Chilaiditi Sign and Chilaiditi Syndrome in Pregnancy.

BACKGROUND: Chilaiditi syndrome is a rare condition characterized by impaired fixation of the colon resulting in symptoms secondary to colonic interposition. It commonly presents with nonspecific abdominal pain and constipation, making clinical diagnosis difficult, especially in pregnancy. CASE REPORT: A 29-year-old afebrile woman in the week 28 of pregnancy presented with right-sided abdominal pain and constipation. With an Alvarado score of 6, the working diagnoses were acute appendicitis and intestinal obstruction. After a normal transabdominal ultrasound, emergent abdominal magnetic resonance imaging showed abnormal fixation of hepatic flexure wedged between the falciform ligament and liver. Without clinical, laboratory, and radiologic signs of complete obstruction or colonic perforation, conservative therapy was introduced and was successful. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms associated with Chilaiditi syndrome in pregnancy include nonspecific abdominal pain, and the correct preoperative diagnosis is difficult. The most common differential diagnoses are intestinal obstruction and acute appendicitis. It is important to diagnose Chilaiditi syndrome early because it can lead to severe complications, including intestinal obstruction, perforation, and ischemia. Therefore, in patients with right-sided abdominal pain with inconclusive transabdominal ultrasound, emergent magnetic resonance imaging leads to early diagnosis and treatment, minimizes maternal and fetal complications, avoids unnecessary explorations, and shortens the hospitalization.

Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome - Two Presentations of the Same Disease?

The two most common entities among generally rare but under-diagnosed autoinflammatory bone disorders are chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Due to their similarities, many authors consider CRMO to be a subtype of SAPHO syndrome. The aim of this study was to compare clinical, laboratory, and imaging features and outcomes of patients with CRMO and SAPHO. The analysis of the data from 6 children with CRMO (four girls and two boys, age 3.5-14 years) and of 6 children (6 boys, age 13.5-17.5 years) with SAPHO syndrome was performed. The initiating symptoms in all patients with CRMO were bone pain with multifocal bone lesions. There were no skin manifestations. Five out of six patients achieved control with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, while one patient required disease-modifying antirheumatic drugs (DMARDs). The initiating symptom in five patients with SAPHO syndrome were severe acne, while in one patient acne occurred two years after the disease onset. Two patients typically developed inflamed sternoclavicular joints and sternum, while the others showed changes affecting other skeletal regions. Three patients achieved control with NSAIDs and corticosteroids, the others required DMARDs and TNFα inhibitors. In comparison with patients with CRMO, patients with SAPHO suffered more frequent and longer lasting exacerbations. In conclusion, CRMO and SAPHO syndrome have an array of common characteristics, but also a number of differences. Nevertheless, further investigation into the etiopathogenesis is required to establish a definite relationship between CRMO and SAPHO.

[RADIOLOGICAL FEATURES IN PEDIATRIC IMAGING].

Juvenile idiopathic arthritis (JIA) is an autoimmune disease usually occurring in children before the age of 16. As one of the most prevalent rheumatic diseases in the pediatric population, with an estimated prevalence of 2 to 20 and an incidence of 16 to 150 per 100,000 children, it is defined as an inflammation of one or more joints, with a duration of 6 weeks minimum. JIA is primarily diagnosed clinically, confirmed by laboratory and radiological findings, with the goal of early detection and assessment of the spread and progress of the disease as well as the response to medication. The current International League of Associations for Rheumatology (ILAR) classification defines eight types of arthritis.

[Application of radiological imaging in rheumatoid arthritis]. / Primjena radioloskih metoda u reumatoidnom artritisu.

Advancement in technology and development in the field of radiological equipment provides us with a variety of diagnostic possibilities. Once diagnosed, further grading of pathologic condition is needed in order to monitor the changes of affected joints, either progression due to the course of the disease or remission due to the applied therapy. Different methods used in imaging of musculoskeletal system are discussed, including use of standard radiography, computed tomography, magnetic resonance, ultrasound and Color Doppler imaging. Bone mineral density results add much additional data so densitometry scanning is performed routinely.

Cardiovascular drugs consumption--comparison between two Croatian regions, City of Zagreb and Lika-Senj County.

The aim of this paper is to determine the differences in the outpatient consumption of cardiovascular drugs between Croatian regions: the City of Zagreb and Lika-Senj County. The data on the number of packages and the purchase price for each drug have been obtained from all pharmacies in Lika-Senj County and all pharmacies in the City of Zagreb. Defined daily doses/1000 inhabitants/day (DDD/1000/day) was calculated for every drug in accordance with its code name and Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) index of the World Health Organization (WHO) for 2007. For drug combinations without defined daily doses, equivalent doses (ED) were used. The quality of drug prescribing within the group of cardiovascular drugs was assessed using the Drug Utilization (DU90%) method and the adherence of the DU90% segment to the guidelines for prescribing individual drug groups. The statistical significance of differences in results between the City of Zagreb and Lika-Senj County was tested using the chi-square test at the level of statistical significance p < 0.05. The comparison of the share of the five most often prescribed drug groups in Lika-Senj County has shown statistically significant differences when compared to the City of Zagreb (chi2 = 28.93, df = 4, p < 0.001). The total outpatient consumption of cardiovascular drugs in the City of Zagreb and Lika-Senj County differs significantly. The consumption, quality of prescribing drugs and cost/DDD in the City of Zagreb is higher than in Lika-Senj County; in the City of Zagreb, newer and more expensive drugs are prescribed to a higher extent.

[Radiologic imaging of crystalline arthritides]. / Radiolosko oslikavanje u kristalinicnim artritisima.

Gout is a group of diseases characterized by arthritis and is a result of urate metabolism disturbance with the deposition of monosodium urate crystals in the joint and soft tissues. Clinical manifestations include acute and chronic arthritis, tophaceous deposits, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joint or body fluids.