Search

Background: Negative CCTA can effectively exclude significant CAD, eliminating the need for further noninvasive or invasive testing. However, in the presence of severe CAD, the accuracy declines, thus necessitating additional testing. The aim of our study was to evaluate the diagnostic performance of noninvasive cFFR derived from CCTA, compared to ICA in detecting hemodynamically significant stenoses in participants with high CAC scores (>400). Methods: This study included 37 participants suspected of having CAD who underwent CCTA and ICA. CAC was calculated and cFFR analyses were performed using an on-site machine learning-based algorithm. Diagnostic accuracy parameters of CCTA and cFFR were calculated on a per-vessel level. Results: The median total CAC score was 870, with an IQR of 642–1370. Regarding CCTA, sensitivity and specificity for RCA were 60% and 67% with an AUC of 0.639; a LAD of 87% and 50% with an AUC of 0.688; an LCX of 33% and 90% with an AUC of 0.617, respectively. Regarding cFFR, sensitivity and specificity for RCA were 60% and 61% with an AUC of 0.606; a LAD of 75% and 54% with an AUC of 0.647; an LCX of 50% and 77% with an AUC of 0.647. No significant differences between AUCs of coronary CTA and cFFR for each vessel were found. Conclusions: Our results showed poor diagnostic accuracy of CCTA and cFFR in determining significant ischemia-related lesions in participants with high CAC scores when compared to ICA. Based on our results and study limitations we cannot exclude cFFR as a method for determining significant stenoses in people with high CAC. A key issue is accurate and detailed lumen segmentation based on good-quality CCTA images. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Barrett's esophagus (BE) requires surveillance to identify potential neoplasia at an early stage. The standard surveillance regimen includes random 4-quadrant biopsies by Seattle protocol. Main limitations of random biopsies are high risk of sampling error, difficulties in histology interpretation, common inadequate classification of pathohistological changes, increased risk of bleeding, and time necessary to acquire the final diagnosis. Probe-based confocal laser endomicroscopy (pCLE) has emerged as a potential tool with an aim to overcome these obvious limitations. Summary: pCLE represents a real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1,000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patients. The main advantages would be real-time diagnosis and decision-making, greater diagnostic accuracy, and evaluation of larger area compared to random biopsies. Clinical pCLE studies in the esophagus show high diagnostic accuracy, and its high negative predictive value offers high reliability and confidence to exclude dysplastic and neoplastic lesions. However, it still cannot replace histopathology due to lower positive predictive value and sensitivity. Key Messages: Despite promising results, its role in routine use in patients with BE remains questionable primarily due to lack of well-organized double-blind randomized trials. [ABSTRACT FROM AUTHOR]

Introduction: Mitral annular disjunction (MAD) is a structural abnormality defined as the separation of the ventricular myocardium between the mitral valve annulus and the left atrial wall during systole. Multiple studies have demonstrated a high prevalence of MAD in the setting of myxomatous mitral valve disease. MAD has exceedingly variable clinical course that patients may present with. It has been associated with a risk of malignant ventricular arrhythmias and sudden cardiac death, consequently recognition of this diagnosis and risk stratification are greatly important.1,2 Case report: 23-year-old male with a history of myxomatous mitral valve disease was admitted to Cardiology Department because of 90 minutes long chest pain. High-sensitive troponin was mildly elevated (307 ng/L), same as NTproBNP (1077 n/L). Inflammation parameters and D-dimer were normal. CT coronary angiography excluded obstructive coronary artery disease (CAD). A transthoracic echocardiogram (TTE) showed normal left ventricular ejection fraction and evidence of Barlow disease with a mild to moderate mitral regurgitation (MR). Additionally, cardiac event monitoring showed no ventricular arrhythmias. Hospitalisation was uneventful, and he was discharged with a diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) with an instruction to do a heart CMR (myocarditis was suspected). CMR showed no signs of oedema or myocardial fibrosis, but it did describe a few crypts in the basal inferoseptal segments of the left ventricle (Figure 1). The missing puzzle was found one year later, when an evaluation TTE described moderate bileaflet mitral valve prolapse (MVP) and prominent MAD, measuring 8 mm in end-systole, together with earlier known mild-moderate MR (Figure 2). On outpatient follow-up, he has no therapy and has not had further chest pain. Conclusion: Although MAD is easy to diagnose, it can be overlooked in daily practice, like it happened in our case. The authors speculate that MVP and MAD were aetiology of MINOCA, and it should be considered in the work-up. The current guidelines recommend implantable cardioverter defibrillator (ICD) for secondary prevention, but the role of primary prevention ICD in MVP and MAD is unclear and decisions should be made on an individual basis.3 Providing the case, we wanted to increase the awareness of this anatomic variation of the mitral valve. [ABSTRACT FROM AUTHOR]

Art is defined as the expression or application of the human creative skill and imagination, producing works to be appreciated primarily for their beauty or emotional power. „Ars medica“ and „Ars musica“ represent two concepts which have been mutually intertwined since the ancient times. Through history, many extraordinary physicians have shown talent towards making and performing music. Guided by the passion for medicine and music, since 2006 the students from the University of Rijeka, Faculty of Medicine have founded an informal group named „In honour of Asclepius and Orpheus“ under the aegis of the Croatian Scientific Society for the History of Health Culture. The group organizes many musical activities such as concerts, musical recitals and events, among which are the most important - the traditional annual concert of Croatian medical students and the European Medical Students Orchestra and Choir project. Apart from Rijeka, they performed several times in Ljubljana, Zagreb, Pula, Karlovac, Krk, Opatija and Crikvenica. The members of this group plan their future work guided by the principles that motivate every physician-musician - art. [ABSTRACT FROM AUTHOR]

Case report: We present a case report of an 82-year-old male patient with known valvular and ischemic heart disease and a history of paroxysmal atrial fibrillation, iatrogenic hypothyroidism and rheumatoid arthritis who was admitted to our Department in August 2018 due to chest pain. Routine echocardiography revealed a large pericardial effusion and pericardiocentesis was performed with instillation of bleomycin. Cytology of the pericardial effusion showed elements of peripheral blood, but there was no evidence of malignant disease. Ten months later he was admitted again due to non-ST elevation myocardial infarction with clinical symptoms and signs of heart failure. Coronary angiogram revealed atherosclerotic disease of left and right coronary artery with significant stenosis of the left main, left anterior descending, left circumflex and right coronary artery. Echocardiography revealed an enlarged right atrium and ventricle with severely thickened interventricular septum and anterolateral wall of the right ventricle which was akinetic and seemed infiltrated as well as adjacent pericardium. A small pericardial effusion was also noted. There were no regional wall abnormalities of the left ventricle, and its ejection fraction was preserved. Additionally, severe aortic stenosis was determined. Magnetic resonance imaging of the heart was performed which showed diffuse myocardial and pericardial infiltrative mass along the right ventricular free wall, right ventricular apex, interventricular septum, and right ventricle papillary muscles. Morphological features were indicative of a cardiac lymphoma. Endomyocardial biopsy was performed. Histopathological analysis of right ventricle samples obtained at endomyocardial biopsy confirmed the presence of a diffuse large Bcell lymphoma. Chemotherapy was initiated with R-mini-CHOP protocol. After the seventh cycle the patient developed febrile neutropenia with signs of heart failure. Echocardiographic findings showed thinner myocardial walls and global hypokinesia with reduced left ventricular ejection fraction. Patient died 7 months after the diagnosis. Conclusion: Primary or secondary lymphomas are rare malignancies of the heart, often presenting with atypical symptoms and signs1,2. Imaging includes echocardiography, computed tomography and magnetic resonance imaging with final diagnosis that is based upon histopathological analysis of the heart tissue obtained on endomyocardial biopsy. The prognosis is poor, and diagnosis is often obtained post mortem1,2. [ABSTRACT FROM AUTHOR]

Systematic review articles are considered as a part of relevant scientific and professional literature which has become an infallible part of everyday medical practice and a vital part in decision making. This scientific work is based on the systematic and strictly defined methodology of research, selection and analysis of available medical evidence which provides and answer to a specific scientific question. The Cochrane Collaboration is a world non-profit organizaton whose goal is to publish high qualitiy systematic reviews through detailed and rigorous methodology. Through out different scientific groups, authors publish Cochrane systematic reviews of interventions and diagnostic tests which are published in the Cochrane Database of Systematic Reviews. These reviews develope in several steps: question formulation, Cochrane group selection, title registration, writing and publishing a protocol and writing, publishing and updating a systematic review. In this article we wish to present the methodology of Cochrane systematic review development as a general insight into its complexity. [ABSTRACT FROM AUTHOR]

Aim: The aim of this retrospecti ve study was to determine the diagnosti c value of computerized tomography (CT) in pati ents without prior surgery who presented with clinical signs and symptoms of acute abdomen with the goal of assessment of the need for surgery and the detecti on of causes of acute abdomen. Pati ents and methods: This retrospecti ve study included all adult pati ents without prior surgery who were referred to perform abdominal CT scan with the diagnosis of acute abdomen in the period from October 31st 2014 ti ll October 31st 2015. Pati ents who had laparotomy of laparoscopy performed within 30 days prior to CT examinati on and those who died during hospitalizati on aft er the CT examinati on and without surgery were excluded. Reference standards in this study were surgery report and hospital observati on during 30 days aft er CT exam in pati ents who had no surgery. CT exams were independently analysed by two radiology specialists with more than 5 years of experience in abdominal CT imaging and all disagreements were sett led with consensus. Results: Out of 81 pati ents (age 19-91, median 69 years, male/female rati o 45/36) 51 had emergency surgery. Duodenal/gastric ulcer perforati on, diverti culiti s and appendiciti s with complicati ons, bowel perforati on and complicati ons of acute cholecysti ti s were the most common causes for surgery. Sensiti vity and specifi city of abdominal CT were 94.6% and 84.6%, while positi ve and negati ve predicti ve values were 93.0% and 87.5%, respecti vely. In pati ents with true positi ve results, CT successfully assessed the localizati on of the cause of acute abdomen in 83% of pati ents. Conclusion: Abdominal CT examinati on in pati ents with signs and symptoms of acute abdomen is a reliable diagnosti c method in the assessment of indicati on for surgery and the detecti on of causes of acute abdomen. [ABSTRACT FROM AUTHOR]

Patient satisfaction has been a widely investigated subject in health care research. Quality of care from the patient perspective, especially in home health care, however has been investigated only very recently. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Multidisciplinary nature of home health care services present challenges to quality measurement that differ from those found in a more traditional hospital settings. The aim of the study was to investigate the satisfaction of elderly patients living on islands with home health care. Participants receiving skilled nursing care in their homes, for any diagnosis, who met selection criteria, were surveyed about their perception of the quality of health care. The research was conducted during the year 2010 among the residents of Kvarnerian islands (Krk, Cres and Mali Lo{inj) under the authority of Croatian Institute for Health Insurance that approved the protocols employed in the investigation. Most older patients (96.2%) reported high levels of satisfaction with health services delivery. Common leading diagnosis among home health care patient include diseases of circulatory system (28.9% of patients), nutritional and metabolic disease(14.5%), malignant diseases (13.2%), musculoskeletal and connective tissue disease (11.8%), diseases of the nervous system (9.2%), followed by injury and poisoning (7.9%). Provision of home health care was well received by elderly patients. Home health care providers seek to provide high quality, safe care in ways that honour patient autonomy and accommodate the individual characteristics of each patients home and family. The demographics of an aging society will sustain the trend towards home-based care. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Art is defined as the expression or application of the human creative skill and imagination, producing works to be appreciated primarily for their beauty or emotional power. "Ars medica" and "Ars musica" represent two concepts which have been mutually intertwined since the ancient times. Through history, many extraordinary physicians have shown talent towards making and performing music. Guided by the passion for medicine and music, since 2006 the students from the University of Rijeka, Faculty of Medicine have founded an informal group named "In honour of Asclepius and Orpheus" under the aegis of the Croatian Scientific Society for the History of Health Culture. The group organizes many musical activities such as concerts, musical recitals and events, among which are the most important - the traditional annual concert of Croatian medical students and the European Medical Students Orchestra and Choir project. Apart from Rijeka, they performed several times in Ljubljana, Zagreb, Pula, Karlovac, Krk, Opatija and Crikvenica. The members of this group plan their future work guided by the principles that motivate every physician-musician - art.

Three institutions: Teaching Institute of Public Health of Primorsko-Goranska County, Croatian Association "Albert Einstein" and Eye Clinic "Dr B.Vojnikovid" Rijeka agreed a five-year project to study children's health status of vision at Primorsko-Goranska County. Main task was the study of damage of vision in children due to prolonged sun exposure. Examination were conducted on a three locations, with the assumption of varying insolation: Island of Rab, Novi Vinodolski and Delnice. The study included children aged between 9 to 14 years. The study included 189 children. Except routine ophthalmologic examinations in addition were preformed biomicroscopic examination of the anterior segment of the eye, intraocular pressure and eye fundus. In a certain number of children with suspect of a specific disease (macular degeneration, glaucoma and refractive error), additional tests were performed: glaucoma treatment, field of vision, optical coherence tomography (OCT) of the eye and detailed eye refraction. This study specifically addressed of refractive error at that three different regions. It was found that the most difficult situation was at the Novi Vinodolski where as many as 40% of children have a refractive error, followed by Island of Rab with 17% and Delnice with 9%. Especially like to mention that on the island of Rab, 50-60 years ago, it was a very rare occurrence of some refractive errors in children.