University of Zagreb Medical School Repository
University of Zagreb Medical School RepositoryNot a member yet
2851 research outputs found
Sort by
Primary ameloblastoma of the temporal bone
Get PDFAmeloblastoma is a locally aggressive tumor derived from odontogenic epithelium. Although benign, its clinical behavior can often exhibit malignant characteristics. It is marked by slow and persistent growth with infiltration of adjacent tissues. Almost 70% occur in the mandible in patients older than 30 years. Recurrence of ameloblastoma from inadequate treatment is frequent. Because of its slow growth, recurrences can present decades after primary surgery. A primary ameloblastoma in an area outside the mandibular, maxillary, and infratemporal fossa regions has not been described in detail to date, with only 1 possible case mentioned in the literature. The authors present a case of primary temporal bone ameloblastoma in a 17-year-old boy. The tumor originated in the left mastoid, infiltrated the lateral semicircular canal, facial nerve, and cochlea, and adhered to the sigmoid sinus and posterior cranial fossa dura. Although invasion of multiple structures in the infratemporal fossa and temporal bone leads to variable disease presentation, this case is unique because the first symptom of disease was sudden and recurring unilateral sensorineural hearing loss. Surgery required transection of the facial nerve. Histopathology confirmed primary temporal bone ameloblastoma. The difficulties in achieving wide surgical margins, diagnostics, and further management are addressed
Smjernice za dijagnozu i liječenje bolesnika s mijelodisplastičnim sindromom [Guidelines for diagnosis and treatment of patients with myelodysplastic syndrome]
Get PDFMyelodysplastic syndrome Working Group of the Croatian Cooperative Group for Hematologic Diseases (CROHEM), Referral center of the Ministry of Health of the Republic of Croatia for diagnostics and treatment of MDS, as well as the Croatian Society for Haematology of the Croatian Medical Association have made Croatian guidelines for diagnosis and treatment of myelodysplastic syndrome (MDS). MDS is a heterogeneous group of clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis, dysplasia, cytopenia and risk of transformation to acute myeloid leukemia (AML). Diagnosis is based on morphological characteristics of hematopoietic cells supplemented with the cytogenetic analysis and bone marrow flow cytometry. Due to great differences in the natural course of the disease, i.e. time to progression to AML and the expected time of survival several scoring systems have been developed to determine the disease risk. The treatment of patients with MDS is based on the risk factors of the disease as well as the individual risk of treatment
Postupnici za periproceduralno zbrinjavanje i zbrinjavanje krvarenja u bolesnika liječenih novim oralnim antikoagulantnim lijekovima [Algorithms for periprocedural management and management of bleeding in patients treated with non-vitamin K oral anticoagulants]
Get PDFThe goal of therapy with vitamin K antagonists (warfarin), and new direct oral anticoagulant drugs (NOAC or DOAC) is the prevention of stroke and embolic events in patients with non-valvular atrial fibrillation and treatment and prevention of venous thromboembolism. In all cases it is necessary to determine renal function with creatinine clearance because it determines the choice and dosage of NOAC’s. It is extremely important to pay attention to older patients with a number of associated conditions and drug interactions, with a high incidence of neurological symptoms and worse outcomes. Oral anticoagulation can represent a challenge, especially in cases of drug overdose or emergencies such as bleeding and need for urgent surgery. The need for the guidelines has emerged during the last years because of new classes of oral anticoagulants being prescribed more frequently. The expert working group of emergency specialists was formed and gathered on Consensus Conference in October 2015 in Zagreb, to design guidelines for the patients with NOAC therapy and provides details of preoperative management and managements in emergency conditions
Smjernice za dijagnostiku i liječenje primarne imunosne trombocitopenije u odraslih [Guidelines for diagnostics and treatment of primary immune thrombocytopenia in adults]
Get PDFWorking Group for Diseases of Hemostasis and Thrombosis of the Croatian Cooperative Group for Hematologic Diseases (CROHEM), Referral Center for Hereditary and Acquired Disorders of Hemostasis of the Croatian Ministry of Health, and Croatian Hematology Society of the Croatian Medical Association developed the Croatian guidelines for the diagnosis and treatment of primary immune thrombocytopenia (ITP). Detailed clinical and laboratory examination should be performed to exclude common secondary causes of thrombocytopenia. An individualized therapeutic approach is proposed, and decision to start active treatment depends on the severity and risk of bleeding, platelet count, patient’s life style, age and comorbidities. Glucocorticoids with or without intravenous immunoglobulines are recommended as the first line treatment. The second line treatments are splenectomy or thrombopoietin receptor agonists as suggested options. Thrombopoietin receptor agonists are recommended treatment for splenectomized patients with relapsed ITP. Alternatively rituximab or other immunosuppressive agents are suggested in second or later treatment lines
Izloženost operacijskog osoblja udisanju ugljičnog monoksida tijekom peritonektomije [Operating theater staff exposure to carbon monoxide during peritonectomy procedure]
Get PDFIn the operating room surgical staff is exposed to inhalation of smoke from the combustion of tissues when using electrocautery. By introducing peritonectomy in the treatment of malignant neoplasms of the peritoneum exposure to smoke is significantly increased. The procedure consists of removing macroscopic tumor masses combined with hyperthermic intraperitoneal chemotherapy. To adequately perform this procedure, high power monopolar cautery is used. The aim of this study was to measure the amount of inhaled carbon monoxide, as the harmful substance found in the smoke liberated during peritonectomy procedures, compared to standard colorectal resections. A total of 360 blood samples from surgeons doing procedures were analysed, divided into two groups. Group A contained blood samples collected during peritonectomy procedures using electrocautery. Group B contained blood samples collected during standard colorectal resections. Samples from total of 30 procedures, 15 in each group, each participated by three surgeons, were collected. Samples were collected at the start of the intervention, in 20th and 40th minutes, and at the end of procedures. Carboxyhemoglobin values of all participants were higher in peritonectomy group. Increase in methemoglobin levels was not statistically significant between two groups. Increase in the value of carboxyhemoglobin with time was measured in control group, but those values did not lead to symptoms of acute poisoning by carbon-monoxide. Results suggest a need to prevent chronic surgical staff CO poisoning by use of personal protective equipment and devices for the evacuation of smoke in each procedure, especially in peritonectomy procedures due to increased production of smoke particles
Utjecaj tipa dijalize prije transplantacije na ishod transplantacije bubrega [The effect of pretransplant dialysis modality on the outcome of renal transplantation]
Get PDFIntroduction: Chronic renal disease is a global disease that primarily affects the elderly population and represents a major financial expense for all healthcare systems. Chronic renal disease is treated by dialysis or kidney transplantation. The goal of the research is to discover the connection between the type of dialysis before the transplantation and the outcome of the kidney transplantation.
Test subjects and methods: This retrospective study includes all kidney recipients or pancreas and kidney recipients in the period from 2007. to 2013. at the University Hospital Merkur, Zagreb.
Results: The research included 280 patients (106 male and 174 female). Of the total number of transplantations, there were 229 kidney transplantations and 51 simultaneous kidney and pancreas transplantations. Before the transplantation most of the patients were on HD (207), while 63 of them were on PD. According to the Kaplan-Meier survival curve, the five year survival of all the patients is 82.9 % while the graft survival is 78.5%). Considering the type of dialysis before the transplantation, there was no statistically significant differences in the survival of the patients (p=.09), kidney survival (p=.19), and graft survival censored for death of the patient (p=.16). The incidence of all infections in the first three months after transplantation was 58.9%, and 50% of all the infections were urinary infections. Considering the type of dialysis before transplantation, there were no statistically significant differences in the incidence of infections. Even though the type of dialysis before the transplantation was one of the factors that affected the value of glomerular filtration in the univariate analysis, it was lost in the multivariate analysis, where only the ages of the recipient and the donor remained as statistically significant variables that affect the function of the kidneys 6 and 12 months after the transplantation. The average price of a kidney transplantation was HRK 85.85±41.67 thousand, and for SPKT it was HRK 111.84±89.20 thousand (p= .02). There was no statistically significant difference in the price of the transplantation considering the type of dialysis before the transplantation. Delayed graft function, death of the patient, type of transplantation, and graft survival censored for death of the patient are statistically significant variables connected to the price of the transplantation. Conclusion: The type of dialysis before transplantation does not affect the survival of the patient and the graft, the incidence of infections, the value of glomerular filtration after the transplantation, or the price of the transplantation itself. That is why PD should be promoted as the first choice method for dialysis treatment of all the patients that do not have contraindications for its use
Profesionalna etička osposobljenost kao instrument za vrednovanje etičnosti i etičke osposobljenosti studenata medicine [Professional ethical competences questionnaire as a tool for evaluating medical students' professional ethical competences]
Get PDFAim: This research was conducted with the main aim to develop an instrument for the assessment of medical students’ professional ethical competences in patients’ autonomy issues and to analyze trends in ethical competences among medical students in different years, according to their socio-demographic characteristics and desired specialization. Material and methods: Research was performed in two phases. First, qualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6th) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. Obtained data were used to construct the instrument Professional Ethical Competence Questionnaire (acronym: PECQ ). Subsequently, PECQ was administered to medical students of Zagreb School of Medicine: 1st year (N=291), 3rd year (N=121) and 6th year (N=124).
Results: Qualitative results show that ethical problems regarding patients’ autonomy issues are frequent in clinical practice. Medical education should deal with these issues appropriately. Quantitative analysis of the PECQ Instrument revealed that different styles can be identified in dealing with patient autonomy issues. Each question should be analyzed separately in line with the clinical context described in the vignette. Nevertheless, the most frequent style in medical decision taking was patient understood as a partner. The least frequent style was defensive/legalistic approach to the patient. Differences in students’ answers were found according to their year of study, sex, desired specialization and place of growing up. No differences were found in relation to parents’ education, age and religiosity. Conclusion: PECQ is an applicable and useful instrument to assess medical students’ professional ethical competence in patients’ autonomy issues
Prva biopsija mozga u Hrvatskoj vođena neuronavigacijom [First frameless neuronavigation guided brain biopsy in Croatia]
Get PDFSummary. First case of frameless neuronavigation guided brain biopsy performed in Croatia is presented. Neuronavigation developing technology enables tissue sample acquiring with a frameless, image-guided technique with visual control of the biopsy needle. Frameless stereotactic brain biopsy was performed using the Medtronic StealthStation® S7® surgical navigation system. The Articulating Arm and the Precision Aiming Device were used for precise and rigid fixation of the needle trajectory. Compared to the frame-based stereotactic procedure, frameless stereotactic biopsy method offers superior visualisation in trajectory planning, multiple target choosing and is a time-saving procedure
Differences in CVVH vs. CVVHDF in the management of sepsis-induced acute kidney injury in critically ill patients
Get PDFWe hypothesized that patients with sepsis and AKI, especially patients without preserved renal function, and treated with continuous veno-venous hemodiafiltration (CVVHDF), have lower risk for mortality than patients treated with continuous veno-venous hemofiltration (CVVH). Patients were included if they fulfilled the diagnosis of severe sepsis or septic shock, suffered AKI and received continuous renal replacement therapy (CRRT) in intensive care unit. There were 62 patients treated by CVVH and 75 treated by CVVHDF. Mean survival time was longer in CVVHDF group with oliguric/anuric patients than in CVVH group. CVVH, and not classic risk factors, was associated with higher overall mortality in oliguric/anuric patients. In the linear regression model, hourly urine output was the strongest and positive predictor of longer survival. CVVHDF is according to our results a CRRT modality of choice for the treatment and lower mortality of septic patients with AKI where renal function is no longer preserved. CRRT has been associated with improved renal recovery, but it should be started earlier in AKI evolution with still preserved hourly urine output which is the most sensitive and prognostic marker of survival in septic patients with AKI
