Diagnostic Performance of 99mTc-Sestamibi SPECT/CT and 18F-Choline PET/CT in Locating Hyperfunctioning Parathyroid Glands in Patients with Primary Hyperparathyroidism.

OBJECTIVE: This study aimed to assess the diagnostic performance of 99mTc-sestamibi SPECT/CT and 18F-choline PET/CT in detecting hyperfunctioning parathyroid glands in patients undergoing surgery for primary hyperparathyroidism (PHPT). METHODS: A retrospective analysis was conducted on patients who underwent PHPT-related surgery between April 2019 and May 2022. The study focused on patients undergoing either 99mTc-sestamibi SPECT/CT (81 patients) or 18F-choline PET/CT (33 patients) scans before surgery to pinpoint hyperfunctioning parathyroid gland(s). In the majority of patients, 18F-choline PET/CT was performed after negative or inconclusive findings on 99mTc-sestamibi SPECT/CT. Pathohistological reports were utilized as the reference standard for evaluating the accuracy of the imaging findings. RESULTS: The study encompassed 83 patients (70 females, 84.3%) with an average age of 57.2 years (24-80 years). The pathohistological analysis identified a total of 98 glands. In a per-lesion analysis, the detection rate of 99mTc-sestamibi SPECT/CT was 57% (95% CI 45.3-68.1), while the detection rate of 18F-choline PET/CT was 90.3% (95% CI 74.3-98.0). CONCLUSION: The results of our study showed the significant usefulness of 18F-choline PET/CT in patients with negative or inconclusive results of 99mTc-sestamibi SPECT/CT in accurately locating hyperfunctioning parathyroid glands in PHPT patients.

32-year-old Traumatic Arteriovenous Fistula Presenting With Leg Ulcer and High-output Heart Failure.

Traumatic arteriovenous fistula (AVF) is not a common disorder, and dermatological signs and heart failure caused by AVF are rarely reported. We present the case of a 55-year-old woman who was referred for congestive heart failure symptoms. Echocardiography revealed preserved left ventricular ejection fraction. Due to edema of the right leg with a long-standing leg ulcer and palpable femoral thrill, duplex ultrasonography was performed. It showed an AVF between the right superficial femoral artery (SFA) and the right femoral vein (FV). The patient recalled a 32-year-old gunshot injury that was not medically treated. After the diagnosis of AVF she was referred to a surgeon for an AVF ligation, with subsequent resolution of her symptoms. The differential diagnosis of leg ulcer with leg edema should include the possibility of AVF as a cause.

Protected area management effectiveness and COVID-19: The case of Plitvice Lakes National Park, Croatia.

The decline in economic activities and tourism during the COVID-19 pandemic has reduced the pressure on the environment and protected area (PA) systems to some extent. However, the financial losses within nature-based tourism due to travel restrictions and park closures will negatively impact tourism income-dependent PAs' management effectiveness. This exploratory study incorporates a risk-assessment framework to investigate and provide first insights into the pandemic's influence on the delivery of management outputs in Plitvice Lakes National Park, Croatia.Although in 2020, this PA faced a 75% decline in overall revenue compared to the year before, analysis suggests that, in the short term, conservation-related outputs are least affected. Visitor management and PA efforts to support the local community's sustainable development are the most severely impacted first-order outputs. Third-order nature-based tourism-related outputs face average to high risks.This study's risk-assessment framework provides a starting point for a post-pandemic reassessment of the delivery of PA management outputs and decision-making about output prioritisation and resource allocation. Results suggest several new avenues for research. Management implications: Post-pandemic recovery of PA requires prioritisation risk framework to identify specific objectives that should be addressed first and which require additional effort or funding. Facing a crisis PA will allocate financial resources in a way that sustains primary functions such as conservation until negative trends change, or at least until financial resources become available. PAs require a paradigm shift, which includes tailoring of financial mechanisms to practical and policy purposes, effective allocation of financial resources, and responsible tourism recovery plans that capture the value and efforts of conservation through tourism and investments in nature-based solutions for sustainable tourism within PA.

High-output heart failure following gunshot injury and traumatic arteriovenous fistula.

BACKGROUND: Heart failure due to high cardiac output rarely occurs. Few cases of post-traumatic arteriovenous fistula (AVF) as a cause of high-output failure were reported in the literature. METHODS: Herein, we report a case of 33-year-old male who was admitted to our institution due to symptoms of heart failure. He reported a gunshot injury of the left thigh 4 months earlier, when he had been shortly hospitalized and discharged 4 days later. Since the gunshot injury he had exertional dyspnea and left leg edema, so the diagnostic procedures were performed. RESULTS: Clinical examination revealed distended neck veins, tachycardia, slightly palpable liver, left leg edema, and thrill over the left thigh. Due to high clinical suspicion, duplex ultrasonography of the left leg was performed that verified femoral AVF. Operative treatment of AVF was made with prompt resolution of symptoms. CONCLUSIONS: This case wants to emphasize the importance of proper clinical examination, and duplex ultrasonography in all cases of penetrating injuries.

Association between Duration of Dialysis and Helicobacter Pylori Infection in Dialysis Patients at the University Clinical Hospital Mostar.

INTRODUCTION: Association of Helicobacter pylori (HP) infection with the length of dialysis in dialysis patients is contradictory. This study was conducted in order to determine the association between the duration of dialysis and the HP infection status in the dialysis patients. Furthemore, biochemical parameters were monitored in two subject groups that were included in this study. SUBJECTS AND METHODS: The study included 51 patients on chronic hemodialysis program who had gastrointestinal symptoms. The subjects were divided in two groups per the length of dialysis treatment. In this study we analyzed age, gender, the time period since the onset of the chronic hemodialysis program, body mass index, biochemical parameters, and whether the patients have arterial hypertension and/or diabetes. The presence of HP antigen was determined in the stool samples with use of he UlcoGnost AG test plate. RESULTS: The incidence of HP infection in hemodialysis patients, with some of the gastrointestinal symptoms, was 25.5%. Patients on hemodialysis for less than 24 months had lower incidence of HP infection than those on hemodialysis program for more than 24 months. HP positive and HP negative subjects were also compared by gender, age, biochemical parameters and body mass index. There was no statistical significant difference between the groups in any of those characteristics. When comparing the HP status of the subjects with the presence of arterial hypertension and diabetes, no statistically significant difference was found between the groups. CONCLUSION: This study showed negative correlation between HP infection and the length of hemodialysis program. Analysis of age, gender, body mass index, biochemical parameters, presence of arterial hypertension and/or diabetes showed no statistically significant difference was found between the hemodialysis patients who were HP positive and those who were HP negative. Additional studies are needed to elucidate the correlation mechanism between the HP infection and the duration of dialysis, in order to examine how long the dialysis time period is the most susceptible to HP infection, and then to improve the prognosis of patients with renal disease.

Body Composition and Inflammation in Hemodialysis Patients.

The volume state of dialysis patients is important in guiding the dialysis process. Volume overload in these patients is associated with inflammation. The objectives of the present study were to assess the body composition of patients on hemodialysis; to determine the concentrations of B-type natriuretic peptide (BNP) in plasma and evaluate the association of BNP concentrations with volume overload; to determine the concentrations of C-reactive protein (CRP), albumin and superoxide dismutase (SOD) activities as indicators of inflammatory or antioxidant processes. The study included 79 maintenance hemodialysis patients. Assessment of body compartments was carried out using a body composition monitor (BCM). After BCM measurements, blood samples were taken from the patients for laboratory tests. There were 40 (50.6%) volume-overloaded patients (relative overhydration >15%). These patients had a higher prevalence of arterial hypertension (P < 0.05), significantly higher concentrations of BNP (P = 0.01), lower body mass index (P < 0.05) and lower fat tissue index (P < 0.05). There was a positive correlation between plasma BNP and CRP concentrations (ρ = 0.231; P < 0.05), and a negative correlation between (log) BNP and albumin (r = -0.021; P < 0.05), as well as (log) CRP and albumin concentrations (r = -3; P < 0.01). SOD activity was positively correlated with albumin concentrations (r = 0.254; P < 0.05). The concentrations of BNP in this study were associated with volume overload and inflammatory markers. Patients with a higher albumin concentration had higher SOD activity.

Atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients.

Atrial fibrillation is one of the most frequent arrhythmias diagnosed in clinical practice and it is also relatively common in dialysis patients. Atrioventricular and intraventricular conduction disturbances are less investigated in hemodialysis patients and data about their prevalence are insufficient. The objective of this study was to determine the prevalence of atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients and to analyze different clinical risk factors. The study included 140 patients on long-term hemodialysis treatment. The presence of atrial fibrillation, atrioventricular blocks and bundle branch blocks was determined by electrocardiogram. Patients were divided into groups depending on the presence or absence of atrial fibrillation/bundle branch blocks and investigated variables were compared. Atrial fibrillation was present in 11 (7.9%) of the 140 patients. In multivariate analysis, age and higher concentration of uric acid were associated with atrial fibrillation. Prevalence of first-degree atrioventricular block was 2.9% (4 patients) and second- and third-degree atrioventricular blocks were not found. Prevalence of bundle branch blocks was 17.1% (24 patients): 5% of patients had a complete right bundle branch block, 6.4% had an incomplete right bundle branch block, 3.6% had a complete left bundle branch block and 2.1% of patients had an incomplete left bundle branch block. The prevalence of atrial fibrillation and bundle branch blocks in this study was relatively high in patients on hemodialysis and greater than that observed in general population. Presence of atrial fibrillation was associated with older age and higher concentration of uric acid.