Dinko Skegro - Academia.edu (original) (raw)
Papers by Dinko Skegro
Diabetologia Croatica, 2013
Neurologia Croatica. Supplement, Jun 11, 2009
Nephron, 2018
Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The a... more Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The aim of this study was to evaluate the safety of biopsy in the outpatient setting. Methods: We analysed kidney biopsies performed from March 2013 to February 2017. 725 biopsies performed in the outpatient setting were identified: There were 592 transplant and 133 native biopsies including 3 solitary kidney biopsies. All were performed under ultrasound guidance using a 16G or 18G needle, with freehand technique. In all patients with eGFR<30ml/min/1.73m 2 desmopressin was administered. Patients were observed for 6h before discharge, with a CBC and urine test after 4h. Major complications were haemorrhage requiring therapeutic intervention or transfusion. Minor complications were significant reduction in Hb levels (>10%), without need for transfusion or intervention and macrohaematuria. Results: There were 506 (69.8%) male patients. Average age was 50.3 ±12.7 yrs. Indications for native kidney biopsy included nephrotic syndrome (39.8%), nephritic syndrome (42.9%), follow-up biopsy (15.8%), and other (1.5%). There were no major complications. A decline in Hb was observed in 72% of pts. Average Hb decline was 4.2±6.3 g/L. In 10.1% pts there was >10% reduction in Hb level, with no evident bleeding, including by ultrasonography. In 2.5% of patients macrohaematuria was present. In a multivariate analysis male gender, lower eGFR, higher prebiopsy Hb and native kidney biopsy were predictive for Hb decline. No therapeutic interventions were required. Conclusion: We found that kidney biopsy performed in an outpatient setting in select patients is only rarely associated with adverse events and is a safe procedure.
Medix : specijalizirani medicinski dvomjesečnik, Apr 15, 2011
Journal of the American Society of Nephrology 12(Program and Abstract Issue), Mar 21, 2001
Znacajnom postotku transplantiranih pacijenata moguce je rano nakon transplantacije ukinuti stero... more Znacajnom postotku transplantiranih pacijenata moguce je rano nakon transplantacije ukinuti steroide.
Nephrology Dialysis Transplantation, Nov 6, 2006
Metastatic tumours are frequently more vaguely differentiated or non-differentiated and, sometime... more Metastatic tumours are frequently more vaguely differentiated or non-differentiated and, sometimes, it is difficult to determine the cellular origin based on the cytomorphologic picture, and even more complex, the primary focus of the tumour. Aims: (1) To analyse the possibility of determining cellular origin and primary focus of the metastatic process by adding the cellular markers to cytomorphology ; (2) to estimate the proliferation status and ploidy of vaguely differentiated metastatic tumours. Methods: The total of 1753 liver and lymph nodes aspirates have been analysed. The aspiration of localised lesions of liver and abdominal lymph nodes was performed by CHIBA needle controlled by ultrasound (US) or computerised tomography (CT), and of superficial lymph nodes by fine needle (FNA) under the US control or based on palpable finding. The preparations were stained by the May-Griinwald-Giemsa method, immunocytochemical treatment was performed by LSAB method monoclonal antibodies (DAKO). The proliferation status was determined in the analysis of the nuclear organiser region (AgNOR), and aneuploidy by the static DNA image cytometry, both by the SFORM programme (VAMSTEC brand from Zagreb). Results: Out of 678 liver aspirates, malignant lesions were dete ; ted in 404 ones. The primary tumours numbered 68, plus 336 metastatic ones (329 of epithelial, and 31 of mesenchymal and embryonal origin). Out of 1075 lymph nodes aspirates, in 540 cases malignant lesions were found (409 malignant lymphomas, 87 epithelial and 25 nonepithelial metastatic tumours, while in four cases the cellular origin couldn't be determined). All together, based on the morphologic picture and immunocytochemic treatment by mononucleal antibodies, the epithelial, mesenchymal or embryonal cellular origin could be determined in 99.1 % cases of all metastatic tumours, while in the epithelial tumours primary focus was recognised in 33.4% cases. In weakly differentiated tumours, the tumour aggressiveness was confirmed by high aneuploidy (DNA image cytometry) and by high proliferation status (AgNOR determination). The cellular markers are unreplaceable addition to the cytomorphologic picture in the determination of cellular origin of tumour cells. However, very often, specific tumour markers reveal tissue co-expression and, as a rule, are not typical for only one organ. Despite this, their combination improves the search for primary focus of the metastatic process or, possibly, determine the additional targeted diagnostic treatment (CT, US, MR, etc.).
Statistika bibliografskih podataka o projektima, znanstvenicima i znantsvenim institucijama.
Hepatocelullar carcinoma (HCC) is among the most common malignancies worldwide and the third lead... more Hepatocelullar carcinoma (HCC) is among the most common malignancies worldwide and the third leading cause of cancer deaths. The increasing incidence of HCC and hepatitis C virus (HCV) in the western world has been observed in recent years. Although advances in imaging techniques obviate the morphological confirmation of clinicaly classic HCC, detection of smaller lesions, especially in patients with cirrhosis and chronic hepatitis, is needed. The preoperative accurate diagnosis of HCC with assessment of an accurate tumor size, number of nodules and the major hepatic vessels invasion are the main considerations in selecting patients for liver transplantation, defined with the Milan criteria. The aim of this study was to evaluate the role of fine needle aspiration biopsy (FNAB) in diagnosis and management of HCC in patients with liver transplantation. During 2002–2012, 71 patients with HCC had undergone liver transplantation. 26 (36.61%) patients had guided FNAB during the preoperative evaluation and in 6 (23.08%) patients FNAB was performed in the follow up period. The FNAB results were compared with histopathology findings after liver transplantation. All patients had HCC with present cirrhosis. According etiology in 30 (42.25%) patients the cause of cirrhosis was alcohol, in 22 (30.98%) patients HCV, in 8 (11.26%) patients hepatitis B virus, in 2 (2.81%) patients primary biliary cirrhosis and in 5 (7.04%)patients the cause of cirrhosis was unknown, cryptogenic. The 30 (42.25%) patients fulfilled the Milan criteria during liver transplantation. Majority of HCC (53.52%) were £3 cm with present 2–3 tumor nodules (45.07%). According WHO Classification of HCC characteristics all HCC were classical type, moderately differentiated (73.23%) and architecturally characterized by trabecular (59.15%)or mixed trabecular–acinar (30.98%) growth pattern. In 14 (19.72%) patients macro or microvascular invasion was present. In 23 of 26 patients with FNAB the accurate diagnosis was made, with sensitivity of 88.46% and specificity of 100%. Majority of HCC (65.38%) diagnosed by FNAB were £3 cm and 12 of 26 patients (46.15%) had normal a-fetoprotein concentrations. The tumor recurrence after liver transplantation was diagnosed by guided FNAB in two patients in liver and in four patients in metastatic intraabdominal lymph nodes. In the follow up period no tumor seeding following FNAB was observed. To conclusion, among patients with HCC guided FNAB is a useful diagnostic method especially in small tumors with normal afetoprotein concentrations, and also a useful method in diagnosis of the tumor recurrence in the follow up period.
![Research paper thumbnail of [Multifocal epithelioid hemangioendothelioma treated by liver transplantation--case report]](https://attachments.academia-assets.com/115668650/thumbnails/1.jpg)
](PubMed, Sep 1, 2011
Multifocal epithelioid hemangioendothelioma of the liver is a rare primary tumor with a variable ... more Multifocal epithelioid hemangioendothelioma of the liver is a rare primary tumor with a variable course of disease. A case is presented of a 27-year-old female patient with multiple hepatic lesions on ultrasonography, suspect of metastatic tumor of the liver. Serum tumor markers were not elevated, while clinical examination of the lungs, gastrointestinal and gynecologic systems did not confirm the presence of a primary tumor process. Metastatic tumor and primary hepatocellular tumor were ruled out by fine needle aspiration cytology. Along with a characteristic immunophenotype of the vascular cell endothelium (positive for CD31 and CD34), high proliferation demonstrated by the analysis of argyrophilic nucleolar organization regions (AgNOR) and DNA aneuploidy, cytomorphological pattern suggested the diagnosis of angiosarcoma. Histopathologic finding corresponded to epithelioid hemangioendothelioma. Ten years after orthotopic liver transplantation, the patient is free from disease relapse, with regular follow up testing. Hemangioendothelioma of the liver is characterized by multifocality, which excludes resection; thus, liver transplantation is the method of choice. Therefore, preoperative diagnostic workup is of utmost importance to differentiate it from other primary and metastatic tumors of the liver.
Medix : specijalizirani medicinski dvomjesečnik, Apr 15, 2011
Cytopathology, Mar 29, 2010
Lijec̆nic̆ki vjesnik, 1996
Diabetologia Croatica, 2013
Neurologia Croatica. Supplement, Jun 11, 2009
Nephron, 2018
Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The a... more Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The aim of this study was to evaluate the safety of biopsy in the outpatient setting. Methods: We analysed kidney biopsies performed from March 2013 to February 2017. 725 biopsies performed in the outpatient setting were identified: There were 592 transplant and 133 native biopsies including 3 solitary kidney biopsies. All were performed under ultrasound guidance using a 16G or 18G needle, with freehand technique. In all patients with eGFR<30ml/min/1.73m 2 desmopressin was administered. Patients were observed for 6h before discharge, with a CBC and urine test after 4h. Major complications were haemorrhage requiring therapeutic intervention or transfusion. Minor complications were significant reduction in Hb levels (>10%), without need for transfusion or intervention and macrohaematuria. Results: There were 506 (69.8%) male patients. Average age was 50.3 ±12.7 yrs. Indications for native kidney biopsy included nephrotic syndrome (39.8%), nephritic syndrome (42.9%), follow-up biopsy (15.8%), and other (1.5%). There were no major complications. A decline in Hb was observed in 72% of pts. Average Hb decline was 4.2±6.3 g/L. In 10.1% pts there was >10% reduction in Hb level, with no evident bleeding, including by ultrasonography. In 2.5% of patients macrohaematuria was present. In a multivariate analysis male gender, lower eGFR, higher prebiopsy Hb and native kidney biopsy were predictive for Hb decline. No therapeutic interventions were required. Conclusion: We found that kidney biopsy performed in an outpatient setting in select patients is only rarely associated with adverse events and is a safe procedure.
Medix : specijalizirani medicinski dvomjesečnik, Apr 15, 2011
Journal of the American Society of Nephrology 12(Program and Abstract Issue), Mar 21, 2001
Znacajnom postotku transplantiranih pacijenata moguce je rano nakon transplantacije ukinuti stero... more Znacajnom postotku transplantiranih pacijenata moguce je rano nakon transplantacije ukinuti steroide.
Nephrology Dialysis Transplantation, Nov 6, 2006
Metastatic tumours are frequently more vaguely differentiated or non-differentiated and, sometime... more Metastatic tumours are frequently more vaguely differentiated or non-differentiated and, sometimes, it is difficult to determine the cellular origin based on the cytomorphologic picture, and even more complex, the primary focus of the tumour. Aims: (1) To analyse the possibility of determining cellular origin and primary focus of the metastatic process by adding the cellular markers to cytomorphology ; (2) to estimate the proliferation status and ploidy of vaguely differentiated metastatic tumours. Methods: The total of 1753 liver and lymph nodes aspirates have been analysed. The aspiration of localised lesions of liver and abdominal lymph nodes was performed by CHIBA needle controlled by ultrasound (US) or computerised tomography (CT), and of superficial lymph nodes by fine needle (FNA) under the US control or based on palpable finding. The preparations were stained by the May-Griinwald-Giemsa method, immunocytochemical treatment was performed by LSAB method monoclonal antibodies (DAKO). The proliferation status was determined in the analysis of the nuclear organiser region (AgNOR), and aneuploidy by the static DNA image cytometry, both by the SFORM programme (VAMSTEC brand from Zagreb). Results: Out of 678 liver aspirates, malignant lesions were dete ; ted in 404 ones. The primary tumours numbered 68, plus 336 metastatic ones (329 of epithelial, and 31 of mesenchymal and embryonal origin). Out of 1075 lymph nodes aspirates, in 540 cases malignant lesions were found (409 malignant lymphomas, 87 epithelial and 25 nonepithelial metastatic tumours, while in four cases the cellular origin couldn't be determined). All together, based on the morphologic picture and immunocytochemic treatment by mononucleal antibodies, the epithelial, mesenchymal or embryonal cellular origin could be determined in 99.1 % cases of all metastatic tumours, while in the epithelial tumours primary focus was recognised in 33.4% cases. In weakly differentiated tumours, the tumour aggressiveness was confirmed by high aneuploidy (DNA image cytometry) and by high proliferation status (AgNOR determination). The cellular markers are unreplaceable addition to the cytomorphologic picture in the determination of cellular origin of tumour cells. However, very often, specific tumour markers reveal tissue co-expression and, as a rule, are not typical for only one organ. Despite this, their combination improves the search for primary focus of the metastatic process or, possibly, determine the additional targeted diagnostic treatment (CT, US, MR, etc.).
Statistika bibliografskih podataka o projektima, znanstvenicima i znantsvenim institucijama.
Hepatocelullar carcinoma (HCC) is among the most common malignancies worldwide and the third lead... more Hepatocelullar carcinoma (HCC) is among the most common malignancies worldwide and the third leading cause of cancer deaths. The increasing incidence of HCC and hepatitis C virus (HCV) in the western world has been observed in recent years. Although advances in imaging techniques obviate the morphological confirmation of clinicaly classic HCC, detection of smaller lesions, especially in patients with cirrhosis and chronic hepatitis, is needed. The preoperative accurate diagnosis of HCC with assessment of an accurate tumor size, number of nodules and the major hepatic vessels invasion are the main considerations in selecting patients for liver transplantation, defined with the Milan criteria. The aim of this study was to evaluate the role of fine needle aspiration biopsy (FNAB) in diagnosis and management of HCC in patients with liver transplantation. During 2002–2012, 71 patients with HCC had undergone liver transplantation. 26 (36.61%) patients had guided FNAB during the preoperative evaluation and in 6 (23.08%) patients FNAB was performed in the follow up period. The FNAB results were compared with histopathology findings after liver transplantation. All patients had HCC with present cirrhosis. According etiology in 30 (42.25%) patients the cause of cirrhosis was alcohol, in 22 (30.98%) patients HCV, in 8 (11.26%) patients hepatitis B virus, in 2 (2.81%) patients primary biliary cirrhosis and in 5 (7.04%)patients the cause of cirrhosis was unknown, cryptogenic. The 30 (42.25%) patients fulfilled the Milan criteria during liver transplantation. Majority of HCC (53.52%) were £3 cm with present 2–3 tumor nodules (45.07%). According WHO Classification of HCC characteristics all HCC were classical type, moderately differentiated (73.23%) and architecturally characterized by trabecular (59.15%)or mixed trabecular–acinar (30.98%) growth pattern. In 14 (19.72%) patients macro or microvascular invasion was present. In 23 of 26 patients with FNAB the accurate diagnosis was made, with sensitivity of 88.46% and specificity of 100%. Majority of HCC (65.38%) diagnosed by FNAB were £3 cm and 12 of 26 patients (46.15%) had normal a-fetoprotein concentrations. The tumor recurrence after liver transplantation was diagnosed by guided FNAB in two patients in liver and in four patients in metastatic intraabdominal lymph nodes. In the follow up period no tumor seeding following FNAB was observed. To conclusion, among patients with HCC guided FNAB is a useful diagnostic method especially in small tumors with normal afetoprotein concentrations, and also a useful method in diagnosis of the tumor recurrence in the follow up period.
PubMed, Sep 1, 2011
Multifocal epithelioid hemangioendothelioma of the liver is a rare primary tumor with a variable ... more Multifocal epithelioid hemangioendothelioma of the liver is a rare primary tumor with a variable course of disease. A case is presented of a 27-year-old female patient with multiple hepatic lesions on ultrasonography, suspect of metastatic tumor of the liver. Serum tumor markers were not elevated, while clinical examination of the lungs, gastrointestinal and gynecologic systems did not confirm the presence of a primary tumor process. Metastatic tumor and primary hepatocellular tumor were ruled out by fine needle aspiration cytology. Along with a characteristic immunophenotype of the vascular cell endothelium (positive for CD31 and CD34), high proliferation demonstrated by the analysis of argyrophilic nucleolar organization regions (AgNOR) and DNA aneuploidy, cytomorphological pattern suggested the diagnosis of angiosarcoma. Histopathologic finding corresponded to epithelioid hemangioendothelioma. Ten years after orthotopic liver transplantation, the patient is free from disease relapse, with regular follow up testing. Hemangioendothelioma of the liver is characterized by multifocality, which excludes resection; thus, liver transplantation is the method of choice. Therefore, preoperative diagnostic workup is of utmost importance to differentiate it from other primary and metastatic tumors of the liver.
Medix : specijalizirani medicinski dvomjesečnik, Apr 15, 2011
Cytopathology, Mar 29, 2010
Lijec̆nic̆ki vjesnik, 1996