- Assistant ProfessorRadiology ConsultantHead of the Department for the Thoracic and Urological Radiologyedit
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In Croatia, lung cancer is the most common malignant disease among male population and the third common among female population where 85% of patients have non-small cell lung cancer. Due to significance of this disease it is necessary to... more
In Croatia, lung cancer is the most common malignant disease among male population and the third common among female population where 85% of patients have non-small cell lung cancer. Due to significance of this disease it is necessary to define and implement standardized approach for diagnostic and treatment algorithm as well to patients monitoring. Several multidisciplinary sessions were organized in achieving this goal. The sessions' results are given in the form of the Clinical guidelines.
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Background and motivation: Lung computed tomography (CT) techniques are high-resolution and are well adopted in the intensive care unit (ICU) for COVID-19 disease control classification. Most artificial intelligence (AI) systems do not... more
Background and motivation: Lung computed tomography (CT) techniques are high-resolution and are well adopted in the intensive care unit (ICU) for COVID-19 disease control classification. Most artificial intelligence (AI) systems do not undergo generalization and are typically overfitted. Such trained AI systems are not practical for clinical settings and therefore do not give accurate results when executed on unseen data sets. We hypothesize that ensemble deep learning (EDL) is superior to deep transfer learning (TL) in both non-augmented and augmented frameworks. Methodology: The system consists of a cascade of quality control, ResNet–UNet-based hybrid deep learning for lung segmentation, and seven models using TL-based classification followed by five types of EDL’s. To prove our hypothesis, five different kinds of data combinations (DC) were designed using a combination of two multicenter cohorts—Croatia (80 COVID) and Italy (72 COVID and 30 controls)—leading to 12,000 CT slices. ...
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Uvod: CT-om vođena transtorakalna biopsija (TTB) pleuralnih lezija minimalno je invazivna radiološka dijagnostička metoda koja se provodi u cilju pribavljanja materijala za citološku i patohistološku analizu bolesnih stanja pleure. Cilj... more
Uvod: CT-om vođena transtorakalna biopsija (TTB) pleuralnih lezija minimalno je invazivna radiološka dijagnostička metoda koja se provodi u cilju pribavljanja materijala za citološku i patohistološku analizu bolesnih stanja pleure. Cilj je ovog istraživanja procijeniti dijagnostički doprinos CT-om vođene transtorakalne biopsije, kao i prikazati učestalost te vrstu komplikacija. Ispitanici i metode: Retrospektivna studija provedena je na Kliničkom zavodu za radiologiju, Kliničkog bolničkog centra Rijeka u razdoblju od ožujka 2007. do siječnja 2019. godine. U istraživanje je uključeno 105 bolesnika podvrgnutih CT-om vođenoj TTB, 84 muškarca i 21 žena. Rezultati: Najučestalija dijagnoza među našim ispitanicima, utvrđena citološkom i patohistološkom analizom bioptata, bio je maligni mezoteliom koji je dijagnosticiran kod 46,7% bolesnika. Osjetljivost CT-om vođene TTB pleuralnih lezija bila je 92,96%, specifičnost 100%, pozitivna prediktivna vrijednost (PPV) 100%, negativna prediktivna v...
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Extracorporeal membrane oxygenation (ECMO) is a form of temporary circulatory support in patients with impaired heart and / or lung function, in whom conventional methods of treatment have been exhausted. ECMO support does not treat the... more
Extracorporeal membrane oxygenation (ECMO) is a form of temporary circulatory support in patients with impaired heart and / or lung function, in whom conventional methods of treatment have been exhausted. ECMO support does not treat the underlying pathology, but allows oxygenation and perfusion of vital organs until complete recovery or as a destination therapy for heart and / or lung transplantation. It is an integral part of modern intensive care for patients with severely impaired cardiac and / or respiratory function. Medical staff involved in the treatment and monitoring of patients on ECMO support should be familiar with the basics of the ECMO system, in accordance with the workplace and with approach to the patient on ECMO support. A radiologist who performs a radiological examination in such a patient requires cooperation with the anaesthesiology team and the team of perfusionists, so that the basic conditions for performing the examination are met and the examination is suc...
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Research Interests: Medicine and Lung Cancer
Research Interests: Medicine and Lung Cancer
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Since vascular calcification is considered a process regulated similar to that of bone tissue mineralization, we investigated the participation of bone formation proteins. We analyzed the correlation of serum circulating bone markers,... more
Since vascular calcification is considered a process regulated similar to that of bone tissue mineralization, we investigated the participation of bone formation proteins. We analyzed the correlation of serum circulating bone markers, osteoprotegerin (OPG) and receptor activator of nuclear factor ĸB ligand (RANKL) in chronic kidney disease (CKD) patients, to coronary artery calcification score. We also considered the effect of inorganic phosphate on pro- and anti-calcifying tissue factors. We confirmed that circulating OPG is an independent calcium score predictor with its high serum concentration favoring high coronary artery calcification. In tissue samples of non-diseased human renal arteries, the expression of OPG and receptor activator of nuclear factor ĸB (RANK) was positive, while expression of RANKL was absent. In atherosclerotic specimens and arteries with medial calcification, the most upregulated was expression of bone morphogenetic proteins, BMP-2 and BMP-7, as well as e...
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Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various... more
Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of ...
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Page 1. Kliničke upute za dijagnozu, liječenje i praćenje bolesnika oboljelih od raka bubrega Clinical guidelines for treating and monitoring patients with renal cancer Marija Petković1, Eduard Vrdoljak2, Ira Pavlović Ružić1, Borislav... more
Page 1. Kliničke upute za dijagnozu, liječenje i praćenje bolesnika oboljelih od raka bubrega Clinical guidelines for treating and monitoring patients with renal cancer Marija Petković1, Eduard Vrdoljak2, Ira Pavlović Ružić1, Borislav Belev3, Tomislav Omrčen2, ...
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A Case Report of Occupational Middle Ear Tuberculosis in a NurseThis article presents a case of a 40-year-old female patient with a right-side middle ear tuberculosis. The patient was a nurse, who had worked at the Department of... more
A Case Report of Occupational Middle Ear Tuberculosis in a NurseThis article presents a case of a 40-year-old female patient with a right-side middle ear tuberculosis. The patient was a nurse, who had worked at the Department of Pulmology, Clinical Hospital Rijeka for 17 years. The cause was infection with Mycobacterium tuberculosis while she assisted in bronchoscopy. The patient was referred to occupational medicine (OM) for confirmation of occupational disease immediately after surgery. The disease was confirmed as occupational by the Croatian Institute for Health Insurance of Health Protection at Work.During surgery a sample was taken for microbiological analysis. We did initial and control multislice computed tomography (MSCT) and control magnetic resonance imaging (MRI) of temporal bones 6 months after the surgery. The initial MSCT showed total mastoid cell shadowing without destruction, while the control image showed almost full recovery save for a few remaining shadowed cells...
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Primary chondrosarcoma is a rare malignant tumor. The five types of chondrosarcomas are: central, peripheral, mesenchymal, differentiated and clear cell. The classic chondrosarcomas are central (arising within a bone) or peripheral... more
Primary chondrosarcoma is a rare malignant tumor. The five types of chondrosarcomas are: central, peripheral, mesenchymal, differentiated and clear cell. The classic chondrosarcomas are central (arising within a bone) or peripheral (arising from the surface of a bone). We describe a patient with central chondrosarcoma of the humerus who underwent surgery and only two weeks later presented with multiple metastases of the lung and small pulmonary tumor embolisms mimicking bilateral pneumonic infiltrates. Therefore, such a fulminant course of central chondrosarcoma, which is not described so far, must be taken into consideration during the treatment of patients with primary chondrosarcoma.
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Pulmonary nodular lymphoid hyperplasia is a rare, nonneoplastic lymphoproliferative disorder mostly manifesting as one or more nodules or localized lung infiltrates. The lesion comprises reactive germinal centers with well-preserved... more
Pulmonary nodular lymphoid hyperplasia is a rare, nonneoplastic lymphoproliferative disorder mostly manifesting as one or more nodules or localized lung infiltrates. The lesion comprises reactive germinal centers with well-preserved mantle zones and sheets of interfollicular mature plasma cells, lymphocytes, histiocytes, and neutrophils. The radiological finding is not specific, and the diagnosis of pulmonary nodular lymphoid hyperplasia relies generally on pathohistological and immunohistochemical analyses. The most important differential diagnoses are extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and immunoglobulin G4–related sclerosing disease. Nonetheless, we present a case of pulmonary nodular lymphoid hyperplasia in a 69-year-old woman with the diagnostic challenge of cytological atypia in alveolar spaces inside the lymphoid tissue, coexisting with the diagnosis of adenocarcinoma of the lepidic pattern. Therefore, this case highlights the importance of...
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In December 2003 in Rijeka, Croatia, a work accident happened when in the meat industry 'Vir" a forklift damaged the ammonia pipe. Two butchers were acutely poisoned. The objective is to warn of the danger of ammonia and of the... more
In December 2003 in Rijeka, Croatia, a work accident happened when in the meat industry 'Vir" a forklift damaged the ammonia pipe. Two butchers were acutely poisoned. The objective is to warn of the danger of ammonia and of the need to improve preventive programs of occupational medicine. The method of comparing the two injured workers, i.e. their spirometric values, was used. The results showed progressive diminishing of patients' respiratory abilities, in the patient with lungs transplanted VC 32%, FVC 33%, FEV1 16% and FEF75% = 6% in 2006, the year when he died. In the patient that survived, the values in 2008 were VC 43.5%, FVC 27.2%, FEV1% 56.7% and FEF75% = 6%. The patients' CT showed diffused fibrosing and bronchiectasiae. Obliterating bronchiolitis developed in both patients. The second patient is the lung transplantation candidate. The first patient developed post transplantation cytomegalovirus pneumonia so he fought CMV antigenemia and infection till the ...
Research Interests: Anthropology, Workplace, Humans, Meat, Male, and 5 moreLung, Ammonia, Middle Aged, Adult, and Occupational Diseases
We demonstrate a rare case of lingual thyroid together with squamous cell carcinoma of the base of tongue. 54-year-old patient presented with left sided lymph node enlargement in regions II, III and IV without any clinical symptoms.... more
We demonstrate a rare case of lingual thyroid together with squamous cell carcinoma of the base of tongue. 54-year-old patient presented with left sided lymph node enlargement in regions II, III and IV without any clinical symptoms. Physical examination revealed semicircular bulge at the base of tongue measuring 30 x 20 mm and tumorous lesion was suspected. Neck ultrasound showed pathological enlargement of lymph nodes and FNA of lymph node revealed squamous carcinoma cells in the smear. Further investigation included CT and MRI of the neck depicted ectopic thyroid tissue in base of tongue and enlarged and necrotic lymph nodes in regions II and III. Primary carcinoma could not be depicted. Biopsy of the lingual mass was performed and histology confirmed ectopic thyroid tissue. Physical examination of the oral cavity was repeated and suspicious area on the left side of the tongue base near ectopic thyroidal tissue was identified. Histology after biopsy confirmed squamous cell carcino...
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Radiation therapy is frequently used method in treatment of the head and neck malignancies. Osteosarcoma is a rare complication of radiation therapy and usually occurs after a long latent period. We report the case of 75-year-old female... more
Radiation therapy is frequently used method in treatment of the head and neck malignancies. Osteosarcoma is a rare complication of radiation therapy and usually occurs after a long latent period. We report the case of 75-year-old female with osteosarcoma of the mastoid process. Twelve years before presentation she received radiation therapy after total parotidectomy and radical neck dissection in treatment of mucoepidermoid carcinoma of the parotid gland. Diagnostic procedures included contrast-enhanced CT and MRI of the head and neck and HRCT of the temporal bone. The final diagnosis of the low grade osteosarcoma was confirmed by biopsy. Diagnostic criteria were fulfilled and the lesion was classified as a radiation induced osteosarcoma.
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Primary chondrosarcoma is a rare malignant tumor. The five types of chondrosarcomas are: central, peripheral, mesenchymal, differentiated and clear cell. The classic chondrosarcomas are central (arising within a bone) or peripheral... more
Primary chondrosarcoma is a rare malignant tumor. The five types of chondrosarcomas are: central, peripheral, mesenchymal, differentiated and clear cell. The classic chondrosarcomas are central (arising within a bone) or peripheral (arising from the surface of a bone). We describe a patient with central chondrosarcoma of the humerus who underwent surgery and only two weeks later presented with multiple metastases of the lung and small pulmonary tumor embolisms mimicking bilateral pneumonic infiltrates. Therefore, such a fulminant course of central chondrosarcoma, which is not described so far, must be taken into consideration during the treatment of patients with primary chondrosarcoma.
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The purpose is to find out whether the diagnostics and registration of patients with mesothelioma in the Littoral Mountainous County of Croatia corresponds to the world trends. Further, the intention was to show the incidence of the... more
The purpose is to find out whether the diagnostics and registration of patients with mesothelioma in the Littoral Mountainous County of Croatia corresponds to the world trends. Further, the intention was to show the incidence of the disease and suggest the measures of prevention in the county of 400,000 inhabitants and its center Rijeka with 140,000 people. To that purpose 43 patients with mesothelioma were monitored in two groups: 25 shipyard workers, mean age 66, and 18 workers in other occupations, mean age 62. Statistically the group did not differ significantly in the incidence of placks, left or right side effusion. The pleural puncture showed the significance (p < 0.05) for incidence of rouse cells. In 20 patients out of 43 mesothelioma was confirmed by taking the material for pathohistology by means of VATS (video assisted thoracoscopy) and in 14 patients by TTB (transthoracic biopsy) with CT control. Spirometric values showed moderate restrictive difficulties. Although a...
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We report a case of aspergilloma in a pulmonary abscess being the first manifestation of malignant bronchial obstruction. In our case, only the autopsy revealed that planocellular carcinoma was the real cause of aspergilloma. Malignant... more
We report a case of aspergilloma in a pulmonary abscess being the first manifestation of malignant bronchial obstruction. In our case, only the autopsy revealed that planocellular carcinoma was the real cause of aspergilloma. Malignant bronchial obstruction finally resulted in pulmonary abscess with secondary fungal colonization. The co-existence of these pathologies is uncommon, and the situation we report is extremely rare. Even in cases when there are no radiological, bronchoscopical or cytological signs of malignancy, as in our case, careful observation of these patients is necessary. Surgical approach should be considered whenever possible.
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We have a 30-year-old female patient suffering from secondary hydrocephalus. She has had a ventriculoperitoneal shunt (VPS) implanted following a rupture and a successful clipping of the aneurysm of the anterior communicating artery... more
We have a 30-year-old female patient suffering from secondary hydrocephalus. She has had a ventriculoperitoneal shunt (VPS) implanted following a rupture and a successful clipping of the aneurysm of the anterior communicating artery (ACoA). Three weeks after implanting of the VPS, respiratory and abdominal difficulties with febrility appeared. We diagnosed cerebrospinal fluid liver pseudocyst using ultrasound (US) and computer tomography scan (CT). Given that we found bacteria in the cerebrospinal fluid (CSF), we converted VPS into an external ventricular drain (EVD). After that, we conducted a US-guided punction and drainage of the CSF liver pseudocyst. The subsequent CT of abdomen showed a regression of the cystic form. The patient died following the septic condition with multiple organ failures (MOF) a month after the cerebrospinal fluid liver pseudocyst diagnosis.The perforation of parenhimatose abdominal organs with distal part of VPS is a rare complication which is most likely a consequence of a shunt infection and of an immunological reaction that took place during the process of localizing an infection.