Repository of the Sestre milosrdnice University Hospital Center
Not a member yet
502 research outputs found
Sort by
Artroskopija kuka: ostatna cam deformacija u kombinaciji s labavim koštanim fragmentom u čahuri kuka
No full textHip arthroscopy is a minimally invasive, effective and innovative orthopedic procedure with a relatively low rate of complications. In our patient, residual cam deformity and a bone fragment that remained in the front hip capsule after hip arthroscopy performed three years before caused thigh numbness, muscle fasciculations, and paresthesia. It was assumed that the loose bony fragment remained following burring on prior procedure. During hip flexion, neural structures were compressed and caused the mentioned symptoms. Revision hip arthroscopy was performed and the loose fragment in addition to residual cam deformity was removed. Resolution of pain and anterior thigh numbness was reported after the revision surgery.Artroskopija kuka je minimalno invazivni, učinkovit i inovativni ortopedski zahvat s niskim rizikom od komplikacija. Kod našeg bolesnika ostatna cam lezija i fragment kosti koji je zaostao u prednjem dijelu čahure kuka nakon artroskopije kuka izvedene tri godine ranije izazvao je utrnulost natkoljenice, fascikulacije mišića i parestezije. Pretpostavljamo da je koštani ulomak zaostao kao komplikacija brušenja kosti u prethodnom zahvatu. Prilikom fleksije kuka komprimirao je živčane strukture i posljedično izazivao spomenute simptome. Komplikacija je riješena revizijskom artroskopijom kuka i uklanjanjem slobodnog fragmenta. Nakon revizijske operacije došlo je do smanjenja boli i prestanka utrnulosti prednjeg dijela bedra u našeg bolesnika
Mikrokirurško liječenje rijetkog slučajno nađenog intraventrikulskog meningeoma: prikaz slučaja i pregled relevantne literature
No full textIntraventricular meningiomas are rare and make up between 0.5% and 3% of all intracranial meningiomas, representing one of the most challenging tumors in neurosurgery due to their difficult location. Being initially asymptomatic, such tumors usually attain large size before clinical presentation and diagnostic detection. Available literature concerned with their surgical management remains scarce. Herein, we present a case of microsurgical resection of incidental intraventricular meningioma in a 32-year-old female patient who was admitted to the hospital due to the sudden loss of consciousness, retrograde amnesia, and nausea following a head trauma. Routine brain magnetic resonance imaging revealed an irregular expansive formation located in the occipital horn of the right lateral ventricle showing heterogeneous contrast enhancement. The patient underwent right-side temporal osteoplastic craniotomy with total tumor microsurgical resection followed by external ventricular drainage, and recovered fully afterwards. Histopathologic analysis of tumor tissue samples confirmed the tumor as meningioma WHO grade I. Postoperative brain computed tomography confirmed complete tumor resection. In conclusion, intraventricular meningiomas are rather rare extra-axial tumors and may present with various symptoms depending on their size and difficult location. The development of most modern neuroimaging methods offers the opportunity of their precise and accurate diagnosis, better surgical planning, and favorable outcome. Microsurgical gross resection utilizing intraoperative neuromonitoring and cutting-edge neurosurgical armamentarium remains the treatment of choice for these location-challenging and surgically demanding, predominantly benign intracranial tumors.Intraventrikulski meningeomi su vrlo rijetki, čineći između 0,5% i 3% svih intrakranijskih meningeoma te zbog svoga zahtjevnog položaja predstavljaju najizazovnije tumore za kirurško liječenje. Kako su početno asimptomatski, ovakvi tumori često ostaju dugo klinički i radiološki neprepoznati prije no što dosegnu kritičnu veličinu. Dostupna literatura o načinima njihovog kirurškog liječenja je još uvijek oskudna. U ovom radu predstavljamo mikrokirurško uklanjanje slučajno nađenog intraventrikulskog meningeoma kroz prikaz slučaja žene u dobi od 32 godine koja je primljena u bolnicu zbog naglog gubitka svijesti, retrogradne amnezije i povraćanja nastalih kao posljedica pretrpljene ozljede glave. Rutinska magnetna rezonancija mozga otkrila je nepravilnu ekspanzivnu tvorbu smještenu unutar zatiljnog roga desne postranične moždane klijetke koja se raznovrsno obojala nakon primjene kontrastnog sredstva. Temeljem ovoga nalaza u bolesnice je učinjena desnostrana temporalna osteoplastička kraniotomija i tumor je mikrokirurški uklonjen u cijelosti, nakon čega je postavljena izvanjska ventrikulska drenaža te je uslijedio potpun oporavak. Patohistološka analiza uzoraka tumorskog tkiva potvrdila je tumor kao meningeom I. stupnja prema klasifikaciji Svjetske zdravstvene organizacije. Poslijeoperacijska kompjutorizirana tomografija mozga potvrdila je potpunu tumorsku resekciju. U zaključku, intraventrikulski meningeomi su prilično rijetki ekstra-aksijalni tumori koji se očituju različitim simptomima ovisnima o njihovoj veličini i zahtjevnom položaju. Zahvaljujući razvitku najsuvremenijih metoda radiološkog oslikavanja znatno je poboljšana mogućnost njihove primjerene i točne dijagnostike, boljeg planiranja kirurškog zahvata i poboljšanog ishoda liječenja. Potpuno mikrokirurško uklanjanje tumora, uz pomoć intraoperacijskog neurofiziološkog praćenja i uporabu najsuvremenijeg neurokirurškog instrumentarija, najbolja je metoda izbora u liječenju ovih lokacijski i kirurški vrlo zahtjevnih, pretežito dobroćudnih intrakranijskih tumora
The effect of transcoutaneous electrical nerve stimulation on pain control during dental procedure in children 9-14 years old
No full textIntroduction: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological method widely used by medical specialists to manage acute and chronic pain in different circumstances. It can be used to manage pain during many dental procedures, as well as pain due to various conditions affecting the maxillofacial region. The aim of this study was to provide insight into the clinical research evidence for the analgetic application of TENS in pediatric patients. The hypothesis was that TENS device will achieve analgetic effect on teeth during dental procedure.
Methods: This study included 125 patients treated at the School of Dental Medicine, University of Zagreb clinic during two-year period. After diagnosis of caries and need for restorative treatment, patients were randomly selected in three groups. Group 1 received local anesthesia, group 2 had no anesthesia and group 3 used TENS device. Level of pain was measured with Visual Analogue Scale (VAS). Research was conducted by one therapist that was calibrated.
Results: We found no statistically significant difference between TENS group and group without anesthesia(p>0.05).
Conclusion: TENS device is not as efficient in achieving analgetic impact during dental procedure as local anesthesia
Procjena rizika u trudnoćama majki u dobi iznad 40 godina
No full textThe objective of this study was to assess the relationship between women’s age and risk of pregnancy-related complications. The study was a retrospective cohort analysis of the pregnancy-related complications and outcomes between two age groups of parturient women. Categorical data were expressed as absolute and relative frequencies. Statistical analysis was performed using χ2-test. The incidence of gestational diabetes was higher in the 40-47 age group as compared with the 20-24 age group. The rates of hypertension, preeclampsia, intrahepatic cholestasis of pregnancy and hypothyroidism did not differ between the two groups. The rates of labor induction, oxytocin use, vaginal delivery, and need for episiotomy were higher in younger age group. Dystocia and breech presentation as indications for cesarean section were more common among younger women. According to study results, the risk of gestational diabetes and rates of cesarean delivery increased with advanced maternal age.Cilj istraživanja bio je ispitati povezanost dobi majke i rizika povezanih s njihovim trudnoćama. Retrospektivno kohortno
istraživanje provedeno je usporedbom pojavnosti rizika i ishoda trudnoća dviju skupina trudnica. Kategorijski podatci prikazani
su apsolutnim i relativnim frekvencijama. Statistička analiza provedena je primjenom χ2-testa. Incidencija gestacijskog
dijabetesa bila je veća u skupini trudnica u dobi od 40-47 godina u usporedbi sa skupinom u dobi od 20-24 godine. Stopa
hipertenzije, preeklampsije, intrahepatične kolestaze u trudnoći i hipotireoidizma nije se razlikovala između dviju dobnih
skupina trudnica. Stope indukcije porođaja, upotrebe oksitocina, vaginalnog porođaja i potreba za epiziotomijom bile su veće
u trudnica mlađe dobi. Nenapredovanje porođaja i stav ploda zatkom kao indikacije za carski rez bile su češće u žena mlađe
dobi. Rezultati istraživanja upućuju na veći rizik gestacijskog dijabetesa i dovršenja trudnoće carskim rezom u trudnica
uznapredovale
životne dobi
Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance
No full textBackground: New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts).The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions.
Methods: We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care.
Results: There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care.
Conclusions: This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities
The Role of Folded Multi-Island Vertical Rectus Abdominis Myocutaneous Flap in Reconstruction of Complex Maxillectomy and Midfacial Defects
No full textThe rationale and outcomes for reconstruction of complex maxillectomy and midfacial defects using a folded multi-island vertical rectus abdominis myocutaneous free flap (MI-VRAM) are analyzed in this study. A retrospective review of prospectively collected database was conducted on all VRAM free flaps used in head and neck reconstruction from 2013 to 2019. A total of 39 cases were identified, of which 21 patients underwent immediate VRAM flap reconstruction for complex maxillectomy and midfacial defects. Variables including age, sex, pathologic subtypes, tumor staging, type of resection, defect classification, adjuvant therapy, complications, follow-up time, and reconstructive details were collected. Single skin-island VRAM was used in 10 (47.6%) patients. Eleven (52.4%) patients required the use of folded MI-VRAM flap. In 6 (28.6%) patients a triple skin-island VRAM was used and 5 (23.8%) received a double skin-island VRAM. The average size of harvested skin paddle was 15 7.2 cm. Secondary flap contouring was required in 6 (28.6%) patients. There were no cases of total flap loss and no major donor site complications recorded. Folded MI-VRAM flap is a reliable method for reconstruction of complex maxillectomy and midfacial defects. It provides multiple independent skin islands with excellent plasticity and abundant volume of tissue for restoration of facial contours
Expression of NEDD9 and connexin-43 in neoplastic and stromal cells of gastric adenocarcinoma
No full textGastric cancer is related to high mortality rates and advanced disease stage at the time of diagnosis. Its carcinogenesis is extensively studied and is associated with genetic and epigenetic changes, changed the interaction between tumor and adjacent stromal cells, and changes in the microenvironment molecule status. Neural precursor cell-expressed developmentally down-regulated 9 (NEDD9) affects different signaling proteins and pathways, apoptosis, adhesion, cell migration, and invasiveness. Connexin-43 (Cx43) also assists in intercellular communications and has several channel-independent functions. Aberrant expression of those two gap junction proteins plays an essential role in metastatic processes. Our scope was to detect the expression of Cx43 and NEDD9 in epithelial and stromal gastric cancer compartments and its relation to tumor progression and lymph node metastases. Cancer tissue from 53 cases of node-negative and 55 cases of node-positive primary gastric carcinoma patients was analyzed for Cx43 and NEDD9 expression by immunohistochemical assay, and the results were correlated with the remaining clinical and pathological findings and survival. In our cohort of patients with lymph node metastases, we detected higher expression of epithelial Cx43 in the primary tumor and stromal Cx43 expression correlated with both epithelial NEDD9 (rho = 0.453) and stromal NEDD9 (rho = 0.484). Higher epithelial Cx43 and NEDD9 expression were associated with higher mortality (HR 1.54, 95% CI 1.01-2.37, p = 0.048). Epithelial Cx43 expression, both epithelial and stromal NEDD9 expression, T and N status were all independently associated with shorter survival. In summary, our findings suggest that increased expression of both epithelial and stromal NEDD9 and epithelial Cx43 could potentially be used as prognostic gastric cancer biomarkers
Psoas muscle index at the time of diagnosis might reflect the prognosis of classical Hodgkinʼs lymphoma patients
No full textWe retrospectively investigated clinical and prognostic significance of psoas muscle index (PMI) calculated as total psoas muscle area at L3 vertebra level obtained from baseline computed tomography (CT) scans in 49 newly diagnosed classical Hodgkin’s lymphoma (cHL) patients prior to specific treatment. Median PMI was 572.5mm2/m2 and was significantly higher in males (P<0.001), patients with higher body mass index (BMI, P<0.001), absence of extranodal disease (P= 0.037), higher absolute lymphocyte count (P= 0.037), higher hemoglobin (P= 0.010) and lower lactate dehydrogenase (LDH, P= 0.050). There were no significant associations with age, disease subtype, presence of constitutional symptoms, Ann Arbor disease stage, presence of advanced disease or international prognostic score. Patients with lower PMI had significantly worse PFS (hazard ratio [HR] 4.91; P= 0.009). This phenomenon persisted in the multivariate model (HR= 5.09; P= 0.042) adjusted for International Prognostic Score (IPS) and chemotherapy type
Interakcije lijek-lijek-gen kao posrednici nuspojava diklofenaka i statina – prikaz slučaja i pregled literature
No full textConcomitant treatment with drugs that inhibit drug metabolising enzymes and/or transporters, such as commonly prescribed statins and nonsteroidal anti-inflammatory drugs (NSAIDs), has been associated with prolonged drug exposure and increased risk of adverse drug reactions (ADRs) due to drug-drug interactions. The risk is further increased in patients with chronic diseases/comorbidities who are more susceptible because of their genetic setup or external factors. In that light, we present a case of a 46-year-old woman who had been experiencing acute renal and hepatic injury and myalgia over two years of concomitant treatment with diclofenac, atorvastatin, simvastatin/fenofibrate, and several other drugs, including pantoprazole and furosemide. Our pharmacogenomic findings supported the suspicion that ADRs, most notably the multi-organ toxicity experienced by our patient, may be owed to drug-drug-gene interactions and increased bioavailability of the prescribed drugs due to slower detoxification capacity and decreased hepatic and renal elimination. We also discuss the importance of CYP polymorphisms in the biotransformation of endogenous substrates such as arachidonic acid and their modulating role in pathophysiological processes. Yet even though the risks of ADRs related to the above mentioned drugs are substantially evidenced in literature, pre-emptive pharmacogenetic analysis has not yet found its way into common clinical practice.Statini i nesteroidni protuupalni lijekovi (NSAID) učestalo se propisuju, pa i kao konkomitantna terapija. Postoji značajna interindividualna razlika u osjetljivosti na njihove najčešće nuspojave. Rizični čimbenici za razvoj nuspojava tih lijekova mogu biti povezani s lijekom i pacijentom ili s vanjskim čimbenicima. Polifarmacija je česta u kroničnih bolesnika i povećava rizik od razvoja interakcija lijekova. Istodobna primjena lijekovima koji inhibiraju CYP, UGT, ABC i / ili SLC prijenosnike lijekova (ABCB1, ABCG2 i OATP1B1) povezana je s produljenjem bioraspoloživosti lijekova, što rezultira povećanim rizikom od razvoja nuspojava. S tim u vezi, predstavljamo slučaj 46-godišnje žene koja je tijekom dvije godine doživjela akutno oštećenje bubrega i jetre, kao i mialgiju, dok je uzimala diklofenak, atorvastatin, fiksnu kombinaciju simvastatina / fenofibrata istovremeno s nekoliko drugih lijekova, uključujući pantoprazol i furosemid. Analiza dobivenih farmakogenetičkih rezultata te pregled dosadašnjeg znanja u tom području upućuju na zaključke da interakcije lijek-lijekgen mogu produljiti bioraspoloživost primijenjenih lijekova. Mehanizam se argumentirano temelji na sporijoj sposobnosti detoksikacije i smanjenoj eliminaciji putem jetre i bubrega, što rezultira toksičnošću za više organa. Jednako tako, prikazuje se važnost polimorfizama CYP u biotransformaciji endogenih supstrata poput arahidonske kiseline i u njihovoj modulacijskoj ulozi u patofiziološkim procesima. Danas postoje prilično značajni znanstveni dokazi o određenim farmakogenetičkim spoznajama koji rezultiraju povećanim rizikom od razvoja nuspojava za spomenute lijekove, no unatoč tomu, farmakogenetička analiza prije uvođenja lijekova u terapiju još nije uvedena u redovitu kliničku praksu
99mTc-MIBI SPECT/CT scintigrafija i ultrazvuk prednje vratne regije u dijagnostici bolesti paratireoidnih žlijezda kod bolesnika s nodoznim promjenama štitnjače
No full textParathyroid scintigraphy with 99mTc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.Scintigrafija paratireoidnih žlijezda 99mTc-MIBI-jem je slikovna metoda nuklearne medicine, a provodi se kod bolesnika sa sumnjom na hiperparatireoidizam (HPT). Cilj istraživanja bio je procijeniti važnost upotrebe ove metode kod bolesnika koji uza sumnju na HPT imaju i nodozne promjene štitnjače. Retrospektivna analiza obuhvatila je razdoblje od 8 godina (2006.-2013.). U studiju je bio uključen 91 bolesnik s klinički ili laboratorijski sumnjivim HPT. Od 67 scintigrafski pozitivnih bolesnika, patološki promijenjena paratireoidna žlijezda dokazana je u njih 47 (70%). U preostalih 20 (30%) bolesnika patološki promijenjena paratireoidna žlijezda nije dokazana. Od 9 bolesnika s negativnim nalazom scintigrafije, a UZV suspektnom povećanom paratireoidnom žlijezdom, patološki promijenjena paratireoidna žlijezda nije dokazana u njih 8 (89%), a dokazana je u jednog (11%) bolesnika. Od 15 scintigrafski dvojbenih bolesnika, njih 8 (54%) je imalo pozitivan nalaz UZV i citološke punkcije uz određivanje PTH u punktatu. U 7 (46%) bolesnika nalaz punkcije i PTH u punktatu bio je negativan. Istraživanje potvrđuje da scintigrafija ima visoku osjetljivost za otkrivanje bolesnika s patološki promijenjenim paratireoidnim žlijezdama (98%). Zbog niske specifičnosti (28%) scintigrafiju treba nadopuniti punkcijom uz određivanje PTH u punktatu u bolesnika sa suspektnim HPT