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Frequency of HLA system alleles in subjects with rheumtoid arthritis - determined by molecular methods
No full textSustav HLA (humani leukocitni antigen) glavni je sustav tkivne podudarnosti. Ključnu ulogu u imunološkim procesima imaju molekule HLA odnosno membranski proteini koji djeluju kao antigeni i u stranom organizmu uzrokuju imunološku reakciju. Antigeni i geni sustava HLA određuju se serološkim i molekularnim metodama. Test mikrolimfocitotoksičnosti serološka je metoda koja se najčešće koristi za određivanje antigena sustava HLA razreda I i II. Molekularno određivanje HLA gena može se izvesti pomoću dvije metode, a to su metoda PCR-SSO (engl. Polymerase chain reaction Sequence Specific Oligonucleotide), a druga metoda je PCR-SSP (eng. Polymerase chain reaction – Sequence Specific Primer). Prije izvođenja molekularnih metoda potrebno je izvršiti izolaciju DNA iz periferne krvi. PCR-SSO metoda zasniva se se na povezivanju molekule DNA koja se amplificirala na suspenziji mikrosfera. Reumatoidni artritis kronična je, teška, autoimuna upalna bolest čija je glavna karakteristika sinovitis. Dolazi do razaranja vezivnoga tkiva i zglobnih struktura što u konačnici dovodi do bolnih i upalnih zglobova s čestim deformacijama. Cilj rada bio je odrediti učestalost alela sustava HLA kod ispitanika koji boluju od reumatoidnog artritisa na području Splitsko-dalmatinske županije. Molekularnim metodoma dokazuje se povezanost zajedničkog epitopa. Molekula HLA razreda II bila je područje od interesa jer je pokazivala posebnu osjetljivost na razvoj bolesti. Molekularne metode olakšale su proučavane te povezanosti koristeći nasljeđene sekvence od navedenih aminokiselina QKRAA, QRRAA ili RRRAA koje se nalaze u hipervarijabilnim regijama kao ciljna mjesta.The HLA system (human leukocyte antigen) is the major tissue matching system. A key role in immunological processes has HLA molecules and membrane proteins that act as antigens and the foreign organism causing an immune response. Antigens and genes of the HLA system are determined by serological and molecular methods. The microlymphocytotoxicity test is a serological method most commonly used to determine class I and II HLA system antigens. Molecular determination of the HLA gene can be performed using two methods, namely the PCR-SSO method (Polymerase chain reaction Sequence Specific Oligonucleotide), and the other method is PCR-SSP (Polymerase chain reaction - Sequence Specific Primer). Before performing molecular methods, it is necessary to isolate DNA from peripheral blood. The PCR-SSO method is based on the binding of a DNA molecule that has been amplified on a suspension of microspheres. Rheumatoid arthritis is a chronic, severe, autoimmune inflammatory disease whose main feature is synovitis. There is destruction of connective tissue and joint structures which ultimately leads to painful and inflammatory joints with frequent deformities. The aim of this study was to determine the frequency of HLA alleles in subjects suffering from rheumatoid arthritis in the Split-Dalmatia County. Molecular methods prove the connection of a common epitope. The HLA class II molecule was an area of interest because it showed particular susceptibility to disease development. Molecular methods have facilitated the study of these linkages using inherited sequences from the listed amino acids QKRAA, QRRAA or RRRAA found in hypervariable regions as target sites
FREQUENCY OF EPISIOTOMIES AND SOFT TISSUE INJURIES IN RELATION TO THE FERTILITY AND WEIGHT OF THE NEWBORNS IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, CLINICAL HOSPITAL CENTER SPLIT IN 2020
No full textUVOD: Epiziotomija je porodnička operacija u kojoj se urezom međice širi predvorje vagine tijekom drugog porođajnog doba s ciljem zaštite glave fetusa od traume i zdjeličnog dna od ozljeda. Svjetske udruge smatraju da postotak epiziotomija ne bi smio prelaziti 30% u tercijarnim perinatalnim centrima s većim brojem patoloških trudnoća i porođaja dok u sekundarnim i primarnim rodilištima taj postotak ne bi smio prelaziti 10-20%. Rizični faktori za nastanak porođajnih ozljeda su cefalopelvična disproporcija, makrosomija, abnormalna zdjelica majke, distocija ramena kod prethodnog poroda, kronična insuficijencija posteljice, preeklampsija, fetalne malformacije, instrumentalno dovršenje poroda, medijana epiziotomija, produljeno drugo porođajno doba. Ozljede rodnice se svrstavaju pod prednje i stražnje. Prednje perinealne ozljede – ozljede prednjeg zida vagine, labija, uretre ili klitorisa i najčešće ne predstavljaju rizik za komplikacije. Stražnje perinealne ozljede – ozljede stražnjeg zida vagine, perinealnih mišića ili opstetričke ozljede analnog sfinktera. CILJ: Cilj ovoga rada je utvrditi učestalost epiziotomija i ruptura mekih tkiva, u odnosu na rodnost žena i težinu novorođenčadi te primjenjuje li se epiziotomija restriktivno ili rutinski u usporedbi s preporukama Svjetske udruge. METODE: Istraživanje je provedeno u Klinici za ženske bolesti i porode KBC-Split, a istraživanje se provodilo za razdoblje od 1. siječnja 2020. godine do 31. prosinca 2020. godine. Kriteriji uključenja su bili sljedeći: vaginalni porodi jednoplodnih trudnoća, živo dijete u stavu glavom i porodi su koji uključivali epiziotomiju i/ili rupture perineuma. Ukupan broj porođaja u 2020. godini u KBC-Split bio je 4100, od toga 2789 vaginalnih porođaja. Za potrebe ovog istraživanja je analizirano 2146 vaginalnih porođaja koji su sadržavali zadane kriterije uključenja. REZULTATI: Od ukupno 2789 vaginalnih porođaja, 1628 (58,4%) je bilo s epiziotomijom, 518 (18,6%) bez epiziotomije, ali s rupturom, a 643 (23%) porođaja bez epiziotomije i bez ruptura. Od sveukupnih vaginalnih porođaja (n=2789), udio ruptura uz epiziotomiju je bio minimalan te iznosi 15% (n=235), dok udio ruptura bez epiziotomije iznosi 45% (n=518). ZAKLJUČCI: Prema rezultatima istraživanja, može se zaključiti kako se u Klinici za ženske bolesti i porode KBC-Split u 2020.godini nije koristila metoda restriktivne upotrebe epiziotomije. Udio ruptura kod vaginalnih porođaja iznosio je 27% (n=753). Dokazano je da je pojavnost ruptura veća kada epiziotomija nije primijenjena. Prema dobivenim podacima se može zaključiti da je niski udio ruptura, rezultat prekomjerne upotrebe epiziotomije.INTRODUCTION: Episiotomy is an obstetric operation in which a perineal incision expands the vestibule of the vagina during the second postpartum period with the aim of protecting the fetal head from trauma and the pelvic floor from injury. World associations believe that the percentage of episiotomies should not exceed 30% in tertiary perinatal centers with a higher number of pathological pregnancies and births, while in secondary and primary maternity hospitals this percentage should not exceed 10-20%. Risk factors for the occurrence of birth injuries are cephalopelvic disproportion, macrosomia, abnormal maternal pelvis, shoulder dystocia in previous birth, chronic placental insufficiency, preeclampsia, fetal malformations, instrumental completion of labor, median episiotomy, prolonged second delivery. Vaginal injuries are classified as anterior and posterior. Anterior perineal injuries - injuries to the anterior wall of the vagina, labia, urethra, or clitoris and most often do not pose a risk for complications. Posterior perineal injuries - injuries to the back wall of the vagina, perineal muscles, or obstetric injuries of the anal sphincter. OBJECTIVE: The aim of this study is to determine the frequency of episiotomies and soft tissue ruptures, in relation to women's fertility and newborn weight, and whether episiotomy is applied restrictively or routinely compared to the recommendations of the World Association. METHODS: The research was conducted at the Clinic for Women's Diseases and Obstetrics KBC-Split, and the research was conducted for the period from January 1, 2020 to December 31, 2020. Inclusion criteria were as follows: vaginal births of singleton pregnancies, head-to-head pregnancies, and births that included episiotomy and / or perineal ruptures. The total number of births in 2020 in KBC-Split was 4,100, of which 2,789 were vaginal births. For the purposes of this study, 2146 vaginal deliveries were analyzed that contained the given inclusion criteria. RESULTS: Out of a total of 2789 vaginal births, 1628 (58.4%) were with episiotomy, 518 (18.6%) without episiotomy but with rupture, and 643 (23%) births without episiotomy and without rupture. Of the total vaginal deliveries (n=2789), the proportion of ruptures with episiotomy was minimal and amounted to 15% (n=235), while the proportion of ruptures without episiotomy was 45% (n = 518). CONCLUSIONS: According to the results of the research, it can be concluded that in 2020, the Clinic for Women's Diseases and Obstetrics KBC-Split did not use the method of restrictive use of episiotomy. The proportion of ruptures in vaginal births was 27% (n=753). Rupture has been shown to be higher when episiotomy is not performed. According to the obtained data, it can be concluded that the low proportion of ruptures is the result of excessive use of episiotomy
Incidence of the two most common subtypes of HLA - B*27 gene in respondents of Split - Dalmatia county
No full textUvod: Sustav humanog leukocitnog antigena, koji se još naziva i glavnim kompleksom tkivne podudarnosti, jedan je od najviše opisanih i istraživanih genetskih sustava kod čovjeka. Ima svoj značaj u tome što kodira molekule zadužene za regulaciju imunoloških procesa i predočavanje endogenih i egzogenih antigena imunološkim stanicama (uglavnom limfocitima T). Sustav se nalazi na kratkom kraku kromosoma 6 a podijeljen je u tri razreda, koji su podijeljeni u lokuse. Sustav čini 1% cjelokupnog ljudskog genoma. Gen HLA – B*27 je gen iz razreda I sustava HLA za kojeg je dokazano da posjeduje povezanost sa brojnim autoimunim bolestima, u prvom redu reumatskim bolestima.
Cilj:U ovom radu analizirali smo učestalost najčešćih podtipova gena HLA – B*27 kod ispitanika sa područja Splitsko – dalmatinske županije korištenjem osnovnih statističkih formula i direktnim brojanjem.
Metode: Metode koje se koriste za dokazivanje gena HLA sustava su serološke i molekularne. Serološko testiranje uključuje test mikrolimfocitotoksičnosti, a molekularno testiranje uključuje metode PCR-SSO i PCR-SSP.
Rezultati: Podtip HLA – B*27:02 je bio prisutan kod najvećeg broja naših pacijenata, sa učestalošću od 43%, zatim slijedi HLA – B*27:05 sa nešto manjom učestalošću od 38%. Inače rijeđi alel, HLA – B*27:03, smo uočili kod naših pacijenata u malo većem broju, sa učestalošću od 18%, a iznimno rijedak alel HLA – B*27:08 utvrđen je kod jednog pacijenta (1%).
Rasprava: Proučavanjem učestalosti ustanovljenih alela gena HLA – B*27 u populacijama svijeta možemo reći da je učestalost najviše uočenih alela HLA – B*27:02 i HLA – B*27:05 unutar našeg uzorka jednaka sa učestalostima tih istih podtipova na području Europe. Podtip HLA – B*27:03 je u našem uzorku ustanovljen kod više pacijenata nego što je to bilo za očekivati, s obzirom da je njegova učestalost veća u nekim drugim dijelovima svijeta (Sjeverna Amerika) nego na području Europe. Podtip HLA – B*27:08 zamijećen je kod jednog pacijenta, a promatrajući njegovu svjetsku rasprostranjenost, ima malu zastupljenost na području Europe, osobito Španjolske.
Zaključak: Učestalost dva najčešća podtipa gena HLA – B*27 kod ispitanika na području Splitsko – Dalmatinske županije se ne razlikuje puno od globalne učestalosti najčešćih podtipova.Introduction: The human leukocyte antigen system, also known as the major histocompatibility complex, has long gone been described in literature, as one of the most researched systems in the field of genetics.. It has its significance in that it encodes molecules responsible for the regulation of immune processes and the presentation of endogenous and exogenous antigens to immune cells (mainly T lymphocytes). It is located on the short tail of the chromosome 6 and is divided into three classes, which are then divided into loci. It makes up for 1% of the entire human genome. The HLA - B * 27 gene, which is a class I gene in the HLA system, has previously been linked to a numerous autoimmune diseases, primearly to reumatoid diseases.
Methods: In this bachelor thesis, the frequency of the most common subtypes of the HLA - B * 27 gene in the population of the Split - Dalmatia County was analyzed with the usage of the basic statistical formulas and direct counting.
The methods used to detect HLA system genes are serological and molecular. Serological testing includes a microlymphocitotoxicity test, and molecular testing includes PCR-SSO and PCR-SSP methods.
Results : The HLA - B * 27: 02 subtype was present in the largest number of our patients, with a frequency of 43%, followed by HLA - B * 27: 05 with a slightly lower frequency of 38%. The otherwise rarer allele, HLA - B * 27: 03, was observed in our patients in a slightly higher number, with a frequency of 18%, and an extremely rare allele HLA - B * 27: 08 was found in one patient (1%).
Disscusion: By studying the frequencies of established alleles of the HLA - B * 27 gene in world populations, we can say that the frequency of the most observed HLA - B * 27: 02 and HLA - B * 27: 05 alleles within our sample is equal to the frequencies of these same subtypes in Europe. The HLA - B * 27: 03 subtype was found in our sample in more patients than expected, as its frequency is higher in some other parts of the world (North America) than in Europe. The HLA - B * 27: 08 subtype was observed in one patient, and observing its worldwide distribution, it has a small representation in Europe, especially in Spain.
Conclusion: The frequency of the two most common subtypes of the HLA - B * 27 gene in subjects in the Split - Dalmatia County does not differ much from the global frequency of the most common subtypes
BIOCHEMICAL INDICATORS IN PATIENTS WITH MYOCARDIAL INFARCTION
No full textCILJ ISTRAŽIVANJA: Usporediti serumske koncentracije visoko osjetljivog troponina I i vrijednosti upalnog parametra hsCRP u STEMI i NSTEMI pacijenata. Utvrditi postoji li statistički značajna razlika u broju leukocita, diferencijalnoj krvnoj slici, aktivnosti serumskog enzima AST-a i glukoze u obje ispitivane skupine.
ISPITANICI I METODE: Ovo istraživanje uključilo je 60 ispitanika sa simptomima srčanog zatajenja, a bili su liječeni na Klinici za bolesti srca i krvnih žila KBC-a Split u periodu siječnja 2018. do veljače 2019. godine. Uzorci su obrađeni i analizirani na Zavodu za medicinsko laboratorijsku dijagnostiku KBC Split. Prikupljeni su klinički podaci o dijagnozi ispitanika te su napravljena različita mjerenja i biokemijska ispitivanja.
REZULTATI: Pacijenti su podijeljeni na STEMI (50%) i NSTEMI akutni infarkt miokarda (50%). Svim pacijentima izmjeren je sistolički i dijastolički tlak, kao i indeks tjelesne mase koji je pokazao pretilost kod 13,3% uključenih u istraživanje. Kod 78,3% pacijenata već je izvedena PCI. Lijekovi korišteni tijekom terapije su statini, varfarin, aspirin, a najčešće korišteni su ACE-inhibitori (50%) i beta blokatori (33,3%). Uspoređuju se komorbiditeti kao što su: šećerna bolest, pušenje, pretilost, a najčešće prisutna je arterijska hipertenzija (60%). Mjerenjem aktivnosti enzima AST-a u krvi uočene su značajne razlike kod STEMI (90,1 ± 108,9 IU/L) i NSTEMI (41,4 ± 28,3 IU/L), kao i kod broja neutrofila: STEMI (8,4 ± 2,9 x10^9/L) i NSTEMI(6,4 ± 2,3 x10^9/L). Značajne razlike uočene su i kod broja limfocita i leukocita. Ostali biokemijski parametri nisu ukazivali na značajne statističke razlike: hsCRP (STEMI (11,2 ± 17,0 mg/L) i NSTEMI (16,1 ± 26,8 mg/L), protrombinsko vrijeme, glukoza, natrij, eritrociti. Jedan od parametara bez značajne razlike je i visoko osjetljivi srčani troponin I: STEMI (417,8 ± 617,6 ng/L) i NSTEMI (314,9 ± 406,6 ng/L), iako je vidljiva njegova viša koncentracija kod STEMI ispitivane skupine.
ZAKLJUČAK:
Bez obzira na rezultate laboratorijskih pretraga, dijagnoza se mora postaviti zajedno s kliničkom prezentacijom pacijenta i zajedno s ostalim dijagnostičkim testovima.OBJECTIVES: To compare the serum concentrations of highly sensitive troponin I and the values of the inflammatory parameter hsCRP in STEMI and NSTEMI patients. To determine whether there was a statistically significant difference in leukocyte count, differential blood count, serum AST enzyme activity, and glucose in both study groups.
PATIENTS AND METHODS: This study included 60 subjects with symptoms of heart failure, and were treated at the Clinic for Cardiovascular Diseases of the Clinical Hospital Center Split in the period from January 2018 to February 2019. The samples were processed and analyzed at the Department of Medical Laboratory Diagnostics, University Hospital Center Split. Clinical data on the diagnosis of the subjects were collected and various measurements and biochemical tests were performed.
RESULTS: Patients were divided into STEMI (50%) and NSTEMI acute myocardial infarction (50%). All patients had systolic and diastolic blood pressure measured, as well as body mass index, which showed obesity in 13.3% of those included in the study. PCI has already been performed in 78.3% of patients. Medicaments used during therapy are statins, warfarin, aspirin, and the most commonly used are ACE inhibitors (50%) and beta blockers (33.3%). Comorbidities such as diabetes, smoking, obesity are compared, and arterial hypertension is most common (60%). By measuring the activity of AST in the blood, significant differences were observed in STEMI (90.1 ± 108.9 IU / L) and NSTEMI (41.4 ± 28.3 IU / L), as well as by measuring the number of neutrophils: STEMI (8, 4 ± 2.9 x10 ^ 9 / L) and NSTEMI (6.4 ± 2.3 x10^9/ L). Significant differences were also observed in the number of lymphocytes and leukocytes. Other biochemical parameters did not indicate significant statistical differences: hsCRP (STEMI (11,2 ± 17,0 mg/L) i NSTEMI (16,1 ± 26,8 mg/L), prothrombin time, glucose, sodium, erythrocytes. One of the parameters without significant difference is the highly sensitive cardiac troponin I: STEMI (417.8 ± 617.6 ng / L) and NSTEMI (314.9 ± 406.6 ng / L), although its higher concentration is visible in STEMI study groups.
CONCLUSION:
Regardless of the results of laboratory tests, the diagnosis should be established with the clinical presentation of the patient and other diagnostic tests
PSYCHOLOGICAL PREPARATION OF THE CHILD FOR SURGERY
No full textSvako dijete je individualno i može reagirati na drugačije načine, pogotovo kada se pronađe u nepoznatoj okolini kao što su odjeli za dječju kirurgiju. Dijete razvija anksioznost, strah, te ostale poremećaje. Cilj predoperativne pripreme je smanjiti razinu anksioznosti, spriječiti negativna ponašanja i emocije, uključiti obitelj i dijete poticati da izrazi svoje osjećaje kroz razne programe.Each child is individual and may react differently, especially when found in an unfamiliar environment such as pediatric surgery departments. The child develops anxiety, fear, and other disorders. The goal of preoperative preparation is to reduce the level of anxiety, prevent negative behaviors and emotions, involve the family and encourage the child to express their feelings through various programs
CYTOLOGICALLY DIAGNOSED FIBROADENOMAS IN 2020.
No full textCilj rada: Ciljevi ovog rada su određivanje raspodjele fibroadenoma prema veličini tumora i dobi žene, određivanje udjela fibroadenoma u ukupnom broju punktata dojke te učestalosti fibroadenoma u lijevoj i desnoj dojci.
Materijali i metode: U istraživanje je uključeno 1135 uzoraka čvorova u dojci punktiranih na Zavodu za radiologiju i 11 čvorova dojke punktiranih na ambulanti Odjela za kliničku citologiju KBC Split, od 1.siječnja 2020. do 31.prosinca 2020.godine.
Podaci o rezultatima citološke analize punkata čvorova u dojci dobiveni su uvidom u medicinsku dokumentaciju (računalna baza podataka KBC Split).
Rezultati: Od 1135 uzoraka čvorova u dojci koji su punktirani na Zavodu za radiologiju i 11 čvorova punktiranih na ambulanti Odjela za kliničku citologiju KBC Split, njih 85 (7,41%) je dijagnosticirano kao fibroadenom. Najveća incidencija je u žena u dobi od 40 do 50 godina, pri čemu su samo dvije žene (2,4%) starije od 50 godina. Fibroadenom je bio više zastupljen u desnoj dojci - 48 žena (56,5%), a kod 37 (43.5%) žena nalazio se u lijevoj dojci. Najveći broj pacijentica, njih 35 (41,52%) imalo je tumor manji od 11 mm, dok je samo kod jedne žene (1,2%) prelazio 40mm. Utvrđeno je da nema ovisnosti između dobi žene i veličine tumora kao ni zastupljenosti u lijevoj ili desnoj dojci.
Zaključak: Citologija ima važnu ulogu u dijagnostici fibroadenoma. Citološkom punkcijom koja je brza, jednostavna i ne izrazito agresivna i bolna metoda, može se postaviti dijagnoza fibroadenoma koji se potom redovito ultrazvučno kontroliraju i samo u slučaju izrazitog rasta ili prisutnih atipija kirurški odstranjuju.Objective: The main objective of this study was to determine the distribution of fibroadenoma according to tumor size and women age, to define the share of fibroadenoma in total number of breast punctures and to determine the frequency of fibroadenoma in the left and right breast.
Materials and methods: The study included 1135 samples of breast nodules punctured at the Department of Radiology and 11 breast nodules punctured at the outpatient department of the Department of Clinical Cytology KBC Split, from January 1, 2020 to December 31, 2020.
Data on the results of cytological analysis of puncture nodes in the breast were obtained by inspecting medical records (computer database KBC Split).
Results: Out of 1135 samples of breast nodules punctured at the Department of Radiology and 11 nodules punctured at the outpatient department of the Department of Clinical Cytology KBC Split, 85 punctured nodules were diagnosed as fibroadenoma, which represents a share of 7.41%. The highest incidence was in women in the age group of 40 to 50 years, while only two women (2,4%) diagnosed with fibroadenoma were older than 50. Fibroadenoma was more prevalent in the right breast - 48 women (56.5%) and in 37 (43.5%) women in the left breast, respectively. The largest number of patients, 35 of them (41.52%) had a tumor smaller than 11 mm, while in only one woman (1.2%) exceeded 40 mm. It was found that there was no relationship between women’s age and tumor size as well as presentation in the left or right breast.
Conclusion: Cytology plays a significant role in the diagnosis of fibroadenoma. FNA cytology is a quick, simple and not so aggressive and painful method. Once the cytological diagnosis is established radiological follow up is recommended. If markedly increased or with cytological signs of atypia, surgery is recommended
POSTOPERATIVE ASSESSMENT OF THE PATIENT AFTER PROSTATE SURGERY
No full textNajčešći razlog posjeta muškarca urologu su simptomi donjeg urinarnog trakta čiji je najčešći uzrok benigna hiperplazija prostate koja u dobi od 70 do 80 godina je zastupljena u 80 do 90 % muškaraca. Za pacijente koji imaju značajne smetnje koje ne odgovaraju na konzervativno liječenje na raspolaganju je velik izbor kirurških metoda, od otvorene operacije do minimalno invazivnih zahvata. Rak prostate pripada najčešćim malignim bolestima u muškaraca. Mortalitet je u usporedbi s drugim malignim bolestima nizak, jer je spororastući tumor ali starenjem populacije učestalost se povećava. Većina bolesnika umire s njim, a ne od njega. Unatoč tome, specifični i značajni tjelesni, seksualni, emocionalni i mentalni zdravstveni problemi često dovode do loše kvalitete života. Odluka o liječenju ovisi o dobi oboljelog, stadiju bolesti te pacijentovom shvaćanju i prihvaćanju rizika i koristi svakog od mogućih načina liječenja. Kirurški zahvati mogu biti radikalna, laparoskopska i robotski asistirana prostatektomija. Moguće posljedice zahvata su inkontinencija i erektilna disfunkcija. Uloga medicinske sestre od velike je važnosti. Sama pomisao da može biti inkontinentan kod pacijenta izaziva odbojnost, strah i nelagodu i zato je važno da uz sebe ima empatičnu i educiranu osobu. Rehabilitacija, kako pacijenta tako i obitelji, započinje čekajući operacijski zahvat. Sestra ga educira o važnosti vježbanja koje uključuje aerobne vježbe, trening otpora i vježbe zdjelične muskulature. Sestra mora uspostaviti odnos povjerenja, pružati emocionalnu podršku i hrabriti pacijenta da se što prije suoči s činjenicama. Planovi zdravstvene njege izrađuju se za svakog pacijenta posebno, na osnovi sustavno i cjelovito utvrđenih potreba, kako prije zahvata, tako tijekom i nakon operacije. Provođenje standardiziranih postupaka te intezivne mjere prevencije očekivanih komplikacija predstavljaju ključni korak u liječenju. Nakon zahvata sestrinska skrb je usmjerena na sprječavanje i ublažavanje komplikacija koje nastaju kao posljedica operacije kao i stanja nakon toga. Od izuzetne je važnosti znati na vrijeme prepoznati potencijalno životno ugrožavajuća stanja kao što je npr. krvarenje, obavijestiti liječnika i pravovremeno intervenirati. Zdravstvena skrb kod otpusta se nastavlja edukacijom pacijenta i obitelji o toaleti urinskog katetera, pravilnoj prehrani, o nastavku vježbanja jačanja mišića zdjelice, uključivanja u grupe za potporu, važnosti redovitih kontrola. Tijekom cijelog vremena sestra mora biti profesionalna, empatična, poticati ga da usvoji vještine samozbrinjavanja kako bi se što prije vratio u život kakav je vodio prije operacije.The most common reason for a man to visit a urologist are the symptoms of the lower urinary tract, the most common cause of which is benign prostatic hyperplasia, which is present in 80 to 90% of men between the ages of 70 and 80. For patients who have significant disorders that do not respond to conservative treatment, a wide range of surgical methods is available, from open surgery to minimally invasive procedures. Prostate cancer is one of the most common malignancies in men. Mortality is low compared to other malignancies because it is a slow-growing tumor but as the population ages, the incidence increases. Most patients die with it, not from it. Nevertheless, specific and significant physical, sexual, emotional, and mental health problems often lead to poor quality of life. The decision to treat depends on the patient's age, stage of the disease, and the patient's understanding and acceptance of the risks and benefits of each of the possible treatments. Surgical procedures can be radical, laparoscopic, and robot-assisted prostatectomy. Possible consequences of the procedure are incontinence and erectile dysfunction. The role of the nurse is of great importance. The very thought of being incontinent causes the patient repulsion, fear and discomfort and that is why it is important to have an empathetic and educated person with you. Rehabilitation, for both the patient and the family, begins with waiting for surgery. The nurse educates him about the importance of exercise that includes aerobic exercise, resistance training, and pelvic floor exercises. The nurse must establish a relationship of trust, provide emotional support, and encourage the patient to face the facts as soon as possible. Health care plans are made for each patient separately, based on systematically and comprehensively identified needs, both before the procedure and during and after surgery. The implementation of standardized procedures and intensive measures to prevent expected complications are a key step in treatment. After the procedure, nursing care is focused on preventing and alleviating the complications that arise as a result of the operation as well as the condition after it. It is extremely important to be able to identify potentially life-threatening conditions such as bleeding in time, inform the doctor and intervene in a timely manner. Discharge health care continues by educating the patient and family about the urinary catheter toilet, proper nutrition, continuing to exercise pelvic floor muscle strengthening, joining support groups, and the importance of regular checkups. At all times, the nurse must be professional, empathetic, encourage him to adopt self-care skills in order to get back to the life he led before the operation
Re-planning in Gamma Knife radiotherapy Centre
No full textGamma knife, stereotaktička radioneurokirurška metoda, se razvija godinama kako bi omogućila liječenje intrakranijalnih lezija bez klasičnog otvaranja lubanje kirurškim putem. Razvoj Elektinog Icon uređaja s integriranim „cone-beam“ CT uređajem pruža nove mogućnosti. „Cone-beam“ CT se smatra najtočnijim modalitetom za definiciju stereotaktičkog prostora. Iako je primarno namijenjen za definiciju stereotaktičkog prostora kod pacijenata kojima se za fiksaciju koristi termoplastična maska, CBCT se može primjeniti i za korekciju položaja tumora kada se koristi Leksellov stereotaktički okvir.
Cilj: Cilj rada je prikazati učestalost replaniranja tumora u svakodnevnom radu, istražiti u kojim slučajevima su terapijski planovi bili replanirani, u kakvom je to odnosu s veličinom i/ili položajem tumora u prostoru i objasniti kliničku važnost adekvatnih protokola planiranja i korištenja “cone beam” CT-a.
Metode: Pri izradi ovog rada, korišteni su dozimetrijski podatci uzeti iz Gamma Plana programa za planiranje, retrospektivno, nakon izvršenog postupka na pacijentima. Analizirani su podatci 50 pacijenata s dijagnozom solitarne metastaze mozga i 50 pacijenata s dijagnozom vestibularnog švanoma. Ulazni podatci poput pokrivenosti, anatomskog pomaka, volumena i histologije tumora su korelirani s učestalosti replaniranja, a statistička značajnost je dobivena pomoću t-testa.
Rezultati: Analiza podaka je pokazala da vjerojatnost replaniranja ovisi veličini tumora. Vjerojatnost replaniranja je veća za manje tumore te je razlika statistički značajna (P=0,009; CI=95). Osim toga, analiza je pokazala da vjerojatnost replaniranja ne ovisi o udaljenosti tumora od centra stereotaktičkog prostora (P=0,865; CI=95) i da vjerojatnost replaniranja ne ovisi o histologiji tumora (P=0,6; CI=95). Od 100 pacijenata, ukupno je replanirano 26 % planova, od toga 28 % planova za metastazu i 24 % planova za vestibularni švanom.
Zaključak: Korekcija položaja i replaniranje korištenjem “cone-beam” CT-a u procesu rada u stereotaktičkoj radiokirurgiji, se pokazalo kao dobra metoda koja omogućava pravilnu isporuku doze na tumor te na taj način poboljšava kvalitetu liječenja.Gamma knife, stereotactic radiosurgery method, has evolved over the years to allow non-open surgical treatment of intracranial pathologies. New Elekta Icon Gamma Knife model comes with integrated cone-beam CT. Cone-beam CT is considered the most accurate modality for coordinate definition of stereotactic space. Primary purpose of CBCT is definition of stereotactic space for frameless treatment where thermoplastic mask is used to immobilize patient’s head. Besides that, it is very usefull for tumor position correction when Leksell stereotactic frame is used.
Purpose: The aim of this paper is to show the frequency of re-planning in daily work, to invesrtigate in which cases the treatment plans were re-planned, what is relation between coverage decrease and volume or between tumor location in stereotactic space and what is clinical importance of re-planning.
Methods: In preparing this paper, dosimetric data taken from the Gamma Plan planning program were used retrospectively, after the procedure was performed on patients. Data for 50 patients diagnosed with solitary brain metastasis and for 50 patients diagnosed with vestibular schwannoma were analyzed. Input data such as coverage, anatomical displacement, volume, and tumor histology were correlated with re-planning frequency, and statistical significance was obtained using a t-test.
Results: Data analysis showed that the chance of re-planning depends on the size of the tumor. The chance of re-planning is higher for smaller tumors and the difference is statistically significant (P = 0.009; CI = 95). In addition, the analysis showed that the chance of re-planning did not depend on the distance of the tumor from the center of the stereotactic space (P = 0.865; CI = 95) and that the chance of re-planning did not depend on tumor histology (P = 0.6; CI = 95). Out of 100 patients, a total of 26% of the plans werere-planned, of which 28% were plans for metastasis and 24% were plans for vestibular schwannoma.
Conclusion: Position correction and re-planning using cone-beam CT, in the process of work in stereotactic radiosurgery, has proven to be a good method that allows proper delivery of the dose to the tumor and thus improves the quality of treatment
DOSE RADIATION AND CHEST CT PROTOCOLS FOR COVID POSITIVE PATIENTS
No full textGlobalna pandemija koronavirusa 2019 (COVID-19) preokrenula je svijet s preko 170 milijuna infekcija i preko 3,5 milijuna smrtnih slučajeva diljem svijeta. Poželjna metoda za dijagnozu infekcije COVID-19 je analiza lančane reakcije polimeraze s obrnutom transkripcijom (RT-PCR test). Međutim, CT pluća često se koristi u pozitivnih bolesnika ili onih u kojih postoji sumnja na COVID-19 zbog regionalnih preferencija, nedostatka dostupnosti PCR testova i lažno negativnih PCR testova, kao i za praćenje napredovanja bolesti, komplikacija i odgovora na liječenje. Budući da CT koristi ionizirajuće zračenje i predstavlja glavni uzrok izloženosti radijaciji iz dijagnostičkih medicinskih postupaka snimanja opće populacije, razvoj protokola snimanja CT-a niskih doza za Covid pacijente vrlo je poželjan.
U ovom radu sustavnim pregledom literature htjeli smo prikazati koji bi tehnički parametri bili poželjni pri snimanju CT-a pluća kod COVID-19 pacijenata, kako bi doza zračenja bila što niža uz dovoljnu dijagnostičku vrijednost provedenog pregleda. Analizirat će se i međunarodne varijacije u korištenju različitih CT protokola te načini zaštite radioloških tehnologa od samog virusa.The global coronavirus pandemic 2019 (COVID-19) turned the world upside down with over 170 million infections and over 3.5 million deaths worldwide. A preferred method for the diagnosis of COVID-19 infection is reverse transcription polymerase chain reaction analysis (RT-PCR test). However, chest CT is often used in positive or suspected COVID-19 patients due to regional preferences, lack of availability of PCR tests and false-negative PCR tests, and to monitor disease progression, complications, and treatment responses. Because CT uses ionizing radiation and is a major cause of radiation exposure from diagnostic medical imaging procedures of the general population, the development of low-dose CT imaging protocols for Covid patients is highly desirable.
In this paper we wanted to show, using systematic review of the literature, which technical parameters would be desirable when recording chest CT in COVID-19 patients, so that the radiation dose is as low as possible providing sufficient diagnostic value of the examination. International variations in the use of different CT protocols and ways to protect radiological technologists from the virus itself will also be analyzed
Shock wave therapy for cacifying tendinitisa
No full textTerapija udarnim valom se primjenjuje u medicini od 90-ih godina prošlog stoljeća. U širokoj je primjeni u raznim granama medicine. Koristi se u liječenju kalcificirajućeg tendinitisa kao jedna od najuspješnijih metoda. Kalcificirajući tendinitis je poremećaj kojeg karakterizira nakupljanje kalcijevih hidorksipipata na tetivama ljudskog tijela, a najčešće na tetivama mišića rotatorne manžete koji pripadaju skupini mišića ramenog obruča. Prema istraživanjima terapija udarnim valom se pokazala kao uspješna metoda u liječenju kalcificirajućeg tendinitisa.Shock wave therapy has been used in medicine since the 1990s. It is widely used in various brenches of medicine. It is used in the treatment of calcifying tendititis as one of the most successful methods. Calcifying tendinitis is disorder caracterized by the accumulation of calcium hydroxipipated on the tendons of human body. The most common localization is on the tendons of the rotator cuff muscles. These muscles belong to the shoulder joint muscles. According to researche, shock wave therapy has been shown to be a successful method in the treatment of calcifying tendinitis