Acta clinica Croatica
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Acta clinica Croatica · Jun 2020
ReviewProphylactic Central Neck Dissection in Well-differentiated Thyroid Cancer.
Well-differentiated cancers, both papillary and follicular, account for 90% of all diagnosed thyroid cancers. They have an indolent disease course with a 20-year disease-specific survival over 90%. According to current guidelines, the therapy of choice for well-differentiated thyroid carcinoma is total thyroidectomy or lobectomy. ⋯ There is no indication for prophylactic central neck dissection in follicular thyroid carcinomas, which primarily metastasize hematogenously. In small solitary papillary thyroid carcinomas (T1 and T2), prophylactic central neck dissection is not indicated as it does not bring benefits in terms of improved patient survival and at the same time significantly increases the risk of temporary and permanent postoperative complications. Prophylactic central neck dissection is indicated in advanced papillary thyroid cancers (T3 and T4) and all other high-risk well-differentiated thyroid cancer, as well as in the presence of metastatic lymph nodes in the lateral neck.
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Acta clinica Croatica · Jun 2020
Review Case ReportsBrucellosis in pregnancy: case reports with different outcomes in an endemic region.
Different outcomes of brucellosis in pregnancy regarding the fetus/neonate and the mother are described. Medical records of five pregnant women with brucellosis were retrospectively analyzed. Patients were treated in several departments of infectious diseases in the Republic of Macedonia between 1995 and 2009. ⋯ Brucellosis, especially if acquired in early pregnancy, can have an impact on pregnancy outcome. In endemic regions, in pregnant women with persisting fever and unspecific manifestations one should always have in mind brucellosis. In these areas, cases with unexplained spontaneous abortion, intrauterine fetal death and premature delivery should also be investigated for brucellosis.
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Acta clinica Croatica · Jun 2020
Review Case ReportsTHE RISK OF MULTIPLE INTRACRANIAL ANEURYSM FORMATION IN PATIENTS WITH MALIGNANT DISEASE UNDERGOING RADIATION THERAPY: A CASE REPORT AND LITERATURE REVIEW.
Neoplastic etiology of intracranial cerebral aneurysm is rare. Yet, the risk of its development is higher in malignant tumor patients receiving radiation therapy. Due to the possible negative effects of irradiation on intracranial vessel walls, the risk of aneurysm formation after radiation therapy, which is crucial for some types of breast cancer patients, continues to be a matter of debate. ⋯ Due to the bilateral aneurysm multiplicity, tumor characteristics and prognosis, comorbidity and relatively advanced age, the patient was not selected for active endovascular or microsurgical aneurysm treatment but only periodical clinical, oncologic and radiological follow-up was advised. In conclusion, the risk of multiple intracranial aneurysm formation in patients with breast cancer undergoing radiation therapy is low, but still possible. Long-term follow-up and regular cerebral angiographic check-up studies are necessary in selected malignant patients to decrease such a risk and to evade the worst outcome associated with aneurysm rupture.
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Acta clinica Croatica · Jun 2020
Case ReportsCOMPUTED TOMOGRAPHY SCAN FOR DIAGNOSIS OF OSTEOARTHRITIS: RARE LOCALIZATION IN THE SHOULDER IN A TWELVE-YEAR-OLD BOY.
Acute osteomyelitis is pyogenic infection of the bone and bone marrow. We report a case of successful diagnosis and treatment in a 12-year-old boy with right shoulder joint osteoarthritis. On admission, he was febrile (39.0 ºC) with pain in his right shoulder. ⋯ The purulent content was removed by surgery. Prolonged antibiotic therapy and rehabilitation led to improvement of the condition. At two-month follow-up, ultrasonography and CT scan showed that there were no pathologic changes, while magnetic resonance imaging showed minimal tissue fibrosis that did no require surgical treatment.
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Acta clinica Croatica · Jun 2020
Case ReportsA 27-year-old patient with congenital bladder exstrophy and recurrent pelvic organ prolapse: a case report.
Bladder exstrophy (BE) is a rare congenital malformation estimated to occur in up to 1/250,000 female live births. The evidence supporting the incidence, uterine preservation and its overall fertility rate in patients with pelvic organ prolapse (POP) and BE is not precisely determined. We report a case of BE and POP in a 27-year-old nulliparous Caucasian. ⋯ After 36 months, the patient was still asymptomatic with no evidence for prolapse recurrence. This case demonstrates diagnostic challenges and surgical dilemmas in treatment strategy for patients with BE and co-existent POP. Furthermore, routine long-term surveillance is necessary in terms of renal function, urinary continence, malignancy and possible obstetric issues.