnika potpunim nestankom simptoma. Zaključak: Iako je sindrom škljocanja mišića tricepsa relativno rijetko stanje, ipak na njega valja posumnjati, osobito ako bolesnik navodi pojavu škljocaja pri fleksiji lakta većoj od 100°. Tada treba sustavnim kliničkim pregledom i dijagnostičkom obradom pokušati utvrditi osnovni uzrok nastanka preskoka i pridruženog škljocanja. Kod simptomatskih bolesnika kirurško liječenje osigurava izvrstan klinički ishod.
This report describes the case of a 42-year-old woman who suffered from postprandial abdominal pain, bouts of tachycardia, belching, tinnitus, and syncope interfering with everyday life. After an extensive diagnostic workup, the correct diagnosis was finally established by computed tomography angiography. The patient had a syndrome caused by compression of the celiac trunk by the median arcuate ligament, also known as Dunbar syndrome. It typically affects younger patients, particularly women, with the triad of postprandial abdominal pain, weight loss, and abdominal bruit. The patient was successfully treated with laparoscopic decompression of the celiac trunk and resection of the celiac plexus. The median arcuate ligament syndrome should be included in the differential diagnosis for young patients presenting with postprandial epigastric pain, food fear, unintentional weight loss, and normal upper gastrointestinal endoscopy findings.
U ovom radu prikazale smo prvo iskustvo rada kliničkog farmakologa u Općoj bolnici Karlovac i njezinu suradnju s kliničkim farmaceutom. Naš cilj bio je opisati aktivnosti i suradnju tijekom prvih šest mjeseci rada, kvantificirati vrste i opseg aktivnosti te analizirati predložene intervencije vezane za farmakoterapiju i njihovu prihvaćenost u kliničkoj praksi. Provele smo retrospektivnu analizu razdoblja od 03. siječnja do 03. srpnja 2024. godine. Podatke smo prikupile iz bolničkog informacijskog sustava i interne evidencije vizita. Nova organizacija uključivala je zajedničke vizite kliničkog farmakologa i kliničkog farmaceuta s ciljem optimizacije farmakoterapije putem analize terapijskih lista i predlaganja intervencija odjelnim liječnicima. U navedenom razdoblju klinički farmakolog obavio je 6 pregleda u ambulanti i 13 konzilijarnih konzultacija, dok smo u zajedničkim vizitama pregledale 1926 terapijskih lista. Predložile smo 72 intervencije, od kojih je 55 (76,39 %) prihvaćeno. Većina intervencija odnosila se na prilagodbu doziranja lijekova prema funkciji bubrega, prevenciju potencijalno klinički značajnih interakcija i razrješenja nejasnoća vezano uz doze, interval doziranja i put primjene. Suradnja kliničkog farmakologa i kliničkog farmaceuta omogućila je ujedinjenje medicinskog i farmaceutskog znanja, povećala sigurnost farmakoterapije te proširila kliničku ulogu farmaceuta. Unatoč dobrim rezultatima, suradnja je privremeno prekinuta zbog organizacijskih razloga, što naglašava osjetljivost novih modela u manjim bolnicama. Zaključujemo da zajednički rad kliničkog farmakologa i kliničkog farmaceuta može pridonijeti sigurnijoj i racionalnijoj primjeni lijekova te može poslužiti kao model za druge opće bolnice.
Enhanced Recovery after Surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery for patients undergoing major surgical procedures. These evidence-based care improvement protocols have become standard for multiple surgical procedures in urology, gynaecology, orthopaedic and breast surgery. Over the last two decades these protocols have gained popularity in obstetrics due to improvements in both maternal and neonatal outcomes. Caesarean Section ERAS protocols are increasingly promoted and have now become widely accepted mostly in high income countries. The ERAS for Caesarean Section covers the entire perioperative period; including preoperative, intraoperative, and postoperative periods, based on multimodal treatments given by a multidisciplinary team consisting of obstetricians, anesthesiologists, midwives, nurses and neonatologists. Barriers for ERAS implementation are lack of manpower and managerial support, poor communication and collaboration among perioperative services and a resistance to shifting away from outdated practices. ERAS protocols should therefore be adapted to incorporate local hospital policies and practices, adjusted to suit obstetric patients and regularly reviewed and updated.
