Dalibor Ilic

Introduction. Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) is an indolent lymphoproliferative disorder characterized by accumulation of mature but dysfunctional B lymphocytes. Aortic complications have been occasionally reported in lymphoma, most often in aggressive subtypes, while they are extremely rare in SLL/CLL. The aim of this report was to present a case of recently developed ruptured abdominal aortic aneurysm in a patient with SLL and its successful hybrid endovascular management. Case outline. A 58-year-old male with SLL/CLL presented with lower back and right flank pain. Initial CT demonstrated marked progression of lymphadenopathy and interval enlargement of the infrarenal aortic diameter compared to prior imaging, remaining below the aneurysmal threshold. Due to persistent symptoms and elevated inflammatory markers, further imaging was performed. MRI of the lumbosacral spine and subsequent CT angiography revealed a newly developed saccular aneurysm of the infrarenal abdominal aorta with retroperitoneal hematoma and surrounding lymph node conglomerates. The patient underwent urgent endovascular repair using an aorto-uni-iliac stent graft with contralateral iliac occlusion, combined with femoro-femoral crossover bypass. Postprocedural imaging confirmed successful exclusion of the lesion without endoleak. Conclusion. This case highlights a rare vascular complication of SLL/CLL and suggests a possible role of lymphomatous infiltration and inflammation in aortic wall weakening. Hybrid endovascular treatment represents an effective therapeutic option.

Background: The interaction of human immunodeficiency virus (HIV), host and antiretroviral therapy (ART) causes a range of metabolic disorders that can be characterized as a metabolic syndrome (MetS) that increases the cardiovascular risk. MetS involves central obesity, which can be detected using different anthropometric parameters. Objective: To assess the abilities of different anthropometric parameters in the prediction of MetS in HIV-infected men on ART. Method: The study involved 92 male participants (mean age 44.46±10.38 years), divided into two groups: with and without MetS. All subjects underwent biochemical evaluation (triglycerides, HDL-cholesterol, fasting glucose), blood pressure measurement and anthropometric assessment: body mass, body height, body mass index (BMI), body fat mass, body circumferences (chest, upper arm, forearm, waist, hip, proximal and middle thigh and calf), sagittal abdominal diameter (SAD), skinfold thicknesses (subscapular, anterior and posterior upper arm, anterior and lateral forearm, abdominal, supraspinal, thigh and calf), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-thigh ratio (WTR), sagittal abdominal diameter–to-body height ratio (SADH), body adiposity index (BAI) and conicity index. MetS was specified according to IDF criteria. Results: Subjects with MetS had statistically significant higher values of all anthropometric parameters except middle thigh circumference, calf skinfold and body height. According to ROC analysis and Binary Logistic Regression, SAD has been shown as the best predictor of MetS with a predictive value of 21.40 cm (AUC:0.91), followed by WHR with a predictive value of 0.93. Conclusion: Sagittal abdominal diameter is the strongest anthropometric indicator of MetS in HIV-infected patients on ART.

Background: In HIV negative population metabolic syndrome and steatosis are related to poorer neurocognitive (NC) performance. We investigated if similar relation exists in people living with HIV (PLWH). Methods:: We included male PLWH aged 20-65, with undetectable viral load for at least 6 months. Data on levels of education, anthropometric measurements, CD4 levels, ART, markers of metabolic syndrome, smoking and concurrent treatment were collected from database. Concentrations of TNF-α and IL-6 were measured. An ultrasound was used to establish the presence of steatosis, visceral fat thickness and carotid intima media thickness. An extensive NC assessment was done by an experienced neuropsychologist. Cognitive domains were defined as executive functions, divergent reasoning, visuo-constructional abilities, delayed recall and working memory and learning and were measured using a battery of 12 tests. Results: 88 PLWH were included (mean age 39,9 years), 51% on PIs, 46% on NNRTI; 20,4% had metabolic syndrome, 42% patients had steatosis. Weak but statistically significant negative correlations were found between the presence of metabolic syndrome, steatosis and VFT and cognitive domains (divergent reasoning, delayed recall and working memory). Poorer perfomrance in the domains of divergent reasoning and in the working memory were found in participants with steatosis (p=0,048 and 0,033 respectively). Conclusion: Although the sample size was relatively small, our results show consistent correlations between the observed neurocognitive variables and metabolic parameters. As central obesity is one of the contributors to NCI, it would be one of the modifiable factors to prevent further neurocognitive decline.

Introduction. Imaging is essential in the assessment of endovascular infrarenal abdominal aortic repair results. Complications include endoleaks, graft migration, kinking and infolding, stenosis, occlusion, and secondary ruptures. Examination Modalities. Contemporary imaging strategies are based on using noninvasive imaging modalities. After endovascular infrarenal abdominal aortic repair, the standard evaluation modality is computed tomography angiography, whereas additional modalities include magnetic resonance imaging, ultrasonography, and radiography. However, although an invasive imaging method, digital subtraction angiography is still performed in some patients. Computed tomography angiography provides excellent contrast, spatial resolution, and exact measurements of structures of interest, which is essential in the follow-up. Follow-up Protocol. Currently recommended follow-up protocol in the first year is contrast- enhanced computed tomography imaging at 1 and 12 months after the procedure. Conclusion. Due to its characteristics, reproducibility and availability, computed tomography angiography remains the cornerstone diagnostic modality of post-procedural assessment in patients with endovascular infrarenal abdominal aortic repair.

Introduction. Infectious or non-infectious noxae may occur in drug-addicted patients who have clinical presentation of meningeal syndrome with a spectrum of possible complications, such as a diffuse or focal brain lesions. The objective of this report is to present a rare case of a drug-addicted male patient, initially suspected of mycosis of the central nervous system, but computed tomography (CT) and magnetic resonance imaging (MRI) showed the signs of an invasive neurosurgical operation that the patient underwent during the treatment of drug addiction. Case outline. A 37-year-old male patient was hospitalized at the Clinic for Infectious Diseases, Clinical Center of Vojvodina, with a meningeal syndrome, initially suspected of mycosis of the central nervous system. He was diagnosed at the Center for Radiology. Neuroimaging ? CT and MRI were used in order to prove or disprove the presence of brain infection. These diagnostic procedures ruled out the presence of brain infection, but opened questions about the type of neurosurgical treatment performed out of legal institution, due to the presence of craniotomy and focal glial brain lesions in the frontal lobes. Conclusion. In drug-addicted patients, meningeal syndrome can be connected with diffuse or focal brain infections. Together with laboratory and clinical analysis, imaging methods contribute to the decision making and optimal treatment of patients. In our case, CT and MRI made a significant contribution in the detection of the focal brain lesions and clarification of their etiology.

Background: Non-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.Objectives: The aim of this study was to explore visceral fat thickness (VFT) and anthropometric measurements associated with the development of NAFLD in patients mono-infected with HIV and on long-standing combination antiretroviral therapy (cART).Method: Eighty-eight (n = 88) HIV-positive male patients, average age 39.94 ± 9.91 years, and stable on cART, were included in this prospective study. VFT was measured using ultrasonography. Anthropometric measurements included body mass index (BMI), waist-to-hip ratio (W/H), waist-to-height ratio (WHtR), waist and hip circumference (WC, HC). Differences between variables were determined using the chi-square test. The receiver operating characteristic (ROC) curve and the Youden index were used to determine optimal cut-off values of VFT and hepatic steatosis. The area under the curve (AUC), 95% confidence intervals, sensitivity and specificity are reported for the complete sample. Significance was set at p < 0.05.Results: Patients with steatosis had significantly higher values of BMI, HC, WC, W/H and WHtR. The VFT was higher in patients with steatosis (p < 0.001). Specifically, VFT values above 31.98 mm and age > 38.5 years correlated with steatosis in HIV-positive patients, namely sensitivity 89%, specificity 72%, AUC 0.84 (95% CI, 0.76–0.93, p < 0.001), with the highest Youden index = 0.61. The sensitivity of the age determinant above this cut-off point was 84%, specificity 73% and AUC 0.83 (95% CI, 0.75–0.92, p < 0.001), with the highest Youden index of 0.57.Conclusion: In the absence of more advanced radiographic and histological tools, simple anthropometric measurements and VFT could assist in the early identification of persons at risk of hepatic steatosis in low- and middle-income regions.

Introduction. Secondary hypertension is a relatively common form of hypertension in childhood with renovascular hypertension being responsible for 5%?10% of all arterial hypertensions in children. An early diagnosis of renovascular hypertension is important when considering an appropriate treatment of hypertension that may prevent or slow further progression of kidney damage. To validate the usefulness of a captopril renal scintigraphy in hypertensive children, we report a case of a 16-year-old female patient with a history of hypertension as a result of fibromuscular dysplasia. Case report. The patient was asymptomatic with elevated blood pressure revealed by a routine physical examination. Laboratory tests showed the increased levels of plasma renin activity with the normal levels of aldosteron. The renal ultrasound was normal. The Doppler of the renal arteries showed no significant differences of resistive index. A renal captopril scintigraphy was performed, including two day study protocol, the baseline study followed by another captopril study several days later. The scintigraphy showed the abnormal baseline and captopril renogram curve of the right kidney with significant cortical retention of radiotracer after angiotensin-converting enzyme inhibition. Following the captopril scintigraphy a renovasography was obtained confirming the presence of a 2 mm long circular narrowing of the right renal artery. It was immediately treated resulting in a significant expansion of the lumen. Conclusion. The captopril renal scintigraphy allows non-invasive functional testing in a selected group of hypertensive children, which can either confirm or rule out the existence of hemodynamically significant renal artery stenosis.

Introduction. The rupture of infrarenal abdominal aortic aneurysm is a surgical emergency condition with a high rate of mortality before the patients arrive at hospital. The signs and symptoms of abdominal aortic aneurysm rupture into the retroperitoneal cavity are pulsatile mass, abdominal pain, hypotension and shock, but sometimes silent symptoms also hide a dangerous and life threatening condition, such as chronic aneurysm rupture of abdominal aorta into the retroperitoneal cavity. Case Report. We present a patient having had the lower back pain for 4 months, which had been recognized and treated as lumbar ischialgia but which was eventually diagnosed to be chronic infrarenal abdominal aortic aneurysm rupture by computed tomography angiography. The surgical intervention was successful and the patient was discharged from hospital after 6 days without any clinical complications. Preoperative imaging by computed tomography angiography of ruptured abdominal aortic aneurysm is highly sensitive for detection of several specific signs for rupture. This condition leads to urgent vascular surgery.